Biomedical subjects

R Noyes

Publications and source records attributed to R Noyes.

At least 19 recordsLinked to original sources

PubMed2004

Randomized controlled trial of Siberian ginseng for chronic fatigue.

BACKGROUND: Chronic fatigue greatly affects quality of life and is a common reason for consulting a physician. Since conventional therapy is often of limited help, fatigued patients may use herbal treatments. This randomized controlled trial evaluated the effectiveness of Siberian ginseng. METHOD: Subjects were recruited from advertisements in Iowa (82%) and members of chronic fatigue syndrome support groups (18%). Potential subjects were required to have substantial fatigue > or = 6 months with no identifiable cause. The mean change in a fatigue measure was compared for placebo and Siberian ginseng at 1 and 2 months. Comparisons were for all subjects and for subjects with characteristics previously identified in the literature as important for categorizing chronic fatigue. RESULTS: Ninety-six subjects were randomized to treatment groups, and 76 provided information at 2 months of follow-up. Fatigue among subjects assigned to either placebo or Siberian ginseng was substantially reduced during the study, but differences between treatment groups were not statistically significant in the full sample. Fatigue severity and duration had a statistically significant interaction with response to Siberian ginseng at the P < 0.05 level. Treatment was effective at 2 months for 45 subjects with less severe fatigue (P = 0.04 unadjusted for multiple comparisons) and for 41 subjects with fatigue for > or = 5 years (P = 0.09 unadjusted for multiple comparisons). CONCLUSION: Overall efficacy was not demonstrated. However, the findings of possible efficacy for patients with moderate fatigue suggests that further research may be of value.

Adult↗

PubMed2001

Genomewide survey of panic disorder.

We completed a genome scan of 23 multiplex families of panic disorder. Ninety family members had DSM-III-R panic disorder, and another 23 had recurrent, spontaneous panic attacks that did not satisfy these criteria. We typed 469 markers from the CHLC map (ver 8c7) with an average intermarker distance of 10.3 cM. Two-point lod scores were calculated with both a dominant and a recessive model, and maps of lod scores < -2.00, assuming genetic homogeneity, were constructed by using DSM-III-R panic disorder as the affected phenotype. Lod scores were < -2.00 over 94-95% of the genome. The greatest lod score was 2.23 (theta = 0.15) at the D7S2846 locus, located at 57.8 cM on chromosome 7 according to the Marshfield Clinic map. Flanking markers analyzed in a nonparametric, multipoint analysis using GENEHUNTER resulted in an NPL score of 2.97 at 63 cM on the Marshfield map. This region lies within 15 cM from the D7S435 locus, where Knowles et al. [1998] obtained a lod score of 1.71 (theta = 0.10) for panic disorder (now 2.45 with the addition of new families; James Knowles, personal communication). Thus, the maximum evidence of linkage from two genome scans of panic disorder lies within a small region of chromosome 7p.

Adult↗

PubMed2001

Comorbidity in generalized anxiety disorder.

GAD has rates of comorbidity that equal or exceed those of other anxiety disorders, and it is one of the most common comorbid conditions with other disorders. Depressive disorders, especially MDD, and other anxiety disorders, especially panic disorder, most commonly co-occur. The pattern of comorbidity is consistent in community and clinical populations and in children and elderly people. Comorbidity is associated with greater impairment, more treatment seeking, and worse outcome among persons with GAD compared with pure GAD. Likewise, patients with panic disorder and MDD who have coexisting GAD tend to have more severe symptoms and less favorable outcome. The relationship between GAD and MDD seems especially close, and data from twin studies suggest that these conditions share a genetic diathesis. Patients with GAD and coexisting conditions respond less well to psychological and pharmacologic treatment, but, for those who do respond, treatment for the primary disorder often also produces improvement in comorbid conditions. Thus, research continues to show that GAD is important as a primary and a comorbid disturbance.

Anxiety Disorders↗

PubMed2000

Hypochondriasis: the patient's perspective.

OBJECTIVE: The purpose of this investigation was to learn how patients with hypochondriasis view their physicians and medical care. METHOD: To accomplish this, we identified 20 patients with DSM-III-R hypochondriasis and 26 nonhypochondriacal patients from a general medicine clinic. Using a semistructured interview, we obtained information from patients about their recent health problems and medical care. The investigators then reviewed transcribed interviews and assigned comments to a series of categories. RESULTS: Hypochondriacal and non-hypochondriacal patients made equal numbers of positive comments, but hypochondriacal patients made significantly more negative comments about physicians' professional characteristics, characteristics of the patients themselves and total negative comments. Many viewed physicians they had seen as unskilled and uncaring. They indicated that, in many instances, their relationships with physicians had suffered from poor communication and collaboration. CONCLUSION: Since successful management of patients with hypochondriasis rests upon positive relationships, ways must be found to improve the frustrating and costly situation that currently exists.

Adult↗

PubMed1999

A 5-year follow-up study of generalized anxiety disorder and panic disorder.

To examine the course and outcome of subjects with generalized anxiety disorder (GAD) and panic disorder, we compared 64 patients with GAD and 68 patients with panic disorder who had participated in drug treatment studies and were interviewed an average of 5 years earlier. At baseline GAD subjects were significantly older, had an earlier onset, and longer duration of illness than panic subjects. GAD subjects also had less severe symptoms. At follow-up, diagnostic stability was observed for both GAD and panic disorder. Significantly fewer GAD subjects achieved full remission at follow-up (18% vs. 45%, p < .01). Subjects with GAD were significantly less anxious at baseline than the panic disorder comparison group, but at follow-up there were few significant differences between groups on most severity of illness variables. This change was due in great part to improvement in the panic disorder group with a concomitant lack of change in the GAD group.

Adult↗

PubMed1998

Possible association of a cholecystokinin promotor polymorphism (CCK-36CT) with panic disorder.

We searched for mutations in the CCK gene in panic disorder with single-strand conformational polymorphism (SSCP) analysis of the three exons and promotor region of the gene. We found a C-->T transition at position -36 (CCK(-36C-->T)) in a GC box, a binding site for transcription factor Sp1, in the promotor region. The allele frequency was 0.168 (95% CI, 0.116-0.221) in 98 persons with panic disorder and 0.083 (95% CI, 0.059-0.107) in 247 geographically matched, unscreened controls. A transmission disequilibrium test based on panic disorder as the affected phenotype was nonsignificant (chi2 = 0.93), but when panic disorder or attacks were considered as affected, statistically significant transmission disequilibrium was detected (chi2 = 4.00, P < 0.05). Linkage analysis was uninformative. In exploratory analyses to search for clinical correlations, the "T" allele was found in 59% of 22 persons with panic attacks but not panic disorder, compared with 31% of those who met the criteria for panic disorder. An association between the CCK polymorphism and panic disorder cannot be considered established due to the inconsistencies in the results noted above, but if the provisional association can be replicated, the findings are consistent with CCK(-36C-->T) being a disease-susceptibility allele that alone is neither necessary nor sufficient to cause panic disorder but that increases vulnerability by acting epistatically.

Adult↗

PubMed1998

Fluvoxamine for somatoform disorders: an open trial.

Although the pharmacologic treatment of somatoform disorders has scarcely been investigated, there is reason to believe that antidepressants might be useful. We examined the response of 29 patients with somatoform disorders from a general medicine clinic to a selective serotonin reuptake inhibitor, fluvoxamine. The drug was administered in doses of up to 300 mg daily for 8 weeks. Sixty-one percent of the patients who took medication for at least 2 weeks were at least moderately improved. In addition to antidepressant effects, fluvoxamine had other beneficial effects and was well-tolerated. The benefits of drug therapy were modest but appear to warrant a placebo-controlled trial.

Adult↗

PubMed1997

Charles Darwin and panic disorder.

Charles Darwin (1809-1882) suffered from a chronic illness that, throughout much of his adult life, impaired his functioning and severely limited his activities. The writings of this famous scientist as well as biographical materials indicate that he probably suffered from an anxiety disorder. His symptoms, when considered individually, suggest a variety of conditions, but taken together they point toward panic disorder with agoraphobia. This diagnosis brings coherence to Darwin's activities and explains his secluded lifestyle, including difficulty in speaking before groups and meeting with colleagues.

Agoraphobia↗

PubMed1997

Moclobemide in social phobia: a controlled dose-response trial.

Although the monoamine oxidase inhibitor phenelzine has proven efficacious in social phobia, the risk of hypertensive crises has reduced its acceptability. The reversible monoamine oxidase inhibitor moclobemide has less potential for such reactions, but its efficacy in this disorder remains unproven. A double-blind, placebo-controlled study was undertaken to assess the efficacy and safety of fixed doses of moclobemide. After a 1-week placebo run-in, subjects with social phobia were randomly assigned to placebo or one of five doses (75 mg, 150 mg, 300 mg, 600 mg, or 900 mg daily) of moclobemide for 12 weeks. Although a trend toward greater efficacy of higher doses of moclobemide was observed at 8 weeks, no differences in response to various doses of the drug and placebo were observed at 12 weeks. At 12 weeks, 35% of subjects on 900 mg of moclobemide and 33% of those on placebo were at least much improved. Moclobemide was well tolerated, insomnia being the only dose-related adverse event observed with the drug. In this dose-response trial, moclobemide did not demonstrate efficacy at 12 weeks. Some other controlled studies have found moclobemide and brofaromine, another reversible monoamine oxidase inhibitor, efficacious in social phobia. Possible reasons for inconsistent findings are discussed.

Adult↗

PubMed1997

A family study of hypochondriasis.

To examine the diagnostic validity of hypochondriasis, we undertook a preliminary family study. Nineteen probands with and 24 without DSM-III-R hypochondriasis were identified among outpatients attending a general medicine clinic. Seventy-two first-degree relatives of hypochondriasis probands and 97 relatives of control probands were personally interviewed with the use of the Structured Clinical Interview for DSM-IV. These relatives also completed self-administered measures of hypochondriasis, psychological and somatic symptoms, and personality traits. No increase in the rate of hypochondriasis was found among the relatives of hypochondriasis probands compared with the relatives of control probands. With respect to other mental disorders, only somatization disorder was more frequent among the hypochondriacal relatives. These relatives also scored higher on measures of hostility, antagonism, and dissatisfaction with medical care. The findings of this study suggest that hypochondriasis may not be an independent disorder but a variable feature of other psychopathology, one that may include somatization disorder.

Adult↗

PubMed1997

Candidate gene study of eight GABAA receptor subunits in panic disorder.

OBJECTIVE: gamma-Aminobutyric acid type A (GABAA) receptor subunit genes are candidate genes for panic disorder. Benzodiazepine agonists acting at this receptor can suppress panic attacks, and both inverse agonists and antagonists can precipitate them. The human GABAA receptor subtypes are composed of various combinations of 13 subunits, each encoded by a unique gene. The authors tested eight of these subunits in a candidate gene linkage study of panic disorder. METHOD: In 21 U.S. and five Icelandic multiplex pedigrees of panic disorder, 104 individuals had DSM-III-R panic disorder (the narrowly defined affected phenotype) and 134 had either this diagnosis or subsyndromal panic disorder characterized by panic attacks that failed to meet either the criterion of attack frequency or the number of criterion symptoms necessary for a definite diagnosis (the broadly defined affected phenotype). The authors conducted lod score linkage analyses with both phenotypes using both a dominant and a recessive model of inheritance for the following loci: GABRA1-GABRA5 (alpha 1-alpha 5), GABRB1 (beta 1), GABRB3 (beta 3), and GABRG2 (gamma 2). RESULTS: The results failed to support the hypothesis that any of these genes cause panic disorder in a majority of the pedigrees. CONCLUSIONS: Within the limitations of the candidate gene linkage method, panic disorder does not appear to be caused by mutation in any of the eight GABAA receptor genes tested.

Adult↗

PubMed1996

Preliminary confirmation of the proposed link between reward-dependence traits and norepinephrine.

The tridimensional theory of personality posits that traits belonging to a personality spectrum called 'reward dependence' are determined in part by the neurotransmitter norepinephrine (NE). We hypothesized that urinary levels of the NE metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG) would be significantly correlated to the reward dependence score on the Tridimensional Personality Questionnaire (TPQ). Twenty-seven never psychiatrically ill subjects collected urine for MHPG measurements and completed the TPQ. There was a significant correlation between the reward dependence score and the level of MHPG. MHPG levels was not associated with the other two personality dimensions, novelty seeking and harm avoidance. This preliminary study supports the hypothesis that reward-dependence traits are in part determined by NE.

Adult↗

PubMed1996

Association of levels of N-acetyl-beta-glucosaminidase with severity of psychiatric symptoms in panic disorder.

Urinary levels of N-acetyl-beta-glucosaminidase (NAG) were measured in 58 patients with panic disorder. NAG levels were found to be significantly related to the severity of 23 of 72 mood states, measured by the Profile of Mood States, which were grouped in three categories: hostility or irritability, sadness, and panic. A similar result was found in a previous study of bipolar patients. NAG levels were also related to scores on the Hamilton Rating Scale for Anxiety and the Sheehan Patient-Rated Anxiety Scale. It is speculated that NAG could be a marker for serotonin.

Acetylglucosaminidase↗

PubMed1996

Physician recognition of hypochondriacal patients.

To examine primary care physician recognition of hypochondriacal patients, we identified a series of such patients in a general medicine clinic using the Whiteley Index. Clinic physicians made blind global ratings of severity of physical disease and unreasonable fear of illness (hypochondriasis) and completed a checklist of somatizing characteristics. Patient records were audited for diagnoses, laboratory tests, consultations, and medications prescribed. Twenty-nine (14%) of 210 patients scored above an established cutoff on the Whiteley Index. These hypochondriacal patients were rated by clinic physicians as more hypochondriacal and were more often given psychiatric diagnoses. Also, clinic physicians identified more somatizing features among hypochondriacal patients including their own reaction to them. This recognition of hypochondriac characteristics may have contributed to better management but may need to be raised to the diagnostic level for maximum benefit.

Adult↗

PubMed1996

Diazepam versus alprazolam for the treatment of panic disorder.

BACKGROUND: Alprazolam has proven efficacy as a treatment for panic disorder, but the place of other benzodiazepines is less well established. METHOD: To compare the efficacy and tolerability of diazepam and alprazolam for the disorder, a placebo-controlled, double-blind trial was undertaken in two sites. Two hundred forty-one subjects with panic disorder or agoraphobia with panic attacks were randomly assigned to flexible doses of diazepam, alprazolam, or placebo for 8 weeks. RESULTS: At the end of the trial, over 60% of subjects taking either diazepam or alprazolam were at least moderately improved compared with less than 30% of those taking placebo. On all measures of efficacy, subjects taking diazepam and alprazolam showed an equally favorable response. Despite some sedation early in the trial, both drugs were tolerated well. More severely ill subjects responded less well to either benzodiazepine. CONCLUSION: The results indicate that diazepam is an effective alternative to alprazolam for the treatment of panic disorder.

Adult↗

PubMed1995

Relationship of generalized anxiety symptoms to urinary 5-hydroxyindoleacetic acid and vanillylmandelic acid.

Urinary levels of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) and the norepinephrine metabolite vanillylmandelic acid (VMA) were measured in 45 patients with generalized anxiety disorder. Multiple regression analysis demonstrated that the severity of several anxiety symptoms was predicted by levels of 5-HIAA and VMA. These data are consistent with the proposal that serotonin and norepinephrine may be involved in the pathophysiology of anxiety.

Adult↗

PubMed1995

Somatization. Diagnosis and management.

Somatization, the somatic expression of psychological distress, occurs in a large proportion of primary care patients. It is associated with substantial distress and impairment and with increased health care utilization. Some somatizing patients have a history of multiple unexplained complaints (somatization disorder), others are excessively worried about serious illness (hypochondriasis), and still others have psychiatric disorders that present with somatic symptoms (depression and anxiety). In general, somatizing patients are characterized by abnormal illness behavior (eg, failure to respond to treatment, excessive utilization of care) and psychological distress (eg, depressive symptoms, psychosocial stressors). Recognition requires alertness to characteristic features and skillful interview technique. Successful management begins by legitimizing symptoms. Restraint should be used in performing workups and assigning diagnoses to somatizing patients. Treatment goals should be clarified and regular visits scheduled. Also, behaviors that threaten the physician-patient relationship should be dealt with. Depression and anxiety should be treated when present. Pharmacologic and psychological treatments for somatizing patients have been described, although none has proven efficacy.

Diagnosis, Differential↗

PubMed1995

Avoidant personality traits distinguish social phobic and panic disorder subjects.

The purpose of this study was to show that, as a group, patients with social phobia and panic disorder differ with respect to personality traits, further validating the distinction between these anxiety disorders. To show this, we compared the response of 46 subjects with social phobia with the response of 72 subjects with panic disorder with or without agoraphobia on the Personality Diagnostic Questionnaire. The subjects, who were recruited for treatment studies, completed this personality questionnaire after they had been off psychotropic medication for at least 1 week. Responses to the Personality Diagnostic Questionnaire showed that the social phobics had more severe personality pathology. These subjects had higher anxious and schizoid cluster scores and differed from panic subjects in having more avoidant personality traits. Panic subjects had more dependent traits. The results indicate that social phobic and panic disorder patients are distinguishable on the basis of personality characteristics. They also show that the generalized situational subtype of social phobia is closely associated with avoidant personality disorder and that these may be differing categorizations of a single disturbance.

Adult↗