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PubMed1986

Urinary norepinephrine excretion in panic and phobic disorders.

Morning urinary norepinephrine (NE) was assessed in 36 patients suffering from panic and phobic disorders according to DSM III. Urinary NE excretion was significantly higher in this group than in a normal control one. Phobic patients excreted lower levels of NE than panic ones. No significant association was found between urinary NE levels and anxiety scores according to Zung's Anxiety Status Inventory or Wittenborn Psychiatric Rating Scale. The NE increase is interpreted as reflecting a sympathetic nervous system hyperactivity in anxiety. A concomitant effect upon NE metabolism of benzodiazepine withdrawal cannot be discarded since the group of patients previously medicated showed the highest NE excretion.

Adolescent↗
PubMed1984

Prognostic factors with four treatment methods for phobic disorders.

The associations between prognostic factors and outcome with four treatment methods for phobic disorders were studied in 103 women. The prognostic factors were sociodemographic, intelligence, personality, early interpersonal relations, aspects of previous and current mental disorder, and intensity of symptoms at start of treatment. All patients received basal therapy, which implied information, advice on exposure in vivo, and anxiolytics. One group received this treatment only (B), while others received supplementary treatment, with therapist-directed prolonged exposure in vivo (PE), supportive therapy (ST) of dynamic type, or relaxation (R). The patients were treated for 3 months, with a 9-month follow-up period. Factors associated with a better outcome were: PE: greater needs for succourance and lower avoidance; ST: higher social class, better relations between parents and with father during childhood, inner conflicts as cause, and lower levels of free anxiety; R: satisfaction with contact when aged 15, bereavement as a cause, and lower levels of several symptoms; B: greater needs for order, stress at the onset, shorter duration and satisfaction with work. There were thus interactions between prognostic factors and type of treatment. The prognostic factors should be taken into account in the choice and design of treatment.

Adult↗
PubMed1984

Relation between outcome and the patient's initial experience of the therapist and therapeutic conditions in four treatment methods for phobic disorders.

One hundred and three phobic women not suitable for insight-oriented psychotherapy were randomized to either therapist-directed prolonged exposure therapy (PE), supportive therapy of dynamic type (ST), relaxation therapy (R), or basal therapy (B). Immediately after seeing their therapist for history taking and beginning of treatment, the patients were asked to report their experience of the therapist, of themselves in relation to the therapist, and of the therapy (Experience of Therapy Inventory, ETI). The patients were informed that the therapists would not see the ETI. The patients were rated by an independent rater with regard to symptoms and functions at the beginning of treatment, at termination of treatment 3 months later, and at a follow-up 1 year after the commencement of the study. 1) Patients treated with PE and R were more satisfied with their therapists than patients treated with ST or B. The PE patients considered their therapists provided better contact, were more assured and knowledgeable, and gave what seemed to be the correct therapy, the R patients considered their therapist showed more warmth. Both PE and R patients felt their therapists were more interested than the ST and B therapists. These differences were probably due to differences in the amount of time offered, in the attitudes of the therapists, and in the characteristics of the therapies. 2) In the PE group there were positive associations between outcome and the initial experience of the therapist. There is, thus, empirical evidence that a good therapist-patient relation is of importance to a good outcome in this type of behaviour therapy. In the ST group there was an association between a good outcome and a positive experience of the rather conflict-centred beginning of the procedure. A positive experience of a conflict-centred approach may thus be regarded as an indication for dynamic therapy.

Adult↗
PubMed2002

[Obsessive-phobic disorder typology in schizophrenia].

The study aims at clinical characteristics of obsessive-phobic disorders (OPD) in schizophrenia with regard to their modification in main disease development and interaction with basic schizophrenia symptoms (positive and negative). Eighteen patients, mean age 28.2 years, were examined. An affinity degree of schizophrenia to OPD was found to be associated with endogenous progressive process. In slowly progressive schizophrenia, an affinity is selective, concerning to one of the obsessive phobic syndrome component (phobic component proper or avoidance behavior) and realizing in either positive, or negative manifestation of schizophrenia. Two obsessive-phobic syndrome types were determined: OPD of the 1st type--panic and generalized anxiety disorder (52 patients) are modified because of overlapping by chronic endogenous anxiety, obsessive-phobic symptoms being not represented in structure of negative changes (asthenia defect); in OPD of the 2nd type (agora and social phobias, 80 patients) an overlapping of psychopathological symptoms related to avoidance behavior and negative changes (psychopathic-like defect "verschroben" type) was found. Phobic syndrome component does not tend to psychopathological transformation and undergoes reverse changes. In typical cases of progressive schizophrenia has no affinity. But exclusion is--the OPD of the 3rd type (obsessive-compulsive disorders with a fear of external threat and massive defense rituals, 49 patients). In this case, total affinity to schizophrenia is realized in overlapping of both obsessive syndrome components with positive and negative manifestation of schizophrenia.

Adult↗
PubMed1990

Panic and phobic disorders in patients with obsessive compulsive disorder.

Obsessive compulsive disorder shares numerous clinical features with other anxiety disorders. To study the relationship between OCD and other anxiety disorders, the authors administered the Structured Clinical Interview for DSM-III to 36 OCD patients. Thirty-nine percent (14) of patients reported a lifetime history of panic attacks, and 14% (5) met DSM-III-R criteria for panic disorder at the time of interview. Fourteen percent (5) met criteria for social phobias, and 19% (7) met criteria for simple phobias. Eighteen patients were treated with clomipramine in doses of at least 100 mg/day for 3 months. Patients with a history of other anxiety disorders responded significantly better to clomipramine.

Acute Disease↗
PubMed1997

[Obsessive-phobic disorders in anorexia and bulimia nervosa].

The data on 1500 patients with syndrome of anorexia and bulimia nervosa were summarised in terms of clinical-psychopathological, catamnestic and experimental-psychological investigation. This syndrome was considered as one disease which presented the variation of borderline mental pathology or the manifestation of schizophrenic process. Obsessive-phobic disorders were observed in majority of patients (95%). Such disorders were characterized by prevalence of obsessive phenomena with food content. It was noted that diagnosis and prognostic significance had either obsessive-phobic disturbances or obsessions with other content which occurred on the initial stage of disease, before development of syndrome of anorexia and bulimia and in period of pronounced cachexia. The therapeutic resistance of obsessive disturbances in patients with anorexia and bulimia were emphasized as well as the necessity of prolonged ambulatory treatment of such patients.

Adolescent↗
PubMed1990

Panic and phobic disorders. Current cognitive behavioural strategies.

The past 5 years have seen the development of a number of treatment strategies suitable for panic and phobic disorders. At this stage, a combined drug and psychological approach is appropriate. Not all patients will accept medication. A number of cognitive-behavioural techniques can be used with hope of success. Sessions must include positive statements such as 'you can do it', 'be persistent', 'look forward to this activity' and 'I am achieving'.

Behavior Therapy↗
PubMed1983

Panic disorder and major depression. Increased risk of depression, alcoholism, panic, and phobic disorders in families of depressed probands with panic disorder.

In a large, case-control family study of depression, 77 (58%) of 133 depressed probands displayed anxiety symptoms that met DSM-III criteria for agoraphobia, panic disorder, or generalized anxiety disorder. In two thirds of these 77 cases, these symptoms were associated with depressive episodes. In a previous study, the lifetime rate of major depression and anxiety disorders among first-degree family members of probands with major depression plus an anxiety disorder was found to be significantly increased regardless of when the anxiety symptoms occurred. In this study we analyzed our data according to the specific anxiety disorders observed. Major depression plus panic disorder in probands was associated with a marked increase in risk in relatives for a number of psychiatric disorders; relatives were more than twice as likely to have major depression, panic disorder, phobia, and/or alcoholism than the relatives of probands with major depression without any anxiety disorder. These results indicate that the relationship between major depression and anxiety disorders requires further study.

Adolescent↗
PubMed2000

The longitudinal study of phobic disorder in a community sample from early to late adolescence.

PURPOSE: This study explored the development of phobic disorder as young subjects move into late adolescence. The objectives were to determine: the frequency of clinical, subsyndromal and subthreshold phobia in late adolescence; the incident episode and stability of phobic symptoms as adolescents move from early to late adolescence; and the relationship between demographic characteristics in early adolescence and the presence of clinical, subsyndromal and subthreshold phobia in late adolescents.METHODS: The data were taken from a two-stage epidemiological study to determine the frequency of and risk factors for DSM-III major depressive disorders and suicidal behaviors in a community population of adolescents. Data were also collected for the frequency of phobias. Three levels of phobias were defined.RESULTS: The prevalences of clinical, subsyndromal and subthreshold phobias in late adolescence were 0.40%, 1.34%, and 5.74% respectively. The weighted incidence of clinical phobia was 0.28%, of subsyndromal phobia was 0.19% and of subthreshold phobia was 4.63%. Race, sex, and having a subthreshold phobia at the initial interview were significantly associated with subsyndromal phobia in late adolescence. Diagnosis of clinical phobia at initial interview was significant in all the multivariate models. Having a subthreshold phobia at initial interview was significant for subsyndromal phobia in late adolescence.CONCLUSIONS: Data on late adolescence showed a strong trend towards remission of phobic symptoms and disorder. However, those with clinical phobia at baseline had an increased risk of being diagnosed again at late adolescence. The most frequently reported symptoms were simple phobias, suggesting that simple phobias start early, have a higher prevalence, and are more frequent over time than social or agoraphobia. Further longitudinal studies are needed.

Journal Article↗
PubMed1999

Contingency management, self-control, and education support in the treatment of childhood phobic disorders: a randomized clinical trial.

This study evaluated the relative efficacy of an exposure-based contingency management (CM) treatment condition and an exposure-based cognitive self-control (SC) treatment condition relative to an education support (ES) control condition for treating children with phobic disorders. Eighty-one children and their parents completed a 10-week treatment program in which children and parents were seen in separate treatment sessions with the therapist, followed by a brief conjoint meeting. Children in both the CM and SC conditions showed substantial improvement on all of the outcome measures. These gains were maintained at 3-, 6-, and 12-month follow-ups. Interestingly, children in the ES condition also showed comparable improvements at posttreatment and at 3-, 6-, and 12-month follow-ups. Implications of the findings are discussed with respect to knowledge development and clinical practice.

Analysis of Variance↗
PubMed2001

[Anxious-phobic disorders in patients with dyspnea].

The examination included 35 patients (21 women, 14 men, mean age 47.2 +/- 2.4 years) with anxious-phobic disorders (APD) and dyspnea phenomena combined bronchial asthma (BA) and hyperventilation syndrome (HVS). There was established that APD in these cases develops more frequently similarly to the panic attacks (PA) and HVS was PA component. Three PA types with dyspnea phenomena were recognized: cognitive ones (with prevalence of cognitive anxiety--8 cases); somatized PA (with prevalence of somatized anxiety--18 cases) and PA with both cognitive and somatized anxiety (9 cases). PA of the first type amplifies BA attack (psychopathologic structure of PA was integrated with manifestations of the acute bronchial obstruction). PA of the second type duplicates (because of the pronounced somatized anxiety associated with asphyxia) an acute bronchial obstruction between BA paroxysms. PA of the third type imitates somatic pathology forming without its participation (polymorphic conversion disorders were found first of all). The link of severity of the anxious-phobic and pulmonary pathology can be interpreted in the ranges of psychosomatic conception of the "reciprocal correlations".

Anxiety Disorders↗
PubMed1977

The management of phobic disorders using clomipramine (Anafranil).

The problem of phobic anxiety is viewed in the context of the entire area of mental illness and of its epidemiology in the general population. The importance of the diagnosis of depression in phobic patients and its simultaneous treatment is emphasized. Psychotherapeutic and psychopharmacological methods are discussed and some results of recent trials of clomipramine (Anafranil) are reported. The author concludes that for the successful outcome of treatment an eclectic approach must be considered. The combination of behavioural techniques of desensitization along a hierarchy of anxiety-provoking situations, together with psychotherapeutic support and the simultaneous exhibition of the more specific antidepressant and antiphobic preparation clomipramine would offer the best hope of symptom relief.

Behavior Therapy↗
PubMed1999

[Chronic anxiety and phobic disorders with persistent agoraphobia: clinical and follow-up study].

There were studied 2 groups of the patients with a diagnosis of agoraphobia (according to ICD = 10). The first group included 34 patients which didn't use a specialized psychiatric service; the second one included 25 patients which needed an active therapy under conditions of psychiatric hospital. Dynamics of a disease was investigated by the method of retrospective (3 years) and following prospective (3 years) evaluation. The first group was characterized by relatively favourable outcome of chronic anxious-phobic disorders (APD) with the phenomena of a stable agoraphobia (5.8% of patients with a decrease of social adaptation): a limited agoraphobic avoidance (2 cases in the average), a rare and only psychogenic exacerbation (23 cases). Comorbid disorders were presented as minor depression (53%), somatophormic disorders (single isolated cardialgias and the conversive disorders--28%), personal disorders of hyperthimic (53%) and hysteric (35.5%) type. The second group was characterised by relatively worse outcome of chronic APD with the phenomena of a stable agoraphobia (32.0% of the patients with a decrease of social adaptation), that was associated with more generalized avoidance behaviour (more than 2 cases), with a gradual increase of both the severity of panic attacks and agoraphobia in limits of either periodic long-term aggravations (46%) or a continuous progredient course (29%). As compared with the 1-st group the second group was also characterised by significantly higher average number in a month of the panic attacks (4.9 + 1.1 vs 2.4 + 0.4; p < 0.01) and hospitalization (2.5 + 0.6 vs 0.2 + 0.2 + 0.1; p < 0.05) during all period of prospective observation. More severe comorbid disorders were revealed: slow-progredient schizophrenia (20% vs 0% in the first group; p < 0.01), a major depressive disorder (28% vs 3%; p < 0.01), dysthymic disorder (32% vs 3%; p < 0.05); personal disorders were presented mostly by the deviations of schizoid type (59%).

Adaptation, Psychological↗
PubMed1986

Panic and phobic disorders--are psychological or pharmacological treatments effective?

Panic disorder with or without phobic avoidance has recently been delineated as a distinct nosological entity. Several controlled studies have demonstrated the efficacy of various pharmacological agents in controlling panic attacks. Behaviour therapy, especially desensitisation, is of value in alleviating phobic avoidance but has not yet been shown to be effective in the alleviation of panic attacks. No systematic studies comparing pharmacological and psychological treatments in panic disorder are available.

Behavior Therapy↗
PubMed1977

Clomipramine (Anafranil) and behaviour therapy in obsessive-compulsive and phobic disorders.

In a comparative study of three treatment regimens in patients with obsessive-compulsive or phobic manifestations, the most favourable therapeutic findings were seen in the clomipramine (Anafranil, Geigy Pharmaceuticals) plus behaviour therapy group and the least favourable therapeutic findings in the clomipramine plus simulated behaviour therapy group. The findings that a combination of behaviour therapy and clomipramine results in more favourable therapeutic changes than either of the two treatments alone is in line with reported studies in the literature.

Adult↗