[Care programmes at mental health centres: the degree of adherence in the first phase of treatment].

Background: Most mental health providers in the Netherlands have implemented programmes of care. However, little is known about the extent to which care programmes are adhered to in routine clinical practice.

Aim: To investigate the extent to which care programmes are adhered to in routine clinical practice.

The complex association of pulmonary function with panic disorder: a rejoinder to Ley (1998).

In a commentary on our paper entitled "Pulmonary function in panic disorder: evidence against the dyspnea-fear theory", Ley (1998) provides a critical analysis of our study. He concludes that our failed attempt to replicate a relationship between pulmonary function and the severity of panic-related symptoms in panic disorder patients may have been a consequence of a lack of comparability between studies, a statistical anomaly, and experimenter-demand effects. After discussing his comments (with most of them we do not agree) in depth, we maintain our conclusion that: (a) pulmonary impairment is not directly associated with panic symptoms; and (b) that the existence of a distinct subgroup of panic disorder patients with signs of actual airways obstruction leading to uncontrollable dyspnea and fear of suffocation remains questionable.

Pulmonary function in panic disorder: evidence against the dyspnea-fear theory.

The present study addresses the hypothesis consistent with the dyspnea-fear theory of panic, that in a subgroup of panic patients a non-pathological pulmonary obstructive component may induce dyspnea, dyspneic fear and, ultimately, panic. In 38 patients who met DSM-III-R criteria for panic disorder, pulmonary function was assessed and various measurements for panic symptoms and concomitant psychopathology were collected. In comparison to patients with a high Forced Expiratory Flow at 50% (FEF 50%), low FEF 50% patients demonstrated significantly lower levels of Forced Expiratory Volume (first second) and Peak Expiratory Flow and significantly lower FEV1/FVC ratios.

[Hyperventilation: not a cause of panic attacks].

Objective: To investigate the importance of hyperventilation in the pathogenesis of panic attacks.

Design: Descriptive.

Setting: The Jelgersma Outpatient Clinic at Oegstgeest and the University Hospital Leiden, the Netherlands.

Hyperventilation and panic attacks in general hospital patients.

The 2-week prevalence of panic attacks according to DSM-III-R criteria was assessed in 102 general hospital patients with unexplained somatic symptoms suggestive of the hyperventilation syndrome (HVS). Thirty-six patients were classified as panickers. In comparison to nonpanickers, panickers reported more severe panic and hyperventilation symptoms and state anxiety during anxiety episodes in daily life and also obtained higher scores on measures for depression, generalized anxiety, agoraphobic anxiety, and agoraphobic avoidance.

Discordance between symptom and physiological criteria for the hyperventilation syndrome.

Hyperventilation is assumed to produce a set of somatic and psychological symptoms, the so-called Hyperventilation Syndrome (HVS). Recognition of symptoms during the hyperventilation provocation test (HVPT) is the most widely used criterion for diagnosing HVS, but additional physiological and symptom criteria have been proposed. The concordance of various diagnostic criteria for HVS is investigated in the present study.

The hyperventilation provocation test in panic disorder.

Forty-eight patients with DSM-III-R Panic Disorder underwent a hyperventilation provocation Test (HVPT). Twenty-four patients rated the symptoms induced during the HVPT as similar to those occurring during panic attacks in daily life. Contrary to the classical hyperventilation model of panic, no differences were found in respiratory physiology between recognizers and non-recognizers before and during voluntary hyperventilation.

Spouse-aided therapy with agoraphobics.

Sixty agoraphobics were treated by behavioural therapy (self-exposure in vivo) either with their partner involved in all aspects of treatment or without their partner. The two treatment formats were about equally effective. Behavioural treatment directed at the agoraphobia resulted in improvement irrespective of marital quality and partner involvement in the therapy.