Family history of alcoholism in women with generalized anxiety disorder who have premenstrual syndrome: patient reports of premenstrual alcohol consumption and symptoms of anxiety.

This study sought to determine whether family history of alcoholism is related to patient reports of premenstrual alcohol consumption and whether family history of alcoholism is related to severity of anxiety-related symptoms, in women who suffer simultaneously from both premenstrual syndrome and generalized anxiety disorder. Fifty-four women with generalized anxiety disorder and prospectively demonstrated premenstrual syndrome were questioned about family history of alcoholism and alcohol consumption patterns across the menstrual cycle. Seventy-six percent of the sample reported having an alcoholic first- or second-degree relative. Furthermore, 74% of those women having a paternal-side family history of alcoholism, but only 22% of those without such a family history, reported increased alcohol consumption premenstrually. Forty-one of these women were assessed by means of psychiatric rating scales during both the premenstrual and follicular phases of the menstrual cycle. During the premenstrual, but not the follicular, phase of the menstrual cycle, women with a paternal-side family history of alcoholism experienced more severe anxiety-related somatic, but not psychic, symptoms of anxiety, than those without such a family history. These findings suggest that family history of alcoholism may be related to premenstrual alcohol consumption patterns and to the severity of premenstrually experienced somatic symptoms of anxiety in women with premenstrual syndrome, and that these women may be self-medicating with alcohol.

Effect of fluvoxamine on panic disorder.

Several reports suggest that selective serotonin reuptake blockers are helpful in the treatment of panic disorder. The aim of the study was to compare fluvoxamine with placebo in 50 panic disorder patients by using an 8-week, double-blind, parallel-groups design. Weekly assessment included a panic attack diary (frequency and severity), the Montgomery-Asberg Depression Scale, the Clinical Anxiety Scale, and the Sheehan Disability Scale. Although both groups improved on all measures, the fluvoxamine group experienced significantly less frequent major panic attacks from the third week on and significantly lower ratings on anxiety, depression, and disability from the sixth week on. Mean ratings of the severity of major and the severity and frequency of minor attacks were not affected differently by fluvoxamine and placebo. At the end of the study, significantly more patients on fluvoxamine were free of major and minor panic attacks. The results indicate that: (1) the administration of fluvoxamine, as compared with placebo, led to a significant reduction in the number of panic attacks. (2) The severity of panic attacks was not affected by fluvoxamine. (3) The effect of fluvoxamine on anxiety, depressive mood, and disability differed from placebo only after 6 weeks of treatment, after which the placebo group showed either no further improvement or a reversal of symptoms. (4) Participation in a drug study, even without additional psychotherapy, led to significant improvement in all patients.

The influence of premenstrual syndrome on ratings of anxiety in women with generalized anxiety disorder.

During the premenstrual and follicular phases of the menstrual cycle, 41 women who had generalized anxiety disorder (GAD) plus premenstrual syndrome (PMS) were assessed with psychiatric rating scales and compared with 21 GAD patients without PMS and 19 controls. The latter two groups were rated only once, in the typical open-ended manner. Symptoms during both phases of the menstrual cycle were more severe in the GAD + PMS patients than in the controls and were more severe during the premenstruum. For the GAD + PMS patients, ratings obtained in the typical open-ended manner were influenced by how patients felt during the premenstruum. Thus, the assessment of women with GAD + PMS may be complicated by cyclical fluctuations in symptom severity, and ratings obtained in the typical manner may be influenced disproportionately by how these patients feel premenstrually.

Symptoms and physiologic manifestations in obsessive compulsive patients before and after treatment with clomipramine.

BACKGROUND: Anxiety and hyperarousal constitute important aspects of obsessive compulsive disorder (OCD). This study examined the effects of clomipramine on symptoms, arousal-related physiologic states, and stress reactions in OCD patients. METHOD: Twenty-five OCD patients were randomly assigned to a clomipramine or placebo group and were assessed for 10 weeks using a double-blind parallel design. They were assessed clinically with the Yale-Brown Obsessive Compulsive Scale, the National Institute of Mental Health Global Obsessive-Compulsive Scale, the patient- and investigator-rated Global Improvement Scales, and the Hamilton Rating Scale for Depression. Prior to treatment, and again during the last day of medication, physiologic states (heart rate, respiration, skin conductance, blood pressure, and EMG) were measured at rest and during both nonspecific (psychomotor tasks) and pathology-specific (visualization) stressors. RESULTS: Patients taking clomipramine, but not those taking placebo, improved significantly on all clinical measures. With the exception of heart rate, treatment did not affect resting physiologic states. Heart rate increased in patients taking clomipramine and decreased in patients taking placebo. Autonomic reactivity to nonspecific and to pathology-specific stressors was attenuated by clomipramine, but not by placebo. CONCLUSION: Clinical improvement on clomipramine treatment was independent of the physiologic state of the patients and was not associated with autonomic down-regulation. The attenuation of autonomic reactivity to stressors appears not to be pathology-specific but may reflect either a direct pharmacologic effect of clomipramine on the autonomic nervous system or a heightened indifference to psychological stressors in general.