Among one hundred patients with alcohol dependence (DSM-III-R) studied in a drug abuse center in the "Bajo Llobregat" area (Barcelona industrial belt it was detected that 27% had life time rate of panic disorder. The age of onset of alcoholism was earlier than the one for panic disorder. In 78.8% of these patients alcoholismo appeared first. 70.4% refer worsening of the panic attacks when drinking large amounts of alcohol. Patients with Panic Disorder: a) are younger (p < 0.05); b) have attended school longer and have higher education (p < 0.01); c) have more alcoholism family history (p < 0.05); d) have more major depressive disorders (0.05) and dysthimic disorder (p < 0.01); e) Worse social functioning according to the GAS (p < 0.01); f) higher score for the Psychological disorders Scale (p < 0.001) and a lower performance at work (p < 0.001) measured by the ASI. The clinical significance of these findings is discussed.

Adult↗

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[Comorbidity of panic disorder and social phobia].

Among 83 patients presenting panic disorder 24% have comorbid social phobia. Its age of onset was earlier than the one for panic disorder, in 95% of social phobics appeared first. Patient comorbid with social phobia and panic disorder: a) have an earlier panic disorder age of onset (p < 0.05); b) have more major depressive disorders (p < 0.01); c) more obsessive compulsive disorders (p < 0.05); d) higher scores in all SCL-90 subscales, except for phobias; e) more severity in the social phobia scale from the Fear Questionnaire of Marks & Mathews. The clinical significance of these findings is discussed.

Adult↗

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[Anesthesia recovery, gas exchange and postoperative hepatic and renal function in patients with morbid obesity undergoing bariatric surgery: comparison of the effects of halothane, isoflurane and fentanyl].

OBJECTIVES: To compare the postoperative effects of three anesthetic agents, fentanyl, halothane and isoflurane, on recovery from anesthesia, changes in arterial blood gases, and tests of liver and kidney function in morbidly obese patients recovering from vertical ring gastroplasty. MATERIAL AND METHODS: Thirty-three patients were studied, randomly distributed into three groups of 11. Induction for all was with atracurium (5 mg), 2.5% thiopentone sodium (5-6 mg.kg-1), succinylcholine (1.5 mg.kg-1) and orotracheal intubation. Anesthesia was maintained with intermittent doses of fentanyl (group F), 2% halothane (group H) or 2.5% isoflurane (group I). All patients received a 50% O2/N2O mixture at a minute volume calculated on ideal weight. Muscle relaxation was achieved by continuous perfusion of atracurium. Postoperative analgesia was by morphine chloride through a lumbar epidural catheter. Time of eye opening and time of extubation were recorded. Arterial blood gas measurements were taken and the results of liver and kidney function tests were recorded until the 7th day after surgery. RESULTS: Eye opening after awakening was earlier in the fentanyl group (6 +/- 5 min), but no differences were found for time of extubation. Blood gas measurements for the 33 patients revealed a significant decrease in PaO2 (58 +/- 14 mmHg), a slight increase of PaCO2 (40 +/- 6 mmHg) and a lower pH (7.32 +/- 0.04) immediately after surgery. On day seven, PaO2 had not yet reached preoperative levels (p < 0.01). These results were independent of anesthetic agent used. Kidney function tests showed significant rises in SGOT (81 +/- 36 U/l), SGPT (150 +/- 110 U/l) and bilirubin (Bil: 15 +/- 5 mmol/l) and decreases in prothrombin activity (PT: 73 +/- 11%) 24 hours after surgery, with later normalization. Urea fell significantly throughout the seven-day period (3.2 +/- 1.3 mmol/l). These results were also independent of the anesthetic agent used. CONCLUSIONS: Morbidly obese patients undergoing gastroplasty recover from anesthesia in the same way regardless of the agent used. The early postoperative period is characterized by severe hypoxemia and transitory changes in kidney function tests. Neither of these findings is dependent on the agent used.

Adult↗

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[Comorbidity in panic disorders and alcoholism (II). Alcoholism in a sample of 148 patients with panic disorders].

Among 148 patients presenting Panic Disorder (DSM-III-R), 18.9% have an alcohol disorder, 8.8% present abuse and 10.1% dependence. Mean age of onset of alcoholism was much earlier than panic disorder. Patients with alcoholism: a) are males more frequently (0.001); b) present more alcoholism in first grade relatives (0.05); c) use more often other drugs like: tobacco (0.01), coffee (p < 0.01), cocaine (p < 0.01) and cannabis (p < 0.001), d) patients with alcoholism refer a greater severity of their panic attacks when drinking large amounts of alcohol (25%) than the group without these problems (2.5%) (x2:14.8) (p < 0.001) e) according to the GAS the overall level of performance is lower in alcoholics (p < 0.005); f) present more anxiety measured by the HARS (p < 0.01), and therefore have more comorbid anxiety disorders according to DSM-III-R (p < 0.01). The clinical significance of these findings is discussed.

Adult↗

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[Desflurane: a new inhalation anesthetic].

Desflurane is a new fluoride-only halogenated inhalational anesthetic. It differs from other halogenated anesthetics, in having a lower solubility in all tissues and greater molecular stability in all media. These traits mean, on the one band, that desflurane affords rapid achievement of depth of anesthesia, recovery and management during surgery, and on the other, that its potential toxicity is low and that it is safe for use in low flow circuits. The pharmacodynamic effects of desflurane are similar to those of isoflurane in the blood stream, airways and brain. Sympathetic hyperactivity with increased heart rate and arterial pressure may be triggered when concentration is increased quickly, but this effect is partially abolished when fentanyl is administered. Induction of anesthesia with desflurane causes irritation of the airways, particularly in children, and its use in pediatric surgery is therefore inadvisable. Desflurane potentiates the action of neuromuscular relaxants, much like isoflurane. Desflurane represents a step forward in the search for the ideal anesthetic.

Anesthesia Recovery Period↗

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[Clinical subgroups of anxiety disorders: from phenomenology to cluster diagnosis].

The panic disorder is heterogeneous. The factorial study of the phenomenology of panic crisis suggests the existence of different subtypes: the cardio-respiratory, the vestibular, the despersonalization, the gastrointestinal and others. We review the clinical and biological data which suggest the display of these subtypes.

Adult↗

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[Comparison of the effect of desflurane with isoflurane in patients over 65 years of age: multicenter study].

OBJECTIVE: To compare the effects of desflurane (DES) and isoflurane (ISO) in patients over 65 years of age based on recovery, hemodynamic variables, need for additional drugs and postoperative rates of nausea and vomiting. PATIENTS AND METHODS: Ninety-eight patients were anesthetized with DES (n = 51) at an inspired concentration of 3% or ISO (n = 47) at a concentration of 0.5%, both combined with 60% nitrous oxide. Anesthetic concentration was later adjusted to maintain hemodynamic variables within 20% above or below baseline. Analgesia was provided with fentanyl and neuromuscular relaxation with atracurium. After surgery, anesthetic gases were withdrawn. We then recorded variables related to anesthetic recovery, postoperative analgesia and the rates of nausea and vomiting. RESULTS: Mean time (+/- SD) until eye opening was 7.6 +/- 5.5 minutes for patients anesthetized with DES and was significantly less than the 14.4 +/- 8.9 minutes taken by patients anesthetized with ISO (p < 0.01). Patients anesthetized with DES spent 23 minutes less time in the recovery room than did patients anesthetized with ISO (p < 0.05). There were no significant differences in need for fentanyl, atracurium, postoperative analgesia, hemodynamic variables or rates of nausea or vomiting. CONCLUSIONS: Patients over 65 years of age anesthetized with DES recovered in half the time of patients anesthetized with ISO. DES is a safe anesthetic for elderly patients and may offer clinical advantages.

Aged↗

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[Panic disorder in the elderly].

UNLABELLED: The existence of panic disorder (PD) in old population is a source of debate. OBJECTIVES: This study is aimed at studying the sociodemographic and clinical characteristics of panic disorder in patients over 60 years of age seen in two outpatient psychiatric clinics. METHOD: All consecutive cases of PD (DSM-III-R) who contacted with two outpatient clinics in a three-year period were assessed by the same team. Those patients aged 60 or more at the time of interview were grouped and compared with a young and adult group. PASS and Marks-Matthews' Phobia Scale were administered to the sample. RESULTS: Fifty-three (15.6%) out of 341 PD patients were over 60 years of age. Elderly patients reported less frequency and severity of symptoms, less comorbidity with social phobia (p < 0.01) and alcoholism disorders (p < 0.01) and more with dysthymia (p < 0.05). The elderly patients with PD reported fewer family histories of alcoholism (p < 0.05), depression (p < 0.05) and PD (p < 0.05). CONCLUSIONS: The rate of PD patients over 60 years of age who get in touch with outpatient psychiatric clinics is variable but not uncommon. Some clinical characteristics of PD in the elderly such as medical comorbidity and less symptom severity may enhance misdiagnosis in clinical settings.

Adolescent↗

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[Separation anxiety and panic disorder].

History od separation anxiety was investigated in several psychiatryc disorders and in 150 patients with panic disorder following DSM III-R criteria. Separation anxiety was reported by 15.3% of patients with panic disorder, 3.3% of the healthy control group, 13.3% of patients with major depression, 16.7% with dystymia, 13.3% with generalized anxiety and 33.3% with social phobia (p < 0.001). Separation anxiety is thus considered a common predisposing factor of anxiety and depressive disorders. Panic disorder patients with a history of separation anxiety had an earlier age at panic onset and greater comorbidity with social phobia and agoraphobia.

Adult↗