Peter F. Marriott

Seasonality in panic disorder.

Following a clinical observation of increased anxiety symptoms and mood changes during winter in panic disorder patients, the Seasonal Pattern Assessment Questionnaire (SPAQ) was completed by 133 patients. Global Seasonality Scores (GSS), and the prevalence of Seasonal Affective Disorder (SAD), were significantly higher than reported in general population studies. Seasonal changes were also found in anxiety and panic attacks. These findings suggest the possibility of a common aetiology for panic disorder and SAD, that seasonality may be a far more general phenomenon in psychopathology, and that light therapy may be a useful treatment for some panic disorder patients.

A Mirror Image Out-Patient Study at a Depot Phenothiazine Clinic

This Mirror Image Study, at a specialised clinic, has shown a significant reduction in days spent in Hospital. Individual features of the sample include sex and age difference in the sub-groups for dosage, duration of treatment and anti-Parkinsonian medication. Preliminary cost-effectiveness analysis has been reported.

Short-acting versus long-acting benzodiazepines: discontinuation effects in panic disorders.

An increasing body of evidence suggests that benzodiazepines--which have long been considered the drugs of choice in the treatment of various anxiety disorders due to their relative lack of side effects, lack of adverse drug reaction, their safety, and increased efficacy over other agents--are effective in the treatment of panic disorders. Originally, the benzodiazepines were believed to be devoid of dependence-inducing properties, even at high doses. Recent evidence, however, suggests that discontinuation of both high and normal doses of both short- and long-acting benzodiazepines generally results in similar withdrawal symptoms, including anxiety and sleep and perceptual disturbances. This article presents a brief review of benzodiazepine withdrawal, with an emphasis on the discontinuation of these drugs following treatment of panic disorders. In particular, short-acting and long-acting drugs may present different features following long-term treatment and withdrawal. Preliminary results from a study comparing alprazolam and diazepam are presented to illustrate this point in contrast to expectations: the problems associated with withdrawal of both agents were comparable.

The pineal hormone melatonin in panic disorder

The nocturnal synthesis of the pineal hormone melatonin was examined from 8 p.m. to midnight in 11 patients with panic disorder and eight control subjects. Patient concentrations of melatonin were significantly lower than controls at 10 p.m. (P less than 0.05; Kruskal-Wallis one-way ANOVA) and midnight (P less than 0.01). At 9 p.m. and 11 p.m., patient concentrations were also lower than controls, but were not statistically significantly different (P = 0.09). From these data, it is postulated that some patients with panic disorder exhibit a generalised defect in sensitivity of beta-adrenergic receptors or of sympathetic transmission.

A short term open clinical trial of clobazam in the treatment of patients with panic attacks.

Clobazam, a 1-5 benzodiazepine with anxiolytic properties, was evaluated in the treatment of patients with DSM-III panic disorder or agoraphobia with panic attacks. In this open clinical trial, 10 of the 15 patients completed 8 weeks of treatment. Six of the 10 completers (60%) were responders (75% reduction in the number of panic attacks from baseline) at the end of 8 weeks. Of the responders so defined, 5 of the 6 were panic free. At the end of week 8 the average dose for the responders to medication was 50 +/- 17 (S.D.) mg per day. Clobazam was well tolerated at the doses used with the few side-effects recorded as mild to moderate. The study suggests that further placebo-controlled studies are warranted to evaluate clobazams potential antipanic effect.

Zimelidine: A placebo-controlled trial in depression

Twenty-eight hospital inpatients with a primary major depressive disorder were treated with either zimelidine or placebo. Patients were matched for age, sex, and initial severity of depression and assigned double blind to the treatment regimen. An initial dosage of 150 mg/day was used for up to 6 weeks. Zimelidine was significantly more effective in alleviating the symptoms of depression than placebo, with 82% of zimelidine and 25% of placebo patients showing clinical improvement. There were few complaints of severe side effects in zimelidine-treated patients, and few effects on the cardiovascular system. Two zimelidine-treated patients were withdrawn for suspected drug-related adverse events. Zimelidine was a safe, effective antidepressant in this group of patients.

Plasma prolactin and fluphenazine concentrations in patients receiving fluphenazine decanoate: stability over injection intervals.

Plasma prolactin and fluphenazine concentrations were measured in a group of 17 patients (9 males, 8 females) with schizophrenia who were receiving chronic treatment with fluphenazine decanoate. Neither measure was significantly correlated with clinical effect, as measured by the Brief Psychiatric Rating Scale, at any of the 5 pre-injection times examined. None of the measures showed statistically significant (P greater than 0.05; MANOVA) variations with time. Neither measure showed a significant correlation with the dose (expressed as mg/kg) of fluphenazine. The implications of the study for monitoring chronic treatment of schizophrenia are discussed.

Mandies are not dandy: Another adverse drug interaction with methaqualone

Abstract There has been a steady increase in methaqualone abuse throughout the world. Phrases used to describe the drug or its effect include “mandies, Sopors, and luding out.” Dependence, attempted suicide, adverse interaction with alcohol, suicide, acute toxic states, and withdrawal epileptic seizures have all been well documented. 1 Epistaxis, menstrual disturbance, dry mouth, and depersonalization have occurred 2 with phenothiazine and or tricyclic antidepressants in combination with the hypnotic. A recent editorial 3 suggests that methaqualone may cause neuropathy. Drug abusers have reported an elation with ataxia and paraesthesia of the extremities, lips, and tongue. 4 This report describes the side effects following a methaqualone-fluphenazine-nortriptyline combination.

Intervals between long acting neuroleptics: Outcome and re-admission variables

A drug monitoring programme has evaluated flexibility in the use of treatment intervals with Depot Fluphenazine. In this large group of schizophrenics over 30% receive injections at intervals of over 3 weeks or longer, with an overall relapse rate of 24%. Analysis of the intervals reveals in those who relapse, that 20% of cases increased their interval by an average of 7 weeks. Generally, there was an increase in intervals by the patients in the second year of treatment.

Patterns of Prescribing Depot Neuroleptics at an Australian Clinic

For a number of years, the Fluphenazine Clinic at Royal Park Hospital, Victoria, Australia, has provided a comprehensive treatment program for schizophrenic patients. In June 1975, 409 patients were attending the clinic, and a total of 684 had been under its care. Using a coding system, staff members transfer data from the case records to a master board, which gives a 12-month, longitudinal picture of patients ! progress. Quarterly reports on each patient also provide precise records, valuable for research purposes; and on the basis of these, a number of questions have been examined. The first question was whether antiparkinsonian (AP) drugs should be prescribed with the first injection of a depot neuroleptic, i.e., as a prophylactic against extrapyramidal side-effects (EPS), or only when the latter appeared. Other topics for investigation were selection and dosage of AP drugs, their degree of efficacy in modifying side effects, how long patients needed to be kept on them, and the side effects and problems occurring with these drugs themselves. One of the authors (P.M.) experience with fluphenazine enanthate started in 1966; but the clinic now uses only the decanoate, because of its longer duration of action (Marriott, Grig or, & Hiep, 1974, 1975). We also believe, like others (Neal & Imlah, 1968; Van Praag & Dois, 1973), that it has fewer side-effects. A review of the literature revealed that the percentage of EPS in different series treated with long-acting fluphenazine varied from 30% to 60%, the majority of side effects occurring in the first