Disability and comorbidity: diagnoses and symptoms associated with disability in a clinical population with panic disorder.

Background. Anxiety disorders are associated with considerable disability in the domains of (1) work, (2) social, and (3) family and home interactions. Psychiatric comorbidity is also known to be associated with disability.

Improved statistical analysis of moclobemide dose effects on panic disorder treatment.

Clinical trials with several measurement occasions are frequently analyzed using only the last available observation as the dependent variable [last observation carried forward (LOCF)]. This ignores intermediate observations. We reanalyze, with complete data methods, a clinical trial previously reported using LOCF, comparing placebo and five dosage levels of moclobemide in the treatment of outpatients with panic disorder to illustrate the superiority of methods using repeated observations.

Escitalopram: an open-label study of bereavement-related depression and grief.

Background: Approximately 8 million Americans suffer the loss of an immediate family member each year. Chronic depression may develop following bereavement-about 15% of the bereaved are depressed at 1 year. Several studies of psychotropic medications have demonstrated improvement in depression ratings, but little data exists for selective serotonin reuptake inhibitor treatment in bereavement-related depression.

Cognitive style, alprazolam plasma levels, and treatment response in panic disorder.

This study investigated an anxiety-prone cognitive style (measured by the Anxious Thoughts and Tendencies Questionnaire, AT&T) as a predictor of the acute response to increasing alprazolam plasma levels in panic disorder. Panic disorder patients (n=26) were treated with escalating doses of alprazolam for 4 weeks, then a fixed dose of 1 mg four times a day for 4 weeks. At 0, 1, 2, 3, 4, 6, and 8 weeks, trough alprazolam plasma levels; clinical, self-report, and performance measures; and vital signs were assessed.

Abrupt discontinuation of alprazolam and cognitive style in patients with panic disorder: early effects on mood, performance, and vital signs.

The objective of this study was to ascertain the relationship of alprazolam plasma levels and an anxiety-prone cognitive style to the characteristics and severity of early withdrawal after abrupt discontinuation of alprazolam in 26 patients with panic disorder. After 8 and 9 weeks of fixed-dose treatment, patients were hospitalized for 24 hours. On 1 admission, ordered at random, treatment was maintained; on the other, placebo was substituted double blind.

Psychopathology of panic attacks in panic disorder.

Purpose: This study examined the relationships among certain subtypes of panic attacks (full vs. limited symptom; spontaneous vs. situational) and between these subtypes, panic disorder subtypes, and other characteristics of panic disorder, especially agoraphobia.

Potential effectiveness and safety of olanzapine in refractory panic disorder.

Panic disorder is a common and disabling psychiatric disorder. Despite treatment advances, refractory panic disorder requires novel interventions. One such pharmacologic intervention with theoretical and case study support includes olanzapine, a thienobenzodiazepine medication currently approved for schizophrenia in the United States.

Long-term effectiveness of cognitive therapy in major depressive disorder.

Cognitive therapy of depression, based on the cognitive theory of depression, is an established treatment for major depressive disorder. Although few clinicians expect acute treatment of depression with antidepressant medication to prevent long-term relapse of the illness, some practitioners of cognitive therapy report long-term effectiveness in preventing relapse after short-term treatment. We set out to reanalyze follow-up studies in the literature, using intent-to-treat principles to assess the long-term effects of acute treatment with cognitive therapy.

Treatment of panic disorder with agoraphobia in an anxiety disorders clinic: factors influencing psychiatrists' treatment choices.

The main objective of this report was to identify patient characteristics that led psychiatrists in an academic anxiety disorders clinic to make a decision about intensive treatment of patients with panic disorder with agoraphobia (PDA) with cognitive-behavioral therapy (CBT) alone, CBT plus a high-potency benzodiazepine (CBT+BZ) or CBT combined with BZ and an antidepressant, fluoxetine (CBT+BZ+AD). On the basis of their clinical judgment and collaborative negotiation with the patient, psychiatrists chose one of the three treatment modalities for 102 PDA outpatients. Two stepwise logistic regressions were performed to explore pre-treatment patient characteristics the psychiatrists may have considered in choosing among these treatments.

Review of the long-term effectiveness of cognitive behavioral therapy compared to medications in panic disorder.

Panic disorder is a recurrent and disabling illness. It is believed that Cognitive Behavioral Therapy (CBT) has a long-term protective effect for this disorder. This would offer CBT considerable advantage over medication management of panic disorder, as patients often relapse when they are tapered off their medications.

A general anxiety-prone cognitive style in anxiety disorders.

Objective: This study compared scores on the Anxious Thoughts & Tendencies (AT&T) questionnaire, a putative measure of a general anxiety-prone cognitive style, among patients with panic disorder without agoraphobia (PD, n=62), panic disorder with agoraphobia (PDA, n=29), generalized anxiety disorder (GAD, n=43), limited social phobia (LSP, n=34), generalized social phobia (GSP, n=33), and community residents (n=319).

Method: Candidates for treatment studies completed a diagnostic interview and the AT&T. AT&T scores were compared among anxious groups using analysis of variance.

Interactive model of therapeutic response in panic disorder: moclobemide, a case in point.

It was proposed that pre-post regression slopes be used to index treatment response when the effect of baseline scores differed among treatments (interaction between treatment and baseline score). Reanalyses of two studies using imipramine and fluoxetine in panic disorder showed doserelated decreases in pre-post slopes for the frequency of unexpected panic attacks, but not for the frequency of situational panic attacks or measures of agoraphobia. This report presents similar analyses of data from a study using moclobemide.

Do antidepressants selectively suppress spontaneous (unexpected) panic attacks? A replication.

The purpose of this study was to test the following interrelated hypotheses in a larger sample by attempting to replicate supportive results from a small therapeutic study: (1) the pathogenesis of panic disorder includes at least two identifiable components: a biological component represented by spontaneous (unexpected) panic attacks, and a cognitive component represented by situational attacks and especially by phobias; (2) these components respond differently to treatment; (3) many biological processes respond to an effective intervention in proportion to their deviance from "normal" prior to treatment ("Law of Initial Value"); and (4) the response of spontaneous panic attacks to an effective treatment conforms to that model. Previously, the authors reanalyzed an 8-week therapeutic study of panic disorder that included groups treated with placebo and with imipramine (225 mg daily). The criteria of response were spontaneous panic attacks (biological component), situational panic attacks (both components), and agoraphobia ratings (cognitive component).

Trends in recommendations for the pharmacotherapy of anxiety disorders by an international expert panel, 1992-1997.

A follow-up survey in 1997 to a 1992 study of the recommendations of an international expert panel on the use of benzodiazepines (BZDs) and other psychotherapeutic medications in the treatment of anxiety disorders suggests that the BZDs remain a mainstay of pharmacotherapy for most of these conditions. BZDs were mentioned more often than any other class of drugs as preferred first-line therapy for anxiety disorders, except obsessive compulsive disorder. The introduction of the selective serotonin reuptake inhibitors (SSRIs) did not significantly affect the experts' recommendations for the use of BZDs as first-line pharmacotherapy.

International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: IV. Therapeutic dose dependence and abuse liability of benzodiazepines in the long-term treatment of anxiety disorders.

Despite decades of relevant basic and clinical research, active debate continues about the appropriate extent and duration of benzodiazepine use in the treatment of anxiety and related disorders. The primary basis of the controversy seems to be concern among clinicians, regulators, and the public about the dependence potential and the abuse liability of benzodiazepines. This article reports systematically elicited judgments on these issues by a representative panel of 73 internationally recognized experts in the pharmacotherapy of anxiety and depressive disorders, a panel which was constituted by a multistage process of peer nomination.

The revised Anxious Thoughts and Tendencies (AT&T) scale: a general measure of anxiety-prone cognitive style.

Background: The AT&T was developed from a perspective which proposes that panic disorder with agoraphobia arises from interaction between a specific biological predisposition, expressed in spontaneous panic attacks, and a general anxiety-prone cognitive style. Many items of the original AT&T, a putative measure of the cognitive component, were complex and ambiguous; and normative data were not available.

Method: In this research, the items were simplified and clarified.

International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: VI. Trends in recommendations for the pharmacotherapy of anxiety disorders, 1992-1997.

Objective: To assemble expert clinical experience and judgment regarding the treatment of anxiety disorders in a systematic, quantitative manner, particularly with respect to changes during the preceding five years.

Method: A panel of 73 internationally recognized experts in the pharmacotherapy of anxiety and depression was constituted by multistage peer nomination. Sixty-six completed a questionnaire in 1992, and 51 of those completed a follow-up questionnaire in 1997.

International Study of Expert Judgement on Therapeutic Use of Benzodiazepines and Other Psychotherapeutic Medications: V. Treatment strategies in panic disorder, 1992-1997.

The objective of this study was to assemble expert clinical experience and judgment regarding the treatment of panic disorder in a systematic, quantitative manner, particularly with respect to changes during the past 5 years. A panel of 73 internationally recognized experts in the field of pharmacotherapy of anxiety and depression was constituted by multistage peer nomination. Sixty-six experts completed a questionnaire in 1992, and 51 of those completed a follow-up questionnaire in 1997.

Panic disorder and agoraphobia: a sufferer's perspective.

This is a story by a woman about her life with panic, agoraphobia, and depression. She tells us about the clinical features, the heritable components, the environmental contributions, the developmental penalties, the social consequences, and the therapies for these conditions far more vividly than even the most dramatic of our systematic studies. But this is more than a clinical vignette.

Medication side effects in anxious patients: negative placebo responses?

The purpose of the present study was to detect any problems among anxious patients in switching from alprazolam to extended release alprazolam. Fifty-four patients with an anxiety disorder, stabilized on alprazolam, entered the study. During the first 2 weeks, all patients took alprazolam as usual.

Moclobemide in social phobia: a controlled dose-response trial.

Although the monoamine oxidase inhibitor phenelzine has proven efficacious in social phobia, the risk of hypertensive crises has reduced its acceptability. The reversible monoamine oxidase inhibitor moclobemide has less potential for such reactions, but its efficacy in this disorder remains unproven. A double-blind, placebo-controlled study was undertaken to assess the efficacy and safety of fixed doses of moclobemide.

Growing placebo response rate: the problem in recent therapeutic trials?

Recently the development of several promising new compounds for anxiety and depression was discontinued because of difficulty demonstrating therapeutic effects. This article explores alternatives to "increasing placebo response rate" as explanations. We reanalyzed a study of 81 panic patients treated with placebo, alprazolam 2 mg or 6 mg, or imipramine 225 mg daily to investigate the effect of baseline pathology and selective effects of treatment on biological and cognitive components of panic disorder.

Personality dimensions in panic disorder and generalized anxiety disorder.

To make a dimensional assessment of personality in individuals with pathological anxiety, the Tridimensional Personality Questionnaire (TPQ) was administered to 32 patients with panic disorder (PD) and 49 patients with generalized anxiety disorder (GAD). The most striking findings were a substantially increased score on the harm avoidance dimension in both groups of patients, and a lack of significant differences between the TPQ scores in patients with PD and GAD. The former finding suggests that higher levels of harm avoidance may be common to (although not necessarily specific for) various types of anxiety disorders.