RESUMEN
BACKGROUND: The objective of this study was to evaluate the efficacy and tolerability of citalopram in the long-term treatment of adult outpatients with panic disorder with or without agoraphobia. METHOD: Patients in this double-blind, parallel-group trial were assigned to 1 of 3 fixed dosage ranges of citalopram (10 or 15 mg/day, 20 or 30 mg/day, or 40 or 60 mg/day), 1 dosage range of clomipramine (60 or 90 mg/day), or placebo. After the completed 8-week acute treatment period, the eligible patients could continue the treatment for up to 1 year. Of the 475 patients who were randomly assigned for the short-term trial, 279 agreed to continue double-blind treatment at their assigned doses. The primary efficacy measure used was the Clinical Anxiety Scale panic attack item, and the response was defined as no panic attacks (score of 0 or 1). The other key measures used were the Physician's Global Improvement Scale, the Patient's Global Improvement Scale, and the Hamilton Rating Scale for Anxiety (HAM-A). RESULTS: In all drug-treated groups, except the group receiving the lowest citalopram dose, the treatment outcome was generally better than with placebo. As determined by a life table analysis of response, the probability of response during the 12 months was significantly greater with all treatment regimens than with placebo (p < .05), with citalopram 20 or 30 mg/day demonstrating the best response. Panic attacks tended to disappear in all patients remaining in the study until the end of follow-up. Analysis of the difference in the number of patients in different treatment groups remaining in the study (perhaps the best measure of long-term efficacy) also demonstrated that the patients treated with citalopram in dosage ranges of 20 or 30 mg/day and 40 or 60 mg/day had better response than placebo-treated patients (p < .0002 and p < .004, respectively). HAM-A and Global Improvement Scale scores also showed that patients treated with active drug showed greater improvement than placebo-treated patients. All treatment groups showed no new or exceptional adverse event clusters. CONCLUSION: Citalopram in the dosage range of 20 to 60 mg/day is effective, well tolerated, and safe in the long-term treatment of patients who have panic disorder.
Asunto(s)
Citalopram/uso terapéutico , Trastorno de Pánico/tratamiento farmacológico , Adolescente , Adulto , Citalopram/administración & dosificación , Citalopram/efectos adversos , Método Doble Ciego , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastorno de Pánico/psicología , Pacientes Desistentes del Tratamiento , Placebos , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Resultado del TratamientoRESUMEN
Neuroleptic malignant syndrome (NMS) is a rare, life-threatening complication of neuroleptic treatment. The authors describe a case of NMS during treatment with a new atypical neuroleptic, remoxipride. To their knowledge, there are no previously reported cases.
Asunto(s)
Síndrome Neuroléptico Maligno/etiología , Remoxiprida/efectos adversos , Anciano , Trastorno Bipolar/tratamiento farmacológico , Trastorno Bipolar/psicología , Femenino , Humanos , Remoxiprida/uso terapéuticoRESUMEN
Fifty-five patients with moderate to sever panic disorder were treated for 9 weeks with alprazolam or imipramine and were then, except for one patient who had committed suicide, re-examined after on average 3 years of treatment. At follow-up most patients (74%) did not suffer from panic attacks at all. In the beginning of the study 87% exhibited phobic avoidance behaviour but after 3 years 68% no longer revealed phobic behaviour. At follow-up 28% of the patients were no longer having psychotropic drug treatment and 20% were completely free of overt psychopathology. No tolerance phenomena were associated with the long-term medication applied in the study.