Impulsivity in patients with panic disorder-agoraphobia: the role of cyclothymia.

The relationship between Panic Disorder (PD) and impulsivity is not well explored. The present investigation aims to compare impulsivity, measured by different rating tools, in PD patients vs. healthy controls and to explore the influence of co-morbid Cyclothymic Disorder (CD) on the relationship between PD and impulsivity. Sixty-four subjects with PD and 44 matched controls underwent a diagnostic and symptomatological evaluations by the Mini Neuropsychiatric Interview (M.I.N.I) Plus 5.0; the Bech-Rafaelsen Depression and Mania Scale (BRDMS), the State-Trait Anxiety Inventory (STAI), the Hypomania Check List (HCL-32) and the Clinical Global Impression (CGI); the Questionnaire for the Affective and Anxious Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Modified (TEMPS-M), the Separation Anxiety Sensitivity Index (SASI), the Interpersonal Sensitivity Symptoms Inventory (ISSI). Finally, psychometric and neurocognitive evaluations of impulsivity was carried out using the Barratt Impulsiveness Scale (BIS-11) and the Immediate and Delayed Memory Task (IMT/DMT). Subjects with PD were more impulsive than the controls in all the explored measures, reporting higher scores in symptomatological and temperamental scales. The comparison between PD patients with (Cyclo+) and without (Cyclo-) comorbid CD and controls showed that Cyclo+ are the most impulsive subjects in all the investigated measures and are characterized by the greatest symptomatological impairment, the highest scores in temperamental scales, and the highest levels of interpersonal sensitivity and separation anxiety. In our patients with PD, without lifetime comorbidity with major mood episodes, trait and state impulsivity may be related to the presence of comorbid cyclothymic mood instability.

Different measures of impulsivity in patients with anxiety disorders: a case control study.

The relationship between anxiety and impulsivity is controversial and not well explored. The present investigation aims to compare impulsivity, measured by different rating tools, in patients with anxiety disorders vs. healthy controls. Forty-seven subjects with different anxiety disorders and 45 matched controls underwent diagnostic and symptomatological evaluations by the Mini Neuropsychiatric Interview (M.I.N.I) Plus 5.0, Bech-Raphaelsen Depression and Mania Scale (BRDMS), State-Trait Anxiety Inventory (STAI), Hypomania Check List (HCL-32) and the Clinical Global Impression (CGI); temperamental evaluations by the Questionnaire for the Affective and Anxious Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Modified (TEMPS-M), the Separation Anxiety Sensitivity Index (SASI), the Interpersonal Sensitivity Symptoms Inventory (ISSI); and psychometric and a neurocognitive evaluations of impulsivity using the Barratt Impulsiveness Scale (BIS-11) and the Immediate and Delayed Memory Task (IMT-DMT). Subjects with anxiety disorders were more impulsive than the controls in all the explored measures, with higher scores in symptomatological and, temperamental scales. Patients with anxiety disorders but without a lifetime history of comorbid major mood episodes had greater trait and state impulsivity than controls. Further investigations are needed to assess the extent to which impulsivity might or might not be directly related to the anxiety disorder.

An open pilot study of zonisamide augmentation in major depressive patients not responding to a low dose trial with duloxetine: preliminary results on tolerability and clinical effects.

BACKGROUND: Despite multiple antidepressant options, major depressive disorder (MDD) still faces high non-response rates, eventually requiring anticonvulsant augmentation strategies too. The aim of this study was to explore such a potential role for zonisamide. METHODS: A total of 40 MDD outpatients diagnosed using the Diagnostic and Statistical Manual for Mental Disorders, fourth edition criteria entered a 24 week open trial receiving duloxetine 60 mg/day for the first 12 weeks and subsequently (weeks 12 to 24) augmentation with zonisamide 75 mg/day if they did not respond to the initial monotherapy. Efficacy and tolerability were assessed using the Hamilton Scales for Anxiety and Depression (a 12 week score ≥50% vs baseline defined 'non-response'), the Arizona Sexual Experience Scale, the Patient Rated Inventory of Side Effects and the Young Mania Rating Scale. RESULTS: At week 12, 15 patients out of 39 (38.5%) were responders, and 1 had dropped out; remarkably, 14 patients out of 24 (58.3%) had achieved response by week 24. Poor concentration and general malaise were associated with non-response both at week 12 and 24 (P = 0.001), while loss of libido and reduced energy were prominent among final timepoint non-responders. Patients receiving zonisamide also experienced weight reduction (2.09 ± 12.14 kg; P = 0.001) independently of the outcome. CONCLUSIONS: Although only a preliminary study due to strong methodological limitations, and thus requiring confirmation by further controlled investigations, the current results indicate zonisamide may be a potential augmentation option for some depressed patients receiving low doses of duloxetine.

Impulsivity in anxiety disorder patients: is it related to comorbid cyclothymia?

OBJECTIVE: The relationship between anxiety and impulsivity is controversial and not well explored. In a previous study we compared impulsivity, measured by different rating tools, in patients with anxiety disorders vs. healthy controls. In the same sample we now explore the influence of comorbid soft bipolar spectrum disorders on the relationship between anxiety disorders and impulsivity. METHOD: A sample including 47 subjects with anxiety disorder(s) and 45 control subjects matched for demographic, educational and work characteristics underwent a diagnostic evaluation by the Mini Neuropsychiatric Interview (MINI); a symptomatological evaluation by the Bech-Rafaelsen Depression and Mania Scale (BRDMS), the State-Trait Anxiety Inventory (STAI), the Hypomania Check List (HCL-32) and the Clinical Global Impression (CGI); a temperamental and personological evaluation by the Questionnaire for the Affective and Anxious Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Modified (TEMPS-M), the Separation Anxiety Symptoms Inventory (SASI), the Interpersonal Sensitivity Symptoms Inventory (ISSI); and, finally, a psychometric and a neuro-cognitive evaluation of impulsivity by the Barratt Impulsiveness Scale (BIS) and the Immediate and Delayed Memory Task (IMT/DMT). The initial sample of patients with anxiety disorders was then subdivided into two subgroups depending on the presence of comorbid cyclothymia (Cyclo+, n=26 and Cyclo-, n=21). For the diagnosis of cyclothymic disorder, we used both the DSM-IV-TR criteria and also a modified threshold for hypomania with a duration of 2 days. We compared symptomatological, temperamental, personological and impulsivity measures in Cyclo+, Cyclo- and controls. RESULTS: The comparison between Cyclo+, Cyclo- and controls showed that Cyclo+ are the most impulsive subjects in all the investigated measures and are characterized by greatest symptomatological impairment, highest scores in temperamental scales, and highest levels of interpersonal sensitivity and separation anxiety. Cyclo- subjects resulted to be more impulsive compared to controls concerning the retrospective trait measures, but not in the neuro-cognitive test. LIMITATIONS: Correlational cross-sectional study. CONCLUSION: In our patients with anxiety disorders, without lifetime comorbidity with major mood episodes, trait and state impulsivity resulted to be greater than in controls. In particular impulsivity was highest in patients with both anxiety disorders and cyclothymia. In anxious-cyclothymic patients also separation anxiety and interpersonal sensitivity were more severe than in anxious patients without cyclothymia and controls. Our findings suggest that impulsivity, rather than being directly related to the presence of the anxiety disorder, could be associated with comorbidity with cyclothymia.