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Biomedical subjects

M R Liebowitz

Publications and source records attributed to M R Liebowitz.

At least 127 records · Page 7Linked to original sources
PubMed1990

Cardiac left ventricular hypertrophy and chamber dilatation in panic disorder patients: implications for idiopathic dilated cardiomyopathy.

Echocardiographic comparison of 35 panic disorder patients to 35 normal control subjects found subclinical increases of cardiac left ventricular chamber size in eight panic patients (and one control subject), and of left ventricular mass (corrected for body surface area) in seven panic patients. There was a significantly greater variance of left heart chamber size and corrected mass in panic patients compared with control subjects, without significant group mean differences. Consistent with a previously reported association of panic anxiety and idiopathic dilated cardiomyopathy, this study suggests that some healthy panic patients may have subclinical myocardial changes.

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

Sodium D-lactate infusion of panic disorder patients.

Nineteen patients with panic disorder received sodium D,L-lactate (racemic) and pure sodium D-lactate infusions in a pilot study. Sodium D-lactate, which is less metabolically active than L-lactate, produced panic attacks in half the patients. D-Lactate also produced hypocapnia and alkalosis, indicating hyperventilation. These findings suggest that metabolism of lactate is not necessary for the induction of panic in susceptible patients. D-Lactate appears similar to other agents that cause panic in its capacity to stimulate respiration in the preliminary study.

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↗
PubMed1989

A comparison of sodium bicarbonate and sodium lactate infusion in the induction of panic attacks.

Infusion of sodium lactate has been shown by a number of investigators to induce panic in patients with panic disorder, but the pathophysiology underlying this phenomenon is unknown. One theory to explain lactate's anxiety-producing effects involves its ability to induce alkalosis because of metabolic conversion to bicarbonate. To test this hypothesis, we administered both sodium lactate and sodium bicarbonate infusions in counterbalanced order to patients with panic disorder. Thirteen of 22 subjects panicked in response to lactate and nine of 20 subjects panicked in response to bicarbonate. Although the rate of panic between the two infusion responses was not significantly different, several aspects of response to the two infusions indicated that lactate may be a more potent producer of anxiety than bicarbonate. An unexpected finding was that bicarbonate panickers had a reduction in arterial carbon dioxide pressure during the infusion, while bicarbonate nonpanickers had an increase in arterial carbon dioxide pressure during the infusion. Induction of hyperventilation and subsequent hypocapnia appears to be a common denominator between lactate- and bicarbonate-induced panic.

Adult↗
PubMed1989

Reliability of anxiety assessment. I. Diagnostic agreement.

Test-retest reliability of lifetime anxiety disorder diagnoses was determined using the Schedule for Affective Disorders and Schizophrenia-Lifetime Anxiety version. The subjects were 104 patients at an anxiety research clinic. Reliability ranged from good to excellent (kappa = +.60 to +.90) for generalized anxiety, social phobic, panic, agoraphobic, and obsessive-compulsive disorders. Simple phobia showed poor agreement. Current episodes showed better agreement than past episodes, particularly for social phobia and obsessive-compulsive disorder. Major sources of disagreement (variance in subject report, rate error, criterion ambiguity) were reviewed for each diagnosis and implications for DSM-IV are proposed.

Adult↗
PubMed1989

Reliability of anxiety assessment. II. Symptom agreement.

Accurate assessment of "subdisorder" anxiety symptoms, ie, anxiety symptoms central to DSM-III-R-diagnosed anxiety disorders but not meeting disorder criteria because of insufficient frequency, duration, or accompanying subjective distress or impairment, may be critical to case identification in genetic, epidemiologic, and high-risk studies. However, concerns that the mild and often transient nature of these phenomena will foster unreliability have discouraged their use. We assessed the test-retest reliability of "subdisorder" anxiety symptoms in 104 outpatients with anxiety. Good to excellent agreement was found for lifetime occurrence of any panic attack, the spontaneous and situationally predisposed subtypes of panic, and five nonsocial irrational fears (public transportation, driving oneself, crowds, situations associated with death [eg, dead bodies and funerals], and cats and dogs). Four social and three additional nonsocial fears were considered to have adequate reliability. However, agreement on stimulus-bound panic, "near" panic attacks, persistent generalized anxiety, and the remaining nine nonsocial and six social irrational fears was only fair to poor. The major source of unreliability was variation in information reported by the subject to the rater.

Ambulatory Care↗