Lactic acid response to caffeine in panic disorder: comparison with social phobics and normal controls.
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Adult↗
Biomedical subjects
M B Stein
Publications and source records attributed to M B Stein.
Comparison of anxiety sensitivity in panic disorder and social phobia.
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Adult↗
Lack of efficacy of the adenosine reuptake inhibitor dipyridamole in the treatment of anxiety disorders.
We administered dipyridamole, an adenosine reuptake inhibitor, to 12 outpatients with DSM-III-R anxiety disorders (2 patients with generalized anxiety disorder, 10 patients with panic disorder). Dipyridamole was administered at a flexible dose in a single-blinded fashion following a placebo washout phase and elimination of placebo responders. The mean duration of active treatment with dipyridamole was 46 days (range 21-88 days); the mean peak dose of dipyridamole was 202 +/- 55 mg/day (range 100-300 mg/day). Symptom ratings were completed at regular intervals by the patient and by a research nurse unaware of the treatment condition. Clinically significant improvement in anxiety symptoms was not demonstrated. The implications of these findings for an adenosinergic dysfunction model of panic disorder are discussed.
Adenosine↗
Lymphocyte beta-adrenoceptors in social phobia.
Beta-adrenergic receptor kinetics were measured in leukocytes from 17 drug-free, nondepressed patients with social phobia (generalized type) and 17 gender-matched and age-matched healthy controls. Binding was characterized using the highly specific beta-adrenergic ligand [125I]pindolol (125IPIN). Contrary to some studies in panic disorder and many studies in depression, no significant difference was found in Bmax or Kd values between social phobic patients and controls. Neither severity of social phobic symptoms nor the severity of certain symptoms of beta-adrenergic activation (i.e., tachycardia, tremor, blushing) influenced Bmax or Kd. To the extent that these peripheral indices can be considered reflective of central processes, these findings suggest that a simple defect in beta-adrenoceptor number of affinity is unlikely to explain the pathophysiology of generalized social phobia.
Adult↗
Posttraumatic stress disorder in the primary care medical setting.
Posttraumatic stress disorder (PTSD) is a prevalent disorder that adversely affects 2-5% of the general population. Little is known about PTSD in the primary care setting. The purpose of the present study was to evaluate the utility of a screening instrument for PTSD (the PCL-C) in primary care and to examine comorbidity, disability, and patterns of healthcare utilization among persons with PTSD in this setting. Adult, English-speaking patients attending for routine medical care (N=368) participated in a two-stage screening consisting of the administration of a self-report measure for posttraumatic stress disorder (the PCL-C) followed by a structured diagnostic interview. Current (1-month) prevalence of PTSD was determined, as were current comorbid disorders. Brief functional impairment and disability indices were administered, and healthcare utilization in the prior 6 months was ascertained. 11.8% (standard error 1.7%) of primary care attendees met diagnostic criteria for either full or partial PTSD. Comorbidity with major depression (61% of cases of PTSD) and generalized anxiety disorder (39%) was common, but less so with social phobia (17%) and panic disorder (6%). Substance use disorder comorbidity (22%) was also fairly common. Patients with PTSD reported significantly more functional impairment than patients without mental disorders. Patients with PTSD also made greater use of healthcare resources than not mentally ill patients. PTSD frequently is encountered in primary care, and is associated with considerable functional impairment and healthcare utilization. Comorbidity with other mood and anxiety disorders is extensive. It remains to be seen if greater awareness and more aggressive treatment of PTSD in primary care will lead to improved functioning and reduced (or more appropriate) healthcare utilization. These are topics for further study.
Adult↗
Vagal attenuation in panic disorder: an assessment of parasympathetic nervous system function and subjective reactivity to respiratory manipulations.
We examined the effects of hyperventilation and other manipulations of respiratory pace on parasympathetic nervous system function and subjective reactivity in 15 patients with panic disorder, 15 patients with social phobia, and 15 healthy control subjects. After a 30-minute rest period subjects completed a 2.5-minute trial of each of hypoventilation, normoventilation, and hyperventilation. Trials were separated by a 3 minute inter-trial interval. Incidence of panic attacks, symptom severity, vagal tone, heart rate, end-tidal carbon dioxide level, and respiratory frequency were measured throughout. Resting physiological measures did not differ between groups. Each respiratory manipulation resulted in the expected physiological changes (e.g., hyperventilation attenuated vagal tone), however, groups did not exhibit differential physiological reactivity to the manipulations. There were no panic attacks reported during either the hypoventilation or normoventilation phases; however, two social phobic subjects (13.3%) and two panic disorder patients (13.3%) reported panic attacks during hyperventilation. Although both groups of anxiety patients reported greater severity of hyperventilation-induced symptoms than did control subjects, symptom severity did not correlate significantly with vagal tone or heart rate. These results suggest that parasympathetic function is unlikely to be aberrant in PD patients and that diminished parasympathetic activity is not sufficient for the experience of panic attacks.
Adult↗
Development of a brief diagnostic screen for panic disorder in primary care.
OBJECTIVE: The purpose of this study was to determine the utility of a brief screening tool for panic disorder in the primary care setting. METHODS: A total of 1476 primary care outpatients in three primary care medical clinics on the West Coast of the United States were studied. Patients completed a brief self-report measure, the five-item Autonomic Nervous System Questionnaire (ANS), while in the waiting room. The presence of DSM-IV panic disorder was subsequently determined in groups of "screen-positive" and "screen-negative" subjects using the Composite International Diagnostic Interview. A subset of patients (N = 511) also completed the 21-item Beck Anxiety Inventory. Indices of diagnostic utility were calculated using receiving operating characteristic analyses to guide the selection of optimal cutoff levels. RESULTS: The two-question version of the ANS had excellent sensitivity (range = 0.94-1.00 across the three clinic sites) and negative predictive value (0.94-1.00) but low specificity (0.25-0.59) and positive predictive value (range 0.18-0.40). The three- and five-question versions of the ANS had only modestly improved specificity, and this was achieved at the cost of reduced sensitivity and increased respondent burden to complete the questionnaire. The 21-item Beck Anxiety Inventory had maximal clinical utility at a cutoff level of > or =20, but sensitivity was lower than desirable for a screening instrument (0.67). CONCLUSIONS: The two-question version of the ANS shows promise as a screening instrument for panic disorder in the primary care setting.
Adult↗
Sexual assault and physical health: findings from a population-based study of older adults.
OBJECTIVE: Prior reports have pointed to an adverse effect of sexual assault on subsequent health, particularly depression and obesity, in women. The objective of this study was to determine whether there is an association between self-reported sexual assault history and objective parameters of physical health in a sample of older men and women. METHODS: We conducted a cross-sectional study of white, middle to upper middle class, older (median age 75 years) men (N = 533) and women (N = 826) within a defined community setting. Sex-specific, age-adjusted risks were calculated for 11 common chronic medical conditions (10 for each sex: coronary heart disease, hypertension, diabetes, osteoporosis, obesity, asthma, migraine, thyroid disease, and arthritis in all subjects; breast cancer in women; and prostate cancer in men) and confirmed by physical or laboratory examination or review of medical records. RESULTS: Sexual assault was reported by 5.4% of men and 12.7% of women; repeated exposure was reported by 10.3 and 21.9% of sexually assaulted men and women, respectively. In women, a history of sexual assault was associated with an increased risk of 2 of 10 conditions: arthritis (OR = 1.76, 95% CI = 1.13-2.76) and breast cancer (OR = 2.21, 95% CI = 1.12-4.33). A "dose-response" effect was observed: Multiple episodes of sexual assault carried a two- to three-fold increased risk of these diseases compared with a single episode. In men, the only statistically significant association was between sexual assault and thyroid disease (OR = 4.68, 95% CI = 1.08-20.3). CONCLUSIONS: These data partially replicate findings from other studies of adverse effects of sexual trauma on health, although the specific diseases are different. Causal mechanisms cannot be inferred from these data. Studies in other cohorts are warranted.
Aged↗
Gender differences in the etiology of anxiety sensitivity: a twin study.
OBJECTIVE: To estimate the magnitude of genetic and environmental factors on anxiety sensitivity by gender. DESIGN: Classic twins reared-together study design. PATIENTS: A community sample of 337 twin pairs, including 179 monozygotic (45 brother and 134 sister pairs) and 158 dizygotic (28 brother, 94 sister, and 36 brother-sister pairs). METHOD: Twin pairs completed the Anxiety Sensitivity Index (ASI) using a postal survey design. The ASI is composed of three factors: (1) fear of anxiety-related somatic sensations; (2) fear of cognitive dyscontrol due to beliefs that sensations like depersonalization are signs of mental illness (e.g., fear of concentration problems); and (3) fear of publicly observable anxiety reactions (e.g., fear of trembling). Biometrical modeling techniques were used to estimate heritability of the ASI dimensions by gender. RESULTS: ASI factors are heritable only in women, accounting for 37% to 48% of the total variance (median, 44.5%). Environmental factors accounted for all the variability in men. CONCLUSIONS: These findings have implications for understanding the etiology of panic disorder. Previous research suggests that anxiety sensitivity is a risk factor or diathesis for this disorder, and that panic disorder is more prevalent in women than men. Our findings suggest the hypothesis that the increased prevalence in women may occur because anxiety sensitivity is heritable in women.
Anxiety↗
Neurocognitive function in panic disorder and social phobia patients.
A neuropsychological test battery designed to assess verbal learning and memory, visual memory, psychomotor speed, cognitive flexibility and concentration was administered to patients with panic disorder (N = 18) and social phobia (N = 18) and a group of healthy control subjects (N = 16). Overall, the neurocognitive performance of the panic disorder and social phobia patients was lower than that of control subjects. Analyses of the verbal test variables indicated reduced performance in panic disorder and social phobia patients, relative to control subjects, on measures of verbal learning and memory. In addition, panic disorder patients exhibited deficits on short-delay free recall. No group differences were observed on tests of visual memory, psychomotor speed, cognitive flexibility, and concentration. These results, while indicative of diminished neuropsychological test performance in patients with panic disorder and social phobia, do not suggest the presence of syndrome-specific or localized neurocognitive deficits.
Adult↗
Neuroendocrine responsivity to monoaminergic system probes in generalized social phobia.
We examined neuroendocrine correlates of central monoamine function in patients with the generalized type of social phobia compared to healthy volunteers in order to test hypotheses of dopaminergic, noradrenergic, and/or serotonergic dysregulation in patients with this disorder. A double-blind, placebo-controlled, neuropharmacological challenge study was performed using probes for the serotonergic (fenfluramine), dopaminergic (levodopa), and noradrenergic (clonidine) systems. Twenty-one patients with DSM-III-R social phobia (generalized type) and 22 "never mentally ill" volunteers participated in the study after providing informed consent. Patients with social phobia had an augmented cortisol response to fenfluramine administration compared to the volunteers. In contrast, we found that neither the prolactin response to fenfluramine, the growth hormone or norepinephrine response to clonidine, nor the prolactin or eye-blink responses to levodopa, differed between patients with social phobia and healthy volunteers. The findings suggest that patients with social phobia may exhibit selective supersensitivity of serotonergic systems, but that dopaminergic and noradrenergic function appear normal. Further challenge studies with more specific serotonin probes before and after treatment may assist in the clarification of the pathophysiology of social phobia.
Adrenergic alpha-Agonists↗