Richard M. Glass

Panic disorder, agoraphobia, and anxiety-relevant cognitive style

We attempted to identify factors differentiating Agoraphobia with Panic Attacks (AG) from Panic Disorder (PD) patients. Twenty-three AG and 27 PD patients were compared. No significant difference in severity of illness was found. As predicted, the groups differed on a measure of anxiety-relevant cognitions developed for this study, the Anxious Thoughts and Tendencies scale (AT&T) (P less than 0.02). We suggest that differences in interpretation of panic attacks account for the development of of phobic avoidance behavior in some but not all PD patients. The intercorrelations among measures suggest that Panic Disorder may be conceptualized as having several independent although related components (panic attacks, general anxiety, phobic anxiety, and cognitive distortions).

Single‐Dose Study of Nabilone in Anxious Volunteers

Abstract: The effects of single oral doses of nabilone, a synthetic cannabinoid, were studied in eight anxious volunteer subjects. Each subject had two exposures to placebo and three dose levels of nabilone at one‐week intervals in a single‐blind balanced Latin‐square design after the nabilone dose range was determined by each subjects response to a test dose. Heart rate and blood pressure were monitored. The Profile of Mood States (POMS), a self‐rating adjective checklist, was used as the quantitative measure of subjective effects. Four subjects performed a continuous avoidance procedure. High doses (4 or 5 mg) of nabilone produced orthostatic hypotension in these subjects. Mild dose‐related increases in heart rate also occurred. Despite the occurrence of highly significant levels of sedation, there were no significant effects of nabilone on the continuous avoidance procedure. Two of these four subjects experienced an antianxiety effect from low (1 or 2 mg) nabilone doses. Four other subjects received comparatively lower doses of nabilone and performed on three behavioral tasks at intervals before and after drug: a recognition memory procedure, a task requiring spaced responding at a controlled rate, and a reaction time task. In these subjects there were no reliable effects on blood pressure or heart rate, no significant subjective effects on the POMS, and no antianxiety effects. Drug effects were also minimal on the three behavioral tasks.

Learning associated with participation in journal‐based continuing medical education

Introduction: Medical journal reading is a standard method of increasing awareness among physicians of evidence‐based approaches to medical care. Theories of physician learning and practice change have suggested that journal reading may be more influential at some stages of behavioral change than at others, but it is not clear how journal reading may influence the learning process that can lead to behavioral change. Methods: A random sample of 170 continuing medical education (CME) participants who had read three journal articles and completed a CME evaluation form received a CME credit certificate with a brief survey appended. The survey asked participants to report their stage of learning on each article topic before and after reading the three articles. Results: Of the 170 CME participants, 138 (81.2%) responded to the survey. Most (106 of 138; 76.8%) reported a progression in stage of learning on the topic of at least one of the three articles read for CME credit. More than one‐fourth of the respondents (37 of 138; 26.8%) made a commitment to change practice related to the topic of one or more articles. CME participants were more likely (relative risk 1.14; 95% confidence interval 1.06–1.22) to report a progression in stage of learning if they had recorded a commitment to change practice related to the same article topic on the CME evaluation form. Discussion: Journal‐based CME activities may be educational at all stages of the learning process, and journal‐based learning episodes may result in commitments to change practice.

A Single Dose Study of Nabilone, a Synthetic Cannabinoid

The effects of single oral doses of nabilone, a synthetic cannabinoid, were studied in four anxious volunteer subjects. Each subject had two exposures to placebo and three dose levels of nabilone at 1 week intervals in a single blind balanced Latin square design after the nabilone dose range was determined by each subjects response to a test dose. The Profile of Mood States (POMS), a self-rating adjective checklist, was used as the quantitative measure of subjective effects. The subjects performed a continuous avoidance procedure. High doses (4 or 5 mg) or nabilone produced orthostatic hypotension. Small dose-related increases in heart rate also occurred. Despite the occurrence of highly significant levels of subjective sedation, there were no significant effects of nabilone on behavior maintained by the continuous avoidance procedure. Two of these subjects experienced an anti-anxiety effect from low (1 or 2 mg) nabilone doses, but there was no statistically significant effect on the mean POMS anxiety factor for the group as a whole. In a follow-up experiment, four other anxious subjects received comparatively lower doses of nabilone. In these subjects there were no important effects on blood pressure or heart rate, and also no anti-anxiety effects.

The value of self-report assessment in studies of anxiety disorders.

This review compares the sensitivities of a physician-rated scale, the Hamilton Anxiety Scale (HAS), and a patient-rated scale, the Hopkins Symptom Checklist (HSCL), in detecting the anti-anxiety effects of benzodiazepines in a large sample of placebo-controlled trials. Scales and subscales were compared within the same study, a methodologic feature unique to this review. The total score, psychic factor, and somatic factor of the HAS were equally sensitive to the effects of benzodiazepines. The total score, anxiety factor, and somatization factor of the HSCL also were equally sensitive. The HAS total score, however, was consistently more sensitive than any of the HSCL scores. There was no evidence that physicians used side effects to make their ratings more sensitive. Sedative side effects, however, adversely affected the sensitivity of patient ratings. The data suggest that patient ratings reflect a cost-benefit computation taking account of both antianxiety and sedative effects.

Correlates of mitral valve prolapse among patients with panic disorder

Mitral valve prolapse (MVP) has been observed more frequently than expected among patients who report the current experience of panic attacks. The MVP observed has been generally of a mild variety and has not been associated with clinically meaningful variables in studies to date. In the current study, 82 patients with panic disorder (PD) who were recruited for a study of the drug treatment of PD were assessed for the presence of MVP, and patients with and without MVP were compared on several variables. Statistically significant findings were that patients with MVP were younger and more often female; reported an earlier age of onset of PD and more frequent panic attacks; and had a higher ponderal index, lower weight, and lower levels of triiodothyronine than patients without MVP. Contrary to previous studies, these results suggest that the presence of MVP among patients with PD is associated with potentially meaningful differences. While generalizability may be limited and causal relationships speculative at this time, the variables identified in this study deserve more explicit attention in future studies of PD and MVP.

Recent developments in the psychotherapy of depression

Abstract The effectiveness of several types of psychotherapy for ambulatory, nonpsychotic depressed patients has been demonstrated in controlled clinical studies. Psychotherapy combined with antidepressant drug treatment appears to be the most effective form of treatment for most outpatients with major depression, although either treatment alone can be effective for patients who will not accept both. There is no evidence for negative interactions between psychotherapy and drug treatment. Interpersonal psychotherapy, cognitive therapy, and intensive psychodynamic cognitive therapy are types of individual psychotherapy that appear to have particular relevance for depression.

Subject-own-control design in evaluating clinical antidepressant effects.

This study tested the use of a subject-own-control, multiple crossover design for evaluating the clinical effects of an established tricyclic antidepressant drug, imipramine. Although significant physiological and cognitive performance effects were demonstrated, only one clinical measure, target symptom change rated by the patients, showed a statistically significant drug-placebo difference. This result is in considerable contrast to the sensitivity of similar designs in detecting the clinical effects of antianxiety drugs in studies employing less than 20 patients. Crossover designs appear to be most successful when the treated condition is continuous, rather than episodic, and the treatment effects have a rapid onset and offset.