Cardiovascular, respiratory, and panic reactions to epinephrine in panic disorder patients.
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Adult↗
Biomedical subjects
R van Dyck
Publications and source records attributed to R van Dyck.
The notion of somatization: an artefact of the conceptualization of body and mind.
BACKGROUND: Somatization is a contemporary notion which derives from the conceptualization of body and mind and the resultant concept of disease. The common element in this thinking is that the presumed separation of the concepts body and mind can be spanned by clinical symptoms. METHODS: This paper examines the history of these concepts and the assumptions underlying them. RESULTS: It is shown that the debate on the pathological regions of the body-mind relation is of early origin. It is reflected in the evolution of concepts of disease and disease entities. The ongoing attempts to form a conceptual synthesis have resulted in a multiplicity of disease entities and in the notion of somatization. However, somatization is shown here to differ conceptually from controversial contemporary disease entities with which it often seems intertwined, such as myalgic encephalomyelitis and the hypersensitivity syndrome. CONCLUSION: This insight may help diminish the ambiguity in this area of research and practice.
Female↗
Epinephrine infusions in panic disorder: a double-blind placebo-controlled study.
Twenty-four subjects with Panic Disorder were infused with epinephrine in physiological doses or placebo according to a double-blind design. The panic rate in the epinephrine group (67%) was higher than in the placebo group (25%). Placebo panic occurred early during the procedure and was apparently associated with anticipation anxiety and stress-provoking situational factors. Panickers were characterized by a greater increase in heart rate as well as a drop in pCO2. Fear of bodily sensations was only weakly associated with state anxiety levels at point of panic. It is concluded that cognitive factors may not be important in epinephrine-induced panic.
Adult↗
Verbal and physical aggression against demented elderly by informal caregivers in The Netherlands.
This study describes the extent of verbal and/or physical aggression as reported by caregivers and correlates of each type of aggression against the demented care recipient. The extent of verbal aggression alone was 30.2% and of physical aggression, 10.7%. Verbal and physical aggression were associated with sharing the same household with the care recipient, caring for a male and caring for an elderly person more severely impaired in cognitive functioning and more dependent in Instrumental Activities of Daily Living. Verbal aggression was also associated with proving more care, and physical aggression with caring for a spouse and more psychological complaints of the caregiver. Accordingly, physical aggression does not seem to be a mere extension of verbal aggression, and different intervention strategies may be required for verbally and physically aggressive caregivers.
Aged↗
Non-drug treatment for social phobia.
When controlled studies on currently available non-drug treatments for social phobia were reviewed, short-term effectiveness was evident for social skills training, exposure therapy and cognitive therapy. The combination of exposure and cognitive therapy may have some superiority over the separate treatments. Group therapy and individual therapy did not differ clearly in outcome, while attempts to match treatment and patient characteristics have so far failed to produce consistently better results. With follow-up periods of either less than a year or more than a year, the therapies reviewed appeared to lead to stable results, although the available data allowed no firm conclusions because of attrition and additional treatments during the follow-up period. Except for the recent landmark study by Heimberg and Liebowitz, cognitive behavior therapy has not been adequately compared to medication. Studies are needed to assess the value of cognitive behavior therapy in combination with medication and to explore the possibilities of self-help manuals in such combination studies.
Behavior Therapy↗
Long-term benzodiazepine use is associated with smaller treatment gain in panic disorder with agoraphobia.
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Adolescent↗
Hyperventilation and panic attacks.
OBJECTIVE: Hyperventilation has been posed as an important symptom-producing mechanism in panic attacks. Some arguments and experimental findings, such as the possibility of inducing panic symptoms by voluntary hyperventilation in panic disorder patients, seem to favor this suggestion. This study was undertaken to clarify the role of hyperventilation in panic disorder. Long-term ambulatory measurement of transcutaneous arterial CO2 pressure (PCO2) offers an opportunity to test directly the co-occurrence of panic and hyperventilation under natural conditions. METHOD: Transcutaneous PCO2 was measured during three to four sessions of approximately 7 hours each in 28 panic disorder patients. Patients were instructed to expose themselves to fear-provoking situations and to press a button as soon as they experienced panic. One-half of the patients experienced one or more panic attacks during these sessions. RESULTS: A decrease in PCO2 was observed during only one of the 24 registered panic attacks that lasted at least 3 minutes. Even during this particular attack, the degree of hyperventilation was not impressive. CONCLUSIONS: These findings indicate that the hypothesis that hyperventilation is an important symptom-producing mechanism in panic may be dismissed.
Adult↗
Psychiatric consultation for somatizing patients in the family practice setting: a feasibility study.
OBJECTIVE: The purpose of the study was to assess the feasibility of a psychiatric consultation intervention for somatizing patients in the family practice setting in terms of 1) patient compliance, 2) patient satisfaction, and 3) compliance and satisfaction of general practitioners (GPs). METHOD: In a period of nine months, forty-six patients were selected for psychiatric consultation in six solo family practices in a semi-urban area in the Netherlands. The consultation included an interview with the consulting psychiatrist, the patient, and the GP. A written summary of the consultation was provided to the GP and the patient. A booster session with a GP and psychiatrist was included to evaluate and reinforce the recommendations. RESULTS: The majority of the selected patients agreed to participate after informed consent. An intervention was implemented containing interpersonal techniques, reattribution, clarification, and structuring. GP compliance with recommendations was 100 percent, patient compliance 75 percent. CONCLUSION: A standardized psychiatric consultation for somatizing patients in a family practice setting can be implemented. Several levels of implementation can be distinguished.
Family Practice↗
Cognitive therapy and exposure in vivo in the treatment of obsessive compulsive disorder.
The present study is the first controlled study that evaluates the effects of cognitive therapy along the lines of Beck (1976) [Cognitive therapy and the emotional disorder. New York: International University Press] and Salkovskis (1985) [Behaviour Research and Therapy, 23, 571-583] in obsessive compulsive disorder (OCD) and compares these effects with those of self-controlled exposure in vivo with response prevention. Seventy-one patients were randomly assigned to either cognitive therapy or exposure in vivo. In each treatment condition seven patients dropped out. Both treatments consisted of 16 sessions. Cognitive therapy as well as exposure in vivo led to statistically significant improvement. Multivariate significant differences suggesting a superior efficacy of cognitive therapy in comparison to exposure in vivo on the obsessive compulsive measures and on the measures for associated psychopathology. However, no univariate differences were found. Further, in both treatment conditions a considerable percentage of the patients was rated as "recovered". Significantly more patients were rated as "recovered" in the cognitive therapy. The results show that this form of cognitive therapy is an effective treatment for OCD and suggest that cognitive therapy may be even more effective than exposure in vivo.
Adult↗
Pseudo-epileptic seizures: hypnosis as a diagnostic tool.
In this pilot study hypnosis was used in an attempt to provide evidence of a psychogenic component of pseudo-epileptic seizures. The criterion for psychogenesis was the reversal of the amnesia, which is often present in epileptic- and pseudo-epileptic seizures. The technique has been validated by a semi-blind referral of cases for analysis after the clinician had been able to make a firm diagnosis based on electro-encephalic corroboration of the nature of the seizure. In eight out of nine patients (of the original 13 patients, three patients dropped out and one patient was not evaluable), the experimental diagnosis corresponded with the clinical diagnosis. As pseudo-epileptic seizures can be characterized by their dissociative nature, a reasonable hypothesis is that patients with pseudo-epileptic seizures are more responsive to hypnosis than patients with epileptic seizures. Measurements of hypnotizability among seven patients with epileptic seizures and six patients with pseudo-epileptic seizures supported this supposition.
Adolescent↗
Dissociative and hypnotic experiences in eating disorder patients: an exploratory study.
Hypnotizability, subjective experiences during hypnotizability assessment, and dissociation were studied in 53 eating disorder patients in order to explore the relationship between these phenomena. Dissociation was measured with a newly developed self-reporting Dissociation-Questionnaire (DIS-Q), level of hypnotizability was assessed with the Stanford Hypnotic Clinical Scale (SHCS), subjective experiences during hypnosis with the Dutch Phenomenology of Consciousness Inventory (DPCI), and the Dutch Resistance to Hypnosis Scale (DRHS). Compared with normals, eating disorder patients scored significantly higher on the DIS-Q and SHCS. Compared with restricting anorexics, anorexics of the mixed type as well as bulimics report higher scores on both the DIS-Q and SHCS, but a significant difference was found only for the DIS-Q subscale loss of control. Although positive correlations between the DIS-Q and SHCS were found, the magnitude of the correlations shows that both instruments probably are measuring different constructs. Some implications of these findings are discussed.
Adult↗
Treatment of panic disorder with agoraphobia: comparison of fluvoxamine, placebo, and psychological panic management combined with exposure and of exposure in vivo alone.
OBJECTIVE: The purpose of this comparative outcome study was to investigate whether the effects of exposure in vivo treatment for panic disorder with agoraphobia could be enhanced by adding interventions specifically for panic attacks before the start of exposure treatment. The additional effect of two types of treatment for panic attacks--pharmacological (fluvoxamine) and psychological (repeated hyperventilation provocations and respiratory training)--was examined. Thus, the combined treatment of panic interventions with exposure in vivo could be compared to exposure in vivo alone. METHOD: Ninety-six patients were randomly assigned to four treatment conditions: double-blind, placebo-controlled fluvoxamine followed by exposure in vivo, psychological panic management followed by exposure, and exposure in vivo alone. Outcome was assessed by self-report measures, a standardized multitask behavioral avoidance test, and continuous monitoring of panic attacks. Seventy-six patients completed the study. RESULTS: All four treatments were effective and resulted in a significant decrease of agoraphobic avoidance. Moreover, the combination of fluvoxamine and exposure in vivo demonstrated efficacy superior to that of the other treatments and had twice as large an effect size (difference between pre- and posttreatment scores) on self-reported agoraphobic avoidance. The other treatments did not differ among each other in effectiveness. CONCLUSIONS: Results of the study indicate that the short-term outcome of exposure in vivo treatment can be enhanced by adding fluvoxamine treatment. Psychological panic management combined with exposure was not superior to exposure alone of equal duration.
Adolescent↗
Respiratory training prior to exposure in vivo in the treatment of panic disorder with agoraphobia: efficacy and predictors of outcome.
Thirty-two patients suffering from panic disorder with agoraphobia were treated with repeated hyperventilation provocations and respiratory training, followed by exposure in vivo. The treatment was evaluated with a comprehensive set of outcome measures, including self-report questionnaires, a multitask behavioural avoidance test and continuous monitoring of panic. The treatment was found effective for the majority of patients in diminishing the frequency of panic attacks and agoraphobic avoidance. The clinical relevance of the treatment effect was evidenced by the considerable number of patients that recovered. The effect of the treatment was sustained over a three and six month follow-up period. The prognostic value of a number of variables for treatment outcome was also investigated. Three variables accounted for the majority of the variance in treatment outcome: a higher pretreatment level of agoraphobic complaints, use of psychotropic medication and a longer duration of the disorder were associated with poorer outcome. Other variables, such as the therapeutic relationship and the quality of the marital bond, had no prognostic value.
Adult↗
[Perceived stress caused by informal caregiving. Construction of a scale].
We hypothesize that 'self-perceived pressure from informal care' is an important result of the appraisal process of caregivers. This pressure refers to the demands of the caregiving situation in comparison with the personal interests of the caregiver. For the measurement of this 'Self-Perceived Pressure from Informal Care' of informal caregivers of demented elderly (N = 167) a 9-item Rasch scale (SPPIC) was developed with a satisfying Index of Subject Separation (.66) and reliability (Rho = .79). Findings revealed that 'Self-Perceived Pressure from Informal Care' is one dimension which varies from less to more pressure. Perceived pressure did not differ for male and female caregivers, and for spouse and non-spouse caregivers. The associations of perceived pressure with the psychological and psychosocial complaints of the caregivers and with the stressors in the caregiving situation support the validity of the SPPIC (Pearson r = .26 - .53). This questionnaire can be used in research on the development of psychological complaints of caregivers, but also for measuring the effect of an intervention on caregivers.
Aged↗
[Panic disorders, agoraphobia and endocrinology].
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Adult↗
Brofaromine versus lithium addition to maprotiline. A double-blind study in maprotiline refractory depressed outpatients.
Depressed outpatients (n = 51) resistant to treatment with maprotiline were treated in a blind, randomized, single-centre study, for 6 weeks with either the reversible and selective monoamine oxidase A-inhibitor (MAO-A-I), brofaromine or lithium addition to maprotiline. The Hamilton Rating Scale for Depression was scored by an independent rater before and after the 6 week treatment period. No significant differences in efficacy were found between the two treatment regimes. In the patients who completed the trial, brofaromine was well tolerated with the exception of insomnia. Anticholinergic effects as well as thyroid dysfunctions (17 out of 20) were more frequent in the maprotiline/lithium group.
Adolescent↗
[Hyperventilation: not a cause of panic attacks].
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Diagnosis, Differential↗