Giampaolo Perna

35 % CO2 challenge in panic and mood disorders

20 patients with Panic Disorder (PD), 19 patients with Mood Disorder (MD) and 20 healthy controls inhaled one vital capacity of 35% CO2-65% O2 gas mixture and of compressed air in a double-blind, random, cross-over design. Only PD patients showed a strong reaction to 35% CO2 while MD patients and controls did not react significantly. These results support the specificity of the 35% CO2 challenge in PD patients and suggest that PD and MD are separate disorders.

Plasma Interleukin-1β and Tumor Necrosis Factor Concentrations in Obsessive–Compulsive Disorders

Plasma interleukin-1 beta (Il-1 beta) and tumor necrosis factor-alpha (TNF-alpha) concentrations were measured twice, at a 48-hour interval, in 27 drug-free obsessive-compulsive patients (12 women and 15 men) and in 27 sex-age-matched healthy controls. Il-1 beta and TNF-alpha concentrations were significantly lower in patients than in controls, whereas there were no differences in either group between men and women, between the samples of the two days, or, in the patients, between those who had and those who had not been previously treated with psychopharmacologic drugs.

Common genetic, clinical, demographic and psychosocial predictors of response to pharmacotherapy in mood and anxiety disorders

The aim of this study is to summarize available knowledge about common genetic, clinical, demographic and psychosocial predictors of response to pharmacotherapy in mood and anxiety disorders. A literature search was carried out by using MEDLINE and references of selected articles. The search included articles published up to March 2008. The main genetic finding concerns the serotonin transporter gene promoter polymorphisms, the long variant of which seems to be related to a positive response to therapy in mood disorders and could also have a role in the treatment of anxiety disorders. Among other predictors, the main factors common to both classes of disorder are comorbid axis II disorders and early onset of illness, which are related to a worse response to therapy and concomitant good physical conditions, absence of earlier treatments, early administration and response to therapies, and higher self- directedness, which is related to a better outcome. Many common predictors have been identified and these seem to be related to features covering the totality of patients that go beyond specific characteristics of single disorders. Possible limitations and suggestions for future research based on a more integrated vision of human complexity are discussed.

Menstrual cycle-related sensitivity to 35% CO2 in panic patients

In a double blind, random, cross-over design, 10 patients and seven controls inhaled one vital capacity of 35% CO2-65% O2 during their early-follicular and midluteal phases. Anxiety after CO2 intake was significantly stronger in the early-follicular phase than in the midluteal phase for patients. Controls had no anxiety reactions.

Novel Antidepressants and Panic Disorder: Evidence beyond Current Guidelines

Aim: The aim of the present review is to summarize available evidence about the efficacy and side effects of novel antidepressants for the treatment of panic disorder. Methods: A literature search was undertaken using MEDLINE, ISI web of knowledge and references of retrieved articles. The search included articles published in English up to September 2009. Both controlled and uncontrolled trials were included. The quality of the reviewed articles was also assessed. Results: Fourteen mainly poor-quality studies were included. Mirtazapine showed some efficacy in reducing the number and the severity of panic symptoms in many uncontrolled studies and was comparable to selective serotonin reputake inhibitors (SSRIs) in direct-comparison studies. Reboxetine was significantly more efficacious than placebo but less effective than SSRIs. Further uncontrolled studies suggested preliminary evidence for the use of milnacipran and duloxetine as well. All drugs were usually well tolerated. Discussion: Current studies do not yet provide convincing evidence supporting the efficacy of mirtazapine, reboxetine, milnacipran and duloxetine for the treatment of panic disorder patients. However, on account of positive preliminary results, further research is warranted.

Tradução e adaptação transcultural do Questionário de Atividade Física Habitual

CONTEXTO: Atualmente ha na literatura um crescente interesse na interface entre exercicio fisico e transtornos psiquiatricos. Apesar disso, ainda ha uma deficiencia de instrumentos de autorrelato para medir os niveis de atividade fisica dos pacientes. OBJETIVO: A traducao, a afericao da equivalencia semântica e uma aplicacao piloto (n = 30), sem pretensao psicometrica, do Questionario de Atividade Fisica Habitual, visando sua utilizacao na populacao brasileira de diferentes niveis de escolaridade. METODOS: O processo envolveu duas traducoes e retrotraducoes realizadas por avaliadores independentes, avaliacao das versoes seguida da elaboracao de uma versao sintese e pre-teste comentado. RESULTADOS: A maioria dos participantes (91%) nao apresentou dificuldades de compreensao com o questionario. Para cada item do instrumento, apresentam-se os resultados das quatro etapas. Mais estudos sao necessarios para determinar a adequacao para populacoes de baixa escolaridade. Os autores recomendam que sujeitos menos instruidos sejam supervisionados ao preencher o questionario. CONCLUSOES: A utilizacao de duas versoes de traducao e retrotraducao, a discussao sobre a versao sintese e a interlocucao com a populacao-alvo proporcionam maior seguranca ao processo de equivalencia semântica.

Is there a hypersensitive visual alarm system in panic disorder

Agoraphobia in panic disorder (PD) has been related to abnormal balance system function. Vision influences balance and behavioural adaptations; peripheral vision influences orienting and fast defensive reactions whereas central vision analyzes details of objects. We have hypothesized that the abnormal balance function in PD could be mainly related to peripheral vision as part of a defensive alarm system in the brain. In 25 patients with PD and agoraphobia and 31 healthy controls we assessed, by posturography, balance system reactivity to video-films projected in peripheral and central visual fields (randomized sequence). Length, velocity and surface of body sway were calculated. Patients increased their body sway during peripheral stimulation, whereas controls did not; the two groups showed a similar increase of body sway during central stimulation. Anxiety levels during peripheral stimulation significantly influenced the postural response in the group of patients. These preliminary results suggest that the higher visual sensitivity to peripheral stimulation in patients with PD and agoraphobia may be linked to a more active visual alarm system involving visual, vestibular and limbic areas that might influence the development of agoraphobia in situations where environmental stimuli are uncertain.

Dizziness, migrainous vertigo and psychiatric disorders

OBJECTIVESnThis study sought to establish the prevalence of vestibular disorders, migraine and definite migrainous vertigo in patients with psychiatric disorders who were referred for treatment of dizziness, without a lifetime history of vertigo.nnnSTUDY DESIGNnRetrospective study.nnnSETTINGnOut-patients in a university hospital.nnnMATERIALS AND METHODSnFifty-two dizzy patients with panic disorders and agoraphobia, 30 with panic disorders without agoraphobia, and 20 with depressive disorders underwent otoneurological screening with bithermal caloric stimulation. The prevalence of migraine and migrainous vertigo was assessed. The level of dizziness was evaluated using the Dizziness Handicap Inventory.nnnRESULTSnDizzy patients with panic disorders and agoraphobia had a significantly p = 0.05 regarding the prevalence of peripheral vestibular abnormalities in the group of subjects with PD and agoraphobia and in those with depressive disorders. Migraine was equally represented in the three groups, but panic disorder patients had a higher prevalence of migrainous vertigo definite migrainous vertigo. Almost all patients with a peripheral vestibular disorder had a final diagnosis of definite migrainous vertigo according to Neuhauser criteria. These patients had higher Dizziness Handicap Inventory scores. The Dizziness Handicap Inventory total score was higher in the subgroup of patients with panic disorders with agoraphobia also presenting unilateral reduced caloric responses or definite migrainous vertigo, compared with the subgroup of remaining subjects with panic disorders with agoraphobia (p < 0.001).nnnCONCLUSIONSnOur data support the hypothesis that, in patients with panic disorders (and especially those with additional agoraphobia), dizziness may be linked to malfunction of the vestibular system. However, the data are not inconsistent with the hypothesis that migrainous vertigo is the most common pathophysiological mechanism for vestibular disorders.

Cardiorespiratory response to physical exercise and psychological variables in panic disorder

OBJETIVO: Investigar a possivel influencia de variaveis psicologicas na resposta cardiorrespiratoria e percepcao de esforco dos pacientes com Transtorno do Pânico (TP) durante exercicio fisico de intensidade submaxima. METODO: Dez pacientes ambulatoriais com TP e dez controles saudaveis foram submetidos a uma caminhada na velocidade de 4 km/h em uma rampa inclinada. A inclinacao da rampa foi aumentada ate que fosse atingida 65% da frequencia cardiaca maxima (FC alvo). Variaveis cardiorespiratorias foram monitoradas continuamente. Antes do exercicio o Inventario de Estado-Traco de Ansiedade, o Indice de Sensibilidade a Ansiedade e o Questionario de Sensacoes Corporais foram aplicados. Durante o exercicio, o nivel de ansiedade (Escala Analoga Visual para Ansiedade - VAS-A) e esforco (Escala Borg CR 10) foram medidos. RESULTADOS: Comparados aos controles, os pacientes atingiram a FC alvo e o limiar respiratorio mais rapido, tiveram menor consumo de oxigenio, FC mais alta e menor desvio padrao da FC em cada sujeito (medida de variabilidade cardiaca). O esforco tambem foi maior e houve uma correlacao significativa entre frequencia respiratoria, volume corrente e FC. Nenhuma associacao significativa foi encontrada entre cardiorrespiratoria resposta, percepcao de esforco e variaveis psicologicas em pacientes com TP. CONCLUSAO: Pacientes com TP mostrou baixa aptidao cardiorrespiratoria e maior esforco durante o exercicio fisico que nao pareceu estar relacionada com as variaveis psicologicas consideradas. Mais estudos em grupos maiores sao necessarios.OBJECTIVEnTo investigate the possible influence of psychological variables on cardiorespiratory responses and perceived exertion of patients with Panic Disorder (PD) during a submaximal exercise test.nnnMETHODnTen outpatients with PD and 10 matched healthy subjects walked up on a treadmill slope at a speed of 4 km/h in order to reach 65% of their maximum heart rate. Cardiorespiratory variables were continuously recorded. Before the exercise, the state and trait anxiety (State-Trait Anxiety Inventory scores), fear of physical sensations (Body Sensation Questionnaire scores), and fear of autonomic arousal (Anxiety Sensitivity Index scores) were assessed; during the exercise, levels of anxiety (VAS-A) and exertion (Borg Scale CR 10) were measured.nnnRESULTSnCompared to controls, patients reached earlier the target HR and the ventilatory threshold, showed lower oxygen consumption, higher HR and lower within-subject standard deviations of HR (a measure of cardiac variability). Exertion was also higher, and there was a significant correlation between breathing frequency, tidal volume and HR. No significant associations were found between cardiorespiratory response, perceived exertion, and psychological variables in patients with PD.nnnCONCLUSIONnAlthough patients with PD presented poor cardiorespiratory fitness and were required to spend more effort during physical exercise, this did not appear to be related to the psychological variables considered. Further studies with larger groups are warranted.

Carbon dioxide-induced panic attacks and quantitative electroencephalogram in panic disorder patients

The objective of the study was to investigate and compare the brain cortical activity, as indexed by quantitative electroencephalographic (qEEG) power, coherence and asymmetry measures, in panic disorder (PD) patients during an induced panic attack with a 35% CO2 challenge test and also in a resting condition. Fifteen subjects with PD were randomly assigned to both 35% CO2 mixture and atmospheric compressed air, in a double-blind study design, with EEG being recorded for a 20-min period. During induced panic attacks we found a reduced right-sided frontal orbital asymmetry in the beta band, a decreased occipital frontal intra-hemispheric coherence in the delta band at both right and left sides, a left-sided occipital delta inter-hemispheric asymmetry and an increased relative power in the beta wave at T4. Our data showed a disturbed frontal cortical processing, pointing to an imbalance of the frontal and occipital sites, common to both hemispheres, and an increased right posterior activity related to the high arousing panic attack condition. Those findings corroborate the Neuroanatomical hypothesis of PD.