ABSTRACT
Ninety-two outpatients (31 women, 61 men) who were treated with oral sildenafil for psychotropic-induced sexual dysfunction (PISD) completed ratings of their sexual functioning pre- and posttreatment. Both women and men reported significant improvements (p = .001) in all domains of sexual functioning, with 88% reporting improvement in overall sexual satisfaction. Significant improvements were reported regardless of psychotropic medication type. However, patients taking selective serotonin re-uptake inhibitors reported less improvement in arousal, libido, and overall sexual satisfaction than did other patients, whereas patients taking benzodiazepines reported significantly more improvement in libido and overall sexual satisfaction. Oral sildenafil may be an effective treatment for PISD.
Subject(s)
Phosphodiesterase Inhibitors/therapeutic use , Piperazines/therapeutic use , Psychotropic Drugs/adverse effects , Sexual Dysfunctions, Psychological/chemically induced , Adult , Arousal/drug effects , Female , Humans , Libido/drug effects , Male , Personal Satisfaction , Phosphodiesterase Inhibitors/pharmacology , Piperazines/pharmacology , Purines , Retrospective Studies , Sex Factors , Sildenafil Citrate , SulfonesABSTRACT
In primates, social stress is associated with activation of the hypothalamic-pituitary-adrenal (HPA) axis. Social phobia is a common, often disabling, form of pathological anxiety characterized by marked distress in situations involving possible scrutiny or evaluation. Little is known about HPA function in patients with social phobia. We examined 24-hour excretion of urinary free cortisol (UFC) in 54 patients with social phobia and post-dexamethasone cortisol levels in 64 patients with social phobia and found no evidence of HPA-axis overactivity compared to normal controls, despite pathological levels of anxiety.
Subject(s)
Dexamethasone , Hydrocortisone/urine , Phobic Disorders/diagnosis , Adolescent , Adult , Arousal/physiology , Depressive Disorder/diagnosis , Depressive Disorder/urine , Female , Humans , Hypothalamo-Hypophyseal System/physiopathology , Male , Middle Aged , Phobic Disorders/urine , Pituitary-Adrenal System/physiopathology , Shyness , Stress, Psychological/complicationsABSTRACT
Sixty-five patients with social phobia were treated in a study that compared a cognitive-behavioral group treatment program with pharmacotherapy with alprazolam, phenelzine sulfate, or pill-placebo plus instructions for self-directed exposure to phobic stimuli. Statistically significant repeated-measures effects were shown on all measures, indicating that the treatments studied were associated with substantial improvements in patients with severe and chronic social phobia. Patients who were treated with phenelzine were rated by clinicians as more improved on a measure of work and social disability than patients who were treated with alprazolam or placebo (patients in the cognitive-behavior therapy group were not rated on this measure). Subjects showed positive cognitive changes from before to after treatment, and there were no differences between treatment groups on the cognitive measure. We discuss the implications of these findings within the context of demographic and clinical predictors of response.
Subject(s)
Alprazolam/therapeutic use , Behavior Therapy , Cognitive Behavioral Therapy , Phenelzine/therapeutic use , Phobic Disorders/therapy , Adolescent , Adult , Ambulatory Care , Double-Blind Method , Female , Follow-Up Studies , Humans , Implosive Therapy , Male , Middle Aged , Personality Inventory , Phobic Disorders/drug therapy , Phobic Disorders/psychology , Placebos , Psychiatric Status Rating Scales , Research DesignABSTRACT
The authors examined the longitudinal course of affective illness retrospectively in 63 patients with social phobia and 54 patients with panic disorder. Significantly fewer (35%) of the patients with social phobia than patients with panic disorder (63%) had experienced at least one major depressive episode. Patients with generalized social phobia and patients with specific social phobia had comparable past rates of major depression (37% and 30%, respectively). The clinical and theoretical implications of these findings are discussed within the context of current concepts regarding the development of depressive symptoms in patients with anxiety disorders.
Subject(s)
Depressive Disorder/complications , Phobic Disorders/complications , Adolescent , Adult , Anxiety Disorders/complications , Anxiety Disorders/diagnosis , Anxiety Disorders/psychology , Depression/complications , Depression/diagnosis , Depression/psychology , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Female , Humans , Male , Panic , Psychiatric Status Rating Scales , Retrospective Studies , Risk FactorsABSTRACT
We evaluated the behavioral and physiologic effects of clonidine hydrochloride, a centrally active alpha 2-adrenergic agonist, in two separate studies of patients with panic disorder. In the first study, intravenous clonidine (2 micrograms/kg) and placebo were administered on a blind basis to 12 patients with panic disorder and ten normal controls. Clonidine produced significantly greater decrements in anxiety at one hour in the patients with panic disorder than in the controls. The changes in pulse, blood pressure, and ratings of sleepiness did not differ significantly between patients and controls. In the second study, oral clonidine was administered to 18 patients in a double-blind, flexible-dose treatment trial averaging ten weeks in duration. While anxiolytic effects were noticed in some patients, these effects did not persist in the group as a whole. These two studies indicate that while clonidine has short-term anxiolytic effects in patients with panic disorder, these effects do not persist with long-term administration in most patients.
Subject(s)
Anxiety Disorders/drug therapy , Clonidine/therapeutic use , Fear , Panic , Administration, Oral , Adult , Anxiety Disorders/psychology , Blood Pressure/drug effects , Clinical Trials as Topic , Clonidine/administration & dosage , Clonidine/pharmacology , Dose-Response Relationship, Drug , Double-Blind Method , Drug Administration Schedule , Female , Heart Rate/drug effects , Humans , Injections, Intravenous , Male , Middle Aged , Personality Inventory , Pulse/drug effects , Sleep/drug effectsSubject(s)
Agoraphobia/physiopathology , Anxiety Disorders/physiopathology , Brain/physiopathology , Clonidine , Fear/physiology , Growth Hormone/blood , Panic/physiology , Phobic Disorders/physiopathology , Adrenergic Fibers/physiology , Adult , Antidepressive Agents, Tricyclic/therapeutic use , Depressive Disorder/physiopathology , Female , Humans , Male , Middle Aged , Neural Pathways/physiopathologyABSTRACT
The authors present a review of existing literature along with new data regarding the phenomenology, differential diagnosis, course and treatment of panic disorder and agoraphobia. Panic attacks are viewed as central to the development of these disorders, and individual cognitive frameworks contribute to the manner in which a patient's symptoms evolve. An apparent though unclear relation to depressive states is described. Substance abuse may also be a consequence of recurrent panic attacks. A scheme towards differential diagnosis of panic disorder from other psychiatric and medical disorders is proposed. Personality characteristics of these patients vary considerably, but certain factors, such as dependency, are common. Family relations are often strained and assume importance in treatment. Data on the longitudinal course of illness is presented implying a relationship of panic disorder to both depression and stressful life events in many patients. Treatments that thus far seem most effective are pharmacological and behavioural approaches. Imipramine, MAO inhibitors, and alprazolam currently appear to be the most useful medications employed, although other agents may at times be useful alternatives. Dietary interventions, family therapy, and group and individual psychotherapy are also reviewed and discussed as adjunctive therapies in the treatment of panic disorder.
Subject(s)
Agoraphobia/diagnosis , Anxiety Disorders/diagnosis , Fear , Panic , Phobic Disorders/diagnosis , Agoraphobia/psychology , Agoraphobia/therapy , Antidepressive Agents/therapeutic use , Anxiety Disorders/psychology , Anxiety Disorders/therapy , Behavior Therapy , Benzodiazepines/therapeutic use , Caffeine/adverse effects , Dependency, Psychological , Depressive Disorder/complications , Depressive Disorder/genetics , Diagnosis, Differential , Family , Humans , Life Change Events , Mitral Valve Prolapse/diagnosis , Personality , Phobic Disorders/complications , Substance-Related Disorders/complicationsABSTRACT
The longitudinal course of panic disorder and its associated symptoms were investigated in thirty-eight patients. The temporal relationships among panic attacks, generalized anxiety, agoraphobia and depression are described. Similar and different biological alterations in the tricyclic-responsive disorders of primary depression and panic disorder are reviewed and discussed.
Subject(s)
Anxiety Disorders/psychology , Fear , Panic , Adult , Agoraphobia/complications , Antidepressive Agents, Tricyclic/therapeutic use , Anxiety Disorders/complications , Anxiety Disorders/drug therapy , Depressive Disorder/complications , Epilepsy, Temporal Lobe/psychology , Female , Humans , Life Change Events , Limbic System/physiopathology , Middle Aged , Retrospective StudiesABSTRACT
Seven of nine patients with panic disorder given a standard glucose tolerance test developed symptomatic hypoglycemia but not panic attacks. These findings suggest that hypoglycemia is an unlikely cause of "spontaneous" panic attacks in this population.
Subject(s)
Anxiety Disorders/blood , Fear , Glucose Tolerance Test , Hypoglycemia/blood , Panic , Adult , Anxiety Disorders/etiology , Anxiety Disorders/psychology , Blood Glucose/analysis , Female , Humans , Hypoglycemia/complications , Middle AgedABSTRACT
Electroencephalographic sleep recordings were compared in patients with panic disorder and normal controls. Correlation coefficients of standard sleep parameters versus ratings of anxiety, depression, and panic attack frequency were calculated in the panic-anxious patients. Overall findings are discussed in the context of previous sleep studies in patients with depressive, anxiety, and obsessive-compulsive disorders.
Subject(s)
Fear/physiology , Panic/physiology , Phobic Disorders/physiopathology , Sleep/physiology , Adult , Arousal , Electroencephalography , Female , Humans , Male , Middle Aged , Motor Activity , Reaction Time , Sleep, REM/physiologyABSTRACT
The experiences of human fear and anxiety are discussed within the context of locus ceruleus function in animals. The rationale for studying correlates of noradrenergic function, such as 3-methoxy-4-hydroxyphenethylene glycol (MHPG), is reviewed, and data demonstrating a positive correlation between plasma free MHPG and state anxiety in normal volunteers is presented. The behavioral effects of oral caffeine (240-720 mg), intravenous clonidine (2 micrograms/kg), and oral yohimbine (20 mg) were studied in various psychiatric patients and normal volunteers. Caffeine and yohimbine had anxiogenic properties; conversely, clonidine reduced self-rated measures of anxiety across a wide spectrum of psychiatric conditions. These findings expand previous research indicating that noradrenergic hyperactivity may be associated with many types of human fear and anxiety.
