Autorotation test abnormalities of the horizontal and vertical vestibulo-ocular reflexes in panic disorder.

Patients with panic disorder often describe dizziness as a disturbing symptom, with more severe episodes reported than in other psychiatric populations. Nineteen patients diagnosed as having a panic disorder were tested for vestibulo-ocular (VOR) abnormalities with the Vestibular Autorotation Test (VAT), a computerized test of the high-frequency (2 to 6 Hz) VOR. The patients were unselected for the presence or absence of balance disorders. Results showed VOR abnormalities, relative to a normal population, in the horizontal and/or vertical VORs of all 19 patients. Vestibulo-ocular reflex asymmetries were commonly present. Because the VAT tested the VOR over a frequency range encountered during common daily activities, the observed abnormalities could result in a perceptually moving visual field (oscillopsia). We hypothesize that the resulting experience of a visual-vestibular disturbance--perhaps in a biologically or psychologically predisposed individual--is catastrophically misinterpreted, leading to more bodily symptoms and anxiety. These could then contribute to more misinterpretation in a positive feedback sense, ultimately leading to a panic attack.

Sertraline in social phobia.

Eleven consecutive SCID-diagnosed generalized social phobias without major depression, other prominent anxiety disorders, substance abuse, alcoholism or organic mental disorder, were treated, open label, with sertraline up to 200 mg daily for 12 weeks. There were seven completers. Of these, five showed substantial improvement, after being on sertraline 100 mg daily for two weeks (following no response to sertraline 50 mg daily for four weeks). There were few side effects among the completers. The four dropouts complained of side effects and loss of interest in continuing treatment. Final average dose for completers who responded was 170 mg daily.

Alprazolam levels and response in panic disorder: preliminary results.

Fifty-five young adult patients completed a study comparing alprazolam, propranolol, and placebo in the treatment of panic disorder and agoraphobia with panic attacks. Twenty completed 5 weeks of treatment with alprazolam. No concomitant psychological treatment was administered. Plasma alprazolam levels were determined at baseline and at the end of the trial by means of automated gas chromatography. These levels were significantly correlated with dose (p = 0.001). Dividing the data into quartiles based on alprazolam concentration, no direct, linear relationship was found between alprazolam levels and response (as defined by a criterion of zero panic attacks). However, analysis of the combined middle two quartiles versus the combined upper and lower quartiles showed a positive trend toward a curvilinear relationship; i.e., there was a greater response rate within the 18-62 ng/ml concentration range than in the combined 0-17 plus 63-107 ng/ml range, (chi 2 = 2.4; p = 0.12). The findings are very preliminary in nature. It remains to be seen if the results will reach significance with a large sample size and a more tightly controlled study design.

Clonazepam in the treatment of social phobia: a pilot study.

Twenty-three patients who met DSM-III-R criteria for social phobia were randomly assigned either to a clonazepam treatment group or to a nontreatment control group in an 8-week pilot study. Clonazepam was found to have a significant effect on the treated patients, as demonstrated by scores on a variety of instruments measuring overall anxiety and phobic avoidance, and social phobic symptoms. Initial sedation, which was experienced by 70% of the treated subjects, was the most common side effect of clonazepam treatment and usually resolved spontaneously or with dose reduction. The preliminary findings of this pilot study are sufficiently promising to warrant further study of the efficacy of clonazepam in this condition.

Generalized anxiety disorder: some biochemical aspects.

Fifty-one patients who met DSM-III criteria for generalized anxiety disorder, and who were recruited to participate in a drug outcome study, filled out a variety of rating scales and had blood samples drawn for plasma norepinephrine, epinephrine, and free 3-methoxy-4-hydroxyphenylglycol (MHPG) after a 20-min rest period. This group was compared to 15 normal controls who also had their blood drawn after a 20-min rest period. While the two groups were initially found to have significantly different levels of plasma free MHPG through the use of t tests, this finding was not confirmed by subsequent discriminant analysis.

Alprazolam, propranolol, and placebo in the treatment of panic disorder and agoraphobia with panic attacks.

Fifty-five patients completed a 5-week double-blind study comparing alprazolam, propranolol, and placebo in the treatment of panic disorder and agoraphobia with panic attacks. There was no concomitant behavioral treatment. Patient and therapist rating scales included Sheehan's Panic and Anxiety Attack Scales, the Marks-Sheehan Phobia Scale, the Hamilton Anxiety Scale, the Hamilton Depression Scale, and the Side Effects Checklist. The results generally support the efficacy of alprazolam, but not propranolol, in the treatment of panic disorder and agoraphobia with panic attacks. The significance of the results are discussed, as well as a number of the unique aspects of our procedures and patient population.

Thyroid hormones in panic disorder, panic disorder with agoraphobia, and generalized anxiety disorder.

Fifty-two patients with generalized anxiety disorder who had symptoms persisting for at least 6 months, 41 patients suffering from either panic disorder (32 patients) or panic disorder with agoraphobia (9 patients), and 14 control subjects were screened for thyroid disease. Total serum thyroxine (TT4), serum-free thyroxine index (FT4I), and triiodothyronine resin uptake (T3RU), were examined for the entire sample, using a one-way analysis of variance (ANOVA). No significant differences were found in TT4 (p = .24), FT4I (p = .24), and T3RU (p = .19). Thyroid-stimulating hormone (TSH) was examined in a subsample of 10 patients with generalized anxiety disorder, 11 with panic disorder or panic disorder with agoraphobia, and 10 controls. One-way ANOVA again showed no significant differences, although there was a trend (p = .07). This is the first report that compares generalized anxiety disorder patients, panic disorder patients, and patients with panic disorder and agoraphobia with controls on measures of thyroid function. It is also the first to report normal values in the thyroid indices of generalized anxiety disorder patients.

Nortriptyline in the treatment of panic disorder and agoraphobia with panic attacks.

Thirty-four consecutive patients with panic disorder or agoraphobia with panic attacks were treated with nortriptyline at the LAC-USC Medical Center's Anxiety Disorders Clinic. Fourteen (67%) of the 21 completers totally lost their panic attacks, five (24%) showed partial improvement, and two (10%) showed no improvement. The relationship of treatment outcome to pretreatment and posttreatment measures of depression is discussed, in addition to the potential role of nortriptyline in treating panic attacks in clinical practice.

Comparison of social anxiety in patients with social phobia and panic disorder.

Differential response patterns to the SCL-90R in patients with social phobia and panic disorder are presented. The differences are discussed in light of Liebowitz's distinction between primary social phobia and the secondary social fears of panic disorder patients. Treatment implications are also discussed.

The onset of driving phobias.

Thirty driving phobics who called the Psychiatry Outpatient Phobia Clinic (25 females and five males) were given a 20-min semi-standardized telephone interview during which they were asked about the circumstances of the onset of their driving fears. Twelve (40%) reported that their fears were precipitated by a panic attack on the freeway; six (20%) by a collision; and three (10%) by other frightening experiences in automobiles. Four (13.3%) related the onset to family stress or upheaval. Other modes of onset also occurred. The implications of these findings are discussed in terms of existing theories of fear acquisition and treatment approaches.

The treatment of phenelzine-induced hypotension with salt tablets: case report.

A 24-year-old woman who met DSM-III criteria for agoraphobia with panic attacks, and who could not tolerate other medications (imipramine and propranolol), was successfully treated with phenelzine sulfate and salt tablets for the accompanying hypotension.

Rational-emotive therapy in the treatment of erectile failure: an initial study.

Sixteen males with erectile failure, married or living with their partners, were assigned to either 12 bi-weekly sessions (6 weeks) of Rational Emotive Therapy (RET) or a 6-week waiting-list control group. Active treatment administered by a graduate student in psychology with special training in RET resulted in patients making significantly more sexual intercourse attempts, reporting significantly reduced sexual anxiety, and having a significantly higher number of successful intercourse attempts than the waiting-list control group. While 6-9 month follow-up revealed that most treated patients had fallen back toward the pretest baseline (lower rates of successful intercourse), group means as a whole were still significantly higher than pretreatment intercourse success rates. The significance of these findings are discussed.

Affective disorder and alcoholism in families of agoraphobics.

We examined the family histories of 68 agoraphobic patients, 35 subjects with miscellaneous-specific phobias, and ten subjects with social phobias. Of the 68 agoraphobic subjects, 26 had a positive family history of affective disorder based on our criteria. Five of the subjects with miscellaneous-specific phobias and none of the social phobic subjects had positive family histories of affective disorder. The difference between these categories is statistically significant. Family history of alcoholism was found to occur significantly more frequently in the agoraphobic vs the miscellaneous-specific phobic group, but not when compared with the social phobic group. A subpopulation in each phobic category was examined for past or present personal depressive illness, but no statistical difference was found. The increased incidence of affective disorder in first-degree relatives distinguishes agoraphobia from other phobic disorders.

Psychological characteristics of males with secondary erectile failure.

This study was designed to obtain objective data on the personality profiles of two groups of males with a primary complaint of erectile failure and compare them to a group of psychiatric patients unselected for sexual dysfunction and to a sexually "normal" control group. Utilizing the Eysenck Personality Inventory, the Institute of Personality and Ability Testing Anxiety Scale, Symptom Checklist, and the Minnesota Multiphasic Personality Inventory, it was determined that males applying to a university/county hospital sex-dysfunction clinic appeared similar to patients seen in the same clinic who were unselected for sex dysfunction and more psychologically disturbed than patients with the same complaint applying for treatment at a private clinic. All three groups showed more psychopathology than sexually normal males. The implications of these findings are discussed.

Retarded ejaculation: a review.

Retarded ejaculation is the persistent difficulty or inability to ejaculate despite the presence of adequate sexual desire, erection, and stimulation. The causes of this dysfunction may be organic, i.e., medical illness or drug ingestion (particularly medications with antiadrenergic effects), the result of surgical interventions, or secondary to inhibiting psychological factors. With regard to psychological determinants, fear, guilt, resentment, and passively have all been implicated, although objective studies are rare. The sexual object choice of men with retarded ejaculation has ben reported by several clinicians and investigators to be other than adult members of the opposite sex, while the marital relationship of these males has been considered etiological in other instances. Outcome assessment to date consists mostly of individual case reports or reports on small groups of patients treated without controls. To some extent, routine reliance on long-term traditional therapy has yielded to shorter, symptomatic learning-based treatments. While improved outcomes have been reported, many patients do not respond well. It is not yet possible to objectively predict succes or failure. Since it is our impression that this sexual dysfunction is more common than previously assumed (or is increasing in frequency), our present lack of data should soon be remedied.