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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Panic disorder, a psychiatric disorder characterised by frequent panic attacks, is the most common anxiety disorder, affecting 2 to 6% of the general population. No one line of treatment has been found to be superior, making a risk-benefit assessment of the treatments available useful for treating patients. Choice of treatment depends on a number of issues, including the adverse effect profile, efficacy and the presence of concomitant syndromes. Tricyclic antidepressants (TCAs) are beneficial in the treatment of panic disorder. They have a proven efficacy, are affordable and are conveniently administered. Adverse effects, including jitteriness syndrome, bodyweight gain, anticholinergic effects and orthostatic hypotension are commonly associated with TCAs, but can be managed successfully. Selective serotonin (5-hydroxytryptamine; 5HT) reuptake inhibitors are also potential first line agents and are well tolerated and effective, with a favourable adverse effects profile. There is little risk in overdose or of anticholinergic effects. Adverse effects include sedation, dyspepsia and headache early in treatment, and sexual dysfunction and increased anxiety, but these can be effectively managed with proper dosage escalation and management. Benzodiazepines are an effective treatment, providing short-term relief of panic-related symptoms. Patients respond to treatment quickly, providing rapid relief of symptoms. Adverse effects include ataxia and drowsiness, and cognitive and psycho-motor impairment. There are reservations over their first-line use because of concerns regarding abuse and dependence. Monoamine oxidase inhibitors, because of their adverse effects profile, potential drug interactions, dietary restrictions, gradual onset of effect and overdose risk, are not considered to be first-line agents. They are effective however, and should be considered for patients with refractory disease. Valproic acid (valproate sodium), while not intensively studied, shows potential for use in panic disorder. More studies are needed in this area before the available data can be confirmed. As a supplement to drug therapy, cognitive behavioural therapy is effective. It is well tolerated, and may be beneficial in certain clinical situations. Its main drawback is the time commitment and effort needed to be made by the patient.
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PMID:A risk-benefit assessment of pharmacological treatments for panic disorder. 963 87

Autogenic Training - Qualitative Meta-Analysis of Controlled Clinical Studies and Relation to NaturopathyAutogenic training is a relaxation technique based on autosuggestions and practice in the perception of 'natural' relaxating processes of the body with an increasing calm basic attitude. The psycho-physiological changes that occur after periodical exercises can be explained by a plausible model which has been empirically proved in many of its aspects. With regard to methodological aspects the present study deals with the qualitative meta-analysis of 64 controlled clinical studies from 1952 to 1997. The clinical effect of autogenic training on the main symptoms as exclusive or at least central psychotherapeutic intervention (partly in combination with a somatic basic therapy) was evaluated. It was proved that autogenic training has positive effects on psychosomatic disorders (hypertension, asthma, intestinal diseases, 'vegetative dystonia', glaucoma, atopic eczema), on preparation for childbirth, sleep disorders and anxiety disorders. A positive effect can also be expected in case of headaches and Raynaud's disease, however, other relaxation techniques seem to be superior in these cases. Moreover, positive effects on the mood (e. g. depressive symptoms) and the general subjective condition (e. g. 'quality of life') have been proved by many studies. Hence indications can be derived according to the basic rules of evidence-based medicine. Nevertheless there are contraindications, for instance regarding exogenous, acute schizophrenic or affective psychosis. Beyond that the preparedness to therapy of many patients can be improved if the therapeutic offers are enlarged by autogenic training as a 'low level' offer. Autogenic training is an effective and useful component of preventive, rehabilitative or therapeutic interventions and can last but not least be part of therapeutic interventions which include naturopathy.
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PMID:Autogenes Training - Qualitative Meta-Analyse kontrollierter klinischer Studien und Beziehungen zur Naturheilkunde. 989 18

A multicenter study was carried out in 10 Italian Headache Centers to investigate the prevalence of psychosocial stress and psychiatric disorders listed by the IHS classification as the "most likely causative factors" of tension-type headache (TTH). Two hundred and seventeen TTH adult outpatients consecutively recruited underwent a structured psychiatric interview (CIDI-c). The assessment of psychosocial stress events was carried out using an ad hoc questionnaire. The psychiatric disorders that we included in the three psychiatric items of the fourth digit of the IHS classification were depressive disorders for the item depression, anxiety disorders for the item anxiety, and somatoform disorders for the item headache as a delusion or an idea. Diagnoses were made according to DSM-III-R criteria. At least one psychosocial stress event or a psychiatric disorder was detected in 84.8% of the patients. Prevalence of psychiatric comorbidity was 52.5% for anxiety, 36.4% for depression, and 21.7% for headache as a delusion or an idea. Psychosocial stress was found in 29.5% of the patients and did not differ between patients with and without psychiatric comorbidity. Generalized anxiety disorder (83.3%) and dysthymia (45.6%) were the most frequent disorders within their respective psychiatric group. The high prevalence of psychiatric disorders observed in this wide sample of patients emphasizes the need for a systematic investigation of psychiatric comorbidity aimed at a more comprehensive and appropriate clinical management of TTH patients.
Cephalalgia 1999 Apr
PMID:Psychiatric comorbidity and psychosocial stress in patients with tension-type headache from headache centers in Italy. The Italian Collaborative Group for the Study of Psychopathological Factors in Primary Headaches. 1023 63

Buspirone is an azapirone with 5-HT1A partial agonist activity which has demonstrated efficacy in the treatment of generalized anxiety disorder, commonly referred to as persistent anxiety. In this meta-analysis report, safety results from two studies comparing buspirone 15 mg twice daily (BID) with buspirone 10 mg three times daily (TID) in patients with persistent anxiety are presented. In the study protocols, qualified patients completed a 7-day placebo lead-in phase and were randomized to receive buspirone 30 mg per day, as either a BID or TID regimen, for 6-8 weeks. A total of 289 patients received buspirone 15 mg BID (n = 144) or 10 mg TID (n = 145) at 15 sites. The incidence of adverse events was similar between the two treatment groups, except for a significantly greater incidence of palpitations in patients receiving buspirone BID (5%) compared to buspirone TID (1%). The most frequently reported adverse events for both buspirone BID- and TID-treated patients were dizziness, headache, and nausea. No appreciable differences between treatments were observed for vital signs, physical exam, ECG, or clinical laboratory results. A change to BID dosing for buspirone may offer convenience and possibly higher compliance in patients with persistent anxiety without compromising the excellent safety and tolerability profile of the medication.
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PMID:Meta-analysis of the safety and tolerability of two dose regimens of buspirone in patients with persistent anxiety. 1035 51

The aims of this study were to estimate the prevalence of somatized mental disorder (SMD) in comparison to psychologized mental disorder (PMD) among a sample of primary health care (PHC) Arab patients, and to investigate the clinical and sociodemographic characteristics of SMD. The first stage of study was conducted by general practitioners (GPs), using the 12-item General Health Questionnaire (GHQ-12). The second stage was carried out by a psychiatrist using the Clinical Interview Schedule (CIS) and an inquiry schedule. Specific operational criteria were used to identify SMD and PMD. The estimated prevalence rate of SMD among the total screened sample was 12%. SMD patients constituted 48% of the psychiatric patients identified, whereas, for the PMD group, this figure was 42%. Educational level was significantly lower in the SMD group. Headache, backache, and abdominal pain were the most commonly presented somatic symptoms. The symptoms pursued a chronic and persistent course and most patients experienced multiple symptoms. The most common ICD-10 psychiatric diagnoses among both SMD and PMD patients were mixed anxiety and depressive disorder, generalized anxiety disorder, and mood and adjustment disorders. Recurrent depressive disorder and dysthymia were significantly more prevalent in the PMD group. The severity of psychiatric illness identified was greater among psychologizers than the somatizers of mental disorder.
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PMID:Somatized mental disorder among primary care Arab patients: I. Prevalence and clinical and sociodemographic characteristics. 1045 71

Cyclic vomiting syndrome in children is a manifestation of various etiologies, including gastroenterological and renal disorders, central and autonomic nervous system abnormalities, as well as metabolic and endocrine dysfunction. Frequently no organic cause is found. Personality profiles of children with cyclic vomiting reveal perfectionism, competitiveness, and aggressive behavior. Vomiting attacks have been induced by anxiety and excitement in patients with cyclic vomiting. We describe an 8-year-old girl with cyclic vomiting, frequently associated with occipital headaches, photophobia or dizziness. Psychiatric evaluation indicated a generalized anxiety disorder.
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PMID:[Cyclic vomiting syndrome in children]. 1091 24

Electromyographic (EMG) voltage that rises continuously during motor performance or mental activity and falls precipitately at the end is known as an EMG gradient. Our review is based on 55 studies of EMG gradients, which were published during the period 1937-1994. The extremely wide diversity of situations yielding EMG gradients suggests the possibility that these gradients may be universal accompaniments of organized goal-directed behavioral sequences, overt and covert. Motor tasks and cognitive tasks (without any requirements for motor output) were found to have this in common: they both produced EMG gradients. EMG gradients were not observed during simple, repetitive exercises. On the efferent side, we propose a dual model for the production of EMG gradients, which is based on empirical findings. This model is discussed in relation to current views on central and peripheral neural control of muscle contractions, and on the electrical properties of extrafusal and intrafusal muscle fibers, with particular reference to surface electromyography. The complex relations between EMG gradient steepness and mental effort seemed well represented by the dual model, which was also useful in the interpretation of certain EMG gradients that were found in patients with anxiety disorders, tension-type headaches, and auditory hallucinations, respectively. On the afferent side, drawing on data from human and animal studies, we consider the evidence for movement-related brain activity generated by proprioceptive input, in relation to different types of feedback to the central nervous system during tasks that produce EMG gradients. On electromyographic (EMG) gradients and movement-related brain activity: significance for motor control, cognitive functions, and certain psychopathologies.
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PMID:On electromyographic (EMG) gradients and movement-related brain activity: significance for motor control, cognitive functions, and certain psychopathologies. 1102 75

We examined pericranial muscle tenderness and abnormalities in the second exteroceptive suppression period (ES2) of the temporalis muscle in chronic tension-type headache (CTTH; n = 245) utilizing a blind design and methods to standardize the elicitation and scoring of these variables. No ES2 variable differed significantly between CTTH sufferers and controls (all tests, P>0.05). We found no evidence that CTTH sufferers with daily or near daily headaches, a mood or an anxiety disorder, or high levels of disability exhibit abnormal ES2 responses (all tests, P>0.05). CTTH sufferers were significantly more likely than controls to exhibit pervasive tenderness in pericranial muscles examined with standardized (500 g force) manual palpation (P<0.005). Female CTTH sufferers exhibited higher levels of pericranial muscle tenderness than male CTTH sufferers at the same level of headache activity (P<0.0001). Elevated pericranial muscle tenderness was associated with a comorbid anxiety disorder. These findings provide further evidence of pericranial hyperalgesia in CTTH and suggest this phenomenon deserves further study. Basic research that better elucidates the biological significance of the ES2 response and the factors that influence ES2 assessments appears necessary before this measure can be of use in clinical research.
Cephalalgia 2000 Sep
PMID:Exteroceptive suppression periods and pericranial muscle tenderness in chronic tension-type headache: effects of psychopathology, chronicity and disability. 1112 21

Systemic lupus erythematosus (SLE) is an autoimmunologic illness, which apart from changes in the skin, the locomotor system and the internal organs, attacks also the nervous system. The paper presents 19 neuropsychiatric symptomic syndromes which after conduction of multidisciplinary, international research were accepted by the American College of Rheumatology (ACR) as the criteria of systemic lupus erythematosus (SLE). This broadens the criteria applied since 1982, which were only considering acute symptoms and psychoses as characteristic of the neuropsychiatric form of systemic lupus erythematosus (NPSLE). In the new neurologic criteria concerning the CNS are: epileptic attacks and acute attack disorders, headaches, vascular diseases, demyelinating syndrome, aseptical meningitis, chorea, myelopathy. Psychiatric syndromes which make up the new criteria are: acute amentive state, anxiety disorders, cognitive function impairment, affective disorders, psychoses. The criteria connected to the CNS are: cranial nerve damage, mononeuropathy, damage of nerve plexus, polyneuropathy, vegetative neuropathy, myasthenia and acute inflammatory demyelinating polyneuropathy. Clinical symptoms of these syndromes were set and laboratory and visualising tests were developed, which are useful in their diagnosis. The intention of the ACR in setting new, significantly broader criteria of NPSLE, was to stress the diversity of symptoms and for a practical aspect to allow the diagnosis of NPSLE in patients having this disease, in whom the symptoms connected with the nervous system may dominate in the clinical picture, or may be before the dermatological, locomotor or internal organ symptoms.
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PMID:[New diagnostic criteria for the neuropsychiatric form of systemic lupus erythematosus]. 1130 90

HIV-positive individuals are at high risk of developing an anxiety disorder, with a prevalence rate as high as 38 percent. The symptoms may occur anytime during the course of the infection, and can become excessive in some patients, impairing the person's ability to cope with their circumstances. Signs and symptoms include chest pain, headache, numbness, and insomnia. HIV treatments that may cause anxiety symptoms include ddI, d4T, AZT, fluconazole, foscarnet, and isoniazid. Health care providers need to thoroughly evaluate anxiety symptoms during an initial evaluation to rule out substance abuse and pre-existing anxiety. Treatment of anxiety in HIV/AIDS ranges from benzodiazepines to alternative therapies such as massage and acupuncture. A chart lists potential drug interactions between common antidepressive and HIV antiretroviral drugs.
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PMID:Anxiety and HIV infection. 1136 9


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