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Biomedical subjects

M B Stein

Publications and source records attributed to M B Stein.

At least 109 records · Page 6Linked to original sources
PubMed1994

Triggering the false suffocation alarm in panic disorder patients by using a voluntary breath-holding procedure.

The authors compared the maximal duration of voluntary breath-holding in patients with panic disorder (N = 23), patients with generalized social phobia (N = 10), and healthy subjects (N = 26). Patients with panic disorder had significantly shorter breath-holding durations than either comparison group. Groups did not otherwise differ in physiologic response to the breath-holding. Implications for a false suffocation alarm in panic disorder are discussed.

Adult↗
PubMed1994

Setting diagnostic thresholds for social phobia: considerations from a community survey of social anxiety.

OBJECTIVE: The goal of this study was to gain a broader perspective on social anxiety in the community than has been achieved by epidemiologic surveys to date. METHODS: The authors conducted a telephone survey of social anxiety among 526 randomly selected respondents in a medium-sized Canadian city. RESULTS: Sixty-one percent of the respondents reported being much or somewhat more anxious than other people in at least one of the seven social situations surveyed. Speaking to a large audience (i.e., public speaking) was the most frequently feared situation (endorsed by 55.0% of the respondents), followed by speaking to a small group of familiar people (24.9%), dealing with people in authority (23.3%), attending social gatherings (14.5%), speaking to strangers or meeting new people (13.7%), and eating (7.1%) or writing (5.1%) in front of others. When the threshold for caseness was systematically modified--by altering the required level of psychosocial interference or distress or by including or excluding subjects with pure public speaking phobia--the rate of "social anxiety syndrome" in the community varied from 1.9% to 18.7%; 7.1% was the prevalence when the criteria were set to conform with DSM-III-R. CONCLUSIONS: Social anxiety is common in the community, but precise delineation of the prevalence of "social phobia" depends heavily on where the diagnostic threshold is set. If DSM-III-R criteria had been applied in previous epidemiologic studies, it is likely that those studies would have documented prevalences of social phobia that are several times as high as the currently accepted rates.

Adolescent↗
PubMed1994

Panic disorder in pregnancy.

BACKGROUND: Some reports have suggested that panic disorder may go into remission during pregnancy. The universality of this finding, however, is questionable. In this retrospective survey, we examined the influence of pregnancy on the course of panic disorder in 46 women who developed panic disorder either before, during, or between pregnancies. METHOD: A questionnaire inquired about the clinical course of panic disorder before, during, and after each pregnancy. Additional questions were asked about symptom change following breastfeeding and about caffeine use during pregnancy. The questionnaire was mailed to 138 women with a DSM-III-R diagnosis of panic disorder who had been assessed in our Anxiety Disorders Clinic. RESULTS: Response rate to the questionnaire was 70%. Forty-six women reported a total of 67 pregnancies occurring after the development of panic disorder. Of these pregnancies, 43% were associated with improvement in panic symptoms, 33% with worsening, and 23% with no change. Furthermore, women were unlikely to experience the same outcome (i.e., worsening, improvement, or no change) in subsequent pregnancies. In contrast, the majority (63%) of pregnancies were associated with exacerbation of symptoms in the postpartum period. No association with weaning or caffeine use was detected. CONCLUSION: Our findings suggest that pregnancy may have a highly variable influence on the course of panic disorder. In contrast, postpartum worsening of panic may be a more consistent phenomenon. Implications for pregnancy counseling and management are discussed.

Adult↗
PubMed1993

Growth hormone response to intravenous clonidine in social phobia: comparison to patients with panic disorder and healthy volunteers.

The growth hormone (GH) response to intravenous administration of clonidine hydrochloride (2 micrograms/kg) was assessed in 16 patients with DSM-III-R social phobia, 13 patients with DSM-III-R panic disorder, and 31 healthy controls. Compared to the healthy volunteers, both social phobic and panic-disorder patients had significantly blunted GH increments after clonidine. The social phobic patients demonstrated a similar degree of GH "blunting" to clonidine as did the patients with panic disorder.

Adult↗
PubMed1993

Sleep in nondepressed patients with panic disorder: II. Polysomnographic assessment of sleep architecture and sleep continuity.

This study assessed the EEG sleep of 16 patients with panic disorder who did not currently meet criteria for major depression in comparison to 16 age-comparable healthy controls. Patients with panic disorder had remarkably normal sleep, with only a modest reduction in total sleep time (374 +/- 46 min vs. 399 +/- 36 min) and delta sleep (11.4 +/- 6.2% vs. 16.4 +/- 6.6%) noted. Contrary to expectation, impairment in sleep maintenance and continuity was not found in the patients with panic disorder. We conclude (a) sleep in non-depressed patients with panic disorder is fairly unremarkable, and does not resemble that classically described for depressed patients, and (b) excessive arousability is not a characteristic feature of sleep in panic disorder.

Adult↗
PubMed1993

Sleep impairment in patients with social phobia.

Patient reports of sleep difficulty and sleep quality were systematically assessed in 30 nondepressed, untreated patients with the generalized subtype of social phobia and 30 sex-matched and age-comparable healthy control subjects. Sleep characteristics of the preceding month were assessed using a standardized, validated instrument: the Pittsburgh Sleep Quality Index (PSQI). Patients with generalized social phobia reported significantly poorer sleep quality, longer sleep latency, more frequent sleep disturbance, and more severe daytime dysfunction. Global PSQI scores did not differ significantly among social phobia with or without a lifetime history of major depression (48%), comorbid dysthymia (15%), or comorbid avoidant personality disorder (64%). These findings, which are reminiscent of those in other anxiety syndromes such as panic disorder, suggest that disturbed sleep may be a feature of the generalized subtype of social phobia that deserves further clinical and research attention.

Adult↗
PubMed1993

Chronic changes in thyroid hormones do not affect brain adenosine receptors.

1. In this study, the authors examined the effects of chronic (14 days) changes in thyroid function on a major neuromodulatory receptor system in the brain- the adenosinergic system. While previous investigators have examined the effects of alteration in thyroid function on adenosine receptors in peripheral tissues (adipocytes), this is the first study to examine such effects in brain. 2. Three groups of male Sprague-Dawley rats were treated for 14 days with either a) oral PTU (0.00625%), iodine-free diet, and i.p. saline injections, b) i.p. saline injections, or c) i.p. triiodothyronine (25 micrograms/100 g) injections. 3. These manipulations reliably resulted in the production of hypothyroidism (TSH 30.2 +/- 8.6 ng/ml), euthyroidism (TSH 2.1 +/- 0.9), and hyperthyroidism (TSH < 0.4). 4. Treatment had no significant effect on the Bmax or Kd of [3H]DPCPX (A1-antagonist) binding to homogenates from cerebral cortex, cerebellum or hippocampus; similarly, no effect on [3H]CGS-21680 (A2-agonist) binding to striatal homogenates was noted. 5. Similarly, quantitative autoradiographic studies failed to reveal consistent regional alterations unique to either hypo- or hyperthyroidism. 6. Incubation of sections with GppNHp resulted in the expected reduction (approximately 40%) in agonist binding, but there was no differential effect seen for either the hypo- or hyperthyroid tissues. 7. These preliminary findings suggest that alterations in brain adenosine receptors or G-protein-receptor coupling are unlikely to be requisite correlates of abnormal thyroid hormone levels.

Adenosine↗
PubMed1993

Sleep in nondepressed patients with panic disorder: I. Systematic assessment of subjective sleep quality and sleep disturbance.

To systematically assess sleep complaints in panic disorder (PD), the Pittsburgh Sleep Quality Index (PSQI) was administered to 34 untreated patients with DSM-III-R PD and 34 age-matched healthy controls (HC). PD patients reported significantly more impaired sleep than HC as indicated by higher global index scores on the PSQI (6.9 +/- 2.9 versus 3.1 +/- 2.0; p < 0.0001) and on four of seven of its subscales; sleep was worst among those PD patients with a prior history of major depression. Sixty-eight percent of patients with PD reported moderately or severely impaired sleep compared to only 15% of HC (chi 2 = 17.5, p < 0.0005). Twenty-six percent of PD patients--but none of the HC--complained of frequent awakenings in the preceding month because they "could not breathe comfortably" (Fisher's exact test, p < 0.00625). One-month prevalence of sleep panic in the patients was 18%; lifetime prevalence was 68%. Whereas these findings confirm previous reports of frequent sleep complaints in patients with PD, they also raise the possibility that some of the findings might be trait phenomena attributable to a history of mood disorder.

Adult↗
PubMed1993

Blunted growth hormone responses to growth hormone-releasing factor and to clonidine in panic disorder.

Blunted growth hormone (GH) responses to growth hormone-releasing factor (GH-RF) and clonidine have been reported in patients with panic disorder. In this study GH-RF and clonidine were administered to 13 patients with panic disorder and 20 healthy volunteers. Compared to the normal subjects, the patients with panic disorder had significantly blunted GH responses after both GH-RF and clonidine.

Adult↗
PubMed1992

High affinity [3H]ryanodine binding sites in postmortem human brain: regional distribution and effects of calcium, magnesium and caffeine.

The pharmacological properties, regional distribution and autoradiographic localization of [3H]ryanodine binding sites were examined in postmortem human brain. Analyses of binding data from labeled ryanodine titration experiments conducted in frontal cortex revealed a single class of high affinity binding sites with a Kd value of 3.6 nM and a Bmax value of 99 fmol/mg protein. In unlabeled ryanodine titration experiments, Kd and Bmax values were 6.5 nM and 132 fmol/mg protein, respectively. Binding was found to be dependent on free Ca2+ (ED50 value, 89 microM) and was decreased by 35% in the presence of 5 mM Mg2+. This Mg2+ inhibition was abolished by the addition of 10 mM caffeine. Analysis of the regional distribution of [3H]ryanodine binding in membrane preparations revealed high levels of sites in putamen and caudate nucleus, intermediate levels in hippocampus and cortex, and low levels in cerebellum. Autoradiographically, the hippocampus displayed a high density of binding sites in the CA3 region and the dentate gyrus. Ryanodine binding sites in human brain exhibit similar, but not identical binding and pharmacological characteristics to ryanodine receptors previously identified in muscle and more recently in rat and rabbit brain and accordingly may be involved in the regulation of intracellular calcium.

Aged↗
PubMed1992

Heart rate and plasma norepinephrine responsivity to orthostatic challenge in anxiety disorders. Comparison of patients with panic disorder and social phobia and normal control subjects.

Heart rate and plasma norepinephrine responsivity to a physiologic challenge, ie, orthostasis, were measured in 20 patients with panic disorder (PD) and 20 age- and sex-matched normal control subjects. While the two groups exhibited similar supine heart rates, patients with PD had a significantly greater heart rate response to orthostatic challenge. Plasma norepinephrine responses did not differ between patients with PD and normal control subjects. In a matched subgroup of 14 patients with PD, 14 normal control subjects, and 14 patients with social phobia, the patients with social phobia exhibited supine and upright plasma norepinephrine levels that were significantly higher than those of the other two diagnostic groups. Taken together, and in the context of findings from other studies, these preliminary observations suggest that the anxiety disorders may demonstrate differing patterns of autonomic dysfunction.

Adult↗
PubMed1992

Quantitative electroencephalographic effects of caffeine in panic disorder.

It has been demonstrated that patients with panic disorder are more sensitive than normal control subjects to the anxiogenic effects of caffeine. The underlying physiologic basis for this difference is unclear. We examined the electroencephalographic (EEG) activity of seven patients with panic disorder and seven normal control subjects during the randomized double-blind, placebo-controlled administration of oral caffeine (7 mg/kg). EEG data were collected on-line from 28 electrodes; artifact-free epochs were selected manually for off-line Fourier transformation. Caffeine was associated with a significant increase in peak occipital alpha frequency and significant decreases in occipital alpha amplitude, central beta amplitude, and central theta amplitude. Despite the observation that caffeine increased anxiety more in the patients with panic disorder than in the normal control subjects, the two groups did not differ in their EEG responses to caffeine.

Adult↗
PubMed1992

An examination of syndromal validity and diagnostic subtypes in social phobia and panic disorder.

BACKGROUND: We investigated whether patients with DSM-III-R panic disorder and patients with social phobia could be distinguished on the basis of selected demographic variables and by several commonly used anxiety and phobia rating scales. METHOD: Sixty-six patients with social phobia and 60 patients with panic disorder (42 with and 18 without agoraphobia) were studied. Subjects completed a battery of self-report measures that assessed phobic fears, avoidance, and related problems. RESULTS: Social phobic patients showed an earlier age at onset than the panic disorder group, and there was a trend for more social phobics to have never married. Social phobics reported significantly greater levels of social phobic avoidance and distress, fear of negative evaluation, and avoidance of social situations than the panic disorder patients who reported more overall anxiety and rated themselves as significantly more avoidant of situations involving exposure to public places and to blood or injury. Discriminant function analyses showed that social phobic and panic disorder patients can be reliably discriminated on these scales. CONCLUSION: The results of this study lend further support for the validity of the DSM-III-R nosologic distinctions between social phobia and panic disorder. Furthermore, generalized social phobia appears to be remarkably different from discrete social phobia on these measures. This study provides less support for considering panic disorder with agoraphobia to be distinct from panic disorder without agoraphobia.

Adolescent↗
PubMed1991

The QKd interval in panic disorder: an assessment of end-organ thyroid hormone responsivity.

The QKd interval was utilized as a presumptive index of end-organ thyroid hormone effect to test the hypothesis that patients with panic disorder might have abnormal tissue-level responsivity to normal levels of peripherally circulating thyroid hormones. No significant differences in QKd intervals were found between 15 patients with panic disorder (230 +/- 50 msec) and 20 normal controls (224 +/- 29 msec) while drug-free. These findings suggest that patients with panic disorder have normal tissue-level responsivity to thyroid hormone.

Adult↗
PubMed1991

Endocrine, cardiovascular, and behavioral effects of intravenous protirelin in patients with panic disorder.

The effects of protirelin administration on the anterior pituitary release of thyrotropin and prolactin were examined in 26 patients with panic disorder and 22 healthy volunteers. There were no differences observed in hormonal responses to protirelin between patients and controls. However, higher Beck Depression Inventory scores were associated with smaller baseline-corrected maximal changes in thyrotropin responses. Cardiovascular responses to protirelin did not differ between a subgroup of 15 patients with panic disorder and 15 age- and sex-matched healthy controls. Although protirelin produced robust increases in heart rate and blood pressure, only one patient with panic disorder experienced a panic attack during the infusion. The hormonal findings suggest that the presence of depressive symptoms may have a significant impact on various indexes of neuroendocrine responsivity and should be taken into consideration when looking at biologic measures in patients with panic disorder. The cardiovascular and behavioral findings do not support the hypothesis that all panic-producing stimuli are nonspecific and suggest that the induction of physical stimuli may be insufficient to produce panic attacks even in susceptible individuals.

Adult↗
PubMed1991

The use of the MMPI-2 in conjunction with the NEO-Personality Inventory.

The combined use of the MMPI-2 Basic and Content Scales and NEO-Personality Inventory has produced data that describe the interplay of psychiatric disorders and personality traits. Diagnostic and clinical implications include the patient's coping style, flexibility, motivation, organization, and compliance in treatment.

Adult↗
PubMed1991

Child and family outreach services as an adjunct to child and adolescent mental health treatment.

Child and Family Outreach Services have been an important adjunct to urban community child and adolescent mental health treatment. The Child and Family Outreach Services Program was developed as an extension of a child and adolescent outpatient and child partial hospitalization program to provide a comprehensive continuum of treatment. The Child and Family Outreach Program generalizes and links traditional therapeutic services to the patient's and family's environment through in-home, in-school, and community intervention. The latter treatment model enables the mental health service provider comprehensively to treat and effect positive change with high-risk patients and their families. Outreach service involvement has increased treatment compliance and reduced out-of-home placements.

Adolescent↗