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Biomedical subjects

A Ehlers

Publications and source records attributed to A Ehlers.

65 records · Page 4Linked to original sources
PubMed1989

Use of medication and in vivo exposure in volunteers for panic disorder research.

A survey of 794 subjects volunteering for studies of panic disorder with or without phobic avoidance revealed that fewer than 15% had received imipramine and fewer than 15% had undergone in vivo exposure, although the majority had engaged in some form of counseling and had used benzodiazepines. Subjects with spontaneous panic attacks reported more avoidance than subjects with situational attacks. One-half of the subjects were unemployed. The authors recommend wider use of the available effective treatments for panic disorder and phobic avoidance.

Adult↗
PubMed1989

Cognitive aspects of panic attacks. Content, course and relationship to laboratory stressors.

Twenty patients with panic attacks and ten controls were given a standardised interview about thoughts occurring during times of anxiety or panic attacks. The interviewer was blind to the subject's diagnosis. The 20 panic patients underwent a psychophysiological test battery which included a cold pressor test, mental arithmetic task, and 5.5% CO2 inhalation. More patients than controls reported thoughts centered on fears of losing control and shame when anxious. Panic patients rated their thoughts as stronger and clearer than did controls and they had more difficulty excluding them from their minds. A feeling of anxiety preceded anxious thoughts in patients. This suggests that 'faulty cognitions' are not the initial event in a panic attack, although anxious thoughts may exacerbate or maintain them. Significant correlations were found between the intensity of anxiety-related thoughts in anticipation of mental arithmetic and changes in diastolic blood pressure and heart rate during mental arithmetic.

Adult↗
PubMed1987

Treadmill exercise test and ambulatory measures in panic attacks.

Treadmill exercise test performance and ambulatory heart rate and activity patterns of 40 patients with panic attacks were compared with 20 age-matched controls (control group 1) and 20 nonexercising controls (control group 2). All patients underwent a symptom-limited exercise stress test. Panic attack patients and control group 1 wore an ambulatory heart rate/activity monitor for up to 3 days. Panic patients had a significantly higher heart rate at 4 and 6 METS than either control group. The max METS were 11.2 +/- 2.3, 13.5 +/- 2.3 and 11.2 +/- 1.8 for the panic attack patients and control groups 1 and 2, respectively. One panic patient had ischemia on the treadmill at 12 METS. Panic patients had a significantly higher standing heart rate than controls. Furthermore, 11 of 39 panic patients had tachycardia on standing compared with 3 of 40 controls. Panic attack patients had higher wake and sleep heart rates than control group 1, but the differences were not significant. These results are consistent with autonomic dysfunction in panic patients but may also be due to differences in physical conditioning. The treadmill can be useful for reassuring patients and for identifying the rare patient with ischemia on exercise.

Adult↗
PubMed1987

Panic attacks in the natural environment.

Despite much recent research, there is still little systematic information about the phenomenology of panic attacks, and their possible causes remain obscure. We investigated panic attacks in the natural environment using an event sampling approach. Twenty-seven panic attack patients and 19 matched normal controls kept panic attack and self-exposure diaries for 6 days and wore an ambulatory heart rate/physical activity recorder for 3 days. Patients reported 175 attacks, generally of moderate severity. The most frequent symptoms were palpitations, dizziness/lightheadedness, dyspnea, nausea, sweating, and chest pain/discomfort. The results did not support the classification of panic attacks recently proposed by Sheehan and Sheehan, which requires three symptoms as a cutoff for panic attacks. Panic attacks classified by the patients as situational (i.e., occurring in feared situations) were more severe and occurred in situational contexts different from spontaneous attacks, but were otherwise phenomenologically similar. Heart rates did not change during spontaneous attacks and were only mildly elevated during situational attacks or during the 15 minutes preceding these attacks. These heart rate changes were interpretable as effects of anxiety, although physical activity showed a similar pattern of changes. Some normal control subjects reported on the panic diary primarily situational anxiety episodes that were phenomenologically similar to, albeit less severe than, the patients' episodes. Panic patients may sometimes fail to perceive environmental triggers for their attacks because many attacks classified as spontaneous occurred in classical "phobic" situations. Furthermore, the comparison of concurrent diary and retrospective interview and questionnaire descriptions showed that panic patients have a tendency toward retrospective exaggeration. Implications for the assessment, definition, and classification of panic attacks are discussed.

Activities of Daily Living↗
PubMed1986

Lactate infusions and panic attacks: do patients and controls respond differently?

Ten patients with panic disorder or agoraphobia with panic attacks and 10 normal controls received infusions of normal saline (placebo) and sodium lactate in a single-blind design. The time course of changes in the dependent variables was closely monitored, and expectancy biases and demand characteristics were minimized. Lactate increased self-reported anxiety and heart rate equally in patients and controls. The only variables showing statistically different responses between the groups were systolic and diastolic blood pressure. Overall, in both groups, the effects of lactate were quite similar to states of natural panic or anxiety for both self-report measures and heart rate. Patients had a tendency to endorse somatic symptoms indiscriminately. Our data do not support response to lactate as a biological marker of proneness to panic attacks.

Adult↗
PubMed1986

Ambulatory heart rate changes in patients with panic attacks.

Of 33 "panic" attacks reported by patients wearing an ambulatory solid-state heart rate/activity monitor for 6 days, 19 (58%) occurred at heart rates disproportionate to activity levels and different enough from surrounding heart rates to indicate a distinct physiologic state. Intense panic attacks with three or more symptoms were the most readily identified. ECG monitoring found the elevated heart rates to be sinus tachycardias. Heart rate elevation did not occur during anticipatory anxiety episodes. Ambulatory heart rate recordings confirm the presence of major physiologic changes during self-reported panic attacks.

Adolescent↗
PubMedDate not supplied

Sodium lactate infusions and panic attacks: a review and critique.

Response to sodium lactate infusions has been proposed as an experimental model and a biologic marker for panic attacks. Several authors have claimed that patients suffering from panic attacks, but not normal controls, "panic" in response to lactate. A careful review of methods and results of 13 studies, however, reveals serious methodologic problems, lack of specificity and sensitivity, and a failure to consider cognitive variables. When baseline differences are ruled out, the responses of patients and controls may not differ. So far, response to lactate cannot be interpreted as a model and marker for panic attacks and does not provide evidence for their underlying biologic distinctness from other types of anxiety. Known biologic mechanisms do not sufficiently explain the effects of lactate. Instead, an interaction of peripheral physiologic changes, past experience, environmental cues, and their appraisal as threatening or dangerous seems to be a more appropriate model.

Anxiety Disorders↗
PubMedDate not supplied

Mitral valve prolapse and panic disorder: a review of their relationship.

There has been considerable speculation about a possible relationship between panic disorder and mitral valve prolapse syndrome (MVP), although empirical results have been highly inconsistent. Some studies report low frequencies of 0-8%, others high frequencies of 24-35% "definite" MVP in panic patients (average across 17 studies: 18% of panic patients, 1% of normal controls). Elevated prevalences of MVP were also reported for generalized anxiety disorder, bipolar affective disorder, and anorexia nervosa. Studies of MVP patients generally failed to find elevated prevalence of panic compared to other cardiac patients or normal controls (averages across seven studies: 14%, 10%, and 8%, respectively). Inconsistent results may be due to widely different diagnostic criteria for MVP, low reliability of this diagnosis, inadequate control groups, "non-blind" ratings of panic or MVP, and sampling bias in both patient and control populations. These problems as well as the great variations in the published results preclude any final judgment. If there is concomitance between MVP and panic, it is small and primarily involves subjects with milder or reversible variants of MVP. At present it seems most justified, however, to assume co-morbidity in highly symptomatic individuals rather than a functional relationship.

Fear↗
PubMedDate not supplied

Psychological and perceptual factors associated with arrhythmias and benign palpitations.

OBJECTIVE: Little is known about how patients who seek medical help for benign palpitations can be distinguished from those with clinically significant arrhythmias. This study tested whether patients with arrhythmia can be distinguished from those who are aware of sinus rhythm or extrasystoles on the basis of sex, prevalence of anxiety disorders, and heartbeat perception. METHODS: A consecutive sample of patients referred to a cardiology clinic participated in the study. Patients were diagnosed as having either arrhythmia (N = 62), extrasystoles (N = 75), or awareness of sinus rhythm (N = 47). They were assessed with use of the anxiety disorders and hypochondriasis modules of the Structured Clinical Interview for DSM-IV. Both patients and control subjects (N = 35) answered questionnaires measuring anxiety, fear of bodily sensations, and depression and underwent a heartbeat perception test. The present report focuses on patients who had palpitations but no comorbid cardiovascular disease. RESULTS: Patients with awareness of sinus rhythm could be distinguished from those with arrhythmia by several variables: female sex, higher prevalence of panic disorder, poor performance on the heartbeat perception test, report of palpitations when doing the test, higher heart rates, lower levels of physical activity, and (as trends) a greater prevalence of panic attacks, fear of bodily sensations, and depression. In contrast, patients with arrhythmias rarely reported palpitations when doing the test but were more likely to perceive their heartbeats accurately than patients with sinus rhythm and control subjects. Performance on the heartbeat perception test was intermediate in patients with extrasystoles; these patients also had an intermediate prevalence of panic disorder and intermediate depression scores. CONCLUSIONS: Measures of panic disorder and a simple heartbeat perception test could complement medical assessment in the diagnosis of patients who seek medical help for palpitations. The results also have implications for the treatment of patients with benign palpitations.

Adult↗