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Biomedical subjects

D V Sheehan

Publications and source records attributed to D V Sheehan.

At least 73 records · Page 4Linked to original sources
PubMed1985

Lactate infusion in anxiety research: its evolution and practice.

The unpredictability of spontaneous unexpected panic attacks has inhibited the controlled study of this phenomenon. Previous studies demonstrated that an increase in blood lactic acid occurred concomitant with symptoms of anxiety in anxiety-prone patients who underwent standard physical exercise. The question of whether these patients had an excessive sensitivity to lactate led to the development of the lactate infusion model, in which anxiety is induced in a controlled environment. The history and current application of the lactate infusion model in the study of neurochemical correlates of panic are described, and a methodology for lactate infusion procedures is outlined.

Anxiety Disorders↗
PubMed1985

Thyroid indices in panic disorder.

Eighty-two patients suffering from panic attacks with or without phobias were examined for evidence of thyroid disease. None of the patients had abnormal total T4 or T3 resin uptake measurements, regardless of whether they were nonmedicated or treated with one of three antipanic drugs: alprazolam, phenelzine, or imipramine. A higher than expected incidence of undetectable TSH levels (22% overall) appeared in all groups. The clinical relevance of this finding is currently uncertain.

Adult↗
PubMed1984

Some biochemical correlates of panic attacks with agoraphobia and their response to a new treatment.

Thirty-two patients with chronic debilitating agoraphobia and panic attacks participated in a comparative study of the triazolobenzodiazepine alprazolam and the anti-inflammatory agent ibuprofen. After a 2-week placebo washout period, patients were randomly assigned to 8 weeks of treatment with alprazolam (2 to 6 mg/day) or ibuprofen (0.8 to 2.4 g/day). Medication was identically packaged and patients were blind to the treatment condition, but investigators were aware of which medication was dispensed. Alprazolam recipients (mean daily dose: 5.4 mg) improved markedly with respect to physician and patient global rating of disease severity, frequency and severity of panic attacks, and phobic anxiety target symptoms on the 90-Item Hopkins Symptom Check List. Ibuprofen recipients (mean daily dose: 2.13 g) experienced significantly less clinical improvement than patients on alprazolam. After 8 weeks of treatment, ibuprofen patients were crossed over to alprazolam, while the original alprazolam group continued on that drug. The daily dosage ceiling was increased to 10 mg. In the ensuing 4 weeks (mean daily alprazolam dose: 6.3 mg), all patients achieved comparably marked clinical improvement relative to baseline. Pretreatment plasma concentrations of platelet factor 4 and beta-thromboglobulin--two measures of platelet turnover and release--were significantly elevated in patients relative to normal controls. The elevated platelet factor 4 and beta-thromboglobulin normalized during treatment with both drugs. Alprazolam appears to produce rapid and specific clinical improvement in patients with severe agoraphobia and panic attacks and deserves further evaluation under double-blind conditions.

6-Ketoprostaglandin F1 alpha↗
PubMed1984

Delineation of anxiety and phobic disorders responsive to monoamine oxidase inhibitors: implications for classification.

Studies of the treatment of panic anxiety and various other states with monoamine oxidase (MAO) inhibitors are critically reviewed. It is concluded that MAOIs have differential effects on several dimensions of pathologic anxiety. The association between depression and anxiety states is also reviewed; it is observed that MAOIs effectively treat severe anxiety and phobic disorders without operating strictly via their antidepressant mechanism. In addition, it is proposed that biologic depression and biologic anxiety should be considered to have some independence from one another. Guidelines for the clinical delineation of anxiety disorders are provided, and the clinical and research implications of the proposal for revision of DSM-III anxiety and phobic disorders section, are outlined in detail. It is suggested that anxiety and phobic disorders be classified into endogenous (disease) and exogenous (nondisease) types.

Alprazolam↗
PubMed1984

Panic anxiety: a new biological model.

Previously unrecognized similarities among metabolic responses to various maneuvers used to evoke anxiety in patients with panic disorder are described. On the basis of these observations, a new biological model is proposed for panic disorder, in which the primary defect--which is neuroendocrine rather than psychiatric--is operationally placed within the redox-regulating apparatus of the brain stem. This model is consistent with many clinical features of panic disorder and also provides a theoretical framework for further studies of the pathophysiology of this and related conditions (e.g., hyperventilation syndrome).

Anxiety Disorders↗
PubMed1983

The diagnosis and drug treatment of anxiety disorders.

Anxiety, phobic and related neurotic disorders lend themselves to diagnostic confusion because of the large and variable array of symptoms associated with them. This has complicated attempts at coherent classification. This paper examines the problems in diagnosis and classification and the diversity of causal models of these disorders. It offers an alternative integrated perspective that may have heurestic merit in guiding clinicians to a practical choice of treatment and in delineating a useful starting point for the biological investigation of these disorders.

Anti-Anxiety Agents↗
PubMed1983

Panic attacks and the dexamethasone suppression test.

Of 51 patients with panic attacks, 11.8% (7.8% with a correction factor) had a positive dexamethasone suppression test. This is significantly lower than the rate for melancholia. This difference suggests that panic attacks and major depression may be associated with different biological mechanisms.

Adult↗
PubMed1982

The classification of anxiety and hysterical states. Part I. Historical review and empirical delineation.

The history of the classification of anxiety, hysterical, and hypochondriacal disorders is reviewed. Problems in the ability of current classification schemes to predict, control, and describe the relationship between the symptoms and other phenomena are outlined. Existing classification schemes failed the first test of a good classification model--that of providing categories that are mutually exclusive. The independence of these diagnostic categories from each other does not appear to hold up on empirical testing. In the absence of inherently mutually exclusive categories, further empirical investigation of these classes is obstructed since statistically valid analysis of the nominal data and any useful multivariate analysis would be difficult if not impossible. It is concluded that the existing classifications are unsatisfactory and require some fundamental reconceptualization.

Agoraphobia↗
PubMed1982

The classification of anxiety and hysterical states. Part II. Toward a more heuristic classification.

In the historical review and empirical delineation of the classification of anxiety and hysterical states (Part I), it was concluded that the existing classifications are unsatisfactory and require some reconceptualization if they are to be useful clinically and empirically. In keeping with more recent developments in the genetic, behavioral, pharmacological, biochemical, and psychophysiological investigation of these disorders, a new classification is proposed. The two major categories of anxiety and hysterical disorders have a different clinical presentation and course, a different mean age of onset, distribution of age of onset, sex distribution, response to treatment modalities, and habituation response on galvanic skin response. Empirical evidence supporting this proposal is cited. This classification has heuristic merit in guiding research efforts and discussions and in directing clinicians to a simple and practical solution to their patients' anxiety disorders.

Adult↗
PubMed1980

Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms.

Endogenous anxiety (anxiety hysteria, agoraphobia with panic attacks) is characterized by sudden, spontaneous panic attacks accompanied by multiple autonomic symptoms, overwhelming fear, a flight response, and polyphobic behavior. Psychotherapy, behavior therapy, and tranquillizers have been of limited success in treating this syndrome. Fifty-seven patients severely disabled by the syndrome for a mean period of 13 years completed the three-month study. Randomly assigned in a double-blind, placebo-controlled design to imipramine hydrochloride, pheneizine sulfate, or placebo, they were seen in supportive group therapy every two weeks. Patients in the pheneizine and imipramine cells showed significant improvement ovehe persistent trend for pheneizine to be superior to imipramine achieved significance only on the Work and Social Disability Scale and the Sympton Severity and Phobic Avoidance Scale. The implications for classification and theory are discussed.

Adult↗