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Biomedical subjects

M W Otto

Publications and source records attributed to M W Otto.

At least 55 records · Page 3Linked to original sources
PubMed1997

Long-term course and outcome of panic disorder.

The longitudinal course of panic disorder is an issue of critical clinical and research importance. For many patients, panic disorder may be a manifestation of an underlying, lifelong predisposition to anxiety with a chronic course, often requiring ongoing maintenance therapy. In this paper, we review some of the pertinent follow-up studies of patients with panic disorder treated with antidepressants, high-potency benzodiazepines, and cognitive behavior therapy, as well as data from longitudinal studies.

Antidepressive Agents↗
PubMed1997

Abecarnil for the treatment of generalized anxiety disorder: a placebo-controlled comparison of two dosage ranges of abecarnil and buspirone.

BACKGROUND: The development of effective and well-tolerated anxiolytic agents is an area of critical clinical importance. Abecarnil, a beta carboline, is a partial benzodiazepine-receptor agonist that has demonstrated promise as an anxiolytic agent. In this study, we examine the efficacy, safety, and discontinuation-related effects of abecarnil, buspirone, and placebo in the acute and long-term treatment of patients who have generalized anxiety disorder. METHOD: This is a double-blind, placebo-controlled study of two dosages of abecarnil and buspirone. In total, 464 patients were randomized. After a placebo run-in week, patients entered a 6-week double-blind treatment period, followed by an optional 18-week maintenance period for treatment responders. After abrupt discontinuation of the acute or maintenance treatment, patients entered a 3-week placebo-substitution follow-up period. Treatment response was assessed with the Hamilton Rating Scale for Anxiety and the Clinical Global Impressions (CGI) Scale. RESULTS: Compared with placebo, abecarnil showed significant anxiolytic activity early in the treatment period, particularly in the high-dosage group, though these differences did not maintain statistical significance at the end of the trial. Buspirone was associated with a slower onset of action and better symptom relief than placebo after 6 weeks of therapy. Withdrawal symptoms emerged in patients who abruptly discontinued abecarnil (particularly at the higher dosage) only in those receiving a longer duration of treatment. CONCLUSION: The results of this study need to be understood in the context of a high placebo-response rate, which hampers the ability to demonstrate significant drug-placebo differences. This study suggests that abecarnil may be an effective anxiolytic agent; further attention is warranted to assess its spectrum of clinical effectiveness.

Adolescent↗
PubMed1996

Relationship of antecedent stressful life events to childhood and family history of anxiety and the course of panic disorder.

The authors examined the incidence of significant life events during the year prior to the onset of panic disorder and its relationship to childhood and family history of anxiety difficulties, comorbidity, and the course of illness in 223 panic patients followed in a naturalistic study of panic disorder. Similar to previous reports, antecedent negative life events occurred in the majority (80%) of patients. Patients with a childhood history of anxiety and comorbid adulthood major depression were more likely to report an antecedent, stressful life event. Antecedent events were not linked with comorbid, adulthood anxiety disorders or a family history of anxiety difficulties. Despite its associations with childhood anxiety pathology and adulthood major depression, the presence of an identifiable antecedent at the onset of panic disorder was not associated with the subsequent severity or course of the disorder.

Adult↗
PubMed1996

Prevalence and correlates of anger attacks: a two site study.

Although anger attacks have been described in depressed outpatients, they have not been well studied in other disorders. In Study 1, we examined the prevalence of anger attacks in 50 outpatients with panic disorder. In Study 2, we replicated the initial findings at an independent site and examined the specificity of anger attacks by comparing their occurrence in patients with panic disorder, patients with other non-panic anxiety disorders and patients with a depressive disorder. At both sites, we also explored the relationship between anger attacks and demographic and clinical characteristics, such as gender, presence and severity of depression, and social anxiety measures. In both sites, the prevalence of anger attacks in patients with panic disorder was approximately one-third. However, anger attacks were not unique to panic disorder, with similar rates emerging for patients with other anxiety disorders. Furthermore, patients with depressive diagnoses had twice the prevalence of anger attacks than did anxiety patients. At both sites, those with anger attacks were significantly more depressed and were likely to have either current or past history of major depression. Anger attacks were not associated with social anxiety measures, but were related to cluster B, cluster C and self-defeating personality disorder traits. Our findings support the notion that anger attacks are best conceptualized as an associated feature of depression.

Adolescent↗
PubMed1996

Symptom subtypes of obsessive-compulsive disorder in behavioral treatment studies: a quantitative review.

Recent reviews and meta-analytic studies have provided an encouraging account of the effectiveness of behavioral interventions for obsessive-compulsive disorder (OCD). One question regarding these estimates concerns their degree of generalizability to the range of OCD subtypes encountered in clinical settings. The purpose of the present study was to provide a quantitative description of the prevalence of various OCD subtypes (i.e. type of compulsions) within the behavioral treatment literature. We examined 65 studies that permitted classification of patients according to symptom subtype. Patients with primarily cleaning and/or checking compulsions predominated, accounting for 75% of the treatment population. On the other hand, patients with multiple compulsions or other compulsions, such as exactness, counting, hoarding, or slowness rituals were underrepresented, comprising only 12% of the population, which is markedly less than clinical epidemiological estimates. Rates of improvements in patients with OCD are most applicable to patients with cleaning and checking compulsions, but may not yet be generalizable to patients with other symptoms. These findings encourage studies of the efficacy of existing and novel interventions for patients with counting, repeating, symmetry, hoarding, or multiple compulsions in order to broaden the clinical application of OCD behavioral treatment.

Behavior Therapy↗
PubMed1996

Dichotic listening before and after fluoxetine treatment for major depression: relations of laterality to therapeutic response.

Despite the wide variance in therapeutic response to antidepressants, there are few clinical or biological predictors of treatment outcome. Studies have suggested the possible value of dichotic listening measures of perceptual asymmetry (PA) as predictors of treatment response. This study examined the relation between outcome of fluoxetine treatment and performance on verbal and nonverbal dichotic tests. As part of a multisite study, 86 outpatients with major depression were tested on dichotic fused-words and complex-tones tests both before and during treatment. Fluoxetine responders differed from nonresponders in having greater right-ear (left-hemisphere) advantage for dichotic words and less left-ear (right-hemisphere) advantage for complex tones. There was no change in PA during fluoxetine treatment, which indicates that PA differences between treatment responders and nonresponders are stable (trait) characteristics. An aggregate, characteristic PA measure was the best predictor of responder status in a logistic regression analysis. Findings from two clinical centers support the hypothesis that a characteristic tendency for relatively greater left-than right-hemispheric activation during dichotic listening is associated with better outcome of fluoxetine treatment.

Acoustic Stimulation↗
PubMed1996

Panic anxiety, dyspnea, and respiratory disease. Theoretical and clinical considerations.

There is intriguing evidence suggesting pathophysiologic relationships among dyspnea, hyperventilation, and panic anxiety. The symptoms of panic attacks and pulmonary disease overlap, so that panic anxiety can reflect underlying cardiopulmonary disease and dyspnea can reflect an underlying anxiety disorder. The pathogenesis of panic may be related to respiratory physiology by several mechanisms: the anxiogenic effects of hyperventilation, the catastrophic misinterpretation of respiratory symptoms, and/or a neurobiologic sensitivity to CO2, lactate, or other signals of suffocation. In a subset of patients with PD, incipient pulmonary dysfunction may also contribute to their anxiety symptoms. Patients with pulmonary disease, particularly those with obstructive lung disease, have a high rate of panic symptoms and PD. There is reason to believe that pulmonary disease constitutes a risk factor for the development of panic related to repeated experiences with dyspnea and life-threatening exacerbations of pulmonary dysfunction, repeated episodes of hypercapnia or hyperventilation, the use of anxiogenic medications, and the stress of coping with chronic disease. Panic in pulmonary patients may carry significant morbidity, including phobic avoidance of activity, overly aggressive treatment with anxiogenic medications, and more prolonged and frequent hospitalization. Successful treatment of panic in these patients can improve functional status and quality of life by relieving anxiety and dyspnea. Nonpharmacologic treatment of panic, including cognitive-behavioral approaches, can be useful in patients with concomitant respiratory disease. Sedating medications such as benzodiazepines should be used with caution in patients with pulmonary disease to avoid respiratory depression. Serotonergic antidepressants (SSRIs) and anxiolytics (buspirone) may be effective treatments for panic or generalized anxiety in pulmonary patients and have relatively little potential for significant adverse effects.

Anxiety↗
PubMed1996

Prevalence of panic in patients referred for pulmonary function testing at a major medical center.

OBJECTIVE: The authors examined the prevalence and correlates of panic disorder in a group of patients who were referred for pulmonary function testing. METHOD: Patients (N = 115) were screened for the presence of panic attacks and panic disorder with a self-report questionnaire; a subgroup (N = 25) received structured diagnostic assessment. RESULTS: Of the 115 patients, 41% (N = 47) reported panic attacks and 17% (N = 20) met screening criteria for panic disorder. From the confirmed rate of panic disorder among the subgroup who received structured diagnostic assessment, the overall prevalence rate of panic disorder was estimated to be 11% and included six of the nine patients (67%) who had a diagnosis of chronic obstructive pulmonary disease. There were no significant differences between patients with and without panic in the severity of pulmonary function abnormalities or in the response to bronchodilators. However, patients with panic attacks were significantly more likely to report dyspnea at rest and irritable bowel symptoms and tended to report difficulty swallowing. CONCLUSIONS: This study suggests that panic disorder and subsyndromal panic are relatively common and may be unrecognized and inadequately treated in patients who present with respiratory symptoms.

Airway Obstruction↗
PubMed1996

Relationship of childhood anxiety to adult panic disorder: correlates and influence on course.

OBJECTIVE: This study investigated the correlates of a childhood history of anxiety disorders in adult patients participating in a longitudinal study of panic disorder. The authors hypothesized that a history of anxiety during childhood would be associated with higher rates of comorbid anxiety and depressive disorders, greater likelihood of anxiety disorders in family members, and greater chronicity, as reflected by decreased time spent in remission. METHOD: The presence of a childhood history of anxiety disorders was assessed by structured interview, and its association with comorbid anxiety and depressive disorders, family history, and select anxiety severity variables was examined in a replication sample of 94 patients. The influence of childhood anxiety on the prospectively ascertained course of disorder was assessed in a full group of 194 patients. RESULTS: Over half (54%) of the patients experienced anxiety disorders during childhood. These patients experienced higher rates of comorbid anxiety and depression, family history of anxiety, and increased levels of agoraphobia, panic frequency, and global severity of illness at baseline evaluation. Childhood anxiety disorders were not independently associated with the number of months in remission or the severity of illness over time, although a modest effect for this variable was evident when degree of avoidance and anxiety sensitivity at baseline were statistically controlled. CONCLUSIONS: Adult panic patients with a history of anxiety disorders in childhood have elevated rates of comorbid anxiety and depressive disorders and a tendency toward increased avoidance, but there was not strong evidence that these patients respond differently to treatment over time.

Adult↗
PubMed1996

Venlafaxine for panic disorder: results from a double-blind, placebo-controlled study.

Venlafaxine has demonstrated efficacy for depression, and recent reports and clinical experience suggest that it may be effective for the treatment of anxiety disorders as well. We present what we believe are the first data from a controlled study designed to test the efficacy of venlafaxine for the treatment of panic disorder. There were 25 patients enrolled at one site of a five-center study; 13 received venlafaxine and 12 received placebo. There were more dropouts for placebo than for venlafaxine (8/12 vs. 2/13) in this 8-week acute trial. Patients treated with venlafaxine experienced significantly greater global improvement than those on placebo and exhibited trends toward greater improvement on anxiety and depression symptoms as assessed by the Hamilton rating scales. These data encourage further evaluation of venlafaxine for the treatment of panic disorder.

Adult↗
PubMed1995

Integrated treatment of panic disorder.

Epidemiological studies suggest that about 3.5% of the adult United States population meet criteria for panic disorder, and that an additional 2-5% suffer from agoraphobia with or without panic. Both biological and behavioral models have been proposed to elucidate the nature of this disorder. The authors review research findings regarding these models, as well as pharmacological and cognitive-behavioral treatment approaches. The complexity of factors contributing to the disorder suggests the need for an integrated treatment approach involving considerations of combination drug therapy and psychosocial interventions.

Adaptation, Psychological↗
PubMed1995

Cognitive-behavior therapy and the longitudinal course of panic disorder.

This article examines the nature and course of panic disorder as understood from a cognitive-behavioral perspective. A model of the causes and maintenance of panic disorder is presented, and is followed by a discussion of the elements and efficacy of cognitive-behavioral treatment. Treatment effects and factors associated with relapse are considered within the context of evidence for a differential course of panic disorder for patients treated with cognitive-behavioral therapy relative to those treated with pharmacotherapy. Issues of combined treatment, maintenance of treatment gains, and preventive interventions are discussed.

Anti-Anxiety Agents↗
PubMed1994

Sleep panic attacks: an association with childhood anxiety and adult psychopathology.

The authors examine whether the presence of sleep panic attacks identifies a subgroup of panic disorder patients. Subjects (n = 95) were consecutive patients with panic disorder participating in the MGH longitudinal study of panic disorder. Patients were evaluated with structured interviews to establish adult anxiety and affective disorders, and the presence of childhood anxiety disorders. Patients were queried whether they had ever experienced at least one panic attack during sleep. Patients with a history of sleep panic had significantly higher rates of comorbid generalized anxiety disorder (p < 0.01), social phobia (p < 0.03), and major depression (p < 0.005). The trend was toward longer length of illness (p < 0.09) and were more likely to have a history of an anxiety disorder during childhood (p < 0.005). The presence of sleep panic attacks may delineate a subgroup of panic disorder patients with early difficulties with anxiety, and comorbid mood and anxiety disorders as adults.

Adult↗
PubMed1994

Anxiety psychopathology predictive of outcome in patients with panic disorder and depression treated with imipramine, alprazolam and placebo.

This study examines clinical predictors of outcome for patients with panic disorder and depression in a 16 week, placebo-controlled trial of alprazolam and imipramine (n = 126). Baseline global severity of illness and phobic avoidance were differentially predictive of acute response to treatment. Patients in the mild to moderate range of global distress experienced smaller degrees of improvement on alprazolam than on imipramine at week 4. At endpoint, the relative effectiveness of the active medication versus placebo was diminished in patients with higher levels of phobic avoidance. This relationship was not evident for completers, suggesting that the adverse effects of avoidance on outcome after sustained treatment was reduced.

Adult↗
PubMed1994

Predicting prospective episodes of depression in patients with panic disorder: a longitudinal study.

This study used a naturalistic, longitudinal study to examine predictors of the emergence of major depression among 90 nondepressed patients with panic disorder who were followed for a 2-year period. Twenty-four percent of the sample experienced a major depressive episode during the study period. Adequacy and type of medication treatment were not associated with decreased risk. Past history of major depression was associated with a greater risk for a prospective episode. The degree of assertiveness, presence of comorbid generalized anxiety disorder, and severity of agoraphobia were each significant predictors of the occurrence of depression when considered alone and when the influence of past history of depression was statistically controlled. The implications of these findings for the clinical management of patients with panic disorder are discussed.

Adolescent↗
PubMed1994

Cognitive-behavioral treatment of choking phobia: 3 case studies.

The present study describes 3 case examples of patients with choking phobia who were given a brief, cognitive-behavioral treatment that combined the interventions of psychoeducation, cognitive restructuring, interoceptive and in vivo exposure. This program was designed to address fears of anxiety and choking sensations as well as fears of swallowing. The patients were treated for 11-13 sessions. All 3 patients responded to the program as measured by their progression on their food hierarchy and by weight gain. Issues in the treatment of these patients are discussed.

Adult↗
PubMed1994

Norms for depressed patients for the California verbal learning test: associations with depression severity and self-report of cognitive difficulties.

This study provides norms for depressed subjects for a widely used test of verbal memory, the California Verbal Learning Test (CVLT). Subjects were 156 outpatients with major depression tested during a drug washout period. Mean CVLT memory scores for these patients were generally between one-half and one standard deviation below age- and sex-corrected norms for nondepressed populations. Severity of depression in the patients was not associated with memory performance, but was associated with self-report of cognitive difficulties. A table of age-, sex-, and education-specific norms for the CVLT is provided.

Journal Article↗