ABSTRACT
OBJECTIVE: To investigate the long-term efficacy, prevention of relapse and safety of sertraline in the treatment of panic disorder. METHOD: This study consisted of 52 weeks of open-label sertraline treatment (n=398) followed by a 28 weeks of a double-blind, placebo-controlled discontinuation trial (n=183). RESULTS: Ninety-three patients were randomized to sertraline and 90 were randomized to placebo. Discontinuation due to insufficient clinical response occurred in 23.6% of placebo-treated patients and 12.0% of sertraline-treated patients (log-rank test, P=0.040). Thirty-three per cent of placebo-treated patients had an exacerbation of panic symptomatology, versus 13% of sertraline-treated patients (log-rank test, P=0.005). Abrupt cessation of sertraline resulted in dizziness (4.3% sertraline vs. 16.9% placebo; P=0.007) and insomnia (4.3% sertraline vs. 15.7% placebo; P=0.013) occurring at significantly higher rates. CONCLUSION: Long-term sertraline treatment was effective in preventing relapse of panic disorder, well tolerated and associated with minimal discontinuation symptoms.
Subject(s)
Agoraphobia/drug therapy , Panic Disorder/drug therapy , Sertraline/therapeutic use , Adult , Agoraphobia/psychology , Dose-Response Relationship, Drug , Double-Blind Method , Drug Administration Schedule , Female , Humans , Long-Term Care , Male , Middle Aged , Panic Disorder/psychology , Recurrence , Sertraline/adverse effects , Substance Withdrawal Syndrome/diagnosis , Treatment OutcomeABSTRACT
Between 1936 and 1950, detailed abstracts were prepared on all patients admitted to The Phipps Psychiatric Clinic from its opening in 1913 through 1950. Of these abstracts, 74% contained follow-up reports. Except for four papers on schizophrenia and affective disorders published between 1939 and 1943, none of this material has ever been analyzed. The present paper, the first of a series, examines the 8172 first admissions from 1913 through 1940, the period of Adolf Meyer's tenure as Clinic Director. Based on discharge diagnoses, we have sorted the patients into eight diagnostic groups with the following frequencies; schizophrenia, 17%; paranoid state, 3%; manic-depressive, 7%; depression, 27%; organic, 20%; neuroses, 15%; substance abuse, 6%; psychopath, 5%. Our manic-depressive group contains cases discharged primarily as hyperthymergasia, mania, or manic depressive insanity (MDI). Of the 349 cases diagnosed MDI at discharge, 10 had neither a history of nor present symptoms of mania, and these were put in the depression group. Frequencies for most of the diagnoses remained remarkably stable over the 28-year period. Only 9% were discharged recovered, whereas 43% were rated unimproved. Mean length of hospitalization was 76 days, with 10% of the patients readmitted. The mean length of follow-up was 9 years. Correlations of diagnoses, year of admission, length of stay, condition at discharge, age, sex, readmissions, change of diagnoses, somatic treatment, length of follow-up, and deaths in the clinic are presented. Meyer's influence on diagnostic practice is discussed.
Subject(s)
Mental Disorders/diagnosis , Psychiatry/history , Biological Psychiatry , History, 20th Century , Hospitalization , Hospitals, Psychiatric/history , Humans , Maryland , Terminology as TopicABSTRACT
The files of 120 hospitalized patients who had participated in drug studies between 1964 and 1966 were examined without knowledge of the patient's subsequent history. These patients, who had originally been diagnosed by DSM-II criteria, were retrospectively diagnosed by New York Research Diagnostic Criteria (RDC), the New Haven Schizophrenia Index (NHSI), the St. Louis criteria, Bland and Orn's modification of the St. Louis critera, Schneider's first rank symptoms (FRS) criteria, and the 12-point "Flexible" system developed by the Washington field center of the International Pilot Study of Schizophrenia. By RDC criteria, 12 patients were diagnosed as major depressive disorders and the remaining 108 patients were diagnosed either schizophrenias, schizoaffective disorders, or unspecified functional psychoses. Of these 108, 97 were also diagnosed schizophrenic or schizoaffective by at least three other sets of critera. Ten-year followups were obtained on 82 (68%) of the 120 patients. Outcome was not significantly predicted by either presence or number of FRS, by an NHSI diagnosis of schizophrenia, or by a diagnosis of schizophrenia using the 12-point Flexible system with a 5-point cutoff. However, a significant relationship was found with the St. Louis criteria and the Bland-Orn score obtained from these criteria. An even higher correlation was found between followup and the Stephens-Astrup scale and the Strauss-Carpenter prognostic scale. RDC and DSM-II diagnoses were also significantly correlated with followup but to a lesser degree.
Subject(s)
Schizophrenia/diagnosis , Adult , Antipsychotic Agents/therapeutic use , Drug Therapy, Combination , Female , Humans , Male , Middle Aged , Outcome and Process Assessment, Health Care , Phenothiazines , Prognosis , Psychotic Disorders/diagnosis , Schizophrenia/drug therapy , Schizophrenic Psychology , Social AdjustmentABSTRACT
The clinical promise of penfluridol as a long-acting oral antipsychotic medication has led to a number of controlled studies designed to verify its usefulness. These studies have been reviewed and compared with a controlled study carried out by the authors. The data obtained from this study have tended to confirm the impression of previous investigators that penfluridol, administered in a dosage of 40 to 80 mg on a once-a-week basis in a single dose, compares favorably with the antipsychotic activity of those neuroleptics requiring administration on a daily basis.
