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Effect of medication and psychotherapy on heart rate variability in panic disorder.
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Effect of medication and psychotherapy on heart rate variability in panic disorder.
Depress Anxiety. 2008 Oct 6;
Authors: Garakani A, Martinez JM, Aaronson CJ, Voustianiouk A, Kaufmann H, Gorman JM
Background: Panic disorder (PD) patients have been shown to have reduced heart rate variability (HRV). Low HRV has been associated with elevated risk for cardiovascular disease. Our aim was to investigate the effects of treatment on heart rate (HR) in patients with PD through a hyperventilation challenge. Methods: We studied 54 participants, 43 with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) PD and 11 controls. Subjects lay supine with their heads in a plastic canopy chamber, resting for 15 min and then breathing at a rate of 30 breaths per minute for 10 min. HRV was sampled for spectral analysis. Clinical and behavioral measures of anxiety were assessed. Treatment was chosen by patients: either 12 weeks of CBT alone or CBT with sertraline. Results: All patients showed significant decrease on clinical measures from baseline and 31 were treatment responders, 8 dropped out of the study before completion of the 12-week treatment phase and 4 were deemed nonresponders after 12 weeks of treatment. Although both treatments led to significant clinical improvement, only CBT alone demonstrated a significant reduction in HR and increase in HRV. Conclusions: Our study replicated the finding that increased HR and decreased HRV occur in PD patients. Given the evidence of cardiac risk related to HRV, CBT appears to have additional benefits beyond symptom reduction. The mechanisms of this difference between CBT and sertraline are unclear and require further study. Depression and Anxiety 0:1-8, 2008. (c) 2008 Wiley-Liss, Inc.
PMID: 18839407 [PubMed - as supplied by publisher]
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The utility of the Generalized Anxiety Disorder Severity Scale (GADSS) with older adults in primary care.
Depress Anxiety. 2008 Oct 6;
Authors: Weiss BJ, Calleo J, Rhoades HM, Novy DM, Kunik ME, Lenze EJ, Stanley MA
Background:The Generalized Anxiety Disorder Severity Scale (GADSS) is an interview rating scale designed specifically for assessing symptom severity of generalized anxiety disorder (GAD), which has demonstrated positive psychometric data in a sample of adult primary care patients with GAD and panic disorder. However, the psychometric properties of the GADSS have not been evaluated for older adults. Methods: This study evaluated the psychometric properties of the GADSS, administered via telephone, with a sample of older primary care patients (n=223) referred for treatment of worry and/or anxiety. Results: The GADSS demonstrated adequate internal consistency, strong inter-rater reliability, adequate convergent validity, poor diagnostic accuracy, and mixed discriminant validity. Conclusions: Results provide mixed preliminary support for use of the GADSS with older adults. Depression and Anxiety 0:1-6, 2008, Published 2008 Wiley-Lis, Inc.
PMID: 18839400 [PubMed - as supplied by publisher]
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Altered cerebral gamma-aminobutyric acid type A-benzodiazepine receptor binding in panic disorder determined by [11C]flumazenil positron emission tomography.
Arch Gen Psychiatry. 2008 Oct;65(10):1166-75
Authors: Hasler G, Nugent AC, Carlson PJ, Carson RE, Geraci M, Drevets WC
CONTEXT: The benzodiazepine (BZD) receptor system has been implicated in the pathophysiologic mechanism of panic disorder (PD) by indirect evidence from pharmacological challenge studies and by direct evidence from single-photon emission computed tomography and positron emission tomography neuroimaging studies. However, the results of previous neuroimaging studies are in disagreement, possibly because of experimental design limitations related to sample size, matching between patients and controls, and confounding medication effects. OBJECTIVE: To compare BZD receptor binding between subjects with PD and healthy control subjects. DESIGN: Cross-sectional study for association. SETTING: Psychiatric outpatient clinic of the National Institute of Mental Health. PARTICIPANTS: Fifteen subjects with PD who were naïve to BZD drug exposure and were not receiving other drug treatment, and 18 healthy controls. INTERVENTION: Images of BZD receptor binding were acquired using positron emission tomography and flumazenil tagged with carbon 11. MAIN OUTCOME MEASURES: The BZD receptor binding potential was assessed by a simplified reference tissue-tracer kinetic model. RESULTS: The BZD receptor binding potential was decreased in multiple areas of the frontal, temporal, and parietal cortices and was increased in the hippocampus/parahippocampal region in subjects with PD vs controls. The most significant decrease was located in the dorsal anterolateral prefrontal cortex (DALPFC); the most significant increase, in the hippocampus/parahippocampal gyrus. These abnormalities were not accounted for by comorbid depression. In subjects with PD, the severity of panic and anxiety symptoms correlated positively with BZD receptor binding in the DALPFC but negatively with binding in the hippocampus/parahippocampal gyrus. CONCLUSIONS: These data provide evidence of abnormal BZD-gamma-aminobutyric acid type A receptor binding in PD, suggesting that basal and/or compensatory changes in inhibitory neurotransmission play roles in the pathophysiologic mechanism of PD. They also provide evidence of an impairment of frontal-limbic interaction in the modulation of anxiety responses, consistent with previous functional and structural neuroimaging studies in PD.
PMID: 18838633 [PubMed - in process]
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"Specificity of treatment effects: Cognitive therapy and relaxation for generalized anxiety and panic disorders": Correction.
J Consult Clin Psychol. 2008 Oct;76(5):iii
Authors: Siev J, Chambless DL
Reports an error in "Specificity of treatment effects: Cognitive therapy and relaxation for generalized anxiety and panic disorders" by Jedidiah Siev and Dianne L. Chambless (Journal of Consulting and Clinical Psychology, 2007[Aug], Vol 75[4], 513-522). The individual measures were not listed in the domains labeled "Panic" and "Cognitive" for the Ost and Westling (1995) citation in Table 3. The corrected table is included, with the added text appearing in bold font. (The following abstract of the original article appeared in record 2007-11558-001.) The aim of this study was to address claims that among bona fide treatments no one is more efficacious than another by comparing the relative efficacy of cognitive therapy (CT) and relaxation therapy (RT) in the treatment of generalized anxiety disorder (GAD) and panic disorder without agoraphobia (PD). Two fixed-effects meta-analyses were conducted, for GAD and PD separately, to review the treatment outcome literature directly comparing CT with RT in the treatment of those disorders. For GAD, CT and RT were equivalent. For PD, CT, which included interoceptive exposure, outperformed RT on all panic-related measures, as well as on indices of clinically significant change. There is ample evidence that both CT and RT qualify as bona fide treatments for GAD and PD, for which they are efficacious and intended to be so. Therefore, the finding that CT and RT do not differ in the treatment of GAD, but do for PD, is evidence for the specificity of treatment to disorder, even for 2 treatments within a CBT class, and 2 disorders within an anxiety class. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
PMID: 18837588 [PubMed - in process]
[Brief psychotherapeutic interventions of general practitioners in patients with anxiety disorders]
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[Brief psychotherapeutic interventions of general practitioners in patients with anxiety disorders]
MMW Fortschr Med. 2008 May 29;150(22):30-2
Authors: Boerner RJ
PMID: 18697414 [PubMed - indexed for MEDLINE]
