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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 19  |  Issue : 1  |  Page : 15-18

Clinical profile and changes in values of mean platelet volume among panic disorder patients


Department of Psychiatry, Katuri Medical College and Hospital, Guntur, Andhra Pradesh, India

Date of Web Publication26-Jun-2018

Correspondence Address:
Dr. Sai Kiran Pasupula
Department of Psychiatry, Katuri Medical College and Hospital, Guntur, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AMH.AMH_4_18

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  Abstract 


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 2018 Jul 17];19:15-8. Available from: http://www.amhonline.org/text.asp?2018/19/1/15/235320




  Introduction Top


Platelets could serve as a window into the brain as they may reflect biochemical changes in the brain in different psychiatric conditions.[1],[2] 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.[3] Studies show that serotonin-mediated response of platelets enhances thrombogenesis in response to any disruption in blood vessel surfaces.[4],[5] 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.[6],[7],[8] 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.[9] 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.[10] 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 Top


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.

Inclusion criteria

  • Panic disorder group
    • Age 18–60 years
    • Patients fulfilling the International Classification of Diseases-10 (ICD 10)[11] 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.


Exclusion criteria

  • 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 [12] was used for screening psychiatric morbidity. The diagnosis of panic disorder was made using the ICD-10 diagnostic criteria.[11] Panic disorder severity scale (scale)[13] and panic and agoraphobia scale (PAS)[14] 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 Top


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).[15] Cases and controls did not differ much in these characteristics (P ≥ 0.05).
Table 1: Sociodemographic data

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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 Top


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.[1],[16]

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.[17],[18] 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.[19]

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,[20],[21],[22] as are stress and panic disorder.[23] 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.[24],[25] 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.[26] 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.[10] 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 Top


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.

Limitations

The current study sample is recruited from a single institute; therefore, results cannot be generalized to the entire population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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