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Biomedical subjects

E Hollander

Publications and source records attributed to E Hollander.

At least 145 records · Page 8Linked to original sources
PubMed1991

Obsessive compulsive disorder, depression, and fluoxetine.

BACKGROUND: Fluoxetine, a selective serotonin reuptake blocker, is an antidepressant medication that has also been shown in open clinical trials and one controlled trial to be effective in the treatment of obsessive compulsive disorder (OCD). OCD is often complicated by depression, and depressive symptoms may interfere with response to both pharmacologic and behavioral treatments. METHOD: We describe pilot data from 10 outpatients who met DSM-III-R criteria for OCD in whom the possibility of a depressive reaction or lack of antidepressant response occurred during an open trial of fluoxetine. RESULTS: Rapid increase in fluoxetine dose to high doses was associated with depressive symptoms in 6 patients. In 8 patients, improvement in depression was associated with addition of a tricyclic antidepressant to fluoxetine treatment. In 5 patients, both OCD and depressive symptoms improved when the patient was switched to the partially selective serotonin reuptake blocker clomipramine. CONCLUSION: This paper serves to alert clinicians to the possibility of a depressive reaction, or lack of antidepressant response, to fluoxetine in OCD patients. This possibility can only be resolved scientifically by adequately controlled experimental trials. If depression occurs, combined fluoxetine and tricyclic treatment, or a switch to a partially selective serotonin reuptake inhibitor, may be helpful. Special considerations and side effects of combined fluoxetine-tricyclic treatment are described.

Adolescent↗
PubMed1990

High-dose carbon dioxide challenge test in anxiety disorder patients.

Many investigators have shown that panic disorder patients and possibly social phobics are hypersensitive to the anxiogenic effects of inhaled carbon dioxide (CO2). In this study we administered double-breath inhalation of 35% CO2 and 65% oxygen (O2) to panic disorder patients, social phobics, and normal controls. At baseline, panic disorder patients were characterized by higher pulse, anxiety score, and evidence of hyperventilation. Panic patients and social phobics panicked more often to 35% CO2 than to room air; normal controls did not have a higher rate of panic to CO2 than to room air. However, we did not find significant group differences in anxiety level, physiological measures, or biochemical measures in response to CO2 breathing compared with room air breathing. These results confirm earlier reports of baseline hyperventilation in panic disorder patients. However, 35% CO2 may be too high a dose to differentiate respiratory responses of patients compared with normals.

Administration, Inhalation↗
PubMed1990

Endogenous event-related potentials in obsessive-compulsive disorder.

Brain event-related potentials (ERPs) were used to investigate central nervous system (CNS) correlates of cognitive function in obsessive-compulsive disorder (OCD). ERPs of 10 unmedicated OCD patients and 10 normal controls were measured in an auditory "oddball" task. Increasing task difficulty resulted in longer N200 and P300 latencies in normal subjects, but not in OCD patients. Moreover, OCD patients displayed shorter P300 latency than normal controls for the more difficult discrimination conditions. This replicates prior findings of Beech et al. (1983) for a visual task. For both levels of task difficulty, OCD patients also showed greater negativity than normal controls in the N200 region, which extended into the subsequent slow wave region. Negativities in the N200 and slow wave regions were larger at sites over the left hemisphere than the right hemisphere. The enhanced negativities and reduced P300 latency in OCD patients are discussed in terms of current theories postulating cortical hyperarousal and left hemisphere involvement in OCD.

Adolescent↗
PubMed1990

Signs of central nervous system dysfunction in obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) has been linked to altered neurological function following head trauma, encephalitis, abnormal birth events, and Gilles de la Tourette's syndrome. Abnormalities in computed tomographic scans, electroencephalograms, positron emission tomographic scans, and evoked potentials have been described in this disorder, but are neither consistent nor pathognomonic of OCD. Neurological soft signs are nonlocalizing signs of deviant performance on a motor or sensory test where no other sign of a neurological lesion is present. We studied 41 medication-free patients with OCD who met DSM-III-R criteria, as well as 20 normal controls, matched for age, sex, and handedness, on 20 individual tasks that involved fine motor coordination, involuntary movements, and sensory and visuospatial function. There were significantly more signs of central nervous system dysfunction in the OCD group, as shown by abnormalities in fine motor coordination, involuntary and mirror movements, and visuospatial function. An excess of findings on the left side of the body and abnormalities of cube drawing may suggest right hemispheric dysfunction in a subgroup of patients with OCD. Soft signs correlated with a severity of obsessions. There was also a correlation between abnormalities in visual memory and recognition on neuropsychological testing and total soft signs. These findings provided additional evidence for a neurological deficit in some patients with OCD. However, further comparisons with other psychiatric populations are needed to determine whether these findings are unique to OCD or are a property of other psychiatric disorders as well.

Adolescent↗
PubMed1990

Dopaminergic sensitivity and cocaine abuse: response to apomorphine.

Ten male patients with chronic cocaine abuse received a single dose of the dopamine agonist apomorphine. Self-ratings of cocaine craving, depression, and anxiety decreased in response to apomorphine. Neuroendocrine response was consistent with central dopaminergic stimulation. Patients in the "craving" phase of the cocaine abuse cycle differed in behavioral but not neuroendocrine response to apomorphine from patients in the "crash" phase. Decrease in cocaine craving correlated with decrease in plasma homovanillic acid (pHVA). Total cocaine consumption correlated negatively with baseline prolactin and pHVA levels and inversely with peak change in prolactin following apomorphine. Patients had blunted neuroendocrine response to apomorphine in comparison to historical normal controls. Implications for the "dopamine" hypothesis of cocaine abuse are discussed.

Adult↗
PubMed1990

Fluoxetine in panic disorder.

Twenty-five patients with a primary DSM-III-R diagnosis of panic disorder with or without agoraphobia were treated openly with the serotonin uptake inhibitor fluoxetine for up to 12 months. For most patients, treatment was initiated at 5 mg/day to minimize adverse effects previously reported with initiation at higher doses. Nineteen (76%) experienced moderate to marked improvement in panic attacks. Four (16%) were unable to tolerate fluoxetine due to adverse effects. Initiating treatment of panic disorder with low doses of fluoxetine may increase its acceptability and permit more patients to benefit from fluoxetine.

Adult↗
PubMed1990

Anxiety and depression: discrete diagnostic entities?

Some forms of anxiety and affective disorder, such as panic disorder and major depression, appear distinct, while other forms, such as generalized anxiety disorder and chronic depression or dysthymia, may lie on a continuum and blend with each other. However, even panic disorder and major depression have many common features. Moreover, for reasons not yet clear, they occur together frequently, and their combined occurrence in the same patient has been associated with greater severity and chronicity, decreased treatment responsiveness, and, possibly, increased familial prevalence of anxiety and/or depression. Finally, studies of primary care patients suggest the frequent occurrence of a mixed anxiety-depressive disorder that may often be subsyndromal by DSM-III-R criteria but is nevertheless associated with prominent distress and/or impairment.

Anxiety Disorders↗
PubMed1990

Reversible and irreversible monoamine oxidase inhibitors in other psychiatric disorders.

In addition to being effective in depressive disorders, monoamine oxidase inhibitors (MAOIs) have been shown to be effective in controlled studies of patient with panic disorder with agoraphobia, social phobia, atypical depression or mixed anxiety and depression, bulimia, posttraumatic stress disorder (PTSD) and borderline personality disorder. Uncontrolled case reports have noted MAOI efficacy in obsessive-compulsive disorder (OCD), trichotillomania, dysmorphophobia and avoidant personality disorder. Reversible inhibitors of MAO-A (RIMAs) appear safer than the classical irreversible MAOIs since they have less potential to increase blood pressure. They have not been studied as yet, however, in most of the conditions responsive to MAOIs. If RIMAs are found effective in these disorders, they would probably achieve wider use than MAOIs because they are safer and tend to cause fewer side effects.

Antidepressive Agents↗
PubMed1990

Pharmacotherapy of four men with paruresis.

Four men with paruresis received trials of atenolol or phenelzine or both. Atenolol was effective in one patient. Three patients had a poor response to phenelzine, and they all experienced troublesome side effects.

Adult↗
PubMed1990

Fenfluramine augmentation of serotonin reuptake blockade antiobsessional treatment.

Seven patients who met DSM-III-R criteria for obsessive compulsive disorder and had only a partial response to the serotonin reuptake blockers fluoxetine, fluvoxamine, or clomipramine or were unable to tolerate therapeutic doses of these agents due to side effects underwent open treatment with fenfluramine augmentation. Fenfluramine is a serotonin releaser and reuptake blocker which is marketed as an anorectic agent. In doses of 20 to 60 mg/day, fenfluramine augmentation was well tolerated and resulted in a further decrease in obsessions and compulsions in six of these patients. Larger controlled studies are needed to confirm this finding.

Adult↗
PubMed1990

Treatment of depersonalization with serotonin reuptake blockers.

Eight patients with depersonalization disorder or with depersonalization symptoms in association with obsessive-compulsive and panic disorders were treated with serotonin reuptake blockers. There was clinical overlap of depersonalization disorder with obsessive-compulsive disorder, and the co-occurrence of obsessive-compulsive and panic features with depersonalization in these patients was associated with a favorable treatment outcome. The chronicity of illness and lack of prior response to a variety of treatments in these patients highlights the positive outcome with this treatment. In addition, issues are raised regarding the current hierarchical exclusion of depersonalization disorder in the presence of obsessive-compulsive and panic disorders.

Adolescent↗
PubMed1990

Phenelzine and atenolol in social phobia.

Seventy-four patients meeting DSM-III criteria for social phobia completed 4 or more weeks of double-blind, randomized treatment with the monoamine oxidase inhibitor phenelzine, the cardioselective beta-adrenergic blocker atenolol, or placebo. Sixty-four percent of the patients on phenelzine demonstrated moderate or marked improvement, compared to 30 percent on atenolol and 23 percent on placebo. Phenelzine was significantly more effective than atenolol or placebo, whereas the efficacy of atenolol and placebo did not differ significantly. Patients were also prospectively divided into generalized and discrete subtypes of social phobia. Phenelzine appeared to be a particularly effective treatment for the generalized form of social phobia. Atenolol may be useful for discrete forms of social phobia such as performance anxiety.

Adolescent↗
PubMed1990

The pharmacotherapy of moral or religious scrupulosity.

Moral or religious scrupulosity is a disabling condition which is sometimes seen in patients with obsessive compulsive disorder (OCD). The authors described 10 patients with moral or religious scrupulosity who were treated with fluoxetine or clomipramine. Seven of the 10 patients completed open treatment of at least 8 weeks without requiring adjunctive medication; 5 of those 7 patients were rated as much improved. Among the 3 patients who required adjunctive medication, 1 was rated as much improved. Of the 4 nonresponders at 3 months, 2 responded after longer treatment trials. These results suggest that extreme moral or religious concerns and behaviors might be a form of OCD and that the scrupulosity can be effectively treated with serotonin reuptake blockers.

Adolescent↗
PubMed1989

Cortisol and sodium lactate-induced panic.

Sodium lactate infusions induce panic attacks in patients with panic disorder, but not in normal controls, by an unknown mechanism. We studied the plasma cortisol response to infusion of 0.5 mol/L of sodium lactate in 103 patients with panic disorder or agoraphobia with panic attacks, and 32 normal controls. Baseline cortisol levels did not distinguish early panickers from non-panickers and controls, but late panickers had significantly elevated baseline cortisol levels. In addition, a higher percentage of late panickers manifested an increase in cortisol during the baseline period compared with the other groups. Despite the fact that late panickers manifested elevated baseline cortisol levels, early panickers had significantly greater somatic distress as measured by the Acute Panic inventory. There was no increase in cortisol with lactate-induced panic, and cortisol levels fell significantly during the lactate infusion in all groups. Cortisol elevation occurred with moderate anxiety but not with severe panic anxiety. These results suggest different pathophysiologic mechanisms of early and late panic, and differences between anticipatory anxiety and panic anxiety.

Adult↗