Bettina Bankier

Panic disorder and cigarette smoking behavior.

Smoking has been discussed both as a risk factor for panic disorder and as a contributing factor to elevated cardiovascular risk in panic disorder patients. Smoking habits and their association with panic disorder were studied in a sample of 102 panic disorder patients. Both for female and for male patients, rates of smokers and of exsmokers were substantially higher than in the general population. However, a surprisingly high number of patients had succeeded in reducing or quitting cigarette smoking because of their panic disorder, although they experienced little benefit in regard to panic symptoms from doing so. We conclude that the motivation for changing smoking habits is high in this population with elevated smoking prevalence and should be taken into consideration by therapists.

Personality disorder and social anxiety predict delayed response in drug and behavioral treatment of panic disorder

BACKGROUND The aim of this study was to analyze the impact of pretreatment characteristics and personality disorders on the onset of response in the treatment of panic disorder. METHODS The data of 73 out-patients with panic disorder who had completed at least 6 weeks of a randomized trial of 24 weeks of either paroxetine only or paroxetine combined with cognitive group-therapy were analyzed in a Cox proportional hazards model. RESULTS The likelihood of having responded to treatment (defined by a CGI rating of improvement) was more than twice as high for patients without a personality disorder or social phobia than for Patients with a personality disorder or social phobia. CONCLUSIONS We suggest that patients with these characteristics do benefit from prolonged treatment, and they may profit from an additional treatment focused on social anxiety.

Violent Sex Offenders Lack Male Social Support

Social networks and social support generally exert an important impact on the management of crisis and may thus influence prevention and rehabilitation strategies. The authors therefore investigated the social network and support in a group of 62 incarcerated sexual offenders. Irrespective of the underlying diagnosis, offenders were divided into a high-violent group and a low-violent group. A factor analysis resulted in five factors describing specific dimensions of social support. A significantly lower perceived social support was found in the high-violent group as compared with the low-violent offenders concerning the factors “talking about problems and feelings to someone” and “rely on someone.” This low support exclusively referred to men outside the family. Neither the number of previous convictions nor length of prior imprisonment predicted the amount of displayed violence. The authors’ results are compared with those in the pertinent literature and are discussed in light of relevant therapeutic strategies in prevention and rehabilitation.

A Case of Asperger’s Syndrome First Diagnosed in Adulthood

A 25-year-old white male patient was admitted to the Department of Psychiatry, Division of Social Psychiatry, of the University of Vienna, Austria, for severe social withdrawal, selective mutism and outbursts of violence with attacks on his mother. Careful examination revealed the presence of all the typical symptoms of Asperger’s syndrome. The diagnosis had never been made before, although the patient had a history of a difficult childhood with several admissions to a child psychiatric inpatient unit for ‘obsessional neurosis’ and an institutional career. It is stressed that, in view of the availability of treatments and the deleterious effect of the untreated condition in the sensitive years of personality development, early recognition and diagnosis of Asperger’s syndrome are of utmost importance.

Clinical Validity of ICD-10 Neurasthenia

Background: Neurasthenia was defined over a century ago. In view of a questionable clinical validity, it was omitted from the 3rd edition of the American Psychiatric Association’s DSM, while it remains as an own diagnostic category in the WHO’s ICD-10. The purpose of this study was, therefore, to examine the clinical validity of ICD-10 neurasthenia in a consecutive sample of chronic pain patients. Patients and Methods: We included 193 patients (mean age 45.1, SD ± 10.2, 63% females) in the study. Psychiatric diagnoses were established by the use of ICD-10 Diagnostic Criteria for Research. In addition, the Screening List for Somatization Symptoms was administered: self-rating of 53 medically unexplained somatic symptoms, and 11 additional screening questions concerning weakness after slight mental or physical exertion and disease conviction. Results: Thirty-three percent of the patients who fulfilled the criteria of ICD-10 neurasthenia also fulfilled the criteria of ICD-10 somatization disorder, 69% the criteria of ICD-10 undifferentiated somatoform disorder, 14% the criteria of ICD-10 hypochondriacal disorder, 66% the criteria of ICD-10 somatoform autonomic dysfunction, 85% the criteria of ICD-10 persistent somatoform pain disorder and 14% the criteria for sexual dysfunction not caused by organic disorder or disease. The symptom profile of ICD-10 neurasthenia was not clearly distinguishable from the symptom profiles of ICD-10 somatoform disorders and ICD-10 sexual dysfunction. Discussion: Due to this substantial diagnostic overlap, the clinical validity of ICD-10 neurasthenia remains questionable.

Delusions in first-admitted patients : Gender, themes and diagnoses

Whether there is a specific link between certain delusional symptoms and particular etiologies has not yet been completely clarified. In this study, 639 first ever admitted deluded patients were investigated in order to find out whether age and gender are associated with certain delusional contents, whether age at first admission may be linked to certain etiologies and whether it is possible to detect indicators particularly related to basic dysfunctions. At first admission, delusional female patients were older than men with a significant predomination of delusions of persecution, while men presented significantly more frequently delusions of jealousy and grandiosity. Within delusions of persecution, of religious or metaphysical content and of grandiosity, women were even significantly older than men. Religious or metaphysical and grandiosity contents occurred significantly more frequently in ICD-8 schizophrenia, indicating that these themes seem to be particularly linked to ICD-8 schizophrenia. Additionally, some target symptoms not included in the delusional symptomatology were investigated to test the relationship between delusions and schizophrenia. Overall, the results of the present investigation indicate that delusions are not specific for schizophrenia, and therefore, other symptomatological criteria should be applied for the nosographic attribution.

Screening for DSM-IV somatoform disorders in chronic pain patients.

Background: The Screening Instrument for Somatoform Symptoms (SOMS) has been developed for selecting subjects with various somatoform disorders. To date, this instrument has not been used for pain patients. The purpose of this study was, therefore, to apply the SOMS to chronic pain patients, and to compare different SOMS cutoff item scores with regard to their sensitivity, specificity and (positive and negative) predictive value for selecting subjects with DSM-IV somatoform disorders among pain patients. Methods: In a consecutive sample of 105 chronic pain outpatients, the SOMS was administered in addition to an operationalized psychiatric assessment according to DSM-IV. Results: Patients with a somatoform disorder reported significantly more SOMS symptoms than patients without somatoform disorders (p < 0.02). As shown, a cutoff score of ≥4 somatoform items appeared useful for determining a somatoform disorder. However, only a limited number of cases could be correctly classified by the SOMS (range 53–66%). Conclusion: Therefore, the applicability of the SOMS as a screening instrument for somatoform disorders in chronic pain patients awaits further clarification.

Valproic acid and carbamazepine : A successful antipsychotic medication? The problem of diagnosis and its relevance for therapy

This single-case study deals with a 24-year-old woman who suffered after a severe depressive episode from paranoid-psychotic symptoms, which did not respond to antipsychotic medication, but to antiepileptics. In this case report, it is elaborated why psychotic symptoms may not respond to antipsychotic medications and the utility of a polydiagnostic approach is shown. Psychotic symptoms based on dynamic instability may occur simultaneously in the pathogenesis of affective disorders and schizophrenia. It is demonstrated that the use of a polydiagnostic approach will lead to a more refined etiopathogenetic attribution.