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Biomedical subjects

M K Shear

Publications and source records attributed to M K Shear.

At least 19 recordsLinked to original sources
PubMed1992

Neuroendocrine and behavioral responses to challenge with the indirect serotonin agonist dl-fenfluramine in adults with obsessive-compulsive disorder.

Neuroendocrine and behavioral responses to a single 60-mg oral dose of the indirect serotonin agonist dl-fenfluramine were assessed in unmedicated adults with obsessive-compulsive disorder (OCD) and neuroendocrine results contrasted with those in normal control subjects. Net fenfluramine-induced prolactin release did not differ significantly between OCD patients and normal controls. Prolactin responses in the OCD group were not significantly correlated with baseline Yale-Brown Obsessive Compulsive Scale scores for either obsessions or compulsions, but were positively correlated with the baseline Hamilton Depression Scale score and Hamilton Anxiety Scale score. No clear difference in the severity of patients' obsessions or compulsions was found following challenge with fenfluramine versus placebo. Although the present study does not demonstrate a serotonergic abnormality in OCD, this may be more a reflection of limitations of the test procedures than evidence that central nervous system (CNS) serotonergic function is normal in the disorder.

Adult↗
PubMed1992

Assessing impairment in patients with panic disorder: the Sheehan Disability Scale.

The DSM-III-R incorporates both distress (symptoms) and disability (impairment) in the definition of a psychiatric disorder. In psychiatric research there is a wide array of instruments used to measure symptom severity, but a limited selection for the assessment of impairment. The psychometric properties of one such instrument, The Sheehan Disability Scale (Sheehan 1983), are evaluated in this paper. The data analyzed come from two studies of patients with panic disorder, the Cross National Collaborative Panic Study--Phase I and the Panic Depression Study. In this report both the alpha coefficients and factor analyses indicate that the reliability of the scale is acceptable. The factor structure of the items and the sensitivity to change of their composite demonstrate satisfactory construct validity. The criterion-related validity is substantiated by the significant relationship between symptomatology and impairment. These analyses were limited to patients with panic disorder. Further work is needed to evaluate the instrument in assessing patients with other disorders.

Activities of Daily Living↗
PubMed1992

Pursuit eye movement dysfunction in obsessive-compulsive disorder.

Disturbances in neural circuitry including the basal ganglia and prefrontal cortex have been hypothesized to be a cause of obsessive-compulsive disorder (OCD). Because eye movements are often impaired in neurologic diseases affecting these brain areas, oculomotor functioning was assessed in 17 unmedicated patients with OCD and in 25 normal controls. As compared with control subjects, patients with OCD demonstrated low-gain (slow) pursuit eye movements and an increased frequency of square wave jerk intrusions, but no increase in anticipatory saccades. In addition, several OCD patients showed an unusual pattern of intrusive, brief epochs of high-gain (fast) pursuit lasting on the order of 50 to 130 msec. These epochs of fast pursuit moved the eyes ahead of the target being tracked, and were terminated by corrective reversal saccades. Studies of eye movement abnormalities may provide an informative neurophysiologic approach for studying disturbances in basal ganglia and frontal cortical function that have been observed in functional neuroimaging and neuropsychological studies of OCD.

Adult↗
PubMed1991

Cognitive-behavioral therapy for panic: an open study.

This paper reports results of an open prospective study of 26 patients who met DSM-III criteria for panic disorder or agoraphobia with panic attacks. Cognitive-behavioral treatment alone produced clinically and statistically significant improvement in panic symptoms, including both full-blown and limited symptom episodes. In addition, the treatment produced improvement in associated symptoms of phobic avoidance and generalized anxiety. This work provides further preliminary indication of the usefulness of cognitive-behavioral strategies as an alternative to medication in symptom-oriented treatments.

Adult↗
PubMed1991

Dynamic treatment of panic disorder: a review.

A review was conducted of the psychoanalytic and psychodynamic literature in order to identify patients with panic disorder who received dynamic treatment. Thirty-five cases were located that fit the description of panic disorder. Their characteristics are compared with those of a current anxiety disorder clinic panic disorder population. Features of the successful dynamic treatment of panic disorder are summarized.

Adult↗
PubMed1991

Vulnerability to sodium lactate in panic disorder patients given cognitive-behavioral therapy.

Six patients with panic disorder who had panicked during sodium lactate infusion were given cognitive-behavioral treatment for 12-24 weeks. After treatment they underwent another lactate infusion, and four patients were rates as having no panic, suggesting that reduced vulnerability to lactate accompanies remission of panic. Controlled trials of cognitive-behavioral therapy and use of lactate infusion as a measure of remission are recommended.

Adolescent↗
PubMed1987

Contrasting patterns of autonomic dysfunction in patients with mitral valve prolapse and panic attacks.

Both mitral valve prolapse (MVP) and panic attacks have been reported to be associated with autonomic dysfunction, but previous studies have been limited by the lack of clear separation between patients with MVP and those with panic attacks and the use of noncomparable control subjects. Accordingly, heart rate and blood pressure responses to deep breathing, five minutes' quiet standing, and the Valsalva maneuver were studied in age- and cardiac symptom-matched groups of 33 control subjects, 66 patients with MVP, 20 patients with panic attacks, and 17 patients with both MVP and panic attacks. Compared with control subjects, patients with MVP exhibited more syncope (13 of 66, or 20 percent, versus none of 33, or 0 percent; p less than 0.01), more orthostatic hypotension during quiet standing (11 of 66, or 17 percent, versus one of 33, or 3 percent; p less than 0.01), loss of the normal decrease with age in vagally-mediated heart rate variability during deep breathing (r = 0.13, p = NS versus r = -0.44, p = 0.01), and lower 24-hour epinephrine excretion (6.1 +/- 0.7 versus 11.0 +/- 2.7 micrograms; p less than 0.01). In contrast, patients with panic attacks had greater increases than control subjects or patients with MVP without panic attacks in heart rate, mean blood pressure, and the product of heart rate and mean blood pressure during each minute of quiet standing and during the early strain phase of the Valsalva maneuver. These findings indicate that autonomic dysfunction occurs both in patients with MVP and in those with panic attacks in comparison with symptomatic control subjects, but that the patterns of abnormality differ. Patients with MVP exhibit decreased effectiveness of responses to orthostatic stress, reduced epinephrine excretion, and abnormal vagal tone, whereas patients with panic attacks have heightened cardiovascular responses to postural and positive intrathoracic pressure stresses.

Adult↗
PubMed1987

Family satisfaction with psychiatric evaluations.

In the current study, psychiatric patient, family, and evaluator satisfaction with initial treatment recommendations was examined in relation to patient compliance with treatment methods and clinical improvement. Only family satisfaction was positively correlated with both compliance and improvement. This finding challenges the predominant view that families play negative roles in psychiatric illness by exacerbating symptomatology and, instead, stresses the positive facilitating role of the family. Implications for involving families in treatment evaluations and social work practice are discussed.

Consumer Behavior↗
PubMed1987

Cardiac rate and rhythm in panic patients.

This study assessed cardiac rate and rhythm by ambulatory monitoring in 23 patients with panic disorder or agoraphobia with panic attacks. The patients had a higher than normal mean daily density of ventricular premature complexes (VPCs), but complex ventricular arrhythmias were uncommon. Heart rate was greater during panic intervals than during asymptomatic periods. The prevalence of arrhythmias within symptomatic intervals was similar during panic, partial panic, and anxiety and was significantly higher than during asymptomatic intervals. However, most panic episodes had no arrhythmias, and arrhythmias during panic intervals were simple VPCs.

Adolescent↗
PubMed1986

Relation between clinical features of the mitral prolapse syndrome and echocardiographically documented mitral valve prolapse.

Mitral valve prolapse, the most common inherited cardiovascular condition, has been associated with a variety of signs, symptoms and electrocardiographic abnormalities, but the true spectrum of the mitral prolapse syndrome remains in doubt because clinical findings often contribute to patient identification and their prevalence in patient groups may be overstated because of ascertainment bias. Accordingly, clinical findings in 88 patients with echocardiographic mitral prolapse were compared with those in 81 of their adult first degree relatives with mitral prolapse (a group free of ascertainment bias) and in two control groups without mitral prolapse: 172 first degree relatives and 60 spouses. Comparison of relatives with and without mitral prolapse demonstrated true associations between mitral prolapse and clicks or murmurs, or both (67 versus 9%, p less than 0.001), thoracic bony abnormalities (41 versus 16%, p less than 0.001), systolic blood pressure less than 120 mm Hg (53 versus 31%, p less than 0.001), body weight 90% or less of ideal (31 versus 14%, p less than 0.005) and palpitation (40 versus 24%, p less than 0.01). In contrast, relatives with mitral prolapse showed no significant increase over normal relatives or spouses without mitral prolapse in prevalence of chest pain, dyspnea, panic attacks, high anxiety or repolarization abnormalities, but these features were all more common in women than in men (p less than 0.01 to less than 0.001). Thus, the true spectrum of the mitral prolapse syndrome encompasses a midsystolic click and late systolic murmur, thoracic bony abnormalities, low body weight and blood pressure and palpitation. Other suggested clinical features, including nonanginal chest pain, dyspnea, panic attacks and electrocardiographic abnormalities, have appeared to be associated with mitral valve prolapse because of ascertainment bias and an erroneous classification of differences between men and women as being due to mitral valve prolapse.

Adolescent↗
PubMed1986

Pathophysiology of panic: a review of pharmacologic provocative tests and naturalistic monitoring data.

Panic is a psychologic symptom with prominent physiologic manifestations. Pathophysiologic theories need to explain both the central emotional state and peripheral symptoms. This paper reviews current findings and hypotheses from studies using two strategies for understanding panic. First, recent results from provocative tests using sodium lactate, caffeine, CO2, yohimbine, and isoproterenol suggest panic patients have a special sensitivity to these substances. Underlying mechanisms may be related to abnormal functioning of the central noradrenergic (locus ceruleus) system. However, cognitive and behavioral aspects of pharmacologic provocative testing need further study. Second, naturalistic studies support findings of peripheral physiologic activation during panic, but do not show evidence for sustained hyperactivity throughout the day. Studies of phobic patients demonstrate the potential for imagined fear to provoke physiologic changes, again underlining the need to pay attention to psychologic aspects of panic.

Anxiety Disorders↗
PubMed1985

Behavior therapy for panic disorder.

Eleven patients who met DSM-III criteria for panic disorder were treated with behavior therapy techniques. Seven patients had mixed phobic avoidance and none were agoraphobic; three had no phobic symptoms. Mean duration of symptoms was 3.4 years. Treatment lasted a mean of 14 weeks and consisted of 1) education about physiology and management of panic symptoms; 2) relaxation, abdominal breathing, and cognitive anxiety management skills; and 3) imaginal and in vivo exposure. Upon termination of treatment, 10 of 11 patients were panic-free and six of seven mixed phobics showed complete remission or significant improvement of phobias. Follow-up data revealed excellent stability of remission. Clinical implications for the use of behavior therapy for panic disorder and directions for future research are discussed.

Adult↗