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Treatment results and personality disorders in social phobia
P3 Anxiety disorders and anxiolytics in particular, cerebral cortex might also influence ventilatory response to CO2.
References [1] Bernard DG, Li A, Nattie EE: Evidence for central chemoreception in the midline raphe. J Appl Physiology 80: 108-15, 1996. [2] Cortield DR, Fink GR, Ramsay SC, Murphy K, Harry HR, Watson JD, Adams L, Frackowiak RS, Guz A: Evidence for the lymbic system activation during CO2-stimulated breathing in man. J Physiol 488: 7784, 1995 [3] Gorman JM, Liebowitz MR, Fyer AJ, Stein J: A neuroanatomical hypothesis for panic disorder. Am J Psychiatry 146: 148~1, 1989. [4] Klein DF: False suffocation Alarms, Spontaneous Panics, and Related Condition. An integrative hypothesis. Arch Gen Psychiatry 50: 306-17, 1993. [5] Perna G, Bertani A, Bussi R, Bellodi L: Antipanic drugs and the panic respiration system. In: Bellodi L, Perna G (eds): The Panic Respiration Connection. MDM Medical Media, Milan, 1998
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Treatment results and personality disorders in social phobia
E. P~lov~i, M. Kovani6ov~. Department of Psychiatry, Medical Faculty
UPJS, Kogice, Slovak republic We present a course analysis of the treatment of patients with the diagnosis of social phobia/SP//DSM-IV/and with specific personality disorders/PD/according to SIDP-R. The group of 38 SP patients was divided into 3 PD clusters, and the group of patients with no PD. Treatment results were assessed on 0., 14., 90., and 180 day of treatment, with SSRI's using Liebowitz's social phobia scale, Sheehan's disability scale, and PCASEE scale for phobia scale, Sheehan's disability scale, and PCASEE scale for measuring quality of life. Results were statistically analysed according to 3 PD clusters and each PD separately. Therapeutic result with SSRI was the best in the group of patients with no personality disorder. Our results also suggest that the presence of some PD may be a negative predicting factor for the outcome of treatment in the group of patients with social phobia.
~ T h e
analysis of efficacy of different therapeutic strategies of borderline neuropsychic disorders
L.L. Pogorelova. Medical Academy, Department of Psychiatry and Med-
ical Psychology, Tver, Russia The purpose of the study was to compare different therapeutic strategies in patients with borderline disorders (F40--F44, F48 in accordance with ICD-10) in course of dynamics of disease. The study was conducted among women-workers of the textile factory, suffering from borderline neuropsychic disorders (BNPD). Apart from clinical assesment in dynamics psychic status of patients was investigated with the help of experimental-psychological methods (MMPI, scale of anxiety by Spilberger-Khanin). Somatic status was also evaluated. In order to compare the results of efficacy of different treatment strategies the contingent of 142 women-patients with BNPD was blindly divided into the following groups: a control (34) group, and three experimental groups No 1, No 2, No 3 (consisting of 56, 30, 22 patients respectively). The patients of the experimental group No 1 underwent the course of combined psychotherapy, consisting of 10 meetings, that were conducted right after the working shift in factory in the conditions of psychophysiologic unloading room. The patients of the group No- 2 underwent alongside with psychotherapy the course of medicamentous treatment by derivatives of benzodiazepin (diazepam, phenazepam, alprosolam, oxasepam) in an in-patient psychic department in according to standard averade dosage. The patients of the experimental group No 3 underwent the same medicamentous treatment as those in group No 2, but psychotherapy was not included in course of treatment. The patients of the control group were not exposed to any treatment.
$317
In all 4 groups the investigation was conducted simultaneously and was repeated in a year's period. The results of the clinic investigation in patients, who didn't undergo the course of psychotherapy, showed the increase of the complaints and prevailence of somatoform complaints. The patients in the control group were complaining more often of insomnia (p < 0.05), mood disorders (p < 0.01 ), the increase of anxiety caused by minute factors (p < 0.01), excitability (p < 0.05), the increase of tiredness (p < 0.01), cephalgias (p < 0.01), the cardialgias (p < 0.05). In the experimental group No 1 in a year we witnessed the dicrease of complaints typical of BNPD: insomnia (p < 0.05), emotional lability (p > 0.05), and somatoform complaints: cephalgias (p < 0.05), cardialgias (p > 0.05), increase of tiredness (p < 0.05). In the experimental group N_o 2 the complaints of insomnia, depressed mood, anxiety, algic syndromes decreased (relatively p < 0.05, p < 0.01, p < 0.01, p < 0.05). In the experimental group No 3 the gained effects of the treatment and the improvement of the state of patient reached the same level as it was before the treatment a year ago. The detailed investigation of psychic status with experimental psychological methods confirmed the data of clinical investigation. The best results were achieved in groups No 1 and No 2. In control group we witnessed the worsening of practically all parameters. In the group No 3 we witnessed the similar results. Thus in dynamics the best results were obtained in groups, where the patients underwent the course of psychotherapy in combination with benzodiazepin derivatives, and in patients that underwent only the course of psychotherapy. Thus we conclude that the treatment of benzodiazepin derivatives combined with psychotherapy is the best possible therapeutic strategy in patients suffering from BNPD.
Anxiety symptoms analysis in patients with borderline disorders in therapy with cassadan I.E. Kupriyanova. Mental Health Research Institute, Tomsk, 634014,
Russia In this work we have tried to evaluate the clinical dynamic of borderline disorders in the course of the therapy with cassadan (55 patients). In addition to clinical description we evaluated quantitatively the level of anxious-phobic symptoms with the help of Hamilton Anxiety Scale. In the analysis of spatial correlation of symptoms we have chosen the maximum correlational pathway method (L.K. Vykhandu, 1964): detection of the highest correlational relationships between separate symptoms and composition of scheme of the interrelation of these magnitudes. In initial examination common level of anxiety constituted 17.23 +/- 0.8 scores with anxious disorders proper being evaluated of 12.06 +/- 0.6 scores, somatic manifestations of anxiety were 4.41 +/- 0.28 scores, and neurovegetative reactions were determined by 3.4 +/- 0.35 scores. At day 14 of the therapy general level of anxiety decreased up to 4.8 +/- 0.81 score with reliable decrease being fixed in all manifestations of anxiety (P < 0.05) with anxious compound being decreased up to 3.48 +/- 0.93 score, somatic one up to 2.3 +/- 0.63, neurovegetative one up to 1.83 +/- 0.13 scores. Maximum correlational pathways method has shown that at baseline in patients symptoms of insonmia and gastrointestinal manifestations were highly correlated (r = 0.94; P < 0.05). Further correlational relationships go in two ways: 1 - from insomnia to tension, then to anxious mood, finishing with cardiovascular symptoms (r = 0.81; P < 0.05); the 2rid way begins from gastrointestinal symptoms, across symptoms of decrease of intellectual productivity, fear, further neurovegetative reactions lead to general somatic manifestations of anxiety and form depressive mood (r = 0.6; P < 0.05). At week 2 of the therapeutic impact of cassadan neurovegetative manifestations are determining and are interrelated with symptoms of mental anxiety and only feeling of somatic uneasiness remains actual. Anxiety symptoms analysis has revealed not only their decrease but alteration of their spatial interrelationship: complex of symptoms of mental anxiety and neurovegetative manifestations constituted "core of the illness" and only upon its destruction recovery was observed.
References [1] Bernard DG, Li A, Nattie EE: Evidence for central chemoreception in the midline raphe. J Appl Physiology 80: 108-15, 1996. [2] Cortield DR, Fink GR, Ramsay SC, Murphy K, Harry HR, Watson JD, Adams L, Frackowiak RS, Guz A: Evidence for the lymbic system activation during CO2-stimulated breathing in man. J Physiol 488: 7784, 1995 [3] Gorman JM, Liebowitz MR, Fyer AJ, Stein J: A neuroanatomical hypothesis for panic disorder. Am J Psychiatry 146: 148~1, 1989. [4] Klein DF: False suffocation Alarms, Spontaneous Panics, and Related Condition. An integrative hypothesis. Arch Gen Psychiatry 50: 306-17, 1993. [5] Perna G, Bertani A, Bussi R, Bellodi L: Antipanic drugs and the panic respiration system. In: Bellodi L, Perna G (eds): The Panic Respiration Connection. MDM Medical Media, Milan, 1998
•
Treatment results and personality disorders in social phobia
E. P~lov~i, M. Kovani6ov~. Department of Psychiatry, Medical Faculty
UPJS, Kogice, Slovak republic We present a course analysis of the treatment of patients with the diagnosis of social phobia/SP//DSM-IV/and with specific personality disorders/PD/according to SIDP-R. The group of 38 SP patients was divided into 3 PD clusters, and the group of patients with no PD. Treatment results were assessed on 0., 14., 90., and 180 day of treatment, with SSRI's using Liebowitz's social phobia scale, Sheehan's disability scale, and PCASEE scale for phobia scale, Sheehan's disability scale, and PCASEE scale for measuring quality of life. Results were statistically analysed according to 3 PD clusters and each PD separately. Therapeutic result with SSRI was the best in the group of patients with no personality disorder. Our results also suggest that the presence of some PD may be a negative predicting factor for the outcome of treatment in the group of patients with social phobia.
~ T h e
analysis of efficacy of different therapeutic strategies of borderline neuropsychic disorders
L.L. Pogorelova. Medical Academy, Department of Psychiatry and Med-
ical Psychology, Tver, Russia The purpose of the study was to compare different therapeutic strategies in patients with borderline disorders (F40--F44, F48 in accordance with ICD-10) in course of dynamics of disease. The study was conducted among women-workers of the textile factory, suffering from borderline neuropsychic disorders (BNPD). Apart from clinical assesment in dynamics psychic status of patients was investigated with the help of experimental-psychological methods (MMPI, scale of anxiety by Spilberger-Khanin). Somatic status was also evaluated. In order to compare the results of efficacy of different treatment strategies the contingent of 142 women-patients with BNPD was blindly divided into the following groups: a control (34) group, and three experimental groups No 1, No 2, No 3 (consisting of 56, 30, 22 patients respectively). The patients of the experimental group No 1 underwent the course of combined psychotherapy, consisting of 10 meetings, that were conducted right after the working shift in factory in the conditions of psychophysiologic unloading room. The patients of the group No- 2 underwent alongside with psychotherapy the course of medicamentous treatment by derivatives of benzodiazepin (diazepam, phenazepam, alprosolam, oxasepam) in an in-patient psychic department in according to standard averade dosage. The patients of the experimental group No 3 underwent the same medicamentous treatment as those in group No 2, but psychotherapy was not included in course of treatment. The patients of the control group were not exposed to any treatment.
$317
In all 4 groups the investigation was conducted simultaneously and was repeated in a year's period. The results of the clinic investigation in patients, who didn't undergo the course of psychotherapy, showed the increase of the complaints and prevailence of somatoform complaints. The patients in the control group were complaining more often of insomnia (p < 0.05), mood disorders (p < 0.01 ), the increase of anxiety caused by minute factors (p < 0.01), excitability (p < 0.05), the increase of tiredness (p < 0.01), cephalgias (p < 0.01), the cardialgias (p < 0.05). In the experimental group No 1 in a year we witnessed the dicrease of complaints typical of BNPD: insomnia (p < 0.05), emotional lability (p > 0.05), and somatoform complaints: cephalgias (p < 0.05), cardialgias (p > 0.05), increase of tiredness (p < 0.05). In the experimental group N_o 2 the complaints of insomnia, depressed mood, anxiety, algic syndromes decreased (relatively p < 0.05, p < 0.01, p < 0.01, p < 0.05). In the experimental group No 3 the gained effects of the treatment and the improvement of the state of patient reached the same level as it was before the treatment a year ago. The detailed investigation of psychic status with experimental psychological methods confirmed the data of clinical investigation. The best results were achieved in groups No 1 and No 2. In control group we witnessed the worsening of practically all parameters. In the group No 3 we witnessed the similar results. Thus in dynamics the best results were obtained in groups, where the patients underwent the course of psychotherapy in combination with benzodiazepin derivatives, and in patients that underwent only the course of psychotherapy. Thus we conclude that the treatment of benzodiazepin derivatives combined with psychotherapy is the best possible therapeutic strategy in patients suffering from BNPD.
Anxiety symptoms analysis in patients with borderline disorders in therapy with cassadan I.E. Kupriyanova. Mental Health Research Institute, Tomsk, 634014,
Russia In this work we have tried to evaluate the clinical dynamic of borderline disorders in the course of the therapy with cassadan (55 patients). In addition to clinical description we evaluated quantitatively the level of anxious-phobic symptoms with the help of Hamilton Anxiety Scale. In the analysis of spatial correlation of symptoms we have chosen the maximum correlational pathway method (L.K. Vykhandu, 1964): detection of the highest correlational relationships between separate symptoms and composition of scheme of the interrelation of these magnitudes. In initial examination common level of anxiety constituted 17.23 +/- 0.8 scores with anxious disorders proper being evaluated of 12.06 +/- 0.6 scores, somatic manifestations of anxiety were 4.41 +/- 0.28 scores, and neurovegetative reactions were determined by 3.4 +/- 0.35 scores. At day 14 of the therapy general level of anxiety decreased up to 4.8 +/- 0.81 score with reliable decrease being fixed in all manifestations of anxiety (P < 0.05) with anxious compound being decreased up to 3.48 +/- 0.93 score, somatic one up to 2.3 +/- 0.63, neurovegetative one up to 1.83 +/- 0.13 scores. Maximum correlational pathways method has shown that at baseline in patients symptoms of insonmia and gastrointestinal manifestations were highly correlated (r = 0.94; P < 0.05). Further correlational relationships go in two ways: 1 - from insomnia to tension, then to anxious mood, finishing with cardiovascular symptoms (r = 0.81; P < 0.05); the 2rid way begins from gastrointestinal symptoms, across symptoms of decrease of intellectual productivity, fear, further neurovegetative reactions lead to general somatic manifestations of anxiety and form depressive mood (r = 0.6; P < 0.05). At week 2 of the therapeutic impact of cassadan neurovegetative manifestations are determining and are interrelated with symptoms of mental anxiety and only feeling of somatic uneasiness remains actual. Anxiety symptoms analysis has revealed not only their decrease but alteration of their spatial interrelationship: complex of symptoms of mental anxiety and neurovegetative manifestations constituted "core of the illness" and only upon its destruction recovery was observed.