Matig Mavissakalian

Measurement of sexual arousal in male homosexuals: Effects of instructions and stimulus modality

Erections were measured in 20 male homosexual subjects under three instructional conditions and within three stimulus modalities. The three conditions were arousal (e.g., imagine yourself involved and get aroused), suppression (e.g., imagine yourself involved but suppress erection responses), and rearousal (e.g., imagine yourself involved and get aroused). The three stimulus modalities studied were video tapes, slides or pictures, and audio tapes of homosexual cues. The results show that video tape generates the highest level of arousal, audio tape the lowest level of arousal, and slides an intermediate level. Both video tape and slides show substantial voluntary suppression effects. During suppression, video tape continues to elicit relatively high levels of arousal in contrast to slides and audio tapes, which are equally low.

Tricyclic antidepressants in obsessive-compulsive disorder. Antiobsessional or antidepressant agents?

The response to tricyclic antidepressants of eight obsessive-compulsive patients was assessed at pretreatment and at 4, 8, and 12 weeks of treatment, with the aim of delineating differential rates of improvement, or desynchrony, between the various symptoms. Change in obsessive-compulsive symptoms paralleled change in depression and anxiety, suggesting a global beneficial effect of the drugs. The analysis of individual data also revealed this synchronous pattern of change, with significant improvement, in responders, occurring within the first 4 weeks of treatment. Furthermore, responders had higher initial Hamilton depression ratings compared to nonresponders. These results do not lend support to the claim that tricyclics possess specific antiobsessional effect which is independent of their antidepressant effect. The limitations of a purely symptomatic approach in exploring the mode of action of antidepressants in obsessivecompulsive disorder is briefly discussed.

Duration of imipramine therapy and relapse in panic disorder with agoraphobia

It has been suggested that maintenance treatment of patients who have remitted panic disorder with agoraphobia beyond the six months of acute phase imipramine treatment may decrease the risk of relapse. This study further explores the relationship between relapse and duration of imipramine treatment in this population. Fifty-one patients, all in remission at the end of six months acute phase open trial with imipramine 2.25 mg/kg/day and randomized to double-blind maintenance or placebo substitution, discontinued imipramine treatment eventually and were followed over a 12-month risk period: 27 during first year placebo substitution, 7 after 12 months of imipramine maintenance in placebo substitution, and 17 after variable durations of imipramine maintenance in open discontinuation. There were no behaviorally oriented interventions or instructions at any time during the acute and maintenance phases of treatment or during imipramine discontinuation. Duration of imipramine treatment, the method of discontinuation (open versus placebo substitution), or any of the 9 variables from the demographic, clinical, and open treatment domains that were entered in a Cox proportional hazard model did not predict relapse. The rate of relapse after only 6 months of treatment (10 out of 27, 37%) was identical to the rate of relapse after 12 to 30 months of treatment (9 out of 24, 37.5%). The results suggest a lack of specific protective effects beyond prophylaxis and underscore the difficulty in predicting relapse in fully remitted panic disorder with agoraphobia patients. Early detection of relapse in patients who discontinue treatment may be a viable alternative to prediction.

Gauging the Effectiveness of Extended Imipramine Treatment for Panic Disorder with Agoraphobia

BACKGROUNDnImipramine has proven efficacy for panic disorder. This study assesses the net effectiveness of systematic, open imipramine treatment in a homogenous sample of panic disorder patients with agoraphobia.nnnMETHODSnOne hundred and ten consecutive patients with DSM-III-R moderate to severe panic disorder with agoraphobia were treated with a fixed regimen of imipramine 2.25 mg/kg/day for 24 weeks. No instructions or encouragement for self-directed exposure to phobic situations or other coping strategies with panic or fear were given. Assessments were conducted at the end of the 2-week placebo run-in and at weeks 8, 16, and 24 of treatment.nnnRESULTSnOverall, 53% had a marked and stable response. Most measures revealed that substantial improvement continued beyond week 8 of treatment. Treatment success was accompanied with significant improvements in anxiety sensitivity, dysphoric mood, and functional well-being.nnnCONCLUSIONSnThese results provide a clinically relevant reference with which to compare the effectiveness of alternative treatments in providing nearly complete symptom remission in patients with primary panic disorder with agoraphobia.

The placebo effect in agoraphobia--II.

Analyses in 44 agoraphobic patients given single-blind placebo over a two-week period, without the customary confound of instructions of exposure to phobic situations, replicated previous findings of a weak placebo response in that there were statistically, but not clinically, significant reductions in panic and phobic symptoms. Further analyses of a representative subsample of 10 patients who continued to receive placebo revealed that the placebo response was maintained and even increased at the end of 10 weeks when 20% to 30% of the patients could be classified as marked responders on key panic and phobic measures. Results also revealed an interesting observation that most of the improvement in panic, anxiety, and depression occurred early whereas improvement in phobic measures was more gradual and increased significantly over time. Implications for clinical research are briefly discussed.

The Relationship of Plasma Imipramine and N-desmethylimipramine to Improvement in Agoraphobia

Plasma tricyclic concentrations were assessed in 15 agoraphobic patients receiving combined imipramine and behavioral treatments. Imipramine but not N-desmethylimipramine plasma levels were found to significantly correlate with improvement. The results suggest that imipramines effect in agoraphobia might be mediated predominantly through the serotonergic action of the parent drug. There was also suggestive evidence for differential antipanic and antiphobic-antidepressant effects. Implications for future studies of the mechanism of action of drug effects in agoraphobia are discussed.

Specific side effects of long-term imipramine management of panic disorder

In a recent study, the authors suggested that tachycardia, dry mouth, and sweating continued to burden patients with panic disorder with agoraphobia who have shown marked and stable response to 6 months of imipramine treatment at the fixed, weight-adjusted dose of 2.25 mg/kg/day. Although sexual dysfunction and weight gain were not a significant burden in that study, they are important problems in long-term treatment with antidepressant drugs. In the present study, in the context of a randomized, double-blind, placebo-controlled, 1-year discontinuation and maintenance study of 53 patients with panic disorder with agoraphobia who respond to imipramine, the authors examine the extent and the specificity of these five side effects of imipramine maintenance using data at pretreatment, at the end of 24 weeks of open imipramine treatment (or month 0 of randomization), and at months 2, 4, 6, 8, 10, and 12 of randomized treatment. Hierarchical linear modeling and repeated measures of analyses of variance in subsamples of completers confirmed that dry mouth, sweating, and increased heart rate constitute a significant and specific enduring burden of imipramine maintenance treatment. The data also revealed that weight gain is a significant and specific side effect of 1-year imipramine maintenance treatment; however, the likelihood of reporting sexual dysfunction decreased over time, with no difference between the placebo and imipramine maintenance conditions. The results are discussed in the context of previous studies of imipramine side effects in the management of depression and the available literature of sexual and weight side effects of antidepressant medications in the treatment of anxiety disorders.

Phenomenology of panic attacks : Responsiveness of individual symptoms to imipramine

A number of studies have demonstrated that individual panic symptoms are not equivalent vis-a-vis their clinical salience. This study investigated the proposition that individual panic symptoms may also differ in their specific responsiveness to treatment in 63 patients with panic disorder with agoraphobia who had completed an 8-week placebo-controlled dose-ranging study with imipramine. The results revealed that fear, unreality, and respiratory symptoms, most strongly dyspnea and choking, displayed the highest degree of early differentiation between effective and ineffective doses of the drug, whereas palpitations, tingling, and sweating had the most pronounced effects between weeks 4 and 8 of treatment. On the other hand, the symptom of hot and cold flashes did not differ between adequate and inadequate treatment. The evidence presented reinforces the notion that individual panic symptoms are not functionally equivalent and suggests that some symptoms, in particular fear, derealization, and the respiratory symptoms, may be more central than others to the therapeutic process just as some of them have been found to be more important for diagnostic considerations. The results are briefly discussed from the methodologic and phenomenologic perspectives.

Initial depression and response to imipramine in agoraphobia.

Thirty-seven patients participating in a controlled treatment study with imipramine were classified as high or low depressed simultaneously on two depression measures. Analysis of variance by 2 (high-low depressed) X 2 (high-low imipramine dosage) groupings revealed significant dose but no depression main effects. The greater dose effect observed in the low depressed group and the greater response rates found among high-dose patients with low initial depression strongly suggest that the beneficial effect of imipramine in agoraphobia was not primarily antidepressant in nature.

Plasma testosterone levels and male homosexuality: a failure to replicate.

The plasma testosterone values for 15 male homosexuals of Kinsey rating 5 or 6 were compared to the values reported by Kolodny et al.(1971), who had found male homosexuals to have lower testosterone values than heterosexuals. The values for our 15 male homosexuals were found to be significantly higher than those reported by Kolodny et al.In fact, the mean values for the current sample did not differ from the mean value reported by Kolodny et al.for heterosexual (Kinsey rating 0 or 1) controls. The present findings thus fail to confirm the relation between degree of homosexuality and plasma testosterone level.