Helene Lycaki

Smoking in patients with panic disorder

We compared smoking prevalence in 217 patients with panic disorder with that in 217 age- and sex-matched control subjects who were obtained by telephone survey from the same neighborhoods. Data were obtained for current smoking habits and smoking status at either the onset of illness (patients) or 10 years previously (control subjects). Patients had been ill for 10.6 (SD = 10.0) years. Female patients with panic disorder had a significantly higher smoking prevalence at the onset of their illness than did control subjects 10 years previously (54% vs. 35%). The current smoking prevalence for female patients was also significantly higher than that of control subjects (40% vs. 25%). Male smoking rates did not differ between patients and control subjects. Caffeine use did not appear to explain these findings. These data suggest a link between smoking behavior and panic disorder in women.

Effect of preexisting borderline personality disorder on clinical and EEG sleep correlates of depression.

Abstract Two groups of depressed patients were studied: (1) The first group comprised 15 inpatients who were diagnosed as predominantly “borderline personality disorders” based on DSM-III and psychometric test criteria; these patients were also clinically depressed. (2) The second group consisted of 18 inpatients who met Research Diagnostic Criteria (RDC) for major depressive disorder (MDD) but who failed to meet the above criteria for borderline personality disorder. Subsequent to the selection of patients for study, an independent diagnostic evaluation revealed that MDD patients with borderline personality disorder had higher ratings than nonborderline MDD patients on items from the Schedule for Affective Disorders and Schizophrenia such as total anxiety, anger, schizotypal features, miscellaneous psychopathology, and alcohol and drug abuse. A further breakdown of miscellaneous psychopathology items revealed greater subjective anger, self-pity, and demandingness in borderline patients. A comparison of RDC subtypes in the two groups revealed a significant increase in bipolar II diagnoses in the borderline MDD group. Electroencephalographic (EEG) sleep studies carried out in a subsample of MDD borderline (n=8) and primary MDD nonborderline (n=11) patients revealed no significant differences between the two groups. Thus, in contrast to the EEG sleep findings reported for secondary depression with other antecedent psychiatric disorders, the present study indicated that a preexisting diagnosis of borderline personality disorder in MDD patients did not alter the characteristics short latency of rapid eye movement (REM) sleep and the sleep continuity disturbances reported in primary MDD. These data confirm earlier reports by Akiskal (1981), Carroll et al. (1981), and McNamara et al. (1982) concerning the phenomenological and EEG sleep profiles of borderline patients.

Isoproterenol-induced panic attacks

Eighty-six panic disorder patients and 45 nonpsychiatric controls were infused with isoproterenol at a rate of 1 microgram/min for up to 20 min in a placebo-controlled, double-blind study. Sixty-six percent of panic disorder patients experienced panic attacks during isoproterenol infusions, compared to 16% during placebo infusions. Nine percent of control subjects panicked with isoproterenol, but none panicked with placebo. Patients were more sensitive than controls to the anxiogenic effects of isoproterenol, as measured by subject self-ratings on a panic description scale. The frequency of panic attacks induced in patients was related to the dosage of isoproterenol; 79% of the patients who received a mean of 18.5 ng/min/kg of isoproterenol panicked. The panic attacks experienced by patients during isoproterenol infusions were similar to those experienced during placebo infusions.

Plasma MHPG levels in lactate and isoproterenol anxiety states

It has been claimed that an increase in brain noradrenergic activity plays a role in panic disorder and that enhanced noradrenergic activity may be reflected by plasma levels of MHPG. We investigated plasma MHPG levels in panic disorder patients at baseline and during lactate- and isoproterenol-induced anxiety states. These infusions and 5% dextrose infusions were given to 10 panic disorder patients and 9 healthy control subjects. Each subject received all three infusions, double-blind, in random order, and at 1-week intervals. When compared to controls, plasma free MHPG levels in panic patients were not elevated at baseline, during lactate or isoproterenol infusions, at the point of panic, or up to 20 min after the onset of panic. MHPG values were also not elevated in subjects who panicked compared to those who did not. MHPG values were significantly lower in three patients who failed to panic with isoproterenol, but the patient panickers had MHPG values similar to those of controls. Significant correlations between MHPG levels and anxiety ratings were infrequent and could be accounted for by chance alone. These results did not support the noradrenergic model for panic anxiety states induced by lactate or isoproterenol.

Carbohydrate craving and increased appetite associated with antidepressant therapy.

The symptom of carbohydrate craving and increased appetite (CHH) was studied in 180 outpatients receiving antidepressant treatment. One hundred and fifty-eight of these patients had a DSM-III diagnosis of panic disorder and 17, major depression. The incidence of CHH was similar in both diagnostic groups. Thus, antidepressant treatment is associated with CHH in patients with diagnoses, other than depression. Desipramine was least likely to induce CHH compared to imipramine, amitriptyline and doxepin. Most patients who developed CHH on imipramine no longer experienced this side effect when switched to desipramine. CHH was not more frequent among women and not associated with antidepressant dosage or treatment response. Histamine H-1 receptor blockade may be an important factor in the etiology of CHH.

Pre-infusion heart rates and laboratory-induced panic anxiety

ABSTRACT— Resting and pre‐infusion heart rates recorded in 66 panic disorder patients revealed no significant differences between panickers and nonpanickers. There was also no significant difference in pre‐fusion heart rates between either lactate or isoproterenol panickers and placebo nonpanickers. There was neither a sensitizing nor a desensitizing effect of laboratory‐induced panic attacks on subsequent pre‐infusion heart rates.

Effects of laboratory-induced panic-anxiety on subsequent provocative infusions

The effects of infusion-induced panic-anxiety on subsequent pre-infusion anxiety ratings and infusion-induced panic attacks were studied in 64 panic disorder patients, in a double-blind randomized study using sodium lactate, isoproterenol, and placebo infusions. While there was a decrease of preinfusion anxiety from one infusion to the next infusion both for panickers and nonpanickers, there was no evidence of either a significant decrease or an increase in the frequency of subsequent panic attacks. These results suggest that there is neither a desensitizing nor a sensitizing effect of pharmacologically induced panic attacks on subsequent infusions in a serial three-infusion design.

The effect of lithium on platelet count

The effect of lithium on platelet count was studied by examing 12 patients treated with lithium carbonate without any additional medication, 13 patients treated with lithium carbonate with additional psychotropic medication, 25 patients with major affective disorder prior to any treatment, 25 patients with panic disorder prior to any treatment and 25 healthy controls. The platelet counts were increased in the group of subjects treated with lithium carbonate without any additional psychotropic medication. The increase was not clinically significant.

Lactate and isoproterenol infusions in bulimic patients.

We compared the responses of bulimic subjects to those of panic disorder patients and normal controls during infusions of sodium lactate and isoproterenol in a double-blind, placebo-controlled study. Four of 8 bulimics infused with lactate had panic attacks. Three of 9 bulimics infused with isoproterenol panicked, and 1 bulimic panicked with a placebo infusion. Although bulimics were less likely than panic disorder patients to panic during provocative infusions, their anxiety levels as measured by a panic description scale were as great. A large portion of the anxiety response in bulimics occurred in those who had concurrent panic attacks.

The effect of tricyclic antidepressants on stress-induced heart rate changes in panic disorder patients.

ABSTRACT: Eight panic disorder patients participated in a double‐blind placebocontrolled infusion study designed to induce panic‐anxiety in the laboratory both before and after treatment with tricyclic antidepressants. Pre‐infusion heart rates for the first infusion were significantly higher than baseline both before and after treatment. The delta increase in pre‐infusion heart rates from baseline and the ratios of pre‐infusion heart rates to baseline values were not significantly different between before and after treatment conditions indicating similar levels of arousal during the two pre‐infusion periods, while the pre‐infusion anxiety ratings after treatment were significantly lower.