Seasonality in panic disorder.

Following a clinical observation of increased anxiety symptoms and mood changes during winter in panic disorder patients, the Seasonal Pattern Assessment Questionnaire (SPAQ) was completed by 133 patients. Global Seasonality Scores (GSS), and the prevalence of Seasonal Affective Disorder (SAD), were significantly higher than reported in general population studies. Seasonal changes were also found in anxiety and panic attacks. These findings suggest the possibility of a common aetiology for panic disorder and SAD, that seasonality may be a far more general phenomenon in psychopathology, and that light therapy may be a useful treatment for some panic disorder patients.

Short-acting versus long-acting benzodiazepines: discontinuation effects in panic disorders.

An increasing body of evidence suggests that benzodiazepines--which have long been considered the drugs of choice in the treatment of various anxiety disorders due to their relative lack of side effects, lack of adverse drug reaction, their safety, and increased efficacy over other agents--are effective in the treatment of panic disorders. Originally, the benzodiazepines were believed to be devoid of dependence-inducing properties, even at high doses. Recent evidence, however, suggests that discontinuation of both high and normal doses of both short- and long-acting benzodiazepines generally results in similar withdrawal symptoms, including anxiety and sleep and perceptual disturbances. This article presents a brief review of benzodiazepine withdrawal, with an emphasis on the discontinuation of these drugs following treatment of panic disorders. In particular, short-acting and long-acting drugs may present different features following long-term treatment and withdrawal. Preliminary results from a study comparing alprazolam and diazepam are presented to illustrate this point in contrast to expectations: the problems associated with withdrawal of both agents were comparable.

A short term open clinical trial of clobazam in the treatment of patients with panic attacks.

Clobazam, a 1-5 benzodiazepine with anxiolytic properties, was evaluated in the treatment of patients with DSM-III panic disorder or agoraphobia with panic attacks. In this open clinical trial, 10 of the 15 patients completed 8 weeks of treatment. Six of the 10 completers (60%) were responders (75% reduction in the number of panic attacks from baseline) at the end of 8 weeks. Of the responders so defined, 5 of the 6 were panic free. At the end of week 8 the average dose for the responders to medication was 50 +/- 17 (S.D.) mg per day. Clobazam was well tolerated at the doses used with the few side-effects recorded as mild to moderate. The study suggests that further placebo-controlled studies are warranted to evaluate clobazam's potential antipanic effect.

Plasma prolactin and fluphenazine concentrations in patients receiving fluphenazine decanoate: stability over injection intervals.

Plasma prolactin and fluphenazine concentrations were measured in a group of 17 patients (9 males, 8 females) with schizophrenia who were receiving chronic treatment with fluphenazine decanoate. Neither measure was significantly correlated with clinical effect, as measured by the Brief Psychiatric Rating Scale, at any of the 5 pre-injection times examined. None of the measures showed statistically significant (P greater than 0.05; MANOVA) variations with time. Neither measure showed a significant correlation with the dose (expressed as mg/kg) of fluphenazine. The implications of the study for monitoring chronic treatment of schizophrenia are discussed.

The pineal hormone melatonin in panic disorder.

The nocturnal synthesis of the pineal hormone melatonin was examined from 8 p.m. to midnight in 11 patients with panic disorder and eight control subjects. Patient concentrations of melatonin were significantly lower than controls at 10 p.m. (P less than 0.05; Kruskal-Wallis one-way ANOVA) and midnight (P less than 0.01). At 9 p.m. and 11 p.m., patient concentrations were also lower than controls, but were not statistically significantly different (P = 0.09). From these data, it is postulated that some patients with panic disorder exhibit a generalised defect in sensitivity of beta-adrenergic receptors or of sympathetic transmission.

Zimelidine: a placebo-controlled trial in depression.

Twenty-eight hospital inpatients with a primary major depressive disorder were treated with either zimelidine or placebo. Patients were matched for age, sex, and initial severity of depression and assigned double blind to the treatment regimen. An initial dosage of 150 mg/day was used for up to 6 weeks. Zimelidine was significantly more effective in alleviating the symptoms of depression than placebo, with 82% of zimelidine and 25% of placebo patients showing clinical improvement. There were few complaints of severe side effects in zimelidine-treated patients, and few effects on the cardiovascular system. Two zimelidine-treated patients were withdrawn for suspected drug-related adverse events. Zimelidine was a safe, effective antidepressant in this group of patients.

Zimeldine in depressive illness--efficacy and safety data.

Two studies of zimeldine in depressive illness are reported, one a double-blind, placebo-controlled trial, the other an open evaluation. In both studies, zimeldine was shown to have antidepressant properties. No simple relationship between plasma zimeldine or norzimeldine and clinical effect was demonstrated in eight patients treated for 6 weeks. Minor changes in electrocardiographic parameters were noted in some zimeldine patients. Side-effects attributable to zimeldine treatment were generally of mild to moderate severity and the drug was well tolerated. During the studies, one patient overdosed on zimeldine (5.2 g) and, although plasma concentrations were excessive, minimum side-effects were recorded. Two cases of suspected adverse drug reactions with zimeldine are described.

Reducing hospital readmission rates among schizophrenics.

Most schizophrenics become in-patients in State mental hospitals, and most improve on neuroleptic medication and are rapidly discharged. The majority require long-term medication; the single most important factor in maintaining remission. This paper describes a mirror-image study using patients as their own controls, and demonstrates the highly significant differences in hospitalization before and after the administration of a depot phenothiazine. It highlights the need for vigorous and determined out-patient follow-up. It is suggested that the costs of an adequately staffed clinic are still small when compared with the costs of hospitalization. Subgroups of poor drug-responders, sex differences, variations in side effects and frequency of administration of the depot drug require further evaluation.