Panic-free status is not associated with improvement on continuous measures in panic disorder.
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Agoraphobia↗
Biomedical subjects
P Spinhoven
Publications and source records attributed to P Spinhoven.
The developmental profile: preliminary results on interrater reliability and construct validity.
This study presents the preliminary results of research into the interrater reliability and construct validity of the Developmental Profile (DP). In the DP a number of developmental lines, such as Object-Relations, Self-Images, and Problem-Solving Capacities, are assessed and classified according to the level of functioning. A total of 108 profiles were assessed, drawn from three different categories of patients. The weighted kappa values for interrater reliability were sufficient. On the adaptive level, but also on the maladaptive levels Symbiosis and Resistance, significant differences were found between psychiatric patients, "normal controls" (dental patients) and somatic patients. No differences were recorded between the latter two groups. The conclusion is that the DP is a promising instrument, of which the reliability and validity has to be further investigated in order to contribute to scientific support for psychodynamic theory formation.
Adaptation, Psychological↗
The relationship between types and severity of repetitive behaviors in Gilles de la Tourette's disorder and obsessive-compulsive disorder.
BACKGROUND: This study investigated which categories of obsessive-compulsive and Tourette-related behaviors in Gilles de la Tourette's disorder and obsessive-compulsive disorder (OCD) without tics are experienced as most severe across the study groups and what the differences are in symptom distribution between the study groups. METHOD: Fourteen subjects with both Tourette's disorder and OCD, 18 subjects with Tourette's only, 21 subjects with OCD (no tics), and 29 control subjects were studied using a semistructured interview designed to equally assess Tourette- and OCD-related behaviors according to DSM-III-R criteria. Each reported repetitive behavior was evaluated on the presence of anxiety and on goal-directedness. Anxiety-related items were categorized as obsessions or compulsions and non-anxiety-related items as impulsions. Severity of each reported item was assessed with respect to time per day consumed and amount of distress and interference induced by the item. Following these criteria, each reported item was classified as a symptom, a subthreshold symptom, or just as being present. RESULTS: Across the study groups, obsessions were experienced as more severe than (Tourette-related) impulsions and compulsions. Within the study groups, patients with both Tourette's disorder and OCD reported more symptomatic Tourette-related impulsions, such as mental play, echophenomena, and impulsive or self-injurious behaviors; less overall symptomatic obsessions; and less symptomatic washing than patients with OCD (no tics). The differences among individuals with Tourette's with or without OCD reflected differences in symptom severity rather than differences in symptom distribution. CONCLUSION: Obsessions are more time consuming, distressing, and interfering than compulsions and impulsions. Furthermore, the symptomatic repetitive behaviors were distributed differently among patients with both Tourette's disorder and OCD and patients with OCD (no tics). Patients with Tourette's and OCD are phenomenologically more similar to Tourette's than to OCD. These differences possibly represent differences in underlying pathophysiology between Tourette's and tic-free OCD.
Adult↗
[Retrieved memories of traumatic events in the youth].
A working party of the Royal College of Psychiatrists has issued a report on retrieved recollections of sexual abuse during childhood and drawn up guidelines for the coping with such recollections. In contradiction to what the working party is asserting, amnesia for sexual abuse in the past may not be excluded. The working party's conclusion that false recollections of negative events can be induced in susceptible persons may be endorsed. As the working party also states, extreme caution is to be exercised in coping with retrieved recollections of childhood traumas, in which no reliable distinction can be made between true and false recollections because independent and objective evidence is often lacking.
Adolescent↗
Cognitive-behavioral therapy for noncardiac chest pain: a randomized trial.
PURPOSE: Patients with nonischemic chest pain frequently experience recurrent symptoms, have persistent functional and occupational disability, and are high utilizers of health-care resources. Our aim was to evaluate the efficacy of a cognitive-behavioral treatment for patients with noncardiac chest pain. PATIENTS AND METHODS: Subjects were recruited from patients with at least weekly episodes of noncardiac chest pain, as diagnosed by a cardiologist. The main outcome measures were frequency and intensity of chest pain at 6 and 12 months. RESULTS: Seventy-two patients were enrolled in the study; 37 were assigned to cognitive-behavior therapy and 35 to usual care. Sixty-five patients completed the study. Intervention patients improved significantly with regard to frequency and intensity of chest pain: 15 (48%) of the 31 patients in the treatment group were pain free at 12-month follow-up compared with 4 (13%) of the 33 patients in the control group (P = 0.002). CONCLUSIONS: Cognitive-behavioral therapy for noncardiac chest pain patients was effective compared with usual care.
Adult↗
The complex association of pulmonary function with panic disorder: a rejoinder to Ley (1998).
In a commentary on our paper entitled "Pulmonary function in panic disorder: evidence against the dyspnea-fear theory", Ley (1998) provides a critical analysis of our study. He concludes that our failed attempt to replicate a relationship between pulmonary function and the severity of panic-related symptoms in panic disorder patients may have been a consequence of a lack of comparability between studies, a statistical anomaly, and experimenter-demand effects. After discussing his comments (with most of them we do not agree) in depth, we maintain our conclusion that: (a) pulmonary impairment is not directly associated with panic symptoms; and (b) that the existence of a distinct subgroup of panic disorder patients with signs of actual airways obstruction leading to uncontrollable dyspnea and fear of suffocation remains questionable.
Data Interpretation, Statistical↗
Double-blindness procedure did not mask giving of medication in panic disorder.
BACKGROUND: The purpose of this study was to measure the degree to which patients and their treating physicians correctly guessed whether patients were on an active treatment (paroxetine or clomipramine) or pill-placebo, and whether correctness of these guesses was related to treatment outcome. METHODS: Ninety-five panic disorder patients, randomized to receive double-blind treatment with paroxetine, clomipramine or placebo for twelve weeks, were asked half-way through this period to classify treatment as active or placebo. Medical doctors were asked the same. RESULTS: Both patients and physicians guessed correctly to a degree much greater than would be expected by chance whether the patient was on an active treatment. Neither patients nor physicians were good at estimating correctly whether a patient was on a placebo. There was a trend approaching significance for patients on a placebo, whose physicians believed that they were on active treatment, to have a higher rating of symptom improvement than those patients who were correctly guessed to be on placebo. CONCLUSION: The 'double-blindness' procedure did not mask the giving of antidepressive medication in panic disorder. There is some evidence that physicians who incorrectly classify patients on a placebo as receiving active treatment relate this to better treatment outcome.
Clomipramine↗
Conditions not attributable to a mental disorder in Dutch psychiatric out-patients.
BACKGROUND: According to DSM-III-R V-code conditions refer to marital relationships, family circumstances, interpersonal relationships, or stressful life events that are not attributable to a mental disorder but that are the focus of treatment. The purpose of the present study was to assess the prevalence and patient and treatment characteristics of adult psychiatric out-patients diagnosed with V-code conditions. METHODS: The records of all 5660 consecutive admissions to a psychiatric out-patient clinic over a 12-year period were studied retrospectively. On the basis of both primary and secondary DSM-III-R diagnoses on Axis I, two subgroups of patients were compared: (1) patients with V-code conditions; and (2) patients with mental disorders. RESULTS: Fourteen per cent of the patients had a V-code condition and no mental disorder, while the remaining patients were diagnosed with mental disorder (with or without an additional V-code condition). Comparisons of sociodemographic and clinical severity characteristics of the two groups indicated that patients with V-code conditions tended to have a higher socio-economic status and to present with less severe problems as assessed both by the primary therapist and the Symptom-Checklist-90. With respect to service use and treatment outcome variables, it appeared that V-code patients tended to be more frequently treated by couple/family therapy and to receive a slightly lower number of treatment sessions. CONCLUSIONS: The pattern of results in The Netherlands seems comparable to results of previous North American studies. Implications of these findings for future studies and for use of mental health services are discussed.
Adult↗
Personality traits and psychological reactions to mental stress of female migraine patients.
The purpose of this study was (i) to compare a range of stress-related personality traits, including defense and coping mechanisms, of migraine patients (n = 23) with those of tension headache patients (n = 18) and dermatologically afflicted, but otherwise healthy, controls (n = 22), and (ii) to compare their state anxiety and other moods before, during, and after the presentation of a psychological stressor (mental arithmetic). For all three groups, mental arithmetic induced a significant increase in state anxiety and mood disturbance, followed by a subsequent decrease during recovery. Migraine patients were not found to have a higher disposition for anxiety, depression, or rigidity than tension headache patients or controls. Between the headache groups no differences in the use of defense and coping mechanisms were found. Compared to the control group, however, both migraine patients and tension headache patients were more inclined to use internally focused defense mechanisms and less inclined to seek social support when confronted with a problem. The psychological reaction of migraine patients to mental stress hardly differed from tension headache and control subjects. Compared to the control subjects, however, both groups of headache patients exhibited a diminished recovery from feelings of vigour, depression, and fatigue due to the stress induced. It is suggested that this distinct psychological reaction to stress of headache patients versus healthy control subjects is related to the more internally focused defense style of the headache sufferers. Thus, in contrast to previous results, this study does not present evidence of a migraine personality. It suggests the development of specific personality characteristics as a consequence of suffering from episodic headache.
Adaptation, Psychological↗
Somatoform dissociation discriminates among diagnostic categories over and above general psychopathology.
OBJECTIVE: The primary aim of this study was to investigate the hypothesis that somatoform dissociation would differentiate among specific diagnostic categories after controlling for general psychopathology. METHOD: The Somatoform Dissociation Questionnaire (SDQ-20), the Dissociative Experiences Scale, and the Symptom Checklist-90-R were completed by patients with DSM-IV diagnoses of dissociative disorders (n = 44), somatoform disorders (n = 47), eating disorders (n = 50), bipolar mood disorder (n = 23), and a group of consecutive psychiatric outpatients with other psychiatric disorders (n = 45), mainly including anxiety disorders, depression, and adjustment disorder. RESULTS: The SDQ-20 significantly differentiated among diagnostic groups in the hypothesised order of increasing somatoform dissociation, both before and after statistically controlling for general psychopathology. Somatoform dissociation was extreme in dissociative identity disorder, high in dissociative disorder, not otherwise specified, and increased in somatoform disorders, as well as in a subgroup of patients with eating disorders. In contrast with somatoform dissociation, psychological dissociation did not discriminate between bipolar mood disorder and somatoform disorders. CONCLUSIONS: Somatoform dissociation is a unique construct that discriminates among diagnostic categories. It is highly characteristic of dissociative disorder patients, a core feature in many patients with somatoform disorders, and an important symptom cluster in a subgroup of patients with eating disorders.
Adult↗
Dissociation in temporal lobe epilepsy and pseudo-epileptic seizure patients.
Patients with epileptic seizures (ES) and especially those with temporal lobe epilepsy (TLE) share many symptoms with patients with pseudo-epileptic seizures (PES), and the differentiation between them is often difficult There is growing evidence that a subgroup of PES patients suffer from a dissociative disorder. It is recognized that dissociative symptoms pertain to both psychological and somatoform components of experience. Questionnaires assessing dissociation might provide positive criteria for the diagnosis of PES. In this study, the Dissociation Questionnaire (DIS-Q) and the Somatoform Dissociation Questionnaire (SDQ-20) were administered to patients with ES (TLE, non-TLE) and PES. To control for the influence of general psychoneurotic complaints, the SCL-90 was administered. Apart from this, answers on a trauma questionnaire were related to the diagnosis. Results showed that PES patients scored significantly higher on the SDQ-20, also after correction with the SCL-90, and no difference was found on the DIS-Q. Also, PES patients significantly more often reported sexual traumatic experiences. A logistic regression revealed that results on the SDQ-20 have no independent value in addition to the contribution of gender, age, age at seizure onset, and the presence of sexual abuse in the prediction of the diagnosis. In conclusion, somatoform and not psychological dissociative symptoms are characteristic for PES patients in comparison to ES patients. Other measures are needed within the framework of the differential diagnosis between PES and ES.
Adolescent↗
Hypnotic recall: a positive criterion in the differential diagnosis between epileptic and pseudoepileptic seizures.
PURPOSE: Because the diagnosis of pseudoepileptic seizures (PESs) is mostly made by excluding epilepsy, availability of a positive criterion for PESs is of great importance. This study was aimed at the validation of a diagnostic technique that intends to provide in such a positive criterion. METHODS: In 17 patients with epileptic seizures (ESs) and 20 patients with PESs, a hypnotic procedure was performed by an investigator blind to other data to recover amnesia for the ictus. If recall was obtained, the experimental diagnosis PES was given; if not, ES was diagnosed. The experimental diagnoses were compared with the clinical, EEG-confirmed diagnoses. Hypnotizability was measured to determine the relation between the outcome of the test and hypnotizability of the patients. RESULTS: Recall for the ictus was obtained in 17 patients. Each of these had a clinical diagnosis of PES. Seventeen patients with "no recall" had a clinical diagnosis of ES, and three patients had PESs. This result yields a specificity of 100% and a sensitivity of 85% for the recall technique. Hypnotizability was significantly higher in patients with PESs than in patients with ESs. In some "low hypnotizables," recall was obtained, and in some "high hypnotizables," no recall was obtained. CONCLUSIONS: A positive recall test indicates PES. A sub-group of patients with PESs is characterized by a high level of hypnotizability. Hypnotizability is not crucial for outcome of the recall test. High hypnotic abilities are especially found in disorders in which it is supposed that "dissociation" is involved. It can be speculated that PES may be one of the dissociative phenomena.
Adolescent↗
Cognitive change following cognitive behavioural therapy for non-cardiac chest pain.
BACKGROUND: Seventeen to 43% of patients with non-cardiac chest pain suffer from anxiety/panic disorders. Cognitive behavioural therapy (CBT) is effective in reducing non-cardiac chest pain. However, no data are available indicating that pain reduction following CBT may be cognitively mediated or whether success of CBT is dependent on the presence of panic. The aim of the study was threefold: (1) does CBT have a differential effect on cognitive measures; (2) does a relationship exist between improvement in non-cardiac chest pain and changes in cognitive measures, and (3) can panic be established as a moderator of the effect of treatment? METHODS: Sixty-five patients with non-cardiac chest pain completed a randomised trial comparing study CBT with 'care as usual'. Dependent measures were: frequency of chest pain, anxiety, the fear of bodily sensations, attributions and catastrophic cognitions. RESULTS: CBT had a differential effect on most of the cognitive measures. Pain reduction was associated with the development of more adequate cognitions with respect to chest pain, independent of anxiety reduction. Although panic patients reported higher baseline scores on the cognitive measures, no differences in treatment results were found between panic and no-panic patients. CONCLUSIONS: Pain reduction following CBT may be cognitively mediated. The presence of panic did not affect the outcome of treatment, implying a broad applicability of the cognitive model for treatment of patients with non-cardiac chest pain.
Adult↗
Paroxetine, clomipramine, and cognitive therapy in the treatment of panic disorder.
BACKGROUND: This 12-week, placebo-controlled study was carried out to compare the relative efficacy of paroxetine, clomipramine, and cognitive therapy in the treatment of DSM-III-R-defined panic disorder with or without agoraphobia. METHOD: After a 3-week single-blind, placebo run-in period, 131 patients were randomly assigned to receive double-blind medication or 12 sessions of cognitive therapy based on the model of Clark. Efficacy assessments included the daily panic attack diary, the Clinical Global Impression scale, the Patient Global Evaluation, the Hamilton Rating Scale for Anxiety, the Marks-Sheehan Phobia Scale, the Montgomery-Asberg Depression Rating Scale, and the Sheehan Disability Scale. RESULTS: Comparisons with placebo revealed significant superiority of paroxetine (20-60 mg/day) and clomipramine (50-150 mg/day) on nearly all outcome measures. On most measures, paroxetine also showed higher efficacy than cognitive therapy. With few exceptions, cognitive therapy did not differ significantly from placebo. The number of subjects becoming panic-free (66%) was higher and the onset of action was faster in the paroxetine-treated group. Treatment with cognitive therapy yielded the highest drop-out rate (26%). CONCLUSION: In this short-term study assessing treatment of panic disorder and agoraphobia, paroxetine and clomipramine were consistently superior to pill placebo, whereas cognitive therapy was superior on only a few measures.
Adolescent↗
[Unexplained non-cardiac chest pain; its prevalence and natural course].
OBJECTIVE: (a) To assess whether data on prevalence and natural course of unexplained chest pain are similar to previous results reported for patients with unexplained chest pain in foreign literature; (b) to find biographical or medical record variables predictive of continuing pain. DESIGN: Retrospective research of medical records. SETTING: University Medical Centre and Diaconessenhuis (peripheral hospital), Leiden, the Netherlands. METHOD: Medical records of patients who had been newly referred between 1992 and 1995 to the cardiac outpatient clinic were screened on the discharge diagnosis: unexplained chest pain. Patients were approached by mail with a questionnaire, inquiring about duration, frequency, intensity, functional limitations and medical consumption with regard to their unexplained chest pain. RESULTS: In 39.8% (1053/2648) of the patients, no explanation was found for their complaints. After 12 and 24 months, 72% and 56% respectively reported still having complaints. 37% experienced limitations in daily activities at the time of the investigation. Sex and duration of pain before visiting the cardiologist were predictors of the persistence of chest pain. 31% of the patients did consult their general practitioner at least once more after the discharge by the cardiologist. CONCLUSION: Unexplained chest pain is a common complaint of patients visiting an outpatient clinic for cardiology and often persists. The present results are largely similar to those reported in foreign literature.
Age Distribution↗
Noncardiac chest pain: interest in a medical psychological treatment.
The aim of this study was to assess to what extent patients with unexplained chest pain (UCP) are interested in a medical psychological treatment, and to find biographical or medical status variables predictive of that need. A total of 1053 patients with a discharge diagnosis of UCP from two cardiac outpatient clinics were approached by mail. Of these, 77.2% returned the questionnaire, which inquired about duration, frequency, and intensity of UCP; limitations in activities; and whether they would like medical psychological treatment for their UCP. Results showed little spontaneous recovery, and indicated no association between duration of UCP and interest in treatment. Younger patients and males were more interested in treatment. Furthermore, limitations in activities rather than frequency or intensity of pain was the most important predictor of interest in treatment. A three-step plan is proposed to enhance care for patients with UCP.
Activities of Daily Living↗
Animal defensive reactions as a model for trauma-induced dissociative reactions.
Patients with complex dissociative disorders remain in alternating psychophysiological states which are discrete, discontinuous, and resistant against integrative tendencies. In this contribution, a parallel is drawn between animal defensive and recuperative states that are evoked in the face of severe threat and the characteristic responses of dissociative disorder patients as displayed in major dissociative states. Empirical data and clinical observations seem to be supportive of the idea that there are similarities between freezing, concomitant development of analgesia and anesthesia, and acute pain in threatened animals and severely traumatized human beings.
Animals↗
Degree of somatoform and psychological dissociation in dissociative disorder is correlated with reported trauma.
In this study, the prevalence and severity of traumatic experiences as reported by patients with dissociative disorders and with other DSM-IV psychiatric diagnoses were compared. Furthermore, the predictive value of emotional, physical, and sexual trauma with respect to somatoform and psychological dissociation was analyzed. In contrast with comparison patients, dissociative disorder patients reported severe and multifaceted traumatization. Physical and sexual trauma predicted somatoform dissociation, sexual trauma predicted psychological dissociation as well. According to the memories of the dissociative disorder patients, this abuse occurred in an emotionally neglectful and abusive social context. Pathological dissociation was best predicted by early onset of reported intense, chronic and multiple traumatization. Methodological limitations restricting causal inferences between reported trauma and dissociation are discussed.
Adolescent↗