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Can sleep disturbance be a cue of mood spectrum comorbidity? A preliminary study in panic disorder

Published online by Cambridge University Press:  11 April 2019

Mario Miniati
Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
Laura Palagini*
Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
Alessandra Maglio
Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
Donatella Marazziti
Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
Liliana Dell’Osso
Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
*Address correspondence to: Laura Palagini, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56100, Pisa, Italy. (Email:



To investigate if sleep disturbances may affect treatment outcomes of patients with panic disorder (PD).


Eighty-five PD outpatients with no Axis I comorbidity for mood disorders completed a baseline assessment (T1) and were evaluated after 3 (T2), 6 (T3) and 12 months (T4), with the Panic Disorder Severity Scale (PDSS) total score as outcome measure during a 12-month naturalistic follow-up. Patients were assessed with the Mood Spectrum Self-Report (MOODS-SR, Lifetime Version), and the PDSS.


Forty-three patients (50.5%) met criteria for remission (PDSS<5) and 42 (49.5%) for no remission. In a logistic regression model with remission as the dependent variable, MOODS-SR sleep disturbances was the only determinant for a lower likelihood of PD remission. The items accounting for this result were the following: Repeated difficulty falling asleep (chi-square = 4.4; df = 1; p = 0.036), and Repeatedly waking up in the middle of the night (chi-square = 5.2; df = 1; p = 0.022).


Lifetime sleep disturbances would represent a cue of mood spectrum (in absence of overt affective comorbidity) that may impair remission in PD.

Original Research
© Cambridge University Press 2019

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Cavicchioli, FL, Maes, M, Roomruangwong, C, et al.Associations between severity of anxiety and clinical and biological features of major affective disorders. Psychiatry Res. 2018; 260: 1723.Google Scholar
Troxel, WM, Kupfer, DJ, Reynolds, CF, et al.Insomnia and objectively measured sleep disturbances predict treatment outcome in depressed patients treated with psychotherapy or psychotherapy-pharmacotherapy combinations. J Clin Psychiatry. 2012;73: 478485.Google Scholar
Harvey, AG.A transdiagnostic approach to treating sleep disturbance in psychiatric disorders. Cogn Behav Ther. 2009; 38: 3542.Google Scholar
Baglioni, C, Battagliese, G, Feige, B, et al.Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011; 135: 1019.Google Scholar
Baglioni, C, Riemann, D.Is chronic insomnia a precursor to major depression? Epidemiological and biological findings. Curr Psychiatry Rep. 2012; 14: 511518.Google Scholar
Sivertsen, B, Salo, P, Mykletun, A, et al.The bidirectional association between depression and insomnia: the HUNT study. Psychosom Med. 2012; 74: 758765.Google Scholar
Nakamura, M, Sugiura, T, Nishida, S, et al.Is nocturnal panic a distinct disease category? Comparison of clinical characteristics among patients with primary nocturnal panic, daytime panic, and coexistence of nocturnal and daytime panic. J Clin Sleep Med. 2013; 9(5): 461467.Google Scholar
Abad, VC, Guilleminault, C.Sleep and psychiatry. Dialogues Clin Neurosci. 2005; 7(4): 291303.Google Scholar
Mellman, TA, Uhde, TW.Patients with frequent sleep panic: clinical findings and response to medication treatment. J Clin Psychiatry. 1990; 51(12): 513516.Google Scholar
Ferini-Strambi, L, Bellodi, L, Oldani, A,et al.Cyclic alternating pattern of sleep electroencephalogram in patients with panic disorder. Biol Psychiatry. 1996; 40(3): 225227.Google Scholar
Cervena, K, Matousek, M, Prasko, J,et al.Sleep disturbances in patients treated for panic disorder. Sleep Med. 2005; 6(2): 149153.Google Scholar
Cousineau, H, Marchand, A, Bouchard, S, et al.Insomnia symptoms following treatment for comorbid panic disorder with agoraphobia and generalized anxiety disorder. J Nerv Ment Dis. 2016; 204(4): 267273.Google Scholar
Cassano, GB, Dell’Osso, L, Frank, E, et al.The bipolar spectrum: a clinical reality in search of diagnostic criteria and an assessment methodology. J Affect Disord. 1999; 54(3): 319328.Google Scholar
Dolsen, MR, Asarnow, LD, Harvey, AG.Insomnia as a transdiagnostic process in psychiatric disorders. Curr Psychiatry Rep. 2014; 16(9): 471.Google Scholar
Savino, M, Perugi, G, Simonini, E, et al.Affective comorbidity in panic disorder: is there a bipolar connection? J Affect Disord. 1993; 28(3): 155163.Google Scholar
Fagiolini, A, Frank, E, Rucci, P,et al.Mood and anxiety spectrum as a means to identify clinically relevant subtypes of bipolar I disorder. Bipolar Disord. 2007; 9(5): 462467.Google Scholar
Miniati, M, Benvenuti, A, Bologna, E, et al.Mood spectrum comorbidity in patients with anorexia and bulimia nervosa. Eat Weight Disord. 2018Jun; 23(3): 305311.Google Scholar
Dell’Osso, L, Armani, A, Rucci, P, et al.Measuring mood spectrum: comparison of interview (SCI-MOODS) and self-report (MOODS-SR) instruments. Compr Psychiatry. 2002 Jan–Feb; 43(1): 6973.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text rev. Washington, DC: American Psychiatric Press; 2000.Google Scholar
Shear, MK, Rucci, P, Williams, J, et al.Reliability and validity of the Panic Disorder Severity Scale: replication and extension. J Psychiatry Res. 2001 Sept–Oct; 35(5): 293296.Google Scholar
American Psychiatric Association (APA). Practice guideline for the treatment of patients with major depressive disorder (revision). Am J Psychiatry. 2000 Apr; 157(4 Suppl): 145.Google Scholar
National Institute for Health and Care Excellence (NICE). Generalized anxiety disorder and panic disorder in adults: management. Clinical Guideline [CG113]. 2011; 1: 3435.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, et al.Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition. (SCID-I/P) New York: Biometrics Research, New York State Psychiatric Institute; 2002.Google Scholar
Furukawa, TA, Shear, MK, Barlow, DH, et al.Evidence-based guidelines for interpretation of the Panic Disorder Severity Scale. Depress Anxiety. 2009; 26(10): 922929.Google Scholar
Keough, ME, Porter, E, Kredlow, MA, et al.Anchoring the Panic Disorder Severity Scale. Assessment. 2012 Jun; 19(2): 257259.Google Scholar
Boylan, KR, Bieling, PJ, Marriott, M, et al.Impact of comorbid anxiety disorders on outcome in a cohort of patients with bipolar disorder. J Clin Psychiatry. 2004; 65(8): 11061113.Google Scholar
Cyranowski, JM, Endicott, J, Fagiolini, A, et al.Influence of panic-agoraphobic spectrum symptoms on treatment response in patients with recurrent major depression. Am J Psychiatry. 2000; 157(7): 11011107.Google Scholar
Frank, E, Cyranowski, JM, Rucci, P, et al.Clinical significance of lifetime panic spectrum symptoms in the treatment of patients with bipolar I disorder. Arch Gen Psychiatry. 2002; 59(10): 905911.Google Scholar
Shear, MK, Cassano, GB, Frank, E, et al.The panic-agoraphobic spectrum: development, description, and clinical significance. Psychiatr Clin North Am. 2002Dec; 25(4): 739756.Google Scholar
Berrocal, C, Ruiz Moreno, M, Merchán, P, et al.The mood spectrum self-report: validation and adaptation into Spanish. Depress Anxiety. 2006; 23: 220235.Google Scholar
Miniati, M, Rucci, P, Frank, E, et al.Sensitivity to change and predictive validity of the MOODS-SR questionnaire, last-month version. Psychother Psychosom. 2009; 78(2): 116124.Google Scholar
Cassano, GB, Mula, M, Rucci, P, et al.The structure of lifetime manic-hypomanic spectrum. J Affect Disord. 2009; 112: 5970.Google Scholar
Rucci, P, Nimgaonkar, VL, Mansour, H, et al.Gender moderates the relationship between mania spectrum and serotonin transporter polymorphisms in depression. Am J Med Genet B Neuropsychiatr Genet. 2009 Oct 5; 150B(7): 907913.Google Scholar
Calugi, S, Cassano, GB, Litta, A, et al.Does psychomotor retardation define a clinically relevant phenotype of unipolar depression? J Affect Disord. 2011; 129: 296300.Google Scholar
Ghouse, AA, Sanches, M, Zunta-Soares, GB,et al.Lifetime mood spectrum symptoms among bipolar patients and healthy controls: a cross sectional study with the Mood Spectrum Self-Report questionnaire. J Affect Disord. 2014; 166: 165167.Google Scholar
Batterham, PJ, Glozier, N, Christensen, H.Sleep disturbance, personality and the onset of depression and anxiety: prospective cohort study. Aust N Z J Psychiatry. 2012 Nov; 46(11): 10891098.Google Scholar