Panic disorder in a Spanish sample of 89 patients with pure alcohol dependence

The influence of ethanol infusion on the effects of 35% CO2challenge. A study in panic disorder patients and healthy volunteers

Alcohol and panic disorders co-occur at a rate that exceeds chance significantly. Early experimental work suggests that alcoholic subjects, compared to non-alcoholics, are less sensitive to sodium lactate and that alcohol intake reduces the response to a 35% CO2challenge in Panic Disorder patients. The present study documents the direct pharmacological effect of ethanol infusion on CO2induced panic.

Methods

According to a placebo-controlled, double-blind, randomized, cross-over design 10 drug free panic disorder patients and 16 healthy volunteers underwent a 35% CO2challenge after intravenous infusion of a moderate dose of ethanol on one test day and of placebo on another test day.

Results

Compared to the placebo condition, the effect of the CO2challenge was significantly smaller after ethanol infusion (P= 0.041).

Discussion

A moderate dose of ethanol decreased the response to a 35% CO2without inducing pre challenge sedation.

Conclusion

The results comfort earlier findings of a direct pharmacological effect of ethanol on panic.

Individual differences in elevated plus-maze exploration predicted higher ethanol consumption and preference in outbred mice

Psychiatric illnesses, such as anxiety, are highly comorbid with drug use disorders in general and alcohol abuse in particular. Unfortunately, the causal role of anxiety in ethanol addiction is still unclear. We asked the question whether high anxiety predicts predilection of mice to voluntarily consume more alcohol than water. In the current study, we used the voluntary alcohol intake in two bottle choice drinking paradigm to explore whether high anxiety predicts higher alcohol preference and intake in outbred Tuck-Ordinary "TO" mice. To this end, mice were tested for their anxiety-like behavior using the elevated plus maze, open field and the marble burying test prior to voluntary continuous access to increasing concentrations of alcohol solutions. To assess their taste discrimination, mice had access to saccharin and quinine solutions. Results showed that compared to low-anxious mice (LAM), high-anxious mice (HAM) showed greater consumption and preference for ethanol but not for saccharin and quinine suggesting alterations in the rewarding effects of alcohol. Taken together, these findings suggest a correlative link between trait anxiety and the behavioral responses to ethanol.

Alcohol use history and panic-relevant responding among adolescents: a test using a voluntary hyperventilation challenge

Given the onset of alcohol use, neurological sensitivity, and enhanced panic-relevant vulnerability, adolescence is a key period in which to study the documented linkage between alcohol and panic-related problems. The current study was designed to build upon and uniquely extend extant work via (a) utilization of well-established experimental psychopathology techniques and (b) evaluation of unique associations between alcohol use and panic symptoms after controlling for theoretically relevant behavioral, environmental, and individual difference variables (i.e., age, gender, negative affectivity, anxiety sensitivity, child and parent tobacco use, and parental panic disorder). Participants were 111 community-recruited adolescents ages 12-17 years (M = 15.76 years; n = 50 girls). Youth completed a battery of well-established questionnaires and a voluntary hyperventilation challenge, and parents present at the laboratory completed a structured clinical interview. Adolescent alcohol use was categorized as Non-Users, Experimenters, or Users. Panic symptoms were indexed via retrospective self-report and adolescents' response to a biological challenge procedure (i.e., voluntary hyperventilation). After controlling for theoretically relevant covariates, Users evidenced elevated panic-relevant symptoms and responding compared with Non-Users; Experimenters did not differ from Non-Users. Findings suggest alcohol use history is uniquely associated with panic symptomatology among youth, including "real-time" reactivity elicited by a laboratory challenge. Although there is significant work yet to be done, these data advance extant work and lay the groundwork for the types of sophisticated designs that will be needed to answer the most pressing and complex questions regarding the link between alcohol use and panic symptoms among adolescents.

Anxiety Psychopathology and Alcohol Use among Adolescents: A Critical Review of the Empirical Literature and Recommendations for Future Research

Adolescent alcohol use is a critical public health concern; accordingly, a considerable body of work exists identifying developmentally salient risk and protective factors. One area receiving increasing attention among adults is the linkage between specific constellations of anxiety psychopathology and alcohol use problems. Relatively less is known about such linkages among adolescents, despite the onset of both anxiety-type problems and alcohol use during this developmental period. The current review presents a detailed summary and analysis of the empirical literature focused on specific forms of anxiety psychopathology as they relate to alcohol use among adolescents, and provides a number of specific recommendations for future work with an emphasis on the utility of experimental psychopathology techniques for clarifying basic questions and forwarding this body of work.

Do rats really express neophobia towards novel objects? Experimental evidence from exposure to novelty and to an object recognition task in an open space and an enclosed space

Three set of experiments were performed in an enclosed space (open-field) and in an open space (elevated platform). The surface of the open-field and the elevated platform were divided in nine equal squares. Rats were exposed (without previous habituation) in a unique session (experiment 1) or three consecutive sessions (experiment 2) either to an open-field (enclosed space) or to an elevated platform (open space) with and without an object on the centre of the field. In experiment 3, rats were exposed (without previous habituation) either to an enclosed or an open space on five consecutive sessions, one session a day. They were tested in an object recognition test in sessions 1, 3 and 5. In sessions 2 and 4, no objects were present. In experiment 1, we recorded the latency, frequency and duration of entries into different areas of the field. In experiment 3, we recorded the latency, frequency and duration of contacts with objects in addition to entries into different areas of the field. The first experiment demonstrates that rats exposed for the first time to an enclosed or an open space do not express neophobia toward novel objects in the absence of walls that surround an open-field. They crossed frequently into and spent more time in areas occupied with an object than in unoccupied areas. After two sessions of habituation to an empty open space or an empty enclosed space, the latency of first approach to a novel object is reduced while the frequency and duration of approaches are increased. The third experiment on object recognition confirmed that rats do not avoid novel objects; they made frequent visit and spent more time in the corner of the field occupied with an object than in empty corners. Recording of crossings provided detailed information about the patterns of exploratory behavior of rats but failed to reveal discrimination between novel and familiar objects which was evident in both open and enclosed space with recording of contacts with objects on the fifth exposure.

Pharmacotherapy of alcoholism in patients with co-morbid psychiatric disorders

There has been an exponential increase in recent years of literature pertaining to the treatment of individuals with alcohol use disorders and co-morbid psychiatric disorders. Patients with mood and anxiety disorders in particular have a very high prevalence of alcoholism. Alcoholism confers significant morbid risks to patients with psychiatric disorders, and vice versa, including markedly increased risk of suicide. Only recently have studies examined the impact of various psychiatric medications on alcohol use among patients with these disorders. Evidence supporting the benefits of antidepressants for co-morbid alcoholism and depression continues to mount. Although these studies have demonstrated benefits in terms of quantitative decreases in the volume and frequency of consumption, the benefits in terms of remission from alcoholism have yet to be shown conclusively. The first randomised, controlled trial involving subjects with co-morbid alcoholism and bipolar disorder was recently conducted, yielding promising results for valproate in this population. The literature regarding co-morbid alcoholism and anxiety disorders has also seen recent progress, particularly in the study of post-traumatic stress disorder (PTSD). A placebo-controlled study of sertraline suggests some benefit in terms of alcohol use among individuals with early-onset PTSD and less severe alcohol dependence. Atypical antipsychotics such as olanzapine and quetipaine have been examined in several open studies of subjects with alcoholism co-morbid with a variety of psychiatric conditions including bipolar disorder, PTSD and schizophrenia. This paper selectively reviews the evidence that is currently available for the pharmacological management of alcoholism among persons with co-morbid psychiatric illness. Effectiveness, safety and tolerability are considered, and directions for future study are discussed.

Alcoholism in 274 patients with panic disorder in Spain, one of the main producers of wine worldwide

BACKGROUND

Though panic disorder (PD) and alcoholism have been found in epidemiologic studies to often co-occur, the influence of cultural factors on the order of onset of the disorders has not been frequently addressed.

METHODS

A sample of 274 patients with PD was assessed and compared according to the presence of alcohol use disorder (AUD) (alcohol abuse or dependence), employing several clinical scales.

RESULTS

A total of 26 subjects were diagnosed from AUD. In 73.1% of patients, onset of alcohol use was previous to PD onset. PD subjects with AUD were found to have an earlier age at PD onset. They were more likely to be males, to have a family history of alcoholism, to abuse other drugs and to experience a more severe PD (more attacks in the last month, higher scores in anticipatory anxiety).

CONCLUSIONS

Patients with PD and alcoholism may represent a distinct clinical subgroup. Our finding of an uncommon order of onset for both disorders may reflect cultural influences.

CLINICAL IMPLICATIONS

(i)The study of panic disorder patients with comorbid alcoholism may help to better characterize this subgroup of patients. (ii) Patterns of alcohol use and the order of onset of both disorders may be influenced by cultural factors, with important practical implications. (iii) Patients with panic disorder and alcoholism may represent a distinct clinical subgroup, with an earlier age at panic disorder onset and greater clinical severity of anxiety.

LIMITATIONS

(i) Our results refer to a clinical sample, which may not be representative of the general population. (ii) Alcoholic patients with a history of other drug abuse or dependence were not excluded. (iii) Owing to the small sample size, patients with alcohol dependence and with alcohol abuse were not separated.

Anxiety and substance use comorbidity among inpatients with schizophrenia

OBJECTIVE

To determine the association between lifetime anxiety symptoms and anxiety disorders and substance use disorders among patients with schizophrenia.

METHOD

Participants were 184 inpatients with schizophrenia at the Schizophrenia Research Unit (SRU) at the New York State Psychiatric Institute (NYSPI). Multivariate logistic regression analyses were used to determine the relationship between specific anxiety symptoms and anxiety disorders and substance use disorders among inpatients with schizophrenia.

RESULTS

Anxiety symptoms and anxiety disorders were prevalent among 31.5% of the sample. Panic attacks were associated with a significantly increased odds (OR=7.4 (1.2, 47.1)) of comorbid alcohol or substance use disorders (lifetime). This association was specific to panic attacks and persisted after adjusting for differences in sociodemographic characteristics and comorbid anxiety symptoms and anxiety disorders.

CONCLUSIONS

These findings are consistent with and extend previous data by providing evidence of an association between panic attacks and increased likelihood of substance use disorders among inpatients with schizophrenia. Future studies that determine the nature of this relationship, the sequence of symptom onsets, and examine whether treatment of anxiety can influence the onset or outcome associated with substance use are needed.