Heart rate and blood pressure in panic disorder, major depression, and comorbid panic disorder with major depression.

Secondary major depression is common in patients with panic disorder (PD) and has been reported to worsen prognosis. Little is known about the effect of comorbid depression on the autonomic symptoms associated with PD. In this study, the heart rate and blood pressure of 44 patients with PD, 20 patients with major depression (MD), and 12 patients with both panic disorder and depression (PDD) were measured during postural challenge. Patients with PDD were found to have higher diastolic and systolic pressures throughout (P < 0.05), and to have a higher resting cardiac load (P < 0.05). This heightened autonomic arousal remained when the effects of age, race, and the frequency of panic attacks were removed. The results suggest that PDD patients may have increased autonomic dysfunction.

Mixed symptoms and syndromes of anxiety and depression: diagnostic, prognostic, and etiologic issues.

Patients with comorbid symptoms of anxiety and depression are common in clinical practice, and yet they continue to pose a diagnostic and therapeutic challenge to clinicians and researchers alike. This article is intended as a comprehensive review of current knowledge derived from a vast body of clinical research regarding the diagnostic interrelationships of anxiety and depressive disorders at both syndromal and subsyndromal levels. The prognostic implications of comorbidity are also reviewed. Biological linkages between the two disorders are explored, and recent biological theories attempting to explain and integrate the two disorders are presented as well. The article concludes with suggestions for further research.

Explained and unexplained medical symptoms in generalized anxiety and panic disorder: relationship to the somatoform disorders.

We have examined the numbers and types of symptoms in a sample of 90 patients with generalized anxiety disorder (GAD) and 77 patients with panic disorder (PD) collected from six different sites during the conduct of a multicenter clinical trial. This information was obtained utilizing the Health Questionnaire, a 47-item self-report list of medical symptoms, patterned after the Somatization Disorder section of the Diagnostic Interview Schedule. Although the patients in this sample had a wide variety of medically explained and unexplained physical symptoms, none of them qualified for a diagnosis of somatization disorder by DSM-III-R criteria. GAD and PD patients reported remarkably similar numbers of explained and unexplained medical symptoms. The panoply of somatic symptoms presented by these patients presents a formidable diagnostic challenge for clinicians. These findings suggest that the pattern of overutilization of medical services that is well documented for PD patients may also be found for GAD patients.

Serum cholesterol levels in patients with generalized anxiety disorder (GAD) and with GAD and comorbid major depression.

OBJECTIVE: To investigate risk for cardiovascular disease in patients with GAD, as well as the effects of comorbid major depression (MD). METHOD: Predrug-trial serum cholesterol and triglyceride levels were assessed in 38 patients with pure GAD and compared with those of 21 patients with mixed GAD and comorbid (MD). RESULTS: Significantly higher cholesterol and triglyceride levels were found in the GAD group. CONCLUSION: Increased noradrenergic activity may be responsible for elevations in lipid levels in patients with pure GAD.

Memory, benzodiazepines, and anxiety: integration of theoretical and clinical perspectives.

The benzodiazepines have been reported to cause anterograde amnestic effects. These impairments are likely mediated through the GABAA receptor complex, which contains the benzodiazepine receptor binding site. This GABAA receptor site is also believed to be the locus of the anxiolytic effects of the drugs as well, and recent research findings suggest that the anxiolytic and amnestic properties of the benzodiazepines may be functionally linked. Normal human memory function is extremely complex and requires the smooth integration of multiple aspects of cognition. On the basis of neuropsychological testing, the processes of memory have been divided into a variety of functions or stores that are interrelated, yet distinct. The amnestic effects of the benzodiazepines have been extensively studied within the context of this conceptual framework. Studies to date have shown that the memory deficits produced by the drugs are relatively selective and are primarily caused by impairments in the acquisition of newly learned information into long-term episodic storage. Benzodiazepines may impair other aspects of memory as well, but findings across studies have been inconsistent. The drugs clearly do not impair the recall of previously learned information, unlike anticholinergic drugs with amnestic effects, such as scopolamine. The amnestic effects of the benzodiazepines are dose-dependent, and can be predicted by pharmacokinetic/pharmacodynamic variables. In addition, multiple clinical factors may influence the likelihood of memory impairments. The amnestic effects of alprazolam are consistent with the drug effects of the benzodiazepines as a group.

Generalized anxiety disorder patients seek evaluation for cardiological symptoms at the same frequency as patients with panic disorder.

Although panic disorder (PD) and generalized anxiety disorder (GAD) have similar somatic symptoms, panic attacks with chest pain and/or palpitations may seem more likely to be mistaken for heart attacks because of their acute onset. One would therefore expect that PD patients are more likely than GAD patients to seek cardiological consultations. In a survey of 146 PD and 154 GAD patients entering a multi-site drug trial, we found virtually identical rates of such consults. Approximately 50% of each patient group sought medical evaluation for cardiac symptoms. Furthermore, 40% of each group had standard treadmill evaluations and 33% reported having an echocardiogram. This study suggests that future epidemiological studies in cardiology populations should include probes for generalized anxiety disorder.

Alprazolam as a neuroleptic adjunct in the emergency treatment of schizophrenia.

OBJECTIVE: While neuroleptics remain the mainstay of drug intervention in the emergency management of psychosis, a variety of agents have received study as alternatives or adjuncts to these drugs in an attempt to improve the safety and efficacy of acute treatment. The purposes of this study were to investigate the efficacy and safety of alprazolam as a neuroleptic adjunct for schizophrenic patients in psychotic relapse and to clarify the effects of combination treatment on specific aspects of the psychotic process. METHOD: Twenty-eight acutely psychotic patients with schizophrenia who were admitted to an emergency psychiatric service were randomly assigned to treatment with either haloperidol and alprazolam or haloperidol with placebo under double-blind conditions. Drug administration lasted 72 hours. RESULTS: Both groups improved significantly. The combination-treated group required significantly less medication and had 56% fewer dystonic reactions. The addition of alprazolam was most effective for symptoms of excitement and uncooperativeness, particularly in the initial hours of treatment. CONCLUSIONS: The combination of alprazolam and haloperidol seems to be the most effective for agitated patients, particularly in the first 48 hours of treatment. It may also result in fewer dystonic reactions.

Differential effects of alprazolam and buspirone upon acquisition, retention, and retrieval processes in memory.

A group of 125 healthy young adults was given a memory battery 1 hour after administration of alprazolam (0.5 and 1.0 mg), buspirone (5 and 10 mg), and placebo under single-dose, double-blind conditions. On the wordlist recall battery and a 24-hour retest, alprazolam appeared to impair acquisition and retention in dosages of 1.0 mg; buspirone did not adversely affect test performance at either dosage. On the basis of a 3-stage model of memory, a neuroantomical/neurophysiological model is proposed to explain the selective effects of the benzodiazepines on memory function.

A comparison of the single-dose effects of alprazolam, buspirone, and placebo upon memory function.

The effects of alprazolam and buspirone at varying dosages were compared with placebo in a battery of memory and cognitive tests in a sample of 125 young, healthy medical students by utilizing a single-dose, double-blind design. Although the dosages in this study did not impair visuomotor reaction time in any of the experimental groups, 1.0 mg of alprazolam did result in significantly impaired performance on selective aspects of memory function as assessed by the memory battery.

Toward a new alliance : psychiatric residents and family support groups.

In an attempt to assess the status of residency training in psychoeducational approaches for families of chronically ill patients, the authors conducted a national survey of U.S. residency training programs. Responses from 154 programs (75%) indicated a wide variation in time allotted, activities, and participants in such training among the respondents. Less than 50% of the programs indicated formal involvement of family support groups such as the National Alliance for the Mentally Ill (NAMI) and the National Depressive and Manie-Depressive Association (NDMDA). The authors describe a program they have initiated that incorporates organized family support groups in such training efforts.

Alcohol and substance abuse among schizophrenic patients presenting to an emergency psychiatric service.

To obtain information regarding patterns of alcohol and substance use, portions of the Diagnostic Interview Schedule (DIS) were administered to 53 schizophrenic patients who presented to the crisis service of an emergency room in a major general hospital. The number of individuals in the sample qualifying for a lifetime diagnosis of an alcohol abuse-related disorder was quite high (47%), and there was a strong correlation between disorders of alcohol abuse and the use of other drugs. Other than alcohol, marijuana was the most frequently abused drug. Individuals who qualified for a diagnosis of an alcohol-related disorder were compared with those who did not on a variety of diagnostic and demographic variables. The authors conclude by suggesting that the high-risk rates of drug use-related disorders reported in this sample may be due to the preferential use of emergency services by schizophrenic patients with alcohol and drug abuse-related disorders.

Effect of a partial report visual cue on information available in tachistoscopic presentations of alphanumeric characters varying in number and type.

The capacity of iconic memory is investigated using a variety of cueing techniques. As an alternative to auditory recall cues, a tachistoscopically presented arrow, with two exposure-fields at different luminances, was employed in a partial report paradigm. Alphanumeric target stimulus arrays varied in number and type. Results with 12 normal adults indicated that subjects recalled fewer items when the target array contained nine elements, as opposed to six, and when the visual cue was presented at a higher luminance. In all cases, numbers appeared easier to recall than letters. In general, subjects had less information available for recall than reported in previous studies employing auditory cues. It is possible that the effects observed are the result of backward masking by the visual cue. Nevertheless, subjects' performance suggests that the visual modality should not necessarily be abandoned for recall cueing.

Effect of diazepam on visuomotor reaction time.

20 male and 10 female adult, normal, healthy subjects, whose mean age was 26.34 yr., participated in a double-blind study of the effect of a single dose (0.2 mg./kg. of body weight) of diazepam on visuomotor reaction time. Reaction time was measured before drug administration, and 60 min., and 120 min. after administration. Separate reaction times for the dominant and nondominant hand were recorded. There were no significant differences between the diazepam and placebo group at each of the three time intervals. Diazepam in the single dose employed does not appear to affect adversely visuomotor reaction time of relatively young, normal, healthy adults. For both groups the difference in visuomotor reaction time between the dominant hand and the nondominant hand was statistically significant as expected.

Critical stimulus durations for some verbal and nonverbal stimuli.

Durations of stimulus exposures in visual backward masking are determined with reference to critical stimulus durations. These are defined as the minimum, undisrupted, durations of exposure for 100% accuracy for a predetermined number of trials. These durations are shown to vary both within and between classes of stimuli for 10 normal adults with a mean age of 26.40 yr. The verbal stimuli employed (letters of the alphabet) were significantly easier to discern than the nonverbal stimuli (arrows). Although some letters were more readily identified than others, differences were not significant. The results suggest that type of stimuli, nature of response, and the ease with which stimuli can be discerned be considered in the selection of target stimuli for experiments using masking.