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 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Mitral valve prolapse (MVP) is due to a heterogeneous group of conditions that may affect the mitral valve or the mitral valve apparatus. Although MVP may progress later in life to frank mitral insufficiency requiring mitral valve repair or may predispose to bacterial endocarditis, in most cases it is a benign, idiopathic condition without serious consequences. However, many investigators have documented that MVP is often associated with a constellation of signs and symptoms, which appear to constitute a distinct syndrome. These associated findings include autonomic dysfunction, frequent complaints of chest pain, palpitations, orthostasis, fatigue, dyspnea on exertion and anxiety. Although the risk of significant myocardial dysfunction or bacterial endocarditis appears to be related to patient sex, age and the severity of valvular prolapse and insufficiency, there appears to be little or no relations between the extent of prolapse and the degree of autonomic dysfunction or the severity of symptoms of chest pain, palpitations, dyspnea on exertion and anxiety. The development of uniform diagnostic standards for mental disorders has helped to make it possible to identify several related entities, including generalized anxiety disorder, panic disorder and agoraphobia; patients with these disorders frequently somatize their anxiety and complain of many symptoms which may be seen in patients with MVP. Although several studies have reported an increased frequency of MVP in patients with anxiety disorders, recent studies suggest that the conditions are not linked. Iatrogenic cardiac neurosis is common in both groups of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Mitral valve prolapse: from syndrome to disease. 332 70

In a multicenter placebo-controlled study, the safety, side effects, and patient acceptance of alprazolam for the treatment of panic disorder and agoraphobia were examined. A total of 525 patients meeting DSM-III criteria for agoraphobia with panic attacks or panic disorder were randomly assigned to receive alprazolam or placebo, which they took for eight weeks. The mean daily dose at the end of the study was 5.7 mg of alprazolam or 7.5 capsules of placebo daily. Potentially serious reactions to alprazolam occurred in ten of 263 subjects who received the drug. These included acute intoxication (three), hepatitis (two), mania (two), amnesia (one), aggressive behavior (one), and depression (one). Treatment-related side effects that were worse in patients taking alprazolam than in those taking placebo included sedation, fatigue, ataxia, slurred speech, and amnesia. Sedation was the most frequent but tended to subside with dose reduction or continued administration of the drug. Patient acceptance of alprazolam, as measured by the rate of completion for study participants, was high. Eighty-four percent of patients receiving active drug completed the study compared with 50% receiving placebo.
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PMID:Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. II. Patient acceptance, side effects, and safety. 335 44

The relationship between psychopathology and the personality trait, locus of control, was examined in 116 adult outpatients diagnosed as having chronic anxiety disorder. Measures consisted of state and trait scales, a measure of social adjustment, and a measure of disturbance during childhood. Patients with an external locus of control were more depressed, had higher levels of state anxiety, and exhibited more indecisiveness, fatigue and agoraphobia than those with an internal locus of control. Externally oriented patients also scored higher on neuroticism and trait anxiety and scored lower on social adjustment. On the somatic scales, externally oriented patients rated themselves, in contrast to physician's rating, as being more symptomatic than internal patients, suggesting the presence of a help-seeking attitude. Locus of control may be of importance in the formulation of therapy and prognosis in patients with anxiety disorders.
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PMID:Locus of control in chronic anxiety disorders. 408 58

We studied the link between chronic fatigue syndrome (CFS) and hyperventilation in 31 consecutive attenders at a chronic fatigue clinic (19 females, 12 males) who fulfilled criteria for CFS based on both Oxford and Joint CDC/NIH criteria. All experienced profound fatigue and fatigability associated with minimal exertion, in 66% developing after an infective episode. Alternative causes of fatigue were excluded. Hyperventilation was studied during a 43-min protocol in which end-tidal PCO2 (PETCO2) was measured non-invasively by capnograph or mass spectrometer via a fine catheter taped in a nostril at rest, during and after exercise (10-50 W) and for 10 min during recovery from voluntary overbreathing to approximately 2.7 kPa (20 mmHg). PETCO2 < 4 kPa (30 mmHg) at rest, during or after exercise, or at 5 min after the end of voluntary overbreathing, suggested either hyperventilation or a tendency to hyperventilate. Most patients were able voluntarily to overbreathe, but not all were able to exercise. Twenty-two patients (71%) had no evidence of hyperventilation during any aspect of the test. Only four patients had unequivocal hyperventilation, in one associated with asthma and in three with panic. Only one patient with severe functional disability and agoraphobia had hyperventilation with no other obvious cause. A further five patients had borderline hyperventilation, in which PETCO2 was < 4 kPa (30 mmHg) for no more than 2 min, when we would have expected it to be normal. There was no association between level of functional impairment and degree of hyperventilation. There is only a weak association between hyperventilation and chronic fatigue syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hyperventilation and chronic fatigue syndrome. 804 70

Side effects play a significant role in the selection of drugs to be used in panic disorder/agoraphobia whose polyphobic symptomatology often includes a suspiciousness about taking drugs and a fear of undesired side effects which may lead to the refusal of treatment. The safety, side effects and patients' acceptance of alprazolam and imipramine versus placebo were evaluated in 1168 subjects with panic disorder/agoraphobia who had been enrolled in the second phase of the Upjohn World Wide Panic Study. Side effects that worsened over baseline to a greater extent with alprazolam than with imipramine and placebo were sedation, fatigue/weakness, memory problems, ataxia and slurred speech. In the imipramine group blurred vision, tachycardia/palpitations, insomnia, sleep disturbance, excitement/nervousness, malaise, dizziness/faintness, headache, nausea/vomiting and decrease in appetite were worse than in the other groups. In the placebo group the anxious symptoms were most prominent. The highest level of compliance was shown in the alprazolam-treated group and the lowest in the placebo-treated group. Strong predictors of side effects were not observed. If a side effect profile is known, it will be easier for a clinician to choose the right drug and the appropriate management by taking into account compliance, safety and efficacy in each patient under treatment. Further information about side effects in long-term maintenance treatment would be of great clinical pertinence in ensuring safety and enhancing patients' quality of life.
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PMID:Adverse effects associated with the short-term treatment of panic disorder with imipramine, alprazolam or placebo. 820 96

Previous studies have shown that both selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are effective in the treatment of panic disorders (PD). In this study, the SSRI fluvoxamine (Fluv) was compared with the MAO-A-I brofaromine (Brof). Thirty patients with the diagnosis of PD with or without agoraphobia were treated with either Fluv or Brof (150 mg daily) in a double-blind design. After 12 weeks of treatment, 93% of the Brof group and 87% of the Fluv group considered themselves much or very much improved. Taking a reduction in the Hamilton Rating Scale for Anxiety score of 50% or more, 33% of the Fluv patients and 47% of the Brof patients were responders to treatment. After an increase in anxiety in the 1st week, which was more severe in Fluv-treated patients than for Brof, a clinically relevant decrease in anxiety symptoms and reduction in panic attacks and avoidance behavior was observed. There was no significant difference between the treatment groups. The most prominent side effects were middle-sleep disturbance (Brof), tiredness (Fluv), and nausea after taking the medication (Brof and Fluv). During a double-blind follow-up period of another 12 weeks, a further improvement was found in both treatment groups without significant differences between the two groups. The selective and reversible MAO-A-I brofaromine and the SSRI fluvoxamine are equally effective in the treatment of PD. Both compounds lead to a reduction in the number of panic attacks and a subsequent reduction in agoraphobic avoidance.
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PMID:A double-blind comparative study of brofaromine and fluvoxamine in outpatients with panic disorder. 883 5

Prodromal personality features possibly presaging PD include excessive introversion, punctuality, and inflexibility. Neurobehavioral symptoms of PD that might complicate recognition and treatment of depression include loss of initiative, social withdrawal, excessive dependency indecisiveness, fatigue, apprehension about new challenges, and agoraphobia. In connection with this last feature, PD patients should be encouraged to venture out of the house because the extrapyramidal motor system, which is compromised in PD, takes over in a relaxed, familiar setting. Thus, Parkinson patients tend to have more symptoms at home than away from home. The deteriorating cognitive function which may occur in some PD patients may exacerbate social withdrawal and certain fears. Features of major depression in parkinsonian depression parallel those of the uncomplicated variety, but loss of appetite/weight and sleep disturbances may be more severe in parkinsonian depression. Serotonin depletion probably underlies the pathophysiology of this condition, in that cerebrospinal-fluid levels of serotonin's terminal metabolite decline to a greater extent in parkinsonian depression than in uncomplicated PD. After establishing the severity of depression, the clinician can contemplate several management approaches: in addition to group psychotherapy, antidepressants (after discontinuation of selegiline to avoid adverse events), particularly tricyclic antidepressants with low anticholinergic action (i.e., low potential for confusion) or selective serotonin reuptake inhibitors may be administered. Depressive symptoms during "off" periods (i.e., at nadirs of drug levels) may be relatively intractable and warrant patient and family education. Finally, electroconvulsive and light therapy represent appropriate therapeutic modalities for selected patients.
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PMID:Depression: impact and management by the patient and family. 1022 3

Only 70% of patients respond to current treatments for panic disorder, and many discontinue drugs because of side effects. myo-Inositol, a natural isomer of glucose and a precursor for the second-messenger phosphatidyl-inositol system, has previously been found superior to placebo in the treatment of depression, panic disorder, and obsessive-compulsive disorder (OCD), but a direct comparison with an established drug has never been performed. A double-blind, controlled, random-order crossover study was undertaken to compare the effect of inositol with that of fluvoxamine in panic disorder. Twenty patients completed 1 month of inositol up to 18 g/day and 1 month of fluvoxamine up to 150 mg/day. Improvements on Hamilton Rating Scale for Anxiety scores, agoraphobia scores, and Clinical Global Impressions Scale scores were similar for both treatments. In the first month, inositol reduced the number of panic attacks per week (mean and SD) by 4.0 (2) compared with a reduction of 2.4 (2) with fluvoxamine (p = 0.049). Nausea and tiredness were more common with fluvoxamine (p = 0.02 and p = 0.01, respectively). Because inositol is a natural compound with few known side effects, it is attractive to patients who are ambivalent about taking psychiatric medication. Continuing reports of inositol's efficacy in the treatment of depression, panic disorder, and OCD should stimulate replication studies.
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PMID:Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. 1138 98

Thought Field Therapy (TFT) is a self-administered treatment developed by psychologist Roger Callahan. TFT uses energy meridian treatment points and bilateral optical-cortical stimulation while focusing on the targeted symptoms or problem being addressed. The clinical applications of TFT summarized included anxiety, adjustment disorder with anxiety and depression, anxiety due to medical condition, anger, acute stress, bereavement, chronic pain, cravings, depression, fatigue, nausea, neurodermatitis, obsessive traits, panic disorder without agoraphobia, parent-child stress, phobia, posttraumatic stress disorder, relationship stress, trichotillomania, tremor, and work stress. This uncontrolled study reports on changes in self-reported Subjective Units of Distress (SUD; Wolpe, 1969) in 1,594 applications of TFT, treating 714 patients. Paired t-tests of pre- and posttreatment SUD were statistically significant in 31 categories reviewed. These within-session decreases of SUD are preliminary data that call for controlled studies to examine validity, reliability, and maintenance of effects over time. Illustrative case and heart rate variability data are presented.
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PMID:Thought Field Therapy clinical applications: utilization in an HMO in behavioral medicine and behavioral health services. 1152 9

The Neuropsych Questionnaire (NPQ) addresses 2 important clinical issues: how to screen patients for a wide range of neuropsychiatric disorders quickly and efficiently, and how to acquire independent verification of a patient's complaints. The NPQ is available over the Internet in adult and pediatric versions. The adult version of the NPQ consists of 207 simple questions about common symptoms of neuropsychiatric disorders. The NPQ scores patient and/or observer responses in terms of 20 symptom clusters: inattention, hyperactivity-impulsivity, learning problems, memory, anxiety, panic, agoraphobia, obsessions and compulsions, social anxiety, depression, mood instability, mania, aggression, psychosis, somatization, fatigue, sleep, suicide, pain, and substance abuse. The NPQ is reliable (patients tested twice, patient-observer pairs, 2 observers) and discriminates patients with different diagnoses. Scores generated by the NPQ correlate reasonably well with commonly used rating scales, and the test is sensitive to the effects of treatment. The NPQ is suitable for initial patient evaluations, and a short form is appropriate for follow-up assessment. The availability of a comprehensive computerized symptom checklist can help to make the day-to-day practice of psychiatry, neurology, and neuropsychology more objective.
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PMID:An Internet-based symptom questionnaire that is reliable, valid, and available to psychiatrists, neurologists, and psychologists. 1831 53


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