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Biomedical subjects

R B Lydiard

Publications and source records attributed to R B Lydiard.

At least 73 records · Page 4Linked to original sources
PubMed1995

Body dysmorphic disorder in patients with anxiety disorders and major depression: a comorbidity study.

OBJECTIVE: The authors evaluated the frequency of body dysmorphic disorder in patients with a primary diagnosis of anxiety disorders and major depression. METHOD: Patients with social phobia (N = 54), obsessive-compulsive disorder (N = 53), generalized anxiety disorder (N = 32), panic disorder (N = 47), and major depression (N = 42) and normal comparison subjects (N = 33) were studied. RESULTS: Body dysmorphic disorder was most common in patients with social phobia (11%) and obsessive-compulsive disorder (8%); it was less prevalent among patients with panic disorder (2%), generalized anxiety disorder (0%), and major depression (0%) and among normal subjects (0%). CONCLUSIONS: These findings suggest that body dysmorphic disorder may share etiologic elements with social phobia and obsessive-compulsive disorder.

Adolescent↗
PubMed1995

Panic disorder. Pathophysiology and drug treatment.

Advances over the past 2 decades in our understanding of the biology of panic disorder have paralleled a remarkable increase in the development of new pharmacological agents with antipanic effects. Although we can not presently use biological tests to help with our choice of therapeutic agent for individual patients, we can use this biological understanding in the development of overall pharmaco-therapeutic strategies. Current evidence does not support the hypothesis that panic disorder is associated with a primary disorder in one neurotransmitter system. Rather, the data suggest that the biological aetiology of panic disorder is related to abnormalities in the function of a variety of neurotransmitters including serotonin (5-hydroxytyrptamine; 5-HT), noradrenaline (norepinephrine), gamma-aminobutyric acid (GABA), dopamine, and cholecystokinin. It is likely, however, that panic disorder is a biologically heterogeneous condition and that biological subtypes may exist in which the primary abnormality may involve one or a few neurotransmitter systems. Currently, the data best support the hypothesis that pharmacotherapeutic agents with primary action at sites within the GABA and serotonin systems are the most effective in the treatment of panic disorder. Nevertheless, some patients will respond well to drugs with predominant activity in other systems, or may require pharmacotherapy designed to affect the function of more than 1 neurotransmitter. As our understanding of the biological aetiology of panic disorder evolves, the pharmacotherapeutic agents and strategies used in the treatment of this disorder will continue to evolve as well.

Benzodiazepines↗
PubMed1995

Comorbidity of axis I psychiatric disorders in bulimia nervosa.

BACKGROUND: The coexistence of other psychiatric disorders in patients with bulimia nervosa is of major clinical and theoretical interest. We therefore studied a group of consecutively evaluated bulimic patients. METHOD: The Structured Clinical Interview for DSM-III-R (SCID) was administered to a sample of 59 female patients with DSM-III-R-defined bulimia nervosa. RESULTS: The following frequencies of lifetime Axis I comorbid diagnoses were found (in decreasing frequency): any affective disorder (75%), major depressive disorder (63%), any anxiety disorder (36%), any substance abuse disorder (20%), social phobia (17%), generalized anxiety disorder (12%), and panic disorder (10%). In the 44 cases with an affective disorder, 27 (61%) had the onset of affective disorder, 27 (61%) had the onset of their affective disorder prior to the onset of their bulimia, 15 (34%) afterward, and 2 (5%) concurrently. In the 21 cases with any anxiety disorder, 15 (71%) had the onset of their anxiety disorder prior to the onset of their bulimia, 4 (19%) afterward, and 2 (10%) concurrently. CONCLUSION: These data confirm previous reports of a strong association between bulimia nervosa and affective illness, which in most cases precedes the eating disorder. In addition, a high frequency of anxiety disorders, particularly social phobia, is seen in bulimic patients.

Adult↗
PubMed1995

The neurobiology of anxiety disorders.

The use of pharmacologic challenges and the application of new brain imaging technologies in the study of patients with anxiety disorders have led to an improvement in the understanding of the neurobiologic basis of these disorders. Abnormal function of noradrenergic, serotonergic, GABAergic, and dopaminergic neural systems as well as abnormal chemoreceptor reactivity have all been implicated in the pathophysiology of anxiety. Functional imaging data have revealed abnormal patterns of cortical and subcortical activity in anxiety patients. These data have allowed significant improvements in the available anatomic models of the anxiety disorders. Further improvements in research technique and technology likely will lead in the near future to a significantly clearer image of the neurobiologic processes involved in anxiety disorders.

Anxiety Disorders↗
PubMed1994

Plasma pyridoxal phosphate in anxiety disorders.

One hundred and eighty-nine subjects with either generalized anxiety disorder, panic disorder, or obsessive-compulsive disorder were evaluated for plasma pyridoxal phosphate (PLP) levels and compared with normal controls. There was no difference in plasma PLP levels between the anxiety disorder groups and normal controls. Low levels of plasma PLP were found in 42% of the controls. Our results suggest that previous reports of low PLP levels in psychiatric patients are unlikely to be significant in the etiology of the psychiatric disorders.

Adult↗
PubMed1994

Predictors of response to alprazolam and placebo in patients with panic disorder.

Date from a panic disorder treatment study with 506 patients, comparing alprazolam and placebo in a double-blind manner for 8 weeks, were analyzed to identify demographic and clinical characteristics of the patients that might predict response to treatment. The strongest predictors of response to alprazolam were age over 40, and lower baseline levels of anxiety and phobic symptoms. Predictors of response to placebo were weaker and, in addition to lower levels anxiety and panic attacks, included a lack of previous psychiatric treatment.

Adult↗
PubMed1994

Pharmacologic management of obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is an intriguing, difficult problem characterized by anxiety-producing intrusive thoughts and performance of anxiety-reducing rituals. Current evidence suggests that OCD may be associated with dysregulation of serotonin and dopamine neurotransmission. Numerous early studies involving the serotonin-specific reuptake inhibitor clomipramine led to the formulation of this hypothesis. Positive results with clomipramine initiated further research with other serotonin-specific reuptake inhibitors, such as fluoxetine, fluvoxamine, sertraline, and serotonergic agents such as buspirone and trazodone. Findings from a number of clinical trials suggest that drugs that inhibit serotonin reuptake or affect serotonergic transmission in other ways are of clear benefit in the treatment of OCD. These drugs may be more effective for obsessive thoughts than for compulsive rituals. Effective pharmacotherapy can dramatically decrease obsessive-compulsive symptoms and improve the patient's quality of life.

1-Naphthylamine↗
PubMed1994

Obsessive-compulsive disorder: a new perspective in diagnosis and treatment.

Once widely regarded as a rare psychodynamic illness, obsessive-compulsive disorder (OCD) is now recognized as a common neurobiological condition affecting 1 in 50 US citizens. The etiology of the illness is still not clearly understood, but the observed therapeutic response in OCD patients to the potent serotonin uptake inhibitor clomipramine hydrochloride (CMI), guided research in the direction of neuronal brain function, and abnormalities of postsynaptic serotonin receptors are currently the leading hypotheses in the pathophysiology of OCD. Clomipramine, an analog of the tricyclic antidepressant imipramine, was the first effective antiobsessional agent available in the US. Clomipramine was, for some time, the treatment of choice for OCD given its superiority over other TCAs which lack potent serotonergic effects. Attention has now shifted to the selective serotonin reuptake inhibitors (SSRIs) whose potent and highly selective serotonin uptake properties account for their antiobsessional efficacy and favorable side effect profiles. The benefits of fluvoxamine, fluoxetine and sertraline have been shown in a number of clinical trials. This paper reviews the epidemiology, etiology, diagnosis and pharmacologic treatment studies of OCD. It summarizes two studies evaluating the efficacy of the SSRI sertraline, which is shown to be effective and well tolerated for both short- and long-term treatment of OCD.

1-Naphthylamine↗
PubMed1994

Panic disorder and gastrointestinal symptoms: findings from the NIMH Epidemiologic Catchment Area project.

OBJECTIVE: Clinical experience and recent reports suggest that there is a high prevalence of gastrointestinal symptoms in patients with panic disorder and that there is a high prevalence of panic disorder in patients with irritable bowel syndrome, a functional gastrointestinal disorder. To assess gastrointestinal symptoms in a nonpatient, community-based sample, the authors surveyed the prevalence of gastrointestinal symptoms in individuals with panic disorder and other or no psychiatric disorders obtained in a national community survey. METHOD: Subjects were 13,537 respondents at four sites of the National Institute of Mental Health (NIMH) Epidemiological Catchment Area project. DSM-III diagnoses were determined by using the NIMH Diagnostic Interview Schedule (DIS). Gastrointestinal symptoms were assessed from the somatization disorder section of the DIS. RESULTS: Individuals with panic disorder had a significantly higher rate of endorsing gastrointestinal symptoms, including those typically associated with irritable bowel syndrome, than those with other or no psychiatric diagnosis. CONCLUSIONS: Findings suggest a diagnostic overlap between panic disorder and irritable bowel syndrome, with similar demographic and clinical characteristics of patients. Limitations of the study are discussed in terms of medical assessment and self-report inventories. Practical and theoretical implications are discussed.

Adolescent↗
PubMed1994

Somatic symptoms in generalized anxiety disorder with and without comorbid psychiatric disorders.

The authors compared the distribution of somatic symptoms associated with generalized anxiety disorder in 28 patients with "pure" generalized anxiety disorder and 77 patients with generalized anxiety disorder plus comorbid current or lifetime psychiatric diagnoses. They found no significant differences in individual symptom endorsement between the two groups, indicating that the basic symptoms of generalized anxiety disorder are specific to the disorder itself.

Adult↗
PubMed1994

Neuropeptides and anxiety: focus on cholecystokinin.

Cholecystokinin (CCK), a gastrin-like neuropeptide, exists in the central nervous system in several forms. The octapeptide (CCK-8) occurs in predominantly sulfated form (CCK-8S), and the tetrapeptide (CCK-4) occurs in smaller but significant quantities. This review highlights recent developments in preclinical and clinical research into the potential role for CCK in mediating anxiety states. Relevant animal and human studies of administration of CCK agonists are discussed, as well as recent data regarding the concentration of CCK-8S in cerebrospinal fluid from patients with panic disorder, bulimia nervosa, and obsessive compulsive disorder. Finally, the development of agents that specifically antagonize CCK receptors will be described, as will potential therapeutic uses for these new compounds.

Animals↗
PubMed1993

The association of alcoholism and anxiety.

The relationship between alcoholism and anxiety disorders is complex and has been the subject of much investigation. While data from community samples as well as samples of treatment-seeking populations indicate that these disorders co-occur far more commonly than would be expected by chance, the nature of the relationship is unclear. It is clear from both prevalence as well as order of onset data that various anxiety disorders have differing associations with alcohol problems. There is much overlap in symptomatology of panic disorder, generalized anxiety disorder, and alcohol withdrawal. This observation has led to speculation about common neurochemical perturbations and a kindling phenomenon as a possible connection between these disorders. Cognitive theories have been used to connect alcohol abuse and phobic disorders. Treatment of patients with co-morbid anxiety and alcoholism is discussed.

Alcohol Drinking↗