Kélin Maggioni Mezzomo

Evaluation of defense mechanisms in adult patients with panic disorder: before and after treatment.

Patients with acute panic disorder (PD) use a more maladaptive pattern of defense mechanisms. This study investigated the use of defense mechanisms by patients with acute symptomatic PD and those in complete remission. Thirty-three patients and 33 controls were evaluated by the Mini International Neuropsychiatric Interview. The defense mechanisms were evaluated by the Defense Style Questionnaire at the beginning of the study and after 16 weeks of sertraline treatment. Panic disordered patients used more neurotic (4.6 vs. 3.6; p = 0.003) and immature (3.6 vs. 3.0; p = 0.024) defenses at baseline. Patients who achieved complete remission (N=25) differed from the control group in the use of neurotic defenses at the baseline (4.4 vs. 3.6; p = 0.033). After treatment, they showed a reduction in the use of neurotic (4.4 vs. 3.7; p=0.014) and immature (3.4 vs. 3.1; p = 0.019) defenses. Defense mechanisms in PD are influenced by the presence of symptoms, severity, and outcome of the disease.

Brazilian patients with panic disorder: the use of defense mechanisms and their association with severity.

This study aims to evaluate the defense mechanisms most frequently used by Brazilian patients with panic disorder when compared with a control group. The study also examines the association between severity of disease and comorbidity and the use of specific defense mechanisms. Sixty panic-disordered patients and 31 controls participated in the study. The Mini International Neuropsychiatric Interview was used to confirm the panic disorder diagnosis and to establish the comorbid diagnosis. The Clinical Global Impression (CGI) was used to assess severity and the Defensive Style Questionnaire (DSQ-40) was used to evaluate the defense mechanisms. Panic patients used more neurotic (mean = 4.9 versus 3.6; p < 0.001) and immature (mean = 3.9 versus 2.8; p < 0.001) defenses as compared with controls. Panic patients with severe disease (n = 37; CGI>4) had more depression comorbidity and used more immature defenses than patients with CGI≤4 (n = 23; mean = 4.2 versus 3.5; p < 0.001). It was concluded that the panic severity and depression comorbidity found in Brazilian panic-disordered patients are associated with the use of maladaptive mechanisms, namely immature defenses.

Behaviorial inhibition and history of childhood anxiety disorders in Brazilian adult patients with panic disorder and social anxiety disorder

OBJETIVOS: Avaliar a presenca de historia de comportamento inibido e de transtornos de ansiedade na infância em pacientes brasileiros adultos com transtorno do pânico e com transtorno de ansiedade social, comparando-os com um grupo controle. METODOS: Cinquenta pacientes com transtorno do pânico, 50 com transtorno de ansiedade social e 50 controles participaram do estudo. Para avaliar a presenca de historia de ansiedade na infância foi utilizada a Escala para Avaliacao de Transtornos Afetivos e Esquizofrenia para Criancas em Idade Escolar - Versao Epidemiologica (K-SADS-E) e o Diagnostic Interview for Children and Adolescents-Parent Version (DICA-P). A presenca de comportamento inibido na infância foi avaliada atraves da Escala Auto-Aplicativa de Comportamento Inibido - Versao Retrospectiva (RSRI-30). RESULTADOS: Os pacientes apresentavam uma prevalencia significativamente maior de historia de transtornos de ansiedade e de comportamento inibido em relacao ao grupo controle. Pacientes com transtorno de ansiedade social apresentavam, tambem, taxas significativamente maiores de transtorno de evitacao (46% x 18%, p = 0,005), transtorno de ansiedade social (60% x 26%, p = 0,001), presenca de pelo menos um transtorno de ansiedade na infância (82% X 56%, p = 0,009), comportamento inibido global (2,89 ± 0,61 vs. 2,46 ± 0,61, p < 0,05) e comportamento inibido escola/social (3,56 ± 0,91 vs. 2,67 ± 0,82, p < 0.05) na infância em comparacao com pacientes com transtorno do pânico. CONCLUSAO: Nossos dados sao similares aos encontrados na literatura e corroboram a teoria da diatese de ansiedade, sugerindo que a historia de transtornos de ansiedade na infância e associada com transtornos de ansiedade, principalmente transtorno de ansiedade social, na vida adulta.

Stress regulates the lymphocyte homing receptor CD62L (L-selectin)

Based on a previous study showing that panic disorder patients had increased expression of na ve phenotype lymphocytes (CD45RA+ and CD62L+), increased plasma cortisol, as well as decreased interleukin-2 (IL-2) producion, we hypothesized that changes in the percentage of expression of these lymphocyte surface molecules could be related to the substances released by the hypothalamic-pituitary-adrenal (HPA) axis and possibly associated to panic disorder (cortisol, IL-2, serotonin and epinephrine). In order to study the altered expression, blood mononuclear cells of normal volunteers were stimulated with mitogen, in the presence of dexamethasone, IL-2, serotonin and epinephrin. CD62L is decreased by IL-2 in vitro. Serotonin and epinephrine did not promote changes in the expression of these surface molecules. The results of the ex vivo study are in agreement with a previous clinical study with panic patients. It could be suggested that stress is responsible for certain immunologic dysfunctions and new studies should be conducted.