LETTER TO EDITOR Year : 2022  |  Volume : 15  |  Issue : 8  |  Page : 379-380

Panic disorder in COVID-19 patients admitted in a tertiary care hospital in South India

KP Lakshmi1, Subhash Chandra2, Dipu Thareparambil Sathyapalan2, Kudrat Jain1
1 Department of Psychiatry, Amrita Institute of Medical sciences and Research Centre, Kochi, Kerala, India
2 Department of General Medicine, Amrita Institute of Medical sciences and Research Centre, Kochi, Kerala, India

Date of Submission09-Aug-2022Date of Decision18-Aug-2022Date of Acceptance25-Aug-2022Date of Web Publication30-Aug-2022

Correspondence Address:
K P Lakshmi
Department of Psychiatry, Amrita Institute of Medical sciences and Research Centre, Kochi, Kerala
India

Source of Support: The authors received no extramural funding for the study, Conflict of Interest: None

DOI: 10.4103/1995-7645.354523

How to cite this article:
Lakshmi K P, Chandra S, Sathyapalan DT, Jain K. Panic disorder in COVID-19 patients admitted in a tertiary care hospital in South India. Asian Pac J Trop Med 2022;15:379-80
How to cite this URL:
Lakshmi K P, Chandra S, Sathyapalan DT, Jain K. Panic disorder in COVID-19 patients admitted in a tertiary care hospital in South India. Asian Pac J Trop Med [serial online] 2022 [cited 2022 Aug 31];15:379-80. Available from: https://www.apjtm.org/text.asp?2022/15/8/379/354523
COVID-19 has led to an increase in psychiatric disorders, stress, trauma and suicidal behaviour. Study published in the Lancet in 2021 have identified anxiety disorder as the most frequently diagnosed psychiatric disorder in COVID-19 survivors[1]. Fear conditioning and hyper-vigilance towards abnormal breathing patterns attributable to COVID-19 or not, can act as etiological and maintenance factors of panic, and hence we should expect an onset or aggravation of panic disorder in COVID-19[2].

The cross-sectional study was onducted in a medical college in Kerala during May and June 2021. Adult patients infected with COVID-19 were assessed by a psychiatrist and diagnosis was made based on ICD10. Socio-demographic details were collected and Panic Disorder Severity Scale was applied. The minimum sample size was calculated as 25 with 95% confidence and 20% allowable error[3].

Among the 109 COVID-19 patients, 59 (54.1%) were males [Table 1], 81 (74.3%) were married, 50 (45.9%) were graduates, 77 (70.6%) were employed. A total of 69 patients (63.3%) had physical illness and among them 44 had multiple physical illnesses. Forty patients (36.7%) were already known to have a psychiatric illness. Thirteen (11.9%) patients had recent alcohol use and 20 (18.3%) were smokers.

Table 1: Prevalence of panic disorder with various socio-demographic variables.

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Fifty-five patients (50.5%) were diagnosed to have panic disorder, with a cutoff score of eight in Panic Disorder Severity Scale. Panic disorder was diagnosed in 54.3% married patients, 32% unmarried and all widow/widower patients (P=0.033). Prevalence of panic disorder was almost equal among males and females (P=0.930), and also among employed and unemployed patients (P=0.869). Prevalence of panic disorder was higher in patients with known physical illness and psychiatric illness (P=0.460 and 0.184, respectively). Prevalence of panic disorder was lower in patients with recent alcohol use, but more in smokers (P=0.741 and 0.322, respectively).

The cohort study showed 50.5% prevalence of panic disorder in the COVID-19 patients, lower when compared to a study by Islam et al. in Bangladesh which showed a prevalence of 79.6%[3]. But their study was a self-reported measure by COVID-19 patients in home quarantine. The finding of increased panic disorder among married patients may be due to their increased responsibilities and the worries about their family. A Spanish study had showed that COVID-19 patients who previously required psychological help were predisposed to develop anxiety[4], which is similar to the findings of our study. As reported by a study in UK[5], our study showed that prevalence of panic disorder increases with increasing age. The finding of decreased panic disorder in patients with recent alcohol use may be explained by the fact that alcohol is a central nervous system depressant (P=0.741). The increased prevalence of panic in smokers may be due to tobacco being central nervous system stimulant (P=0.322). The study was conducted in hospitalized patients and the results may not be the same in COVID-19 patients in home treatment. Physical symptoms of the disease itself can be misunderstood as panic symptoms thus leading to over-reporting.

To conclude, panic disorder was prevalent in this cohort of COVID-19 patients. Adequate screening and treatment of panic symptoms will help in the management of COVID-19 patients.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Scientific Research and Ethics Committee of the institute with clearance number ECAM- AIMS-2021-291. Informed consent were obtained from all the admitted patients.

Acknowledgments

The authors would like to thank all the participants in the study whose cooperation were necessary for the completion of this research. We would like to thank Dr. Bindu Menon, Professor and Head, Department of Psychiatry, Amrita Institute of Medical sciences and Research Centre, Dr. MGK Pillai, Professor and Head, Department of General Medicine, Amrita Institute of Medical sciences and Research Centre, Dr. Dinesan, Former HOD and Professor, Department of Psychiatry, Amrita institute of Medical sciences and Research Centre, for their support and encouragement.

Funding

The authors received no extramural funding for the study.

Authors’ contributions

LKP, SC and DTS conceptualized the research and prepared draft protocol. Protocol presentation to Scientific Research Committee was done by LKP. Data collection was done by LKP and KJ. Data analysis and statistics was done by SC, KJ and LKP. Preparation of manuscript was done by LKP and proof reading was done by SC, and DTS. Final manuscript was approved by all authors.

 

  References 
1.Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: Retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psy 2021; 8(2): 130-140.  
    2.Javelot H, Weiner L. Panic and pandemic: Review of the literature on the links between panic disorder and the SARS-CoV-2 epidemic. Encephale 2020; 46(3): S93-S98.  
    3.Islam MS, Ferdous MZ, Potenza MN. Panic and generalized anxiety during the COVID-19 pandemic among Bangladeshi people: An online pilot survey early in the outbreak. J Affect Disord 2020; 276: 30-37.  
    4.Cárdaba-García RM, Pérez Pérez L, Niño Martín V, Cárdaba-García I, Durantez-Fernández C, Olea E. Evaluation of the risk of anxiety and/or depression during confinement due to COVID-19 in central Spain. Int J Environ Res Public Health 2021; 18(11): 5732.  
    5.Shevlin M, McBride O, Murphy J, Miller JG, Hartman TK, Levita L, et al. Anxiety, depression, traumatic stress and COVID-19-related anxiety in the UK general population during the COVID-19 pandemic. BJPsych Open 2020; 6(6): e125.  
    

 
 

  [Table 1]