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The prediction of nonresponse to drug therapy in social phobia
288
114-351
Poster session I
RIOL. PSYCHIATRY 1997;42:15-297S
The prediction of nonresponse to drug therapy in social phobia
B.R. Slaap 1, I.M. van Vliet 2, H.G.M. Westenberg2, J.A. den Boer 1 . 1 Groningen Graduate School for Behavioural and Cognitive Neurosciences, Department of Biological Psychiatry. Academic Hospital. Groningen. the Netherlands, 2 Department of Psychiatry. Academic Hospital Utrecht, the Netherlands
Conclusions: Although our data confirm that panic patients have a high anxiety sensitivity, do not suggest that lears of bodily sensations might be a good predictor 01 CO2 sensitivity in panic patients.
114-381
The prevalence of mitral valve prolapse among panic disorder patients
M. Latas. S. Milovanovic, I. Djurdjic, S. Djurdjic. Institute of Psychiatry. Clinical Centre of Serbia. Pastef0V6 2.• Belgrade. Yugoslavia
The aim 01 the present study was to Identify differences at baseline between responders and nonresponders to drug therapy In Social Phobia (SP). Methods: For the present study the data 01 two previously published double blind, placebo controlled studies were pooled. The 30 SP patients, who were treated lor 12 weeks with brolaromlne or lIuvoxamine, were the subject 01 this study. Four criteria 01 nonresponse were used to divide the patient group In responders and nonresponders. The variables that differed signilicantly between the groups were used to predict nonresponse to drug therapy. Results: Depending on the criterion variable up to 72% 01 the patients were regarded as nonresponders. Nonresponders differed lrom responders in that they had a higher heart rate and a higher blood pressure. They were also characterized by higher scores on several psychometric scales, Indicative 01 illness severity. These variables could predict nonresponse. Conclusions: At baseline nonresponders to drug therapy were charac• terized by several variables, indicative 01 illness severity and by a higher heart rate and blood pressure. Further research is warranted to substantiate these lindlngs.
This study was aimed to Investigate the relationship between mitral Valve prolapse and panic disorder. Symptoms common to both conditions Include palpitations and tachycardia, dizziness, actual and near syncope. latigue. dispnea and chest pain atypical of angina pectoris. The presence, detection and treatment of mitral valve prolapse in patients with panic disorder could have an important impact on predisponlng, clinical leature, prognosis and quality 01 Iile 01 these patients. In this study we evaluated a population of patients who have panic disorder (Which was diagnosed using DSM-IV criteria) to determine the prevalence of mitral valve prolapse, with diagnOSis made clinically and by standard echocardiographic criteria. The result of this study was that the prevalence 01 mitral valve prolapse In our sample of panic disorder patients was not considerably higher than prevalence of mitral valve prolapse in general population. We conclude that, because of close association 01 symptoms 01 both disorders, panic patients should refer routinely lor cerdiac evaluation to exclude structural mitral valve disease. which can mimic symptoms 01 panic disorder.
114-361
114-391
Sertrallne treatment of panic disorder: CombIned results from two placebo-controlled trials
R. Pohll, C.M. Clary2, R. Wolkow 2. 1 Wayne State University, Detroit. MI.
USA, 2 PfIZer Inc., New York, NY. USA
Two randomized, 1o-week, multi-center studies comparing sertraline (dose 50-200 mg) with placebo were conducted In outpatients with panic disorder with or without agoraphobia (DSM-III-R). Patients were required to have had 4 panic attacks In the 4 weeks prior to baseline and at least 3 panic attacks in the 2-week single-blind placebo lead-in. Both studies (N 342) had Identical designs, and there were no significant between-study differences In key clinical and demographic variables, so the results are combined lor this presentation. There was a significant treatment advantage lor sertraline vs. placebo in all 01 the primary efficacy measures. Frequency 01 major panic attacks was significantly reduced lor the sertraline group relative to the placebo group by week 2 (p < 0.005), and this advantage was sustained through the end 01 the study. Patient global ratings 01 improvement also achieved significance lor sertraline by week 3 (p < 0.005). Treatment with sertrallne was well-tolerated, with only 8% attrition for adverse events. The results 01 these combined studies are consistent with the individual results 01 each study, and suggest thet sertrallne is sale and effective in the treatment 01 panic disorder.
=
114-371
Salivary cortisol In panic disorder
B. Bandelow, D. Wedekind. G. HOther, A. Broocks. G. Hajak. G. Sengos. E. ROther. Department of Psychiatry. The University of Gc5ttingen. von-Siebold-Str. 5. 0.37075 Gc5ttlngen. Germany Introduction: Recent studies have suggested a disturbance 01 the hYpotha• lamus-pitultary-adrenal (HPA) axis In patients with panic disorder. There was only one study investigating spontaneous panic attacks In a laboratory situation by using an indwelling catheter2. To our knowledge, no Investi• gation exists that measured cortisol levels In non-provoked, spontaneous panic attacks in the patients' natural environment by using saliva sampling techniques. Method: Panic patients were given a set 01 saliva sample sets to take home and instructed to collect saliva samples every 5 minutes whenever a panic attack occurred. Cortisol levels in panic attack saliva samples were compared with control samples obtained the next day at the same time of the day during a panic-free period. During the panic attack, the patients had to complete the Acute Panic Inventory to measure severity 01 panic attacks. Results: Salivary cortisol was significantly elevated during panic attacks. The correlation between severity of panic attacks and the ratio 01 panic attack/resting cortisol was not significant. Relerences [1) Cameron OG, Lee MA, Curtis GC, McCann OS. Endocrine and physiological changeS during 'spontaneous' panic attacks. Psychoneuroendocrlnol1987; 12: 321-31
Anxiety sensitivity and 35% C02 reactiVity In panic patients
G. Pema, D. Caldirola, L Allevl, L Bellodl. Anxiety Disorders Clinical and Research Unit, Department of Neuropsychiatric Sciences. 1st/tufa Sclentifico H.S. Raffaele, Milan. Italy Introduction: Since panic patients show a high but relatively variable reactivity to CO2 and some recent studies reported a correlation between anxiety sensitivity scores and C02 sensitivity in healthy controls, we have Investigated the possibility that anxiety sensitivity might be a predictor of 35% C02 sensitivity in panic patients. Methods snd Results: Included In this study were 28 patients with Panic Disorder, according to DSM IV criteria. Each patient was Invited to fiil In the Anxiety SensitiVity Index (ASI) and to inhale one vital capacity 0135% C02• 65% 02, scoring anxiety Immediately before and after the Inhalation on a Visual Analogue Scale (VAS). Among patients investigated 27 (96%) had a high anxiety sensitivity (ASI ~ 27) and 23 (82%) showed a positive reaction to the 35% C02 challenge. All of the 5 negative reactors showed ASI scores higher than 27. No significant correlations between ASI scores and t. %VAS or VAS after CO2 Inhalation were lound. No slgnllicant differences in ASI scores were lound between positive (43.5 ± 9.9) and negative (42 ± 8.4) reactors.
114-40
I Comorbld depression and panic disorder
F. Roulllon. Centre Hospital/er Louis Mourler, Colombes C8dex, France The Epidemiological Catchment Area study lound the co-occurrence of panic attacks with major depression to be 11-tlmes higher than expected by chance (OR .. 11.4). In Intematlonal epidemiological studies, between 32 and 60% 01 all subjects with panic disorder also lulfilled criteria of lifetime major depression. Moreover. both panic disorder and depression OCCurred in the same year In approximately 50% of patients. Family studies have also Indicated an Increased prevalence 01 major depression among relatives 01 panic probands; similarly the prevalence 01 panic disorder is IncreaSed among relatives 01 depressed patients. Sufferers of both disorders are twice as likely to commit suicide than people who suffer lrom either condition alone' this may be due to the severity of both disorders appearing to be greater I~ sufferers 01 both conditions. Patients with comortlld depression and Panic disorder have also been shown to respond poorly to treatment, reqUire extended psychiatric therapy, and are more likely to have long-term Illness. Therefore, It is Important thet the anxiety and the depression are effectively treated whenever these conditions co-exlst. Often only the depression is actively managed, or when anxiolytic compounds are used to treat the anxiety
114-351
Poster session I
RIOL. PSYCHIATRY 1997;42:15-297S
The prediction of nonresponse to drug therapy in social phobia
B.R. Slaap 1, I.M. van Vliet 2, H.G.M. Westenberg2, J.A. den Boer 1 . 1 Groningen Graduate School for Behavioural and Cognitive Neurosciences, Department of Biological Psychiatry. Academic Hospital. Groningen. the Netherlands, 2 Department of Psychiatry. Academic Hospital Utrecht, the Netherlands
Conclusions: Although our data confirm that panic patients have a high anxiety sensitivity, do not suggest that lears of bodily sensations might be a good predictor 01 CO2 sensitivity in panic patients.
114-381
The prevalence of mitral valve prolapse among panic disorder patients
M. Latas. S. Milovanovic, I. Djurdjic, S. Djurdjic. Institute of Psychiatry. Clinical Centre of Serbia. Pastef0V6 2.• Belgrade. Yugoslavia
The aim 01 the present study was to Identify differences at baseline between responders and nonresponders to drug therapy In Social Phobia (SP). Methods: For the present study the data 01 two previously published double blind, placebo controlled studies were pooled. The 30 SP patients, who were treated lor 12 weeks with brolaromlne or lIuvoxamine, were the subject 01 this study. Four criteria 01 nonresponse were used to divide the patient group In responders and nonresponders. The variables that differed signilicantly between the groups were used to predict nonresponse to drug therapy. Results: Depending on the criterion variable up to 72% 01 the patients were regarded as nonresponders. Nonresponders differed lrom responders in that they had a higher heart rate and a higher blood pressure. They were also characterized by higher scores on several psychometric scales, Indicative 01 illness severity. These variables could predict nonresponse. Conclusions: At baseline nonresponders to drug therapy were charac• terized by several variables, indicative 01 illness severity and by a higher heart rate and blood pressure. Further research is warranted to substantiate these lindlngs.
This study was aimed to Investigate the relationship between mitral Valve prolapse and panic disorder. Symptoms common to both conditions Include palpitations and tachycardia, dizziness, actual and near syncope. latigue. dispnea and chest pain atypical of angina pectoris. The presence, detection and treatment of mitral valve prolapse in patients with panic disorder could have an important impact on predisponlng, clinical leature, prognosis and quality 01 Iile 01 these patients. In this study we evaluated a population of patients who have panic disorder (Which was diagnosed using DSM-IV criteria) to determine the prevalence of mitral valve prolapse, with diagnOSis made clinically and by standard echocardiographic criteria. The result of this study was that the prevalence 01 mitral valve prolapse In our sample of panic disorder patients was not considerably higher than prevalence of mitral valve prolapse in general population. We conclude that, because of close association 01 symptoms 01 both disorders, panic patients should refer routinely lor cerdiac evaluation to exclude structural mitral valve disease. which can mimic symptoms 01 panic disorder.
114-361
114-391
Sertrallne treatment of panic disorder: CombIned results from two placebo-controlled trials
R. Pohll, C.M. Clary2, R. Wolkow 2. 1 Wayne State University, Detroit. MI.
USA, 2 PfIZer Inc., New York, NY. USA
Two randomized, 1o-week, multi-center studies comparing sertraline (dose 50-200 mg) with placebo were conducted In outpatients with panic disorder with or without agoraphobia (DSM-III-R). Patients were required to have had 4 panic attacks In the 4 weeks prior to baseline and at least 3 panic attacks in the 2-week single-blind placebo lead-in. Both studies (N 342) had Identical designs, and there were no significant between-study differences In key clinical and demographic variables, so the results are combined lor this presentation. There was a significant treatment advantage lor sertraline vs. placebo in all 01 the primary efficacy measures. Frequency 01 major panic attacks was significantly reduced lor the sertraline group relative to the placebo group by week 2 (p < 0.005), and this advantage was sustained through the end 01 the study. Patient global ratings 01 improvement also achieved significance lor sertraline by week 3 (p < 0.005). Treatment with sertrallne was well-tolerated, with only 8% attrition for adverse events. The results 01 these combined studies are consistent with the individual results 01 each study, and suggest thet sertrallne is sale and effective in the treatment 01 panic disorder.
=
114-371
Salivary cortisol In panic disorder
B. Bandelow, D. Wedekind. G. HOther, A. Broocks. G. Hajak. G. Sengos. E. ROther. Department of Psychiatry. The University of Gc5ttingen. von-Siebold-Str. 5. 0.37075 Gc5ttlngen. Germany Introduction: Recent studies have suggested a disturbance 01 the hYpotha• lamus-pitultary-adrenal (HPA) axis In patients with panic disorder. There was only one study investigating spontaneous panic attacks In a laboratory situation by using an indwelling catheter2. To our knowledge, no Investi• gation exists that measured cortisol levels In non-provoked, spontaneous panic attacks in the patients' natural environment by using saliva sampling techniques. Method: Panic patients were given a set 01 saliva sample sets to take home and instructed to collect saliva samples every 5 minutes whenever a panic attack occurred. Cortisol levels in panic attack saliva samples were compared with control samples obtained the next day at the same time of the day during a panic-free period. During the panic attack, the patients had to complete the Acute Panic Inventory to measure severity 01 panic attacks. Results: Salivary cortisol was significantly elevated during panic attacks. The correlation between severity of panic attacks and the ratio 01 panic attack/resting cortisol was not significant. Relerences [1) Cameron OG, Lee MA, Curtis GC, McCann OS. Endocrine and physiological changeS during 'spontaneous' panic attacks. Psychoneuroendocrlnol1987; 12: 321-31
Anxiety sensitivity and 35% C02 reactiVity In panic patients
G. Pema, D. Caldirola, L Allevl, L Bellodl. Anxiety Disorders Clinical and Research Unit, Department of Neuropsychiatric Sciences. 1st/tufa Sclentifico H.S. Raffaele, Milan. Italy Introduction: Since panic patients show a high but relatively variable reactivity to CO2 and some recent studies reported a correlation between anxiety sensitivity scores and C02 sensitivity in healthy controls, we have Investigated the possibility that anxiety sensitivity might be a predictor of 35% C02 sensitivity in panic patients. Methods snd Results: Included In this study were 28 patients with Panic Disorder, according to DSM IV criteria. Each patient was Invited to fiil In the Anxiety SensitiVity Index (ASI) and to inhale one vital capacity 0135% C02• 65% 02, scoring anxiety Immediately before and after the Inhalation on a Visual Analogue Scale (VAS). Among patients investigated 27 (96%) had a high anxiety sensitivity (ASI ~ 27) and 23 (82%) showed a positive reaction to the 35% C02 challenge. All of the 5 negative reactors showed ASI scores higher than 27. No significant correlations between ASI scores and t. %VAS or VAS after CO2 Inhalation were lound. No slgnllicant differences in ASI scores were lound between positive (43.5 ± 9.9) and negative (42 ± 8.4) reactors.
114-40
I Comorbld depression and panic disorder
F. Roulllon. Centre Hospital/er Louis Mourler, Colombes C8dex, France The Epidemiological Catchment Area study lound the co-occurrence of panic attacks with major depression to be 11-tlmes higher than expected by chance (OR .. 11.4). In Intematlonal epidemiological studies, between 32 and 60% 01 all subjects with panic disorder also lulfilled criteria of lifetime major depression. Moreover. both panic disorder and depression OCCurred in the same year In approximately 50% of patients. Family studies have also Indicated an Increased prevalence 01 major depression among relatives 01 panic probands; similarly the prevalence 01 panic disorder is IncreaSed among relatives 01 depressed patients. Sufferers of both disorders are twice as likely to commit suicide than people who suffer lrom either condition alone' this may be due to the severity of both disorders appearing to be greater I~ sufferers 01 both conditions. Patients with comortlld depression and Panic disorder have also been shown to respond poorly to treatment, reqUire extended psychiatric therapy, and are more likely to have long-term Illness. Therefore, It is Important thet the anxiety and the depression are effectively treated whenever these conditions co-exlst. Often only the depression is actively managed, or when anxiolytic compounds are used to treat the anxiety