|Year : 2018 | Volume
| Issue : 1 | Page : 15-18
Clinical profile and changes in values of mean platelet volume among panic disorder patients
Sanjay Yalamanchili, Sai Kiran Pasupula, Raviteja Chilukuri
Department of Psychiatry, Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India
|Date of Web Publication||26-Jun-2018|
Dr. Sai Kiran Pasupula
Department of Psychiatry, Katuri Medical College and Hospital, Guntur, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Context: The serotonin system is involved in the pathophysiology of anxiety disorders, but it is not practical to measure the serotonin levels inside the brain. Peripheral serotonin activity may reflect the central serotonergic function. An affordable and easy measure of peripheral serotonergic function is the mean platelet volume (MPV). Hence, MPV could possibly be used as a measure of central serotonergic function and hence could be a predictor of treatment outcome and response in panic disorder.
Aims: This study aims to study the changes in MPV in patients with panic disorder with or without agoraphobia compared to healthy controls, thereby elucidating the relationship between panic disorder and MPV.
Subjects and Methods: Patients (n = 65) who fulfilled the selection criteria and healthy controls (n = 65) were taken up for the study. Sociodemographic details and clinical variables were recorded in a special pro forma prepared for the study. Mini International Neuropsychiatry Interview-Plus was used for screening psychiatric morbidity. The diagnosis of panic disorder was made using the International Classification of Diseases-10 diagnostic criteria. Panic disorder severity scale and panic and agoraphobia scale were administered to all patients. MPV was assessed, and variations in MPV were studied between the groups.
Statistical Analysis Used: Two-tailed independent sample t-test was used to compare the cases and controls.
Results: It was observed that MPV values were higher for patients with panic disorder than healthy controls.
Conclusion: MPV values were higher in panic disorder patients when compared to the healthy controls, so they could serve as predictors/indicators of treatment outcome and response in panic disorder.
Keywords: Anxiety disorders, mean platelet volume, panic disorder
|How to cite this article:|
Yalamanchili S, Pasupula SK, Chilukuri R. Clinical profile and changes in values of mean platelet volume among panic disorder patients. Arch Ment Health 2018;19:15-8
|How to cite this URL:|
Yalamanchili S, Pasupula SK, Chilukuri R. Clinical profile and changes in values of mean platelet volume among panic disorder patients. Arch Ment Health [serial online] 2018 [cited 2019 Jul 17];19:15-8. Available from: http://www.amhonline.org/text.asp?2018/19/1/15/235320
| Introduction|| |
Platelets could serve as a window into the brain as they may reflect biochemical changes in the brain in different psychiatric conditions., Serotonin is an important factor in the pathophysiology of panic disorder, other anxiety disorders, and depression. Serotonin also has an important role in the regulation of vascular tone and platelet aggregation. Studies show that serotonin-mediated response of platelets enhances thrombogenesis in response to any disruption in blood vessel surfaces., Platelet response and activation cannot be directly measured, so mean platelet volume (MPV) is used as a marker for the same. Several cardiovascular diseases such as acute myocardial infarction, ischemic heart disease, and congestive heart failure are associated with increased MPV.,, Selective serotonin reuptake inhibitors (SSRIs), which are commonly used in the treatment of panic disorder and depression, have been shown to cause decreased platelet activity in several recent studies. This effect of SSRIs on platelet activity possibly points toward the role of a serotonergic mechanism in the pathophysiology of panic disorder.
There are only a few studies which have reported a relationship between MPV and panic disorder. Hence, the aim of this study was to examine the varied clinical manifestations of patients with panic disorder and to study changes in MPV in patients with panic disorder, compared with age- and sex-matched healthy controls.
| Subjects and Methods|| |
This nonrandomized case–control study was conducted in a tertiary care hospital. We selected the sample size based on previous studies and included 65 patients with a diagnosis of panic disorder and 65 healthy controls. In the sample, patient group was drawn from patients admitted to the psychiatry ward, either directly or transferred from other departments and the controls were selected from the general population (they were mostly hospital staff and attenders of patients admitted to other departments). Participants were selected sequentially, and no sampling was done.
- Panic disorder group
- Age 18–60 years
- Patients fulfilling the International Classification of Diseases-10 (ICD 10) diagnostic criteria for panic disorder, either with or without agoraphobia
- First-time admission and drug-naïve individuals.
- Control group – age- and gender-matched healthy individuals.
- Pregnant women
- Individuals with comorbid psychiatric disorders
- Individuals with comorbid medical disorders.
The study protocol was approved by the Institutional Ethics Committee. After explaining the purpose and design of the study, a written informed consent was obtained for participation from all individuals included in the sample. Sociodemographic and clinical variables were recorded in a specific pro forma prepared for the study. Mini-International Neuropsychiatry Interview-Plus  was used for screening psychiatric morbidity. The diagnosis of panic disorder was made using the ICD-10 diagnostic criteria. Panic disorder severity scale (scale) and panic and agoraphobia scale (PAS) were used to assess the severity of the disorder. For individuals in both groups, 5 ml of blood was drawn into vacutainer tubes containing 0.04 ml of 7.5% ethylene diamino tetraacetic acid (tri-potassium salt). Patient interviews and collection of blood samples were done at 8 AM for all individuals. MPV and platelet counts were measured using standardized equipment at the central laboratory of our hospital. Levels of 150,000–400,000/mm 3 and 6.2–11.4 femtoliter (fL, a metric unit of volume equal to 10–15 L) were accepted as normal ranges for platelet counts and MPV, respectively.
Data were tabulated into a spreadsheet and IBM SPSS Statistics for Windows, Version 20.0 was used for statistical analysis of data. Two-tailed independent sample t-test was used to compare the cases and controls. P < 0.05 was considered as statistically significant.
| Results|| |
Our sample had more females than males. The mean age in our sample was 32.55 ± 9.4 years. Most individuals with panic disorder were in the age group of 18–39 years. Rest of the demographic characteristics were as shown in [Table 1]. A majority were Hindus, literate, unmarried, unemployed, and belonged to the middle socioeconomic status (according to the modified Kuppuswamy scale for the classification of socioeconomic status). Cases and controls did not differ much in these characteristics (P ≥ 0.05).
We had more cases with a diagnosis of panic disorder without agoraphobia (n = 39) than panic disorder with agoraphobia (n = 26). In this sample, the most prominent symptom of patients with a diagnosis of panic disorder with or without agoraphobia was chest pain (n = 53), followed by hyperventilation (n = 7), palpitations (n = 4), and least common was dizziness (n = 1) [Graph 1].
There was no significant difference in the platelet counts between groups. The MPV of the panic disorder group was 10.02 ± 0.37 fL and of the control group was 6.96 ± 0.99 fL. This difference (panic disorder > controls) was statistically significant (at P = 0.0001). The MPV values of the control groups and the panic disorder group were normal, but, values were significantly higher in the latter [Graph 2].
| Discussion|| |
Currently, there is no convenient and cost-effective way of measuring central nervous system serotonergic function, but peripheral serotonergic function can be gauged easily by MPV. Several studies have reported that measures of platelet function can act as indicators of central serotonergic function.,
Our study is one of the first nonrandomized case–control studies which looks at a possible correlation between MPV and panic disorder at a tertiary care hospital.
In spite of being a cross-sectional study, our study sample gender characteristics were comparable to the past epidemiological studies which suggest that panic disorder is more common in women. This possibly also reflects the findings of past studies done on the prevalence of panic disorder, more so for the women., We had more cases with a diagnosis of panic disorder without agoraphobia than panic disorder with agoraphobia, a finding consistent with findings of previous literature.
MPV in the panic disorder group was significantly higher than in the control group. These findings emulate the past studies done on MPV and panic disorders.
Changes in the platelet parameters among the panic disorder individuals can be explained by the increased sympathetic activity among them. Few studies have shown that elevated MPV and heightened sympathetic activity are interrelated,,, as are stress and panic disorder. A relationship between panic disorder and a higher MPV is probably due to the involvement of the stress pathways.
The most common symptom of panic attacks found among the current sample was chest pain, and least number of the individuals suffered from dizziness. Panic attacks could lead to chest pain through mechanisms that directly affect coronary vasculature. Both autonomic activation and hyperventilation (via alkalosis) during panic attacks can lead to coronary artery spasm. In addition, panic attacks could provoke ischemic pain in patients with coronary disease by increasing myocardial oxygen demand through increases in heart rate and blood pressure mediated by the autonomic nervous system., A study of 29 patients with syndrome X (chest pain, a positive exercise stress test, and normal coronary arteries) found that hyperventilation or mental stress reliably produced chest pain in 34% of patients. The chest pain is associated with reduced coronary blood flow and is suggestive of the increased microvascular resistance.
Not all studies have found a consistent increase in the MPV in panic disorder patients. In a study done by Göğçegöz Gül et al. there was a lower MPV in panic disorder patients, but no clear explanation could be found for the results which contradict our findings. They could only speculate that abnormal serotonin metabolism caused a decreased MPV.
| Conclusion|| |
In our study, we found that though MPV is not abnormal in panic disorder patients, it is significantly higher when compared with controls. MPV values could serve as predictors/indicators of treatment outcome and response in panic disorder. There is a need for multicentric studies with larger samples in this topic for more definitive evidence for MPV as a biomarker for panic disorder.
The current study sample is recruited from a single institute; therefore, results cannot be generalized to the entire population.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Koudouovoh-Tripp P, Sperner-Unterweger B. Influence of mental stress on platelet bioactivity. World J Psychiatry 2012;2:134-47.
Camacho A, Dimsdale JE. Platelets and psychiatry: Lessons learned from old and new studies. Psychosom Med 2000;62:326-36.
Vanhoutte PM. Platelet-derived serotonin, the endothelium, and cardiovascular disease. J Cardiovasc Pharmacol 1991;17 Suppl 5:S6-12.
Lopez-Vilchez I, Diaz-Ricart M, White JG, Escolar G, Galan AM. Serotonin enhances platelet procoagulant properties and their activation induced during platelet tissue factor uptake. Cardiovasc Res 2009;84:309-16.
Galan AM, Lopez-Vilchez I, Diaz-Ricart M, Navalon F, Gomez E, Gasto C, et al.
Serotonergic mechanisms enhance platelet-mediated thrombogenicity. Thromb Haemost 2009;102:511-9.
Huczek Z, Kochman J, Filipiak KJ, Horszczaruk GJ, Grabowski M, Piatkowski R, et al.
Mean platelet volume on admission predicts impaired reperfusion and long-term mortality in acute myocardial infarction treated with primary percutaneous coronary intervention. J Am Coll Cardiol 2005;46:284-90.
Slavka G, Perkmann T, Haslacher H, Greisenegger S, Marsik C, Wagner OF, et al.
Mean platelet volume may represent a predictive parameter for overall vascular mortality and ischemic heart disease. Arterioscler Thromb Vasc Biol 2011;31:1215-8.
Kandis H, Ozhan H, Ordu S, Erden I, Caglar O, Basar C, et al.
The prognostic value of mean platelet volume in decompensated heart failure. Emerg Med J 2011;28:575-8.
Markovitz JH, Shuster JL, Chitwood WS, May RS, Tolbert LC. Platelet activation in depression and effects of sertraline treatment: An open-label study. Am J Psychiatry 2000;157:1006-8.
Göğçegöz Gül I, Eryılmaz G, Ozten E, Hızlı Sayar G. Decreased mean platelet volume in panic disorder. Neuropsychiatr Dis Treat 2014;10:1665-9.
World Health Organization. International statistical classification of diseases and related health problems. 10th
Revision (ICD-10). Geneva: World Health Organization; 1992.
Lecrubier Y, Sheehan D, Weiller E, Amorim P, Bonora I, Sheehan K, et al
. The MINI international neuropsychiatric interview (MINI) a short diagnostic structured interview: Reliability and validity according to the CIDI. Eur Psychiatry 1997;12:224-31.
Shear MK, Brown TA, Barlow DH, Money R, Sholomskas DE, Woods SW, et al.
Multicenter collaborative panic disorder severity scale. Am J Psychiatry 1997;154:1571-5.
Bandelow B. Assessing the efficacy of treatments for panic disorder and agoraphobia. II. The Panic and Agoraphobia Scale. Int Clin Psychopharmacol 1995;10:73-81.
Singh T, Sharma S, Nagesh S. Socio-economic status scales updated for 2017. Int J Res Med Sci 2017;5:3264-7.
Haroon E, Raison CL, Miller AH. Psychoneuroimmunology meets neuropsychopharmacology: Translational implications of the impact of inflammation on behavior. Neuropsychopharmacology 2012;37:137-62.
Yonkers KA, Zlotnick C, Allsworth J, Warshaw M, Shea T, Keller MB, et al.
Is the course of panic disorder the same in women and men? Am J Psychiatry 1998;155:596-602.
McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res 2011;45:1027-35.
Kessler RC, Chiu WT, Jin R, Ruscio AM, Shear K, Walters EE, et al.
The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2006;63:415-24.
Vizioli L, Muscari S, Muscari A. The relationship of mean platelet volume with the risk and prognosis of cardiovascular diseases. Int J Clin Pract 2009;63:1509-15.
Lande K, Gjesdal K, Fønstelien E, Kjeldsen SE, Eide I. Effects of adrenaline infusion on platelet number, volume and release reaction. Thromb Haemost 1985;54:450-3.
Thompson CB, Eaton KA, Princiotta SM, Rushin CA, Valeri CR. Size dependent platelet subpopulations: Relationship of platelet volume to ultrastructure, enzymatic activity, and function. Br J Haematol 1982;50:509-19.
Durmaz T, Özdemir Ö, Keleş T, Bayram NA, Akçay M, Yeter E. Platelets and sympathetic activity in MI. Turk J Med Sci 2009;39:259-65.
Argyle N, Roth M. The phenomenological study of 90 patients with panic disorder, part II. Psychiatr Dev 1989;7:187-209.
Klein DF. False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis. Arch Gen Psychiatry 1993;50:306-17.
Katon WJ. Chest pain, cardiac disease, and panic disorder. J Clin Psychiatry 1990;51 Suppl 5:27-30.