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Biomedical subjects

D F Klein

Publications and source records attributed to D F Klein.

At least 235 records · Page 13Linked to original sources
PubMed1984

Relationship between separation anxiety and panic and agoraphobic disorders.

The paper addresses several issues pertinent to the characteristics and treatment of separation anxiety in children and adults. The rationale for separating separation anxiety from other childhood anxiety conditions rests on clinical observations of its relationship to panic disorder and its response to drug treatment. The psychopharmacological treatment of separation anxiety is reviewed, with special emphasis on the use of tricyclic antidepressants. The literature relevant to a possible association between separation anxiety and adult panic disorder is presented. The prevalence of separation anxiety disorder in adult outpatients with panic disorder is discussed. Data are presented to address the issue of treatment response in adult panic disorders with and without separation anxiety.

Adult↗
PubMed1984

Hypoglycemia and panic attacks.

Many patients with panic disorder believe hypoglycemia causes their symptoms. Of 10 patients with panic disorder given sodium lactate to induce panic, none had evidence of low blood sugar levels when they began to experience anxiety symptoms.

Adolescent↗
PubMed1984

Insulin levels during lactate infusion.

To determine whether the lactate-induced panic of patients with panic attacks results from hyperinsulinism balanced by epinephrine-enhanced gluconeogenesis, the authors measured 10 subjects' insulin levels exactly when the lactate-induced attacks began. The insulin levels were normal.

Adult↗
PubMed1984

Treatment of panic disorder with imipramine alone.

Ten patients with panic disorder were treated solely with imipramine in an open pilot trial. All patients reported cessation of panic attacks and considerable overall improvement. Four patients who took medication 5 months or longer reported marked overall improvement.

Adult↗
PubMed1984

Response to hyperventilation in a group of patients with panic disorder.

Twelve patients with DSM-III diagnoses of panic disorder and four normal volunteers were studied during hyperventilation of room air and increased ventilation stimulated by 5% CO2. Patients also underwent sodium lactate infusion. Eight of the patients had a panic attack during sodium lactate infusion, seven during CO2 inhalation, and three during room-air hyperventilation. Since CO2 increases the firing of the locus ceruleus, and since sodium lactate infusion is known to increase cerebral CO2, these findings are consistent with other evidence implicating the locus ceruleus in panic anxiety.

Adult↗
PubMed1984

Effects of naloxone on patients with panic attacks.

To determine whether endogenous opiates are involved in panic anxiety, the authors challenged 12 patients with panic attacks with intravenous naloxone hydrochloride alone or combined with sodium lactate. Naloxone did not produce panic attacks or alter responses to lactate.

Adult↗
PubMed1984

Psychopharmacologic validation of atypical depression.

Sixty patients meeting specific criteria for atypical depression completed 6 weeks of double-blind, randomly assigned treatment with phenelzine, imipramine, or placebo. Patients who had a history of spontaneous panic attacks or hysteriod dysphoric features showed extremely low placebo-response rates, moderate responses to imipramine, and high rates of response to phenelzine. Conversely, patients without such features responded moderately well to all three treatments. Based on preliminary data, MAOI-specific atypical depression does appear to exist, although in more delimited forms than previously recognized.

Adolescent↗
PubMed1984

Sodium lactate infusion, panic attacks, and ionized calcium.

The ability of sodium lactate to precipitate panic attacks in vulnerable individuals has been repeatedly demonstrated, although its mechanism of action is unknown. Pitts and McClure hypothesized that the panicogenic effect of sodium lactate was due to its induction of a peripheral hypocalcemia via the complexing of infused lactate ions with extracellular ionized calcium. In the current study, serial ionized calcium measurements during lactate infusion are assessed for 22 panic patients who panicked during infusion, 11 panic patients who did not panic during the procedure, and 6 normal controls. Intravenous sodium lactate infusion was found to be associated with a significant decrease in ionized calcium in all groups. No specific association was found between the rate or magnitude of decrease in ionized calcium and the occurrence of a panic attack during the infusion.

Agoraphobia↗
PubMed1983

Treatment of phobias. I. Comparison of imipramine hydrochloride and placebo.

In a controlled-outcome study of phobias, 218 adult phobic patients (147 women and 71 men) received a course of 26 weekly treatment sessions that consisted of behavior therapy (BT) and imipramine hydrochloride, BT and placebo, or supportive psychotherapy and imipramine. The BT consisted of systematic desentization using fantasy and assertiveness training. Patients were classified as agoraphobic, mixed phobic, or simple phobic. Although the conditions of most patients in each group showed moderate to marked improvement, the effects of imipramine were significantly superior to those of placebo in patients with spontaneous panic attacks, ie, patients with agoraphobia or mixed phobia. In patients with simple phobia, who do not experience spontaneous panic, there was not a significant difference between imipramine and placebo. This study clearly distinguished those phobic patients who experienced spontaneous panic from those who did not in terms of pharmacologic benefits.

Adult↗
PubMed1983

Treatment of phobias. II. Behavior therapy and supportive psychotherapy: are there any specific ingredients?

Systematic hierarchical desensitization (behavior therapy [BT]) was compared with supportive psychotherapy (ST) during a 26-week treatment trial of patients with agoraphobia, mixed phobia, or simple phobia. We found essentially no difference in effectiveness, not because patients treated with BT had done badly, but because patients receiving ST had done well. A detailed methodologic review concludes that this finding is entirely compatible with the major critical reviews of the psychotherapy literature. Is the active ingredient in psychotherapy simply the generation of hopeful expectancies? This is necessary but not sufficient. For phobics, the psychotherapy session serves primarily as an instigator. The specific corrective activity occurs outside of the formal session in the form of maintained exposure in vivo. Supposed differences between therapies may be entirely due to the rapidly with which the instigational function becomes effective.

Agoraphobia↗
PubMed1983

Efficacy of desipramine in depressed outpatients. Response according to research diagnosis criteria diagnoses and severity of illness.

The efficacy of desipramine for mild depression was tested in a double-blind, placebo-controlled study of outpatients with scores below 19 on the Hamilton Rating Scale for Depression (HAM-D). Of 103 such patients, 23 dropped out and 16 improved during a ten-day placebo period. Among 64 patients completing the randomized portion of the study, significantly more improved with desipramine that with placebo. The Research Diagnostic Criteria (RDC) category of major depressive disorder largely accounted for the drug-placebo response difference found for the entire sample. Patients with intermittent depressive disorder improved significantly less frequently with desipramine than patients with major depressive disorder. Independent of RDC diagnosis, severity of illness correlated with outcome. Thus, patients with pretreatment HAM-D scores at or above the median demonstrated significant drug effect, while patients with lower pretreatment HAM-D scores did not.

Adolescent↗
PubMed1983

Discordance between the SCL-90 and therapists' psychopathology ratings.

This study examines the symptom checklist 90 (SCL-90), a patient self-report rating scale, as a screening and baseline psychopathology measure in an outpatient clinic. A low correlation (r = .17) was found between the SCL-90 and the SCL analogue, a matched psychopathology instrument rated by clinicians. The most common causes of discordance in ratings were patients' underreporting of symptoms due to patients' paranoia or fearfulness, overreporting of symptoms consistent with patients' "demonstrative" style, and false-positive items related to patients' physical illness. We conclude that the SCL-90 has limited validity as a clinical measure in the study of patients seen in evaluation in our setting.

Adult↗
PubMed1983

Effect of acute beta-adrenergic blockade on lactate-induced panic.

Many clinical and theoretic attempts have been made to link anxiety disorders and the beta-adrenergic nervous system. Six patients with panic disorder, who had panic attacks produced by sodium lactate infusions, were given repeated lactate infusions that were immediately preceded by intravenous administration of propranolol hydrochloride. In all cases, propranolol pretreatment infusion failed to prevent panic attacks, anxiety, tachycardia, and increased systolic BP during the lactate infusion.

Adult↗
PubMed1983

Children with reading disorders--II. Effects of methylphenidate in combination with reading remediation.

Sixty-six children received individual reading instruction for 18 weeks, in combination with methylphenidate (mean daily dose 44.2 mg/day) or a placebo. Assignment to medication was random and double blind. Children were re-evaluated at the end of treatment, and two and eight months later. Only occasional and weak methylphenidate effects were obtained on measures of reading performance. Highly significant improvement in some tests of mathematics was found. No treatment differences occurred at follow-up. The results do not support the hypothesis that the enhancement of attention with stimulant treatment facilitates the acquisition of reading skills in children with pure reading disorders.

Achievement↗
PubMed1982

Growth hormone response to dextroamphetamine in depressed patients and normal subjects.

The human growth hormone (HGH) response to dextroamphetamine sulfate (doses, 0.1 and 0.15 mg/kg) was determined in both the morning and evening in patients with endogenous and atypical depression and in normal young men and normal postmenopausal women. Although the HGH response was found to be reduced in endogenously depressed postmenopausal women, it was equally reduced in normal postmenopausal women and in patients with atypical depression. Depressed and normal men had larger HGH responses, but there were no differences between depressed and normal men. These results do not confirm an earlier report that the reduced HGH response to dextroamphetamine is specific to endogenous depression. The results do suggest the importance to control for other variables in studies of HGH responses in psychiatric patients.

Adult↗