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Efficacy of the combination of pharmaco-and psychotherapy in the treatment of panic disorder
30S
1997;42:1S-297S
In the present naturalistic study we explore the course of DO and other psychosensorial phenomena In a sample of eo outpatients with PO, accord• ing to DSM·III-A criteria, and their response to pharmacological treatment during a perlod of one year. Patients were evaluated by means of DO Cues· tionnaire (Petracca et al., 1989) and Ule-up (Keller. 1987). Patients were treated with Selective Serotonin re-uptake Inihibltors (SSAI) and 70"A. With Tricytic Antidepressants (TCA). In our experience. TCA and SSAI seem to be equally effective In the treatment of all the panic phenomena, Including psychosensorial features. Our study represents the first attempt to gather prospective data on the course of the psychosensorial symptoms In patients with PD. Inspite of the short period of observallon and the limited number of patients the results of our study can give some useful preliminary infonnation. Further studies are necessary to describe the course of this special subgroup of patients with PO and to define their response to treatment.
[14:i7J
Seroprevalence of borna disease virus antibodies Is not Increased In panic disorder patients
J. Windhaber, N. Nowotny. S. Herzog, K. Dantendorfer, D. Maierhofer, P. Berger. Department of PSycfliatry. University of Vienna, Austria Statistics show that up to eight percent 01 any given population will at some point during their lifespan suffer a panic attack. three percent can be diagnosed as panic disorder (PO). Several studies reported subtle morphologic brain abnormalities In PO patients. In subgroups of PO high frequencies of brain abnormalities, especially In structures 01 the limbic system were found with MAl. Boma disease virus (BOV) is a RNA virus which is Intensely neurotopic and cumulates In the limbic system of animals and men. 4 to 13 percent of psychiatric patients have positive BDV antibodies. The aim 01 our study was to Investigate the seroprevalence of BOV In PO patients and In healthy controls since PO shares some clinical and morphologic aspects with BOV-Infection. Method: We carried out a SCIO report based on OSM IV to diagnose PO, and created an antibody screen (indirect Immunofluorescence assay) for BOV in PO patients and in a group of age and gender matched healthy controls. Results: In one year, we tested 55 PO patients and 34 healthy controls. Four PO patients (7.2%) and two healthy controls (5.9%) showed antibodies to BDV. Statistically, there was no difference between the PO group and the healthy controls. Conclusion: There seems to be no relationship between BDV and PD. Further research, maybe in a more extensive &le, Is needed.
114-481
Poster session I
BIOL. PSYCHIATRY
Plasma and platelet catecholamine concentrations as predictors of the cardiovascular, psychological and panic-like-symptoms Induced by CCK-4 In healthy subjects
I. Jerabek, J.P. Boulenger. Y.J. Lavall~e. F.B. Jolicoeur. Dept. of Psychiatry Sherbrooke University. Quebec, canada The present study examined If the panlc·like reactions to CCK-4 can be predicted from basal concentrations ot plasma and platelet catecholamines. Method: Sixteen healthy subjects were SUbjected to a panic-inducing challenge (25 IlQ 01 CCK-4 I.V.) and their psychological (state anxiety, number. intensity, fear and duration 01 symptoms) and cardiovascular (heart rate and blood pressure) reactions were assessed. Plasma and platelet concentrations of OOfepinephrine (NE), epinephrine (EPI) and dopamine (OA), were determined by HPLC-ECO. Results: MUltiple regression analyses revealed thal basal platelet concan· trstlons of NE and OA can explain 65% 01 the total variability in state anxiety. Plasma NE accounted for 28"10 of the variability In tra~ anXiety. Baseline measures 01 plasma and platelet EPI and NE levels can predict 70% of the total variability found in the intensity of post-ecK-4 state-anXiety, 26. 27 and 71% 01 the variability In number of symptoms. Intensity 01 symptoms, and blood pressure respectively. Conclusion: Basal plasma and platelet levels of catecholamines may Influence the panlo-like reactions to CCK-4. We are presently completing a study examining the same parameters in patients suffering from panic disorder. Supported by FRSQ and FCAR.
114-491
Therapeutic potential of the 5HT2C receptor agonist Ro 60-0175 In panic, depression and OCD
F. Jenek, M. Boes, J.R. Martin, A. Sleight, J.-L Moreau. Preclinical eNS Research, ROCHE. Basel, Switzerland Ao 6Q.{)175 has been characterized In vitro and in vivo as a full and selective agonist at the 5HT2C receptor subtype. This compound, a 1-(2 aminopropyl) indole derivallve. exhibits both nanomolar affinity for 5HT2C receptors and selectivity (> 1.5 log unit) over more than forty other binding s~es with established physiological relevance (Including 5HT2A receptors and sites on GAB" receptor complex). Ro 60-0175 was tested for in vivo effects indicative of potential therapeutic action in animal models of panic anxiety. depreSSion and compulsive behavior and compared with fluoxetine In those models. Effects suggestive of antipanic-Iike action were obtained in a model of intense lear induced by brain stimulation applied to the dorsolateral peri• aqueduetal gray matter; in this model, Ro 6Q.{)175 was found to be more potent and more efficacious than fluoxetine. Antidepressant-like properties were detected following chronic administration of Ro 60-0175 to rats sub• mitted to a regimen of chronic mild stress generating an anhedonic state In control animals. Effects suggestive of potential therapeutic action against obsessive-compulsive disorder were recorded for Ro 60-0175 and f1uoxetine in schedule-Induced polydipsia in rats and drug-induced whole-body scratch• Ing in squirrel monkeys. The data suggest that the 5HT2C receptor SUbtype is likely to play an important role In the therapeutic properties of selective serotonin reuptake inhibitors. Selective 5HT2C receptor agonists such as Ro 60-0175 may also offer novel and improved therapeutic opportunities for the biological treatment of psychiatric disorders.
114-50
I Suppression of conditioned fear by administration of CCKa receptor antagonist or CCKa receptor antisense
T. Tsutsuml, J. Akiyoshi. K Isogawa, T. Hikichi, I. Fujii. Dept Neuropsychiatry. Olta Medical University. Oita, Japan The aim of this study Is whether CCKe receptor antagonist PDl35158 and CCKs receptor antisense suppress conditioned fear. Methods: We examined the effect of the selective significantly antagonist POl35158 on freezing behavior Induced by conditioned fear stress. We used GH3 cell that is pituitary tumor 01 rat and the surface of of GH3 cell has CCKs receptor. After administration of significantly anllsense, GH3 cell was stimulated by CCK4 and intracellular Ca concentration was measured. CCKB receptor antisense was administered into lateral ventricle constantly and suppression 01 conditioned fear was evaluated. Results: CCKB antagonist PDl35158 suppressed conditioned fear. CCKa receptor antisense significantly suppressed intracellUlar ca concentration in GH3 cell. The result of CCKs receptor antisense will be reported on that day.
114-51
I Efficacy of the combination of pharmaco- and psychotherapy In the treatment of panic disorder
W.H. Strauss. Rhein. Landes- u. Hochschullclinik, Psychiatric Hospital of the Helnrich-Heine-Universlty DiJsseldorf, Germany Behavioral treatments and therapy with imipramine were regarded as ef• fective therapeutical methods in patients suffering from panic diSOrders. Although both methods were often applied In combination, there Is a lack of controlled studies In this area. Methods: 48 patients with the OSM-III-R diagnosis panic disorder With and Without agoraphobia were treated Individually for three months In 24 sessions with either (a) Cognitive Behavior Therapy (CBT) (b) Aelaxatlon Training (RT) (c) CBT and 150 mg Imipramine (d) AT and 150 mg Imipramine The effects of the therapy were controlled by self-assessment scaJes (Beck Anxiety Inventory, Fear Questionnaire. Fear Diary). ratings (HAMO. HAMA, Global Improvement scale). and behavior test (DBTA) at the end of therapy and with one year follow-up. Results: The data show that patients 01 the cogn~ive behavior groups were more often ImprOVed than the patients 01 the relaxation groups. Imipramine has an additive effect to CBT. but an Inhibiting effect to relaxation training.
1997;42:1S-297S
In the present naturalistic study we explore the course of DO and other psychosensorial phenomena In a sample of eo outpatients with PO, accord• ing to DSM·III-A criteria, and their response to pharmacological treatment during a perlod of one year. Patients were evaluated by means of DO Cues· tionnaire (Petracca et al., 1989) and Ule-up (Keller. 1987). Patients were treated with Selective Serotonin re-uptake Inihibltors (SSAI) and 70"A. With Tricytic Antidepressants (TCA). In our experience. TCA and SSAI seem to be equally effective In the treatment of all the panic phenomena, Including psychosensorial features. Our study represents the first attempt to gather prospective data on the course of the psychosensorial symptoms In patients with PD. Inspite of the short period of observallon and the limited number of patients the results of our study can give some useful preliminary infonnation. Further studies are necessary to describe the course of this special subgroup of patients with PO and to define their response to treatment.
[14:i7J
Seroprevalence of borna disease virus antibodies Is not Increased In panic disorder patients
J. Windhaber, N. Nowotny. S. Herzog, K. Dantendorfer, D. Maierhofer, P. Berger. Department of PSycfliatry. University of Vienna, Austria Statistics show that up to eight percent 01 any given population will at some point during their lifespan suffer a panic attack. three percent can be diagnosed as panic disorder (PO). Several studies reported subtle morphologic brain abnormalities In PO patients. In subgroups of PO high frequencies of brain abnormalities, especially In structures 01 the limbic system were found with MAl. Boma disease virus (BOV) is a RNA virus which is Intensely neurotopic and cumulates In the limbic system of animals and men. 4 to 13 percent of psychiatric patients have positive BDV antibodies. The aim 01 our study was to Investigate the seroprevalence of BOV In PO patients and In healthy controls since PO shares some clinical and morphologic aspects with BOV-Infection. Method: We carried out a SCIO report based on OSM IV to diagnose PO, and created an antibody screen (indirect Immunofluorescence assay) for BOV in PO patients and in a group of age and gender matched healthy controls. Results: In one year, we tested 55 PO patients and 34 healthy controls. Four PO patients (7.2%) and two healthy controls (5.9%) showed antibodies to BDV. Statistically, there was no difference between the PO group and the healthy controls. Conclusion: There seems to be no relationship between BDV and PD. Further research, maybe in a more extensive &le, Is needed.
114-481
Poster session I
BIOL. PSYCHIATRY
Plasma and platelet catecholamine concentrations as predictors of the cardiovascular, psychological and panic-like-symptoms Induced by CCK-4 In healthy subjects
I. Jerabek, J.P. Boulenger. Y.J. Lavall~e. F.B. Jolicoeur. Dept. of Psychiatry Sherbrooke University. Quebec, canada The present study examined If the panlc·like reactions to CCK-4 can be predicted from basal concentrations ot plasma and platelet catecholamines. Method: Sixteen healthy subjects were SUbjected to a panic-inducing challenge (25 IlQ 01 CCK-4 I.V.) and their psychological (state anxiety, number. intensity, fear and duration 01 symptoms) and cardiovascular (heart rate and blood pressure) reactions were assessed. Plasma and platelet concentrations of OOfepinephrine (NE), epinephrine (EPI) and dopamine (OA), were determined by HPLC-ECO. Results: MUltiple regression analyses revealed thal basal platelet concan· trstlons of NE and OA can explain 65% 01 the total variability in state anxiety. Plasma NE accounted for 28"10 of the variability In tra~ anXiety. Baseline measures 01 plasma and platelet EPI and NE levels can predict 70% of the total variability found in the intensity of post-ecK-4 state-anXiety, 26. 27 and 71% 01 the variability In number of symptoms. Intensity 01 symptoms, and blood pressure respectively. Conclusion: Basal plasma and platelet levels of catecholamines may Influence the panlo-like reactions to CCK-4. We are presently completing a study examining the same parameters in patients suffering from panic disorder. Supported by FRSQ and FCAR.
114-491
Therapeutic potential of the 5HT2C receptor agonist Ro 60-0175 In panic, depression and OCD
F. Jenek, M. Boes, J.R. Martin, A. Sleight, J.-L Moreau. Preclinical eNS Research, ROCHE. Basel, Switzerland Ao 6Q.{)175 has been characterized In vitro and in vivo as a full and selective agonist at the 5HT2C receptor subtype. This compound, a 1-(2 aminopropyl) indole derivallve. exhibits both nanomolar affinity for 5HT2C receptors and selectivity (> 1.5 log unit) over more than forty other binding s~es with established physiological relevance (Including 5HT2A receptors and sites on GAB" receptor complex). Ro 60-0175 was tested for in vivo effects indicative of potential therapeutic action in animal models of panic anxiety. depreSSion and compulsive behavior and compared with fluoxetine In those models. Effects suggestive of antipanic-Iike action were obtained in a model of intense lear induced by brain stimulation applied to the dorsolateral peri• aqueduetal gray matter; in this model, Ro 6Q.{)175 was found to be more potent and more efficacious than fluoxetine. Antidepressant-like properties were detected following chronic administration of Ro 60-0175 to rats sub• mitted to a regimen of chronic mild stress generating an anhedonic state In control animals. Effects suggestive of potential therapeutic action against obsessive-compulsive disorder were recorded for Ro 60-0175 and f1uoxetine in schedule-Induced polydipsia in rats and drug-induced whole-body scratch• Ing in squirrel monkeys. The data suggest that the 5HT2C receptor SUbtype is likely to play an important role In the therapeutic properties of selective serotonin reuptake inhibitors. Selective 5HT2C receptor agonists such as Ro 60-0175 may also offer novel and improved therapeutic opportunities for the biological treatment of psychiatric disorders.
114-50
I Suppression of conditioned fear by administration of CCKa receptor antagonist or CCKa receptor antisense
T. Tsutsuml, J. Akiyoshi. K Isogawa, T. Hikichi, I. Fujii. Dept Neuropsychiatry. Olta Medical University. Oita, Japan The aim of this study Is whether CCKe receptor antagonist PDl35158 and CCKs receptor antisense suppress conditioned fear. Methods: We examined the effect of the selective significantly antagonist POl35158 on freezing behavior Induced by conditioned fear stress. We used GH3 cell that is pituitary tumor 01 rat and the surface of of GH3 cell has CCKs receptor. After administration of significantly anllsense, GH3 cell was stimulated by CCK4 and intracellular Ca concentration was measured. CCKB receptor antisense was administered into lateral ventricle constantly and suppression 01 conditioned fear was evaluated. Results: CCKB antagonist PDl35158 suppressed conditioned fear. CCKa receptor antisense significantly suppressed intracellUlar ca concentration in GH3 cell. The result of CCKs receptor antisense will be reported on that day.
114-51
I Efficacy of the combination of pharmaco- and psychotherapy In the treatment of panic disorder
W.H. Strauss. Rhein. Landes- u. Hochschullclinik, Psychiatric Hospital of the Helnrich-Heine-Universlty DiJsseldorf, Germany Behavioral treatments and therapy with imipramine were regarded as ef• fective therapeutical methods in patients suffering from panic diSOrders. Although both methods were often applied In combination, there Is a lack of controlled studies In this area. Methods: 48 patients with the OSM-III-R diagnosis panic disorder With and Without agoraphobia were treated Individually for three months In 24 sessions with either (a) Cognitive Behavior Therapy (CBT) (b) Aelaxatlon Training (RT) (c) CBT and 150 mg Imipramine (d) AT and 150 mg Imipramine The effects of the therapy were controlled by self-assessment scaJes (Beck Anxiety Inventory, Fear Questionnaire. Fear Diary). ratings (HAMO. HAMA, Global Improvement scale). and behavior test (DBTA) at the end of therapy and with one year follow-up. Results: The data show that patients 01 the cogn~ive behavior groups were more often ImprOVed than the patients 01 the relaxation groups. Imipramine has an additive effect to CBT. but an Inhibiting effect to relaxation training.