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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Clinical experience and controlled studies confirm the efficacy of pharmacologic and cognitive-behavioral interventions for the acute treatment of panic disorder and agoraphobia. However, while some patients experience long periods of true remission, panic disorder remains chronic for many, with intermittent periods of acute exacerbation and continued residual distress. Findings from the Massachusetts General Hospital Naturalistic Study of the Longitudinal Course of Panic Disorder suggest that (1) a number of factors contribute to the severity and persistence of panic disorder, including phobic subtype, comorbid anxiety disorders, depression, personality disorders, and anxiety sensitivity; (2) chronicity is common; (3) for some, an anxiety diathesis is manifested early in childhood and sets the tone for later chronicity and comorbidity; (4) maladaptive personality characteristics may be manifestations of an underlying anxiety disorder; (5) patients with continued symptomatology despite improvement may benefit from the flexible integration of pharmacologic and cognitive-behavioral treatment approaches; and (6) long-term treatment is indicated for many patients.
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PMID:Longitudinal course of panic disorder: findings from the Massachusetts General Hospital Naturalistic Study. 225 71

The 36 inpatients who entered this prospective study were admitted to hospital because of cardiac phobia. Their treatment consisted of a behavior therapy program. Twenty-nine of them could be reexamined after 2 1/2 years: 41% were free of symptoms during more than 75% of the follow-up period; 59% suffered recurrences of their anxiety. One patient had committed suicide. A lower educational level, being single, and interpersonal difficulties and conflicts were the sociodemographic factors associated with a poor prognosis; a long pretreatment period of illness and the presence of depression or agoraphobia on admission were significantly more frequently correlated with an unfavorable outcome. The onset sequence of depression, agoraphobia and anxiety attacks was also of prognostic relevance.
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PMID:Prognosis of cardiac phobia. 225 11

Thirty out-patients suffering from panic disorders associated with agoraphobia were enrolled in a double-blind, controlled trial to compare the effectiveness and tolerability of etizolam and placebo. After a 1-week washout period on placebo, patients were allocated at random to receive twice daily doses of either 0.5 mg etizolam or placebo over a period of 4 weeks. Assessments, made at baseline and after 2 and 4 weeks of treatment, used the Hamilton Rating Scales for Anxiety and for Depression, the Covi Anxiety Scale, and determination of the weekly panic crises frequency. The results showed that etizolam produced significant improvements in chronic anxiety, phobic ideas, associated depressive symptoms and episodic anxiety, and was significantly more effective than placebo. Etizolam treatment was generally well tolerated and was not significantly different from placebo in this respect.
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PMID:Etizolam versus placebo in the treatment of panic disorder with agoraphobia: a double-blind study. 227 92

Sixty surviving patients from a community-based stroke register who had CT scan evidence of a single brain lesion and neurological signs appropriate to it were interviewed three to five years following their first-ever stroke. Mood disorder (anxiety and depression), physical disability, and intellectual impairment were assessed using standardized measures. The position and volume of the brain lesion was determined from CT scans performed soon after the stroke. The prevalence of depressive disorder was lower in this sample than that reported in previous studies (DSM-IIIR major depression 8.3%; all DSM-IIIR depressive disorders 18.3%). Reports by other workers for an association of depressive disorder either with left-sided brain lesions, or with anteriorly placed lesions in the left cerebral hemisphere, were not supported. Neither was there evidence of a correlation between symptom score and proximity of the lesion to the anterior pole of the left cerebral hemisphere. Psychiatric symptom scores were however greater with larger volume brain lesions. Anxiety disorders, especially agoraphobia, were relatively common (20% if diagnosed in the presence of depressive disorder), but were not related to lesion location or volume.
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PMID:Mood disorders in long-term survivors of stroke: associations with brain lesion location and volume. 228 90

The authors administered the Diagnostic Interview Schedule to 21 patients with borderline personality disorder. The patients met criteria for various other DSM-III diagnoses, meeting exclusion criteria in some cases, and not in other cases. Frequency distribution of each diagnosis and the diagnoses of each individual patient, are presented. Affective disorder was the most common diagnosis (85%). Of these, 62% had primary major depression, and 23% had secondary depression. Other diagnoses include bipolar disorder, dysthymia, panic, agoraphobia, alcohol and Drug abuse, somatization disorder, and many others. The authors conclude that while borderline disorder may be a sub-affective disorder, a specific diagnostic profile for this disorder that accounts for the presence of other Axis I and Axis II syndromes has yet to be delineated.
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PMID:Associated diagnoses (comorbidity) in patients with borderline personality disorder. 232 83

Patients with panic disorder and/or agoraphobia appearing in psychiatric settings report rates for lifetime major depression between 24% and 91%. Between 40% and 90% of patients with panic disorder in psychiatric populations report concomitant agoraphobia. A recent study of panic disorder subjects appearing in an outpatient cardiology clinic confirmed the strong link between panic and depression but found only a weak association between panic disorder and agoraphobia. In order to test the reliability of these outpatient cardiology findings, the authors studied major depression and agoraphobia in patients with angiographically normal coronary arteries and panic disorder. Twelve of the 32 (37.5%) panic disorder subjects reported a lifetime history of major depression (nine current, three past only). Only two of the 32 (six percent) reported any phobic avoidance. This study confirms the previous findings which suggest that major depression is common in cardiology populations with panic disorder and that phobic avoidance is uncommon in this group.
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PMID:Major depression and agoraphobia in patients with angiographically normal coronary arteries and panic disorder. 234 94

Urinary free cortisol (UFC) levels were measured at baseline and at four and eight weeks after initiation of treatment in 66 patients who met DSM-III-R criteria for primary panic disorder (PD). Thirty-seven normal control subjects also had UFC levels measured three times at monthly intervals. Patients were randomly assigned to treatment with alprazolam, diazepam, or placebo. At baseline, complicated PD patients (those with agoraphobia and secondary depression) had significantly higher UFC levels than did normal controls. At four and eight weeks, complicated PD patients receiving alprazolam and diazepam had significant reductions in UFC excretion compared to baseline. Patients with uncomplicated PD maintained UFC levels comparable to controls at each sampling period. Treatment with benzodiazepines did not lower UFC levels in this group. These findings suggest that patients with complicated PD demonstrate hyperactivity of the hypothalamo-pituitary-adrenal axis that is decreased by treatment with benzodiazepines.
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PMID:Reduction in urinary free cortisol during benzodiazepine treatment of panic disorder. 236 14

Prostaglandins are thought to act as neuromodulators of both central catecholamine and endocrine systems. Abnormalities of these systems have been described in affective disorders, in general, and in agoraphobia with panic attacks, in particular. This study measured basal prostaglandin-E (PGE) cerebrospinal fluid (CSF) levels in 20 patients with agoraphobia with panic attacks and 10 nonpsychiatric controls. In a subgroup of patients and controls, CSF levels of adrenocorticotrophic hormone (ACTH) and corticotropin-releasing factor (CRF) were also measured. There was no significant difference in CSF PGE levels between patients and controls. However, patients with higher depression scores had lower CSF PGE levels. CSF PGE levels tended to correlate with CSF ACTH, but not CSF CRF in the patient group, in general, and in the female patients, in particular. These findings do not support an abnormality in basal CNS PGE production in agoraphobia with panic attacks, but suggest further study of the PGE modulatory effect on the hypothalamic-pituitary-adrenal axis in this disorder.
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PMID:CSF prostaglandin-E in agoraphobia with panic attacks. 254 88

The present study investigates the differential effectiveness of three treatment packages for agoraphobia. Patients suffering from panic disorder with agoraphobia (DSM-III-R) received one of three treatments: Breathing Retraining with Cognitive Restructuring (BRCR), graded self-exposure in vivo (EXP), or a combination of BRCR and EXP. Treatments consisted of 8 sessions. Assessment consisted of self-report measures for panic, phobic anxiety and avoidance, depression, general anxiety, somatic complaints and fear of body sensations, and of two respiratory measures (respiratory rate and alveolar pCO2). The treatments resulted in a reduction in symptomatology on all self-report measures, except panic frequency, and in a decrease in respiratory rate. There was no evidence for a differential efficacy for any of the treatments on any of the variables. Contrary to expectation, and at odds with findings from earlier studies, BRCR had no significant effect on panic frequency. A detailed comparison of sample characteristics of patients in our study and previous studies, did not yield insight into possible causes for the failure to replicate earlier results. The limited effectiveness of breathing retraining in reducing panic, as observed in the present study, leads us to conclude that the role of hyperventilation in panic is less important than previously thought.
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PMID:Breathing retraining, exposure and a combination of both, in the treatment of panic disorder with agoraphobia. 188 10

Three studies examine the role that provocative visual stimuli have in eliciting anxiety reactions in people with agoraphobia. Such stimuli elicit more anxiety in agoraphobic patients than control subjects. The effect of visual stimulation appears to be specific: (1) non-visual stimulation is without comparable effect; (2) both control and agoraphobic groups show similar effects of visual stimulation on another reaction such as headache. The anxiety effects of visual stimuli are correlated with the extent to which subjects experience depersonalization and somatic symptoms of agoraphobia, but not correlated with depression or the behavioural or cognitive aspects of agoraphobia. Alternative accounts of the possible role of visual stimulation in the anxiety reactions of agoraphobic patients are discussed.
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PMID:The role of provocative visual stimuli in agoraphobia. 259 84


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