Johann Windhaber

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.

The Consequences of Non-Cognitive Symptoms of Dementia in Medical Hospital Departments

Objective: To our knowledge, there are no studies investigating the non-cognitive symptoms of patients with dementia such as depression, agitation, or delusions among general hospital inpatients. The aim of this study was to investigate the frequency of such non-cognitive symptoms among medical inpatients and to analyze their impact on the length of hospital stay and on admission to nursing homes. Method: The sample consisted of 372 elderly inpatients admitted to four internal medical departments (i.e., not including psychiatric wards) in Austria. Patients were investigated by research psychiatrists using the Clinical Interview Schedule. For the analyses of the non-cognitive symptomatology, only marked and severe symptoms were included. To identify predictors for the length of hospital stay and for nursing home placement, multivariate regression procedures were used. Results: Of all inpatients, 27.4% met criteria for dementia according to DSM-III-R. Of those with dementia, 27.8% had marked or severe non-cognitive symptoms. A diagnosis of dementia markedly increased the risk for nursing home referral and prolonged the duration of inpatient treatment. Among the demented, both, cognitive and non-cognitive symptoms turned out to be significant predictors for nursing home placement and for prolonged duration of acute hospital stay, even when controlling for other independent variables. Conclusions: Non-cognitive symptoms occur frequently among medical inpatients with dementia and considerably increase both the duration of inpatient treatment and the risk of nursing home placement. Since such non-cognitive symptoms are treatable, they should receive attention from the hospital staff.

Does psychiatric comorbidity increase the length of stay in general hospitals

Several studies reported that in non-psychiatric hospital departments mentally ill patients have a longer length of hospital stay than mentally well. But their methods are often limited because other predictors of length of stay were excluded from statistical analyses. Using the Clinical Interview Schedule, research psychiatrists interviewed 993 patients of medical, surgical, gynecological, and rehabilitation departments in Austria. Using several multiple regression analyses, the influence of psychiatric comorbidity and other variables on length of stay was analyzed. 32.2% of all patients suffered from psychiatric morbidity. Of all psychiatric cases, 6.2% received more than one psychiatric diagnosis. Presence of psychiatric disorders, age, a diagnosis of neoplasms, number of all somatic diagnoses, and the number of previous non-psychiatric hospital admissions predicted length of stay. Patients with dementia, with substance abuse disorders, and with alcohol- and drug-related psychiatric disorders showed a significantly increased length of stay, while other psychiatric diagnoses did not differ from the mentally well. Even after controlling for confounding variables, dementia and substance related diagnoses increase the length of hospital stay. It is important to investigate interventions for early recognition and treatment of these disorders.

High frequency of EEG and MRI brain abnormalities in panic disorder.

The frequency and quality of brain abnormalities in panic disorder (PD) were assessed with magnetic resonance imaging (MRI). The use of electroencephalography (EEG) to detect PD patients with a high probability of morphologic brain abnormalities was also explored. Consecutive PD patients (n = 120) were screened with routine EEG examinations and were divided into the following subgroups on the basis of their EEG findings: patients with non-epileptic EEG abnormalities (EEG-A group, n = 28), matched patients with normal EEG results (EEG-N group, n = 28) and matched healthy controls (n = 28). PD patients showed a higher than expected rate of non-epileptic EEG abnormalities (29.2%; 35 of 120). EEG screening was effective in identifying patients with a high probability of morphologic brain abnormalities. MRI abnormalities were found in 60.7% of the EEG-A patients, 17.9% of the EEG-N patients, and only 3.6% of the controls. A high frequency of septo-hippocampal abnormalities was found. Further research should focus on attempts to subtype PD on the basis of neuroanatomic and functional brain abnormalities.

Non-cognitive symptoms of dementia in nursing homes: frequency, course and consequences

Since most studies concerning the frequency of non-cognitive symptoms of dementia are based on samples of psychiatric services, the results of these studies may be influenced by their selection procedure. For this reason, we investigated the frequency of non-cognitive dementia symptoms based on an epidemiological nursing home study. The sample consisted of 249 nursing home residents in Austria who were interviewed with the Clinical Interview Schedule within 2 weeks after admission (T1) and again 6 months later (T2). For the analyses of the non-cognitive symptoms among the demented, only manifest clinical abnormalities observed during the interview were included. Further, mobility and impaired self-care were assessed. At admission, dementia was found in 63.9% of the sample. At T1, 38%, and at T2, 36.1% of the demented suffered from any non-cognitive symptoms. Flattened or incongruous affect, suspiciousness or aggressiveness, and anxiety were found most frequently. Multiple regression analyses showed that non-cognitive symptoms increase the risk for impaired self-care. Despite the fact that the frequency of several non-cognitive symptoms found in our survey is lower than reported from studies based on psychiatric samples, a high proportion of the demented in nursing homes suffer from such symptoms. Non-cognitive symptoms of dementia increase the risk for an impaired self-care, which supports the assumption that they raise the costs of caring.

Jackson seizure and panic disorder relieved by carbamazepine.

Pathophysiological connections between panic disorder (PD) and epilepsy (E) have been repeatedly discussed (Spitz, 1991; Weilburg et al, 1987; Dantendorfer et al, 1995). We present a patient who suffered one Jackson seizure, later developed PD and was successfully treated with carbamazepine. A 32 year-old male was referred by his neurologist because of recurrent panic attacks which had started four months earlier. Symptoms included intense anxiety with fear of dying, palpitations, dyspnea, sweating, trembling and nausea. The patient reported neither derealization nor paresthesias. Attacks occurred on an average of three per week and lasted for 10 to 20 minutes. Since the age of 18 years, the patient had been occasionally suffering from migrainous headache with scotomas. Three years earlier he had experienced one episode with involuntary movements of the right hand spreading to the right upper arm, lasting for about two minutes. The episode was followed by a short period of speech arrest, but no loss of consciousness had occurred. The episode had been diagnosed as a Jackson seizure by a neurologist. As such an episode had never been experienced before and did not reoccur, no therapeutic steps were taken at that time. Clinical workup at referral showed a normal neurologic status and somatic routine diagnostic measures were without any pathological findings. A structured clinical interview (SCID) was performed by two psychiatrists. A diagnosis of PD but no other psychiatric diagnosis was made, reservedly the results of further diagnostic steps. EEG showed an increase of theta waves and theta wave groups in temporo-anterior localization in both hemispheres. There were no signs of increased brain excitability. HMPAO-Spect found reduced tracer uptake in the left temporal lobe. MRI revealed an arachnoidal cyst of 2 cm 0, in front of the left temporal pole (fig 1). A therapeutic attempt with carbamazepine was made. Dosage was increased to 600 mg/day and plasma levels Fig 1. MRI scan showing a sharply delineated, cerebrospinal fluid isointense lesion (arachnoial cyst; arrows) on the left temporal pole. 0.5 T superconducting MRI system; Tl weighted axial section.

Gruppenpsychotherapie bei Panikstörung

Seit die Panikstorung im Diagnosticai and Statistical Manual of Mental Disorders (DSM-III) des Amerikanischen Psychiaterverbandes (APA 1980) definiert wurde, ist eine grose Zahl von pharmakotherapeutischen Studien erschienen. Dabei haben sich die alten trizyklischen und die neuen selektiv serotonergen Antidepressiva wie auch die Monoaminooxidase-Hemmkorper bei Anwendung uber 8 bis 12 Wochen als wirksam erwiesen; es kommt durch diese Medikamente zu einer deutlichen Reduktion der Panikattacken und der agoraphoben Symptomatik sowie der damit einhergehenden Behinderungen (Katschnig 1996). Auch aus dem psychotherapeutischen Bereich kamen nach und nach Studien, in denen belegt werden konnte, das bei Panikattacken zumindest kognitive Therapie auserst wirksam ist (Margraf et al. 1993). Bis heute gibt es nur wenige randomisierte Vergleichsstudien, die Pharmakotherapie und Psychotherapie miteinander vergleichen. In einer der am besten geplanten Untersuchungen, der von Clark und Mitarbeitern (1994), zeigte sich, das sowohl medikamentose als auch kognitive Therapie wirksam ist, nach Ende der Therapie kognitive Therapie jedoch einen persistierenderen Effekt als eine abgesetzte Pharmakotherapie aufweist.