P. Berger

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.

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.

Personality disorder and social anxiety predict delayed response in drug and behavioral treatment of panic disorder

BACKGROUNDnThe aim of this study was to analyze the impact of pretreatment characteristics and personality disorders on the onset of response in the treatment of panic disorder.nnnMETHODSnThe data of 73 out-patients with panic disorder who had completed at least 6 weeks of a randomized trial of 24 weeks of either paroxetine only or paroxetine combined with cognitive group-therapy were analyzed in a Cox proportional hazards model.nnnRESULTSnThe likelihood of having responded to treatment (defined by a CGI rating of improvement) was more than twice as high for patients without a personality disorder or social phobia than for Patients with a personality disorder or social phobia.nnnCONCLUSIONSnWe suggest that patients with these characteristics do benefit from prolonged treatment, and they may profit from an additional treatment focused on social anxiety.

Nonorganic insomnia in panic Disorder: comparative sleep laboratory studies with normal controls and placebo-controlled trials with alprazolam

Objective and subjective sleep and awakening quality was investigated in 11 drug‐free patients (4 females, 7 males) aged 30–55 (mean: 44±9) years with nonorganic insomnia (F 51·0) related to panic disorder (F 41·0) as compared with 11 age‐ and sex‐matched normal controls aged 30–58 (mean: 44±9) years, utilising polysomnography (PSG) and psychometry. PSG demonstrated decreased sleep efficiency (primary target variable), total sleep time (TST) and S2 as well as increased middle and late insomnia, S1, S3+S4, snoring and PLM in patients. There were no intergroup differences in REM variables. Subjective sleep quality deteriorated, as did drive and fine motor activity in the morning, while concentration increased. Blood pressure in the evening and morning and pulse rate in the evening were elevated. These differences as compared with normals were distinct from those observed in other sleep disorders. In a subsequent acute, placebo‐controlled cross‐over design study, patients received alprazolam 0·5 mg (Xanor®;) and placebo. As compared with placebo, alprazolam induced an increase in sleep efficiency (primary target variable), TST and S2, a decrease in wakefulness during the total sleep period, S3+S4 and the oxygen desaturation and PLM indices, and improved subjective sleep quality, somatic complaints, drive, affectivity and drowsiness in the morning. There were no changes in REM variables. Thus, alprazolam induced changes that were opposite to the differences observed between patients and controls before treatment, thereby normalizing sleep and awakening quality. As observed in insomnia related to GAD and subsequent benzodiazepine therapy, the present study also points to a key‐lock principle in the treatment of insomnia caused by anxiety disorders and neurophysiologically visualizes processes at the receptor level (e.g. benzodiazepine agonists versus inverse agonists). Copyright

Embarrassment about the first panic attack predicts agoraphobia in panic disorder patients

In order to find out whether contextual variables of the first panic attack and the persons reaction to it predict the development of agoraphobia in panic disorder patients, 60 patients with a DSM-III-R diagnosis of panic disorder with agoraphobia and 30 patients suffering from panic disorder without agoraphobia were interviewed about their first panic attack. Single comparisons between groups of agoraphobic and non-agoraphobic patients were carried out and a logistic regression model was applied. Occurrence of the first panic attack in public and the feeling of embarrassment were found to be significantly associated with the development of agoraphobia. It is concluded that eliciting this specific form of social concern at an early stage might help to identify patients at risk for later agoraphobia, which could, in turn, help to further specify early therapeutic interventions and concentrate therapeutic efforts on a high-risk group of panic disorder patients.

Gender related disabilities in panic disorder

SummaryGender differences with regard to specific psychosocial factors were investigated in 100 outpatients with the diagnosis of panic disorder (DSM-IV) with and without agoraphobia (78% with agoraphobia). Patients were recruited for a randomized clinical trial of paroxetine alone versus paroxetine plus a specific form of group psychotherapy. Similar to previous results, no significant differences were found on measures of demographic data, symptomatology and comorbidity. However, psychosocial disabilities and interpersonal problems were associated with being female. Family function was more highly impaired in women than in men, and women had a higher rate of catastrophic thinking. Women differed from men in one interpersonal factor, namely being overly expressive.

P02-271 - The reliability of a brief diagnostic interview, the trips, for the assessment of psychiatric disorders according to ICD-10 in primary care and non-psychiatric medical settings

Introduction Although there are instruments for the assessment of DSM-IV mental disorders in primary care, there is no brief instrument to assess mental disorders in primary care according to the ICD-10. Aims The aim of the study was to assess the reliability of a new diagnostic interview, the TRIPS, designed for the assessment of anxiety-, mood-, and alcohol related disorders according to ICD-10 by non-mental health professionals. Methods At first, all Patients completed a screening questionnaire and were subsequently assessed by the staff of somatic departments of a Vienna General Hospital with the TRIPS. Within a week, patients were re-assessed by psychiatrists of the department of psychiatry with the Composite International Diagnostic Interview (CIDI). Results Finally, 290 patients could be assessed with both instruments. With the CIDI, 106 out of 290 patients (37%) got any diagnosis of a mental disorder, 74 (26%) had a mood disorder, 64 (22%) an anxiety disorder and 10 patients (3%) an alcohol-related disorder. Sensitivity of the TRIPS was 88%, specificity was 76% and diagnostic accuracy was 80% for any disorder, and 88%, 83%, and 84% respectively for any mood disorder, 72%, 88%, and 84% for any anxiety disorder, and 60%, 98%, and 97% for alcohol related disorders. Conclusions The results show that the TRIPS is a useful instrument with sufficient reliability to detect anxiety disorders and mood disorders in patients with somatic disorders by health professionals without psychiatric training. Due to the low base rate the test criteria for alcohol-related disorders cannot be interpreted sufficiently.

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.