ABSTRACT
Blunted neuroendocrine and physiological responses to the selective 5-HT(1A) receptor agonist, ipsapirone, have been observed in patients with panic disorder and/or agoraphobia (PDA). In order to examine whether this hyporesponsiveness to ipsapirone is modified by pharmacological or non-pharmacological therapeutic interventions, challenges with an oral dose of ipsapirone (0.3 mg/kg) and placebo were performed in patients with PDA before and after 10 weeks of treatment with clomipramine, aerobic exercise and placebo. Before treatment, administration of ipsapirone was followed by significant increases of cortisol, anxiety and other psychopathological symptoms in comparison to the placebo challenge. In addition, a significant decrease of body temperature was observed. After the 10-week treatment period, the psychological responses to ipsapirone were significantly reduced in the clomipramine and the exercise group. In contrast, there was a non-significant trend towards higher cortisol responses after clomipramine and exercise treatment. The hypothermic response to ipsapirone was significantly reduced by clomipramine treatment. In conclusion, our results demonstrate that effective treatment of panic disorder has divergent effects on the psychological, neuroendocrine and temperature responses to ipsapirone.
Subject(s)
Clomipramine/therapeutic use , Exercise Therapy , Exercise , Panic Disorder/metabolism , Panic Disorder/therapy , Receptors, Serotonin/metabolism , Selective Serotonin Reuptake Inhibitors/therapeutic use , Adolescent , Adult , Agoraphobia/drug therapy , Agoraphobia/psychology , Body Temperature/drug effects , Combined Modality Therapy , Double-Blind Method , Exercise Test , Female , Humans , Hydrocortisone/blood , Male , Middle Aged , Panic Disorder/psychology , Psychiatric Status Rating Scales , Pyrimidines/blood , Pyrimidines/therapeutic use , Receptors, Serotonin/drug effects , Receptors, Serotonin, 5-HT1 , Serotonin Receptor Agonists/blood , Serotonin Receptor Agonists/therapeutic useABSTRACT
BACKGROUND: A new 13-item scale has been developed for measuring severity of illness in patients with panic disorder and agoraphobia, the Panic and Agoraphobia Scale (P & A). The scale has five subscales covering the main factors that reduce quality of life in panic disorder patients (panic attacks, avoidance, anticipatory anxiety, disability and worries about health). The application of this scale in a double-blind placebo-controlled panic disorder trial is described. At the same time, the aim of the study was to compare the therapeutic effects of aerobic exercise with a treatment of well-documented efficacy. METHODS: Patients with Panic disorder (DSM-IV) were randomly assigned to three treatment modalities: running (n=45), clomipramine (n=15) or placebo (n=15). Treatment efficacy was measured with the Panic and Agoraphobia Scale (P & A) and other rating scales. RESULTS: According to the P & A and other scales, both exercise and clomipramine led to a significant decrease of symptoms in comparison to placebo treatment. Clomipramine was significantly more effective and improved anxiety symptoms significantly earlier than exercise. The evaluation of the P & A subscales revealed that exercise exerted its effect mainly reducing anticipatory anxiew and panic-related disability. CONCLUSIONS: The new Panic and Agoraphobia Scale was shown to be sensitive to differences between different panic treatments. Analysis of the scales five subscores may help to understand mechanisms of action of panic disorder treatments.
Subject(s)
Agoraphobia/psychology , Agoraphobia/therapy , Panic Disorder/psychology , Panic Disorder/therapy , Antidepressive Agents, Tricyclic/adverse effects , Antidepressive Agents, Tricyclic/therapeutic use , Clomipramine/therapeutic use , Combined Modality Therapy , Double-Blind Method , Exercise Therapy , Female , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Running/psychologyABSTRACT
OBJECTIVE: The purpose of this study was to compare the therapeutic effect of exercise for patients with panic disorder to a drug treatment of proven efficacy and to placebo. METHOD: Forty-six outpatients suffering from moderate to severe panic disorder with or without agoraphobia (DSM-III-R criteria) were randomly assigned to a 10-week treatment protocol of regular aerobic exercise (running), clomipramine (112.5 mg/day), or placebo pills. RESULTS: The dropout rate was 31% for the exercise group, 27% for the placebo group, and 0% for the clomipramine group. In comparison with placebo, both exercise and clomipramine led to a significant decrease in symptoms according to all main efficacy measures (analysis of variance, last-observation-carried-forward method and completer analysis). A direct comparison of exercise and clomipramine revealed that the drug treatment improved anxiety symptoms significantly earlier and more effectively. Depressive symptoms were also significantly improved by exercise and clomipramine treatment. CONCLUSIONS: These results suggest that regular aerobic exercise alone, in comparison with placebo, is associated with significant clinical improvement in patients suffering from panic disorder, but that it is less effective than treatment with clomipramine.
Subject(s)
Clomipramine/therapeutic use , Exercise , Panic Disorder/therapy , Adult , Agoraphobia/drug therapy , Agoraphobia/epidemiology , Agoraphobia/therapy , Bias , Comorbidity , Female , Humans , Male , Outcome Assessment, Health Care , Panic Disorder/drug therapy , Panic Disorder/epidemiology , Placebos , Psychiatric Status Rating Scales/statistics & numerical data , Treatment OutcomeABSTRACT
Several studies in healthy volunteers have shown a positive effect of endurance training on anxiety, depressive symptoms, self-esteem, concentration and stress tolerance. There are only a few controlled studies examining the therapeutic potential of exercise in psychiatric disorders. However, there is good evidence that exercise is effective in mild to moderate depression and in anxiety disorders. The therapeutic effect did not correlate with changes in cardiopulmonary fitness in the majority of studies. Therefore, other neurobiological and psychological mechanisms are discussed which might explain the effectiveness of regular physical training. The authors offer a variety of suggestions, how exercise could be integrated and evaluated in the treatment of psychiatric disorders.
Subject(s)
Anxiety Disorders/rehabilitation , Depressive Disorder/rehabilitation , Exercise/psychology , Mental Disorders/rehabilitation , Anxiety Disorders/physiopathology , Anxiety Disorders/psychology , Combined Modality Therapy , Depressive Disorder/physiopathology , Depressive Disorder/psychology , Exercise/physiology , Humans , Mental Disorders/physiopathology , Mental Disorders/psychology , Physical Fitness/physiology , Physical Fitness/psychology , Serotonin/physiology , Treatment OutcomeABSTRACT
Questionnaires assessing interpersonal problems may be of relevance in the field of psychotherapy not only to determine therapeutic goals but also for predicting the quality of the therapeutic alliance. Our study on the clinical validity of the Inventory of Interpersonal Problems-IIP (Horowitz) focussed on patients with affective disorders. According to the literature we hypothesized two subgroups with different areas of problems: one with high interpersonal dependency, one with an overly autonomous stance. Our sample comprises 169 patients of a psychotherapeutic outpatient clinic for students with the diagnosis of an affective disorder according to ICD 10 and a partly (age, sex, subject) comparison group of 119 students. The IIP was able to replicate the aforementioned groups. The instrument therefore may be applied to measure change in depressive psychopathology. It also might offer help for differential indication in psychotherapy.
