Klaus Kuch

Psychotropic Medication and Insomnia Complaints in Two Epidemiological Studies

Objective: Motor vehicle accidents (MVA) may result in intractable disability. This paper investigates posttraumatic stress disorder (PTSD) as a potential cause. Method: The literature was reviewed for recent studies on prevalence, symptom profile, and outcome of PTSD. Results: PTSD is prevalent in roughly 10% of survivors of MVAs during the first year. Comorbid depression and pain are common. Medical complications, psychophysiological reactivity, and possibly litigation may slow remission. Phobic symptoms can persist for years. Mood disturbance may augment the impact of pain on daily living and on self-perceived disability. Conclusion: Recently developed screening instruments, structured interviews, and behavioural approach tests yield quantitative and reliable assessments of symptom severity. Cognitive–behavioural intervention and antidepressants may improve coping, ease fear, and reduce the impact of pain.

Post-traumatic stress disorder after car accidents

Survivors of car crashes often suffer from a posttraumatic fear of driving, generalized anxiety and depression. Unremitting pains are also common. As part of a pilot study 30 referred subjects were exposed to imagery of driving and accidents. Seventy-seven percent were phobic of driving. Fifty-three percent responded with increased anxiety to the imagery. Twelve treatment referrals received exposure therapy and six improved markedly. An additional four improved when a Benzodiazepine was added temporarily. Four out of eight subjects lost their unremitting pains along with their fears. When guided imagery evoked intense anxiety this seemed to predict a favourable outcome. A resumption of pleasure trips was a reliable criterion of recovery. The frequency of phobic symptomatology and its importance to the understanding and management of post-traumatic anxiety states is discussed.

Phobias, panic, and pain in 55 survivors of road vehicle accidents

Abstract We examined 55 survivors of road vehicle accidents (RVA) with minimal injury and chronic pain physically, by structured clinical interview, by panic, phobia, anxiety sensitivity, and pain scales. Twenty-one (38.2%) of the 55 RVA survivors met DSM-III-R criteria for simple phobia with onset after RVA, and eight (38.1%) of the 21 met full criteria for current PTSD. Five (23.8%) of the 21 phobics and none of the nonphobics gave a past history of other phobia. Gender, pain location, and pain severity were similar in phobics and nonphobics. Fears were predominantly specific for RVA and, with the exception of three RVA survivors, panic occured exclusively in cars. Results on prevalence of phobias and PTSD after RVA are similar to earlier findings. The results also suggest that “accident phobia” is not similar to agoraphobia, that past anxiety disorder may predispose towards fear aquisition, but that it may not necessarily predetermine fear content.

Pre-treatment predictors of treatment outcome in panic disorder and agoraphobia treated with alprazolam and exposure

Pre-treatment predictors of treatment outcome were examined in a group of 144 patients with panic disorder and agoraphobia randomly allocated to alprazolam+exposure (AE), placebo+exposure (PE), alprazolam+relaxation (AR), and placebo+relaxation (PR). First-time psychotropic medication use, severity of agoraphobic disability, and longer duration of illness predicted less global improvement at post-treatment. Pre-treatment severity of agoraphobia predicted less improvement both in the short- and the long-term. Predictors of poorer outcome at 6-month follow-up were older age, past history of depression, severity of phobia targets, and longer duration of illness. Sex, source of referral, pre-treatment depression-anxiety-panic, and expectancy from treatment did not relate to outcome.

To what extent do anxiety and depression interact with chronic pain

In 61 patients with generalized musculoskeletal pain, severity of anxiety and depression correlated significantly with self-reported impact of illness and physician-rated disability. Depression was significantly associated with pain-frequency, whereas anxiety was unrelated. Depressed mood was more closely tied to patients’ ability to function than to their experience of pain.

Chronic pain in panic disorder

Studies indicate that panic disorder is often associated with high levels of somatic preoccupation, but the nature of these somatic complaints have not been investigated in detail. One hundred and forty-one consecutive panic disorder patients were administered a pain questionnaire and pain location diagram. Almost 40% of the patients reported chronic pain and 7.8% reported using analgesics daily. The most common locations of pain were the head, shoulders, and lower back. When compared with panic disorder patients with no reports of pain, these patients scored significantly higher on several measures of psychopathology. Panic patients with chronic pain may have more functional illness behaviors that require specific treatment considerations and may represent a subset of panic disorder that is particularly at risk for somatization, hypochondriasis, and excessive health care utilization.

Otoneurological functioning in panic disorder patients with prominent dizziness

Fifteen panic disorder patients with prominent dizziness underwent audiologic, caloric, and vestibuloocular reflex activity testing and were compared with normal controls. There were no abnormalities detected on audiologic and caloric tests. Compared with normal controls, panickers with dizziness showed a greater discrepancy between eye and head movements on vestibulo-ocular reflex activity in the dark. Panickers with prominent dizziness did not differ from a second control group of panickers with severe heart palpitations on a number of psychological tests. The results did not support the hypothesis that organic dizziness is etiologically important in the causation of panic or agoraphobia, but do suggest that vestibuloocular reflex activity should be further studied in panic disorder.

Dimensions of agoraphobia assessed by the mobility inventory

Factor analyses of the When Accompanied and When Alone subscales of the Mobility Inventory (Chambless, Caputo, Jasin, Gracely & Williams, Behaviour Research and Therapy, 23, 35-44, 1985) were conducted using the responses of 177 panic disorder with agoraphobia patients. For both subscales a three-factor model was the most appropriate and accounted for approx. 60% of the variance in each case. The three factors were reliable and theoretically meaningful: fear of public places, enclosed spaces and open spaces. The fear of public places factor accounted for most of the explained variance and is discussed in relation to the social evaluation component of panic attacks.

Anticipatory anxiety and avoidance in panic disorder with agoraphobia

The present study utilized the responses of 34 patients with panic disorder with agoraphobia to investigate the occurrence and anticipation of panic attacks in relation to the avoidance of specific situations from the Fear Questionnaire [Marks & Mathews (1979) Behaviour Research and Therapy, 17, 263-267]. Results indicated that self-reports of avoidance of specific situations were often significantly correlated with the anticipation of panic but rarely with the occurrence of panic. The occurrence and anticipation of panic were also frequently associated with social phobic situations in addition to agoraphobic situations.

Precipitating events, locations and reactions associated with initial unexpected panic attacks

This study examined the phenomenology of the initial panic attack in 85 panic disorder patients with or without agoraphobia. Patients were divided into minimal and extensive avoiders and three domains were assessed: precipitating factors, location of initial panic, and reaction to the panic. No apparent precipitating factor could be identified in approx 40% of the patients. The most common precipitants were injury/illness and interpersonal conflict. Extensive avoiders were more likely to have experienced the initial panic in classic agoraphobic situations. Public transportation was the most common location for the total sample. In reaction to the panic, minimal avoiders were more likely to have gone to a hospital emergency room (ER) whereas extensive avoiders were more likely to have done nothing in terms of help-seeking. Many patients with either minimal or extensive avoidance avoided the locations where the initial panic occurred, suggesting that circumscribed avoidance does not always generalize.