Biomedical subjects

A Ehlers

Publications and source records attributed to A Ehlers.

At least 55 records · Page 3Linked to original sources

PubMed1996

How good are patients with panic disorder at perceiving their heartbeats?

Palpitations are among the most common symptoms of panic attacks. The present review addresses the question of whether systematic differences in heartbeat perception exist between patients with panic disorder and control subjects. Paradigms involving the comparison of heartbeat sensations with external signals such as discrimination task have failed to find group differences. Recent improvements in methodology may give clearer results in future studies. The majority of studies using the mental tracking paradigm have shown that panic disorder patients show a better heartbeat perception than controls. Discrepant results are probably related to different instructions and differences in sample characteristics such as the inclusion of patients on medication affecting the cardiovascular system. More accurate heartbeat perception, may, however, be restricted to those patients who show agoraphobic avoidance behavior. It is also conceivable that group differences in the mental tracking paradigm are due to attentional biases or a tendency to interpret weak sensations as heartbeats rather than differences in perceptual sensitivity. More ambulatory studies are needed to test whether the results can be generalized to the patients' natural environment. So far ambulatory studies have established superior heartbeat perception only in the subgroup of panic disorder patients with cardiac neurosis. A 1-year prospective study showed that heartbeat perception as assessed with the mental tracking paradigm predicted maintenance of panic attacks. This supports the clinical significance of the findings. Increased cardiac awareness may increase the probability of anxiety-inducing bodily sensations triggering the vicious cycle of panic. Laboratory and ambulatory monitoring studies showed that panic disorder patients respond with anxiety when they think that their heart rate has accelerated. Increased cardiac awareness may also contribute to the maintenance of the disorder by motivating the patients to avoid situations in which these sensations occur.

Agoraphobia↗

PubMed1995

Conditioning theory: a model for the etiology of public speaking anxiety?

To study the etiology of public speaking anxiety (speech phobia), 30 Ss with the fear of public speaking, and 24 controls without this fear were asked about past public speaking experiences, their beliefs about the main reason for their phobia, and their concerns in the feared situation. All speech phobics met the DSM-III-R criteria for social phobia. Results showed that traumatic external events, vicarious and informational learning--the causes for phobia that fit in best with Rachman's conditioning theory--were notably uncommon among these phobics, who attributed their fear most often to panic attacks. Yet it was not clear whether panic attacks were causes or consequences of phobia.

Adult↗

PubMed1995

Heartbeat perception and panic disorder: possible explanations for discrepant findings.

Results on cardiac awareness in panic disorder are inconsistent. The present study attempted to clarify whether differences in instructions or the inclusion of patients taking antidepressant medication could account for these inconsistencies. 112 patients with panic disorder with agoraphobia were compared to 40 normal controls on the heartbeat perception task developed by Schandry (1981) [Schandry, R., Psychophysiology, 18, 483-488] using a standard instruction ("count all heartbeats you feel in your body") and a strict instruction ("count only those heartbeats about which you are sure"). Superior heartbeat perception for patients was only found with the standard instruction. Similarly, only with the standard instruction, patients taking medication affecting the cardiovascular system performed worse than patients without medication, as expected based on the relationship between stroke volume and heartbeat perception. The pattern of group differences indicates that agoraphobic patients have a better feeling for how fast their heart is beating than controls although these differences may be due to a tendency to interpret weak sensations as heartbeats. Furthermore, we tested in a subgroup of 40 patients whether cardiac awareness changes with exposure treatment. No changes in heartbeat perception were observed.

Adrenergic beta-Antagonists↗

PubMed1995

A 1-year prospective study of panic attacks: clinical course and factors associated with maintenance.

A prospective naturalistic 1-year follow-up study of 39 patients with current panic disorder, 17 remitted panic patients, 46 infrequent panickers, 22 patients with simple phobias, and 45 controls assessed clinical course and variables related to the maintenance of panic attacks. Nearly all panic disorder patients (92%) continued to experience panic attacks, and 41% of the initially remitted patients relapsed. No significant effects of treatments delivered in the community were found. Infrequent panickers tended to be more likely to develop panic disorder (15%) than controls (2%). Maintenance/relapse was most consistently linked with good heartbeat perception, anxiety sensitivity, and avoidance in the different subsamples. Patients with simple phobias or normal controls who experienced their first panic attack during follow-up had shown higher anxiety sensitivity at initial assessment than nonpanickers.

Adult↗

PubMed1995

Psychophysiological differences between subgroups of social phobia.

Individuals meeting criteria of the revised third edition of Diagnostic and Statistical Manual for Mental Disorders (American Psychiatric Association, 1987) for social phobia with a fear of speaking in front of people were subdivided into those with (n = 16) and without (n = 14) avoidant personality disorder (APD). These individuals and nonanxious controls (n = 22) spoke in front of a small audience while speaking time, subjective anxiety, fearful thoughts, and electrocardiographic and respiratory measures were recorded. Controls spoke for longer than either social phobia group. Those with social phobia and APD reported more subjective anxiety and more fear cognitions than the other two groups; phobic individuals without APD showed greater heart rates in the phobic situation than either social phobics with APD or controls. The latter two groups did not differ in heart rate. These results indicate incongruent subjective and heart rate responses to the feared situation. A similar pattern of results was found when participants were divided into generalized and specific social phobia groups.

Adolescent↗

PubMed1995

Treatment of atopic dermatitis: a comparison of psychological and dermatological approaches to relapse prevention.

A randomized controlled trial compared the effectiveness of 4 group treatments for atopic dermatitis, a chronic skin disorder characterized by severe itching and eczema: dermatological educational program (DE), autogenic training as a form of relaxation therapy (AT), cognitive-behavioral treatment (BT), and the combined DE and BT treatments (DEBT). BT comprised relaxation, self-control of scratching, and stress management. Group treatments were also compared with standard medical care (SMC). Assessments at 1-year follow-up showed that the psychological treatments (AT, BT, and DEBT) led to significantly larger improvement in skin condition than intensive (DE) or standard (SMC) dermatological treatment, accompanied by significant reductions in topical steroids used. The results corroborate preliminary reports that psychological interventions are useful adjuncts to dermatological treatment in atopic dermatitis.

Adolescent↗

PubMed1994

Atopic dermatitis and stress: possible role of negative communication with significant others.

Clinical reports have related stressful social interactions to the course of atopic dermatitis (AD). Controlled behavioral observations of interaction patterns of AD patients and their significant others, however, were lacking. In two studies, adult AD patients and their mothers (N1 = 26) or partners (N2 = 67) engaged in a discussion of a mutual problem. Their verbal and nonverbal communication behavior was analyzed with a reliable standardized interactional coding system and compared to that of control dyads (N1 = 18, N2 = 28). Although AD patients and their significant others did not differ from controls in their self-reported satisfaction with the relationship, the behavioral observations showed less positive and more negative communication patterns compared to the control dyads. Negative interactions with significant others may prevent the solution of everyday problems and may add to the patients' stress level.

Journal Article↗

PubMed1993

Somatic symptoms and panic attacks: a retrospective study of learning experiences.

Individuals with panic attacks evaluate physical anxiety symptoms as dangerous and tend to respond to them with fear. In a retrospective questionnaire study, we explored childhood and adolescent learning experiences with respect to somatic symptoms of panickers. Compared to normal controls (N = 61), patients with panic disorder (N = 121), infrequent panickers (N = 86) and patients with other anxiety disorders (N = 38) reported more frequent instances prior to age 18 when they had experienced symptoms like dizziness, shortness of breath, palpitations or nausea, accompanied by special attention from their parents and instructions to restrain from strenuous or social activities. The differences were due to higher symptom frequencies in the anxiety groups. All anxiety groups reported more frequent uncontrolled behavior of their parents than controls. Patients with panic disorder and infrequent panickers reported that their parents had suffered more frequently from physical symptoms typical of anxiety than patients with other anxiety disorders or normal controls. Panickers, but not patients with other anxiety disorders, had observed sick-role behavior related to panic symptoms in their parents more often than controls. Panic attack Ss reported a higher number of household members suffering from chronic illnesses than controls and patients with other anxiety disorders. No group differences were found in the reported behavior of parents when Ss had colds. Overall, the results point to the role of severe illnesses and physical symptoms typical of anxiety in significant others in the history of Ss with panic attacks. These experiences during childhood and adolescence may contribute to their belief that physical symptoms are dangerous. In contrast, there was no specificity for panic with respect to the Ss' own physical symptoms or cold-related symptoms.

Adolescent↗

PubMed1992

Imipramine and alprazolam effects on stress test reactivity in panic disorder.

The reactivity of 40 panic disorder patients on mental arithmetic, cold pressor, and 5% CO2 inhalation stressors was tested before and after 8 weeks of treatment with imipramine, alprazolam, or placebo. Mean levels of subjective and physiological stress measures were compared during a baseline before any stressors were given, and at anticipation, stressor, and recovery periods for each stressor. After treatment, imipramine patients differed from the other two treatment groups on the prestressor baseline in showing higher systolic blood pressure (mean difference about 10 mmHg), higher diastolic blood pressure (10 mm Hg), higher heart rate (15 bpm), less respiratory sinus arrhythmia, shorter pulse transit time, and lower T-wave amplitude. Respiratory measures, electrodermal measures, body movement, and self-reported anxiety and excitement did not distinguish the groups. Reactivity to the stress tests was unaffected by the medications, but tonic differences present in the baseline persisted.

Adult↗

PubMed1992

Stress test reactivity in panic disorder.

The psychological and physiological reactivity of 52 patients with panic disorder to mental arithmetic, cold pressor, and 5% carbon dioxide inhalation tests was compared with that of 26 age- and sex-matched normal subjects. In general, patients with panic disorder were neither more physiologically reactive to these stressors than normal subjects nor slower to recover from them, but they were tonically more anxious and much more likely to ask to stop carbon dioxide inhalation or to report panic attacks during this test. Patients who reported panic attacks (46%) had manifested greater anticipatory anxiety before the gas was delivered, accompanied with increased beta-adrenergic cardiac tone. Thus, anticipatory anxiety can be an important factor in panic provocation. Physiological measures varied greatly in their sensitivity to phasic or tonic anxiety. Carbon dioxide stimulated large increases in respiratory minute volume, but these increases were no greater for patients than for normal subjects.

Adult↗

PubMed1992

Increased cardiac awareness in panic disorder.

We investigated cardiac perception in panic disorder with both self-report and objective measures. In Study 1, 120 patients with panic disorder, 86 infrequent panickers, and 38 patients with other anxiety disorders reported greater cardiac and gastrointestinal awareness than 62 normal control subjects. Subjects with panic attacks reported greater cardiac awareness, but not gastrointestinal awareness, than those with other anxiety disorders. Studies 2 and 3 included a test of heart rate perception in which subjects silently counted their heart-beats without taking their pulse. In Study 2, 65 panic disorder patients showed better performance than 50 infrequent panickers, 27 patients with simple phobias, and 46 normal control subjects. No group differences were found in ability to estimate time intervals. In Study 3, 13 patients with panic disorder and 15 with generalized anxiety disorder showed better heart rate perception than 16 depressed patients.

Adult↗

PubMed1991

How "blind" are double-blind studies?

Psychopharmacological studies usually attempt to eliminate "nonspecific" influences on outcome by double-blind designs. In a randomized, double-blind comparison of alprazolam, imipramine, and placebo, the great majority of panic disorder patients (N = 59) and their physicians were able to rate accurately whether active drug or placebo had been given. Moreover, physicians could distinguish between the two types of active drugs. Inasmuch as correct rating was possible halfway through treatment, concerns about the internal validity of the double-blind strategy arise.

Adult↗

PubMed1990

Skin conductance habituation in panic disorder patients.

Skin conductance habituation was compared between 38 patients meeting DSM-III criteria for Panic Disorder and 29 normal controls. Approximately half of each group was randomly assigned to be given 100 dB SPL tones and the other half 75 dB tones. All indices pointed to slowed habituation in patients compared with normals: number of trials to response habituation, total number of responses, and slope of decline of skin conductance level. Patient-normal differences were not significantly larger for 100 dB than for 75 dB. In addition, patients compared with normals had more nonspecific fluctuations, higher skin conductance levels, and a shorter response latency to the first stimulus. Stepwise discriminant analyses classified patients and normals better in the 100 dB than in the 75 dB condition, and showed that the various skin conductancy variables were largely redundant at the higher intensity.

Acoustic Stimulation↗

PubMed1990

Motor activity and tonic heart rate in panic disorder.

Motor activity and tonic heart rate were monitored in 62 drug-free panic disorder patients and 40 normal control subjects. Mean daily activity, mean waking heart rate controlled for activity, and mean sleeping heart rate were determined. Panic disorder patients without phobic avoidance showed higher activity than control subjects or patients with limited or extensive avoidance. Similarly, an "inverted U", relationship between trait anxiety and activity was observed. On the other hand, neither mean waking nor sleeping heart rate showed significant differences between patients and controls, suggesting that the differences previously reported in laboratory studies result from anticipatory anxiety.

Adult↗

PubMed1990

Cardiovascular and symptomatic reduction effects of alprazolam and imipramine in patients with panic disorder: results of a double-blind, placebo-controlled trial.

Seventy-nine patients with panic disorder were randomized to an 8-week double-blind treatment with alprazolam, imipramine, or placebo. Patients kept daily records of panic attacks, activity, anxiety, sleep, and medication use. Weekly measures of anxiety, depression, somatic symptoms, fears, avoidance, disability, and improvement were obtained. All patients underwent a symptom-limited exercise treadmill and other cardiovascular measures. By physician and patient global assessment, patients receiving alprazolam or imipramine were significantly better than patients on placebo. The alprazolam effects were apparent by week 1; the imipramine effects by week 4. All groups showed significant reductions in anxiety, depression, somatic measures, and panic attack frequency. At 8 weeks, patients in the alprazolam group reported significantly less fear than patients in the other two groups. Subjects in the imipramine group showed a significant increase in heart rate and blood pressure.

Adult↗

PubMed1990

Guttman scaling in agoraphobia: cross-cultural replication and prediction of treatment response patterns.

The Fear and Avoidance Scales (FAS) is an 11-item questionnaire consisting of two subscales that measure features of agoraphobia and claustrophobia and that were demonstrated to be valid Guttman scales in a British clinical population. The purposes of the study reported here were to replicate the scale characteristics in the United States and to determine if improvement during treatment would follow the sequence predicted by the hierarchy implied in the scales. The FAS was given to 25 female agoraphobics before and after behavioural treatment. A principal components analysis replicated the agoraphobia and claustrophobia factors established in the British sample. Scalogram analyses showed that the Claustrophobia subscale of the FAS was a valid Guttman scale in the US sample whereas the Agoraphobia subscale yielded a high coefficient of reproducibility but a low coefficient of scalability. Treatment reduced the patients' fears and avoidances in the predicted sequence since for both scales the hierarchy of items remained unchanged following treatment.

Adult↗

PubMed1990

Surreptitious drug use by patients in a panic disorder study.

In a double-blind, placebo-controlled trial comparing alprazolam and imipramine for panic disorder, serum analysis revealed that a substantial proportion of the patients took explicitly prohibited anxiolytic medication. Excluding these patients changed the results.

Adult↗

PubMed1990

[The psychosocial status of patients with endogenous eczema. A study using cluster analysis for the correlation of psychological factors with somatic findings].

The present study was performed to investigate whether patients with atopic dermatitis differ as a group from controls on psychological measures of mood and personality or whether psychologically deviant and normal patient subgroups can be distinguished. Furthermore, we were interested in what clinical characteristics might co-vary with psychological disability in patients with atopic dermatitis. In all, 93 patients filled in a standardized mood scale (Hamburg-Erlanger-Stimmungsbarometer) and a personality scale (Kurztest zur Erfassung der Persönlichkeitsstruktur). Compared with matched controls, patients described themselves as being more anxious, more aroused, more depressed and less energetic, and they reached higher neuroticism scores. A cluster analysis identified four patient subgroups. Only one of the subgroups (n = 17) was psychologically disabled according to the questionnaire scores. In contrast to a psychologically stabile patient group, the psychologically disabled patients showed an earlier age of onset of dermatitis, but less intense itching and scratching. They reported more somatic complaints and a higher level of familial stress, were more dissatisfied with their life situation and work, had fewer friends and experienced more losses of significant others. Furthermore, they more frequently rated their disorder as being determined by psychological factors and were more intelligent. Thus, the questionnaires identified a subgroup of patients who may need psychotherapeutic interventions.

Adolescent↗