1
|
Garakani A, Buono FD, Salehi M, Funaro MC, Klimowicz A, Sharma H, Faria CGF, Larkin K, Freire RC. Antipsychotic agents in anxiety disorders: An umbrella review. Acta Psychiatr Scand 2024; 149:295-312. [PMID: 38382649 DOI: 10.1111/acps.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Although not approved for the treatment of anxiety disorders (except trifluoperazine) there is ongoing off-label, unapproved use of first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) for anxiety disorders. There have been systematic reviews and meta-analyses on the use of antipsychotics in anxiety disorders, most of which focused on SGAs. OBJECTIVE The specific aims of this umbrella review are to: (1) Evaluate the evidence of efficacy of FGAs and SGAs in anxiety disorders as an adjunctive treatment to traditional antidepressant treatments and other nonantipsychotic medications; (2) Compare monotherapy with antipsychotics to first-line treatments for anxiety disorders in terms of effectiveness, risks, and side effects. The review protocol is registered on PROSPERO (CRD42021237436). METHODS An initial search was undertaken to identify systematic reviews and meta-analyses from inception until 2020, with an updated search completed August 2021 and January 2023. The searches were conducted in PubMed, MEDLINE (Ovid), EMBASE (Ovid), APA PsycInfo (Ovid), CINAHL Complete (EBSCOhost), and the Cochrane Library through hand searches of references of included articles. Review quality was measured using the AMSTAR-2 (A MeaSurement Tool to Assess Systematic Reviews) scale. RESULTS The original and updated searches yielded 1796 and 3744 articles respectively, of which 45 were eligible. After final review, 25 systematic reviews and meta-analyses were included in the analysis. Most of the systematic reviews and meta-analyses were deemed low-quality through AMSTAR-2 with only one review being deemed high-quality. In evaluating the monotherapies with antipsychotics compared with first-line treatments for anxiety disorder there was insufficient evidence due to flawed study designs (such as problems with randomization) and small sample sizes within studies. There was limited evidence suggesting efficacy of antipsychotic agents in anxiety disorders other than quetiapine in generalized anxiety disorder (GAD). CONCLUSIONS This umbrella review indicates a lack of high-quality studies of antipsychotics in anxiety disorders outside of the use of quetiapine in GAD. Although potentially effective for anxiety disorders, FGAs and SGAs may have risks and side effects that outweigh their efficacy, although there were limited data. Further long-term and larger-scale studies of antipsychotics in anxiety disorders are needed.
Collapse
Affiliation(s)
- Amir Garakani
- Department of Psychiatry and Behavioral Health, Greenwich Hospital, Greenwich, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Frank D Buono
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mona Salehi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Melissa C Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, USA
| | - Anna Klimowicz
- Department of Psychiatry, New York University Langone Health, New York, New York, USA
| | - Harshit Sharma
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Clara G F Faria
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Kaitlyn Larkin
- Department of Psychology, Northern Illinois University, DeKalb, Illinois, USA
| | - Rafael C Freire
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Psychiatry and Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Kingston General Hospital Research Institute, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| |
Collapse
|
2
|
Al-Mahrouqi T, Al Alawi M, Freire RC. Dexmedetomidine in the Treatment of Depression: An Up-to-date Narrative Review. Clin Pract Epidemiol Ment Health 2023; 19:e174501792307240. [PMID: 37916205 PMCID: PMC10507216 DOI: 10.2174/17450179-v19-230823-2023-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 11/03/2023]
Abstract
Depressive disorders (DD) are common, and their prevalence is expected to rise over the next decade. Depressive disorders are linked to significant morbidity and mortality. The clinical conundrum of depressive disorders lies in the heterogeneity of their phenomenology and etiology. Further, the currently available antidepressants have several limitations, including a delayed onset of action, limited efficacy, and an unfavorable side effect profile. In this review, Dexmedetomidine (DEX), a highly selective and potent α2-adrenergic receptor (α2-AR) agonist, is proposed as a potentially novel antidepressant with multiple mechanisms of action targeting various depression pathophysiological processes. These mechanisms include modulation of the noradrenergic system, regulation of neuroinflammation and oxidative stress, influence on the Brain-Derived Neurotrophic Factor (BDNF) levels, and modulation of neurotransmitter systems, such as glutamate. The review begins with an introduction before moving on to a discussion of DEX's pharmacological features. The pathophysiological and phenomenological targets of DD are also explored, along with the review of the existing preclinical and clinical evidence for DEX's putative anti-depressant effects. Finally, the review ends by presenting the pertinent conclusions and future directions.
Collapse
Affiliation(s)
- Tamadhir Al-Mahrouqi
- Department of Behavioural Medicine, Sultan Qaboos University Hospital, Muscat, Oman
- Psychiatry Residency Training Program, Oman Medical Speciality Board, Muscat, Oman
| | - Mohammed Al Alawi
- Department of Behavioural Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Rafael C. Freire
- Department of Psychiatry and Centre for Neuroscience Studies, Queens University, Kingston, Canada
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de, Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
3
|
Garakani A, Freire RC, Buono FD, Thom RP, Larkin K, Funaro MC, Salehi M, Perez-Rodriguez MM. An umbrella review on the use of antipsychotics in anxiety disorders: A registered report protocol. PLoS One 2022; 17:e0269772. [PMID: 35709149 PMCID: PMC9202921 DOI: 10.1371/journal.pone.0269772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/27/2022] [Indexed: 01/08/2023] Open
Abstract
Anxiety disorders, including panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), agoraphobia, and specific phobia, are among the most common psychiatric disorders. Although the traditional pharmacologic treatments for anxiety included barbiturates and then benzodiazepines, the introduction of tricyclic antidepressants, followed by the selective serotonin reuptake inhibitors (SSRIs), marked a tidal shift in the treatment of anxiety. Although not approved for treatment of anxiety disorders (with the exception of trifluoperazine) there is ongoing off-label, unapproved use of both first-generation “typical” antipsychotics (FGAs) and second-generation or “atypical” antipsychotics (SGAs) for anxiety. Although there have been systematic reviews and meta-analyses on the use of antipsychotics in anxiety disorders, most of these reviews focused on SGAs, primarily the use of quetiapine in GAD. Given that there is little known about the potential benefits and short-and long-term risks of using antipsychotics in anxiety, there is a need for an umbrella review of systematic reviews and meta-analyses of the use of both FGAs and SGAs in anxiety disorders. The specific aims of this study are as follows: (1) Evaluate the evidence of efficacy of FGAs and SGAs in anxiety disorders as an adjunctive treatment to SSRIs, serotonin norepinephrine reuptake inhibitors (SNRIs) and other non-antipsychotic medications; (2) Compare monotherapy with antipsychotics to first-line treatments for anxiety disorders in terms of effectiveness, risks, and side effects; and (3) Evaluate the short- and long-term risks and side effects of prescribing antipsychotics in anxiety disorders. The review is registered on PROSPERO (CRD42021237436). Since data extraction has not begun, there is not preliminary data to share.
Collapse
Affiliation(s)
- Amir Garakani
- Department of Psychiatry and Behavioral Health, Greenwich Hospital, Greenwich, CT, United States of America
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
- * E-mail:
| | - Rafael C. Freire
- Department of Psychiatry and Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Frank D. Buono
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Robyn P. Thom
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Kaitlyn Larkin
- Department of Psychology, Northern Illinois University, DeKalb, IL, United States of America
| | - Melissa C. Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, United States of America
| | - Mona Salehi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | | |
Collapse
|
4
|
Garakani A, Murrough JW, Freire RC, Thom RP, Larkin K, Buono FD, Iosifescu DV. Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Focus (Am Psychiatr Publ) 2021; 19:222-242. [PMID: 34690588 PMCID: PMC8475923 DOI: 10.1176/appi.focus.19203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
(Appeared originally in Frontiers in Psychiatry 2020 Dec 23; 11:595584)
Collapse
|
5
|
Garakani A, Freire RC, Murrough JW. Editorial: Pharmacotherapy of Anxiety Disorders: Promises and Pitfalls. Front Psychiatry 2021; 12:662963. [PMID: 33815180 PMCID: PMC8012478 DOI: 10.3389/fpsyt.2021.662963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amir Garakani
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Silver Hill Hospital, New Canaan, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Rafael C Freire
- Department of Psychiatry and Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - James W Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| |
Collapse
|
6
|
Kyriakoulis P, Kyrios M, Nardi AE, Freire RC, Schier M. The Implications of the Diving Response in Reducing Panic Symptoms. Front Psychiatry 2021; 12:784884. [PMID: 34912254 PMCID: PMC8667218 DOI: 10.3389/fpsyt.2021.784884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022] Open
Abstract
Increased CO2 sensitivity is common in panic disorder (PD) patients. Free divers who are known for their exceptional breathing control have lower CO2 sensitivity due to training effects. This study aimed to investigate the immediate effects of cold facial immersion (CFI), breath holding and CO2 challenges on panic symptoms. Healthy participants and patients with PD were subjected to four experimental conditions in a randomly assigned order. The four conditions were (a) breath-holding (BH), (b) CFI for 30 s, (c) CO2 challenge, and (d) CO2 challenge followed by CFI. Participants completed a battery of psychological measures, and physiological data (heart rate and respiration rate) were collected following each experimental condition. Participants with PD were unable to hold their breath for as long as normal controls; however, this finding was not significant, potentially due to a small sample size. Significant reductions in both physiological and cognitive symptoms of panic were noted in the clinical group following the CFI task. As hypothesized, the CFI task exerted demonstrable anxiolytic effects in the clinical group in this study by reducing heart rate significantly and lessening self-reported symptoms of anxiety and panic. This outcome demonstrates the promise of the CFI task for clinical applications.
Collapse
Affiliation(s)
- Peter Kyriakoulis
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Michael Kyrios
- College of Education, Psychology & Social Work, Orama Institute for Mental Health & Wellbeing, Flinders University, Adelaide, SA, Australia
| | - Antonio Egidio Nardi
- Institute of Psychiatry-Federal University of Rio De Janeiro, Rio De Janeiro, Brazil
| | - Rafael C Freire
- Institute of Psychiatry-Federal University of Rio De Janeiro, Rio De Janeiro, Brazil.,Department of Psychiatry and Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Mark Schier
- School of Health, Swinburne University, Hawthorn, VIC, Australia
| |
Collapse
|
7
|
Javelot H, Weiner L, Hingray C, Freire RC, Nardi AE. COVID-19 and its psychological consequences: Beware of the respiratory subtype of panic disorder. Respir Physiol Neurobiol 2020; 282:103530. [PMID: 32818605 PMCID: PMC7431396 DOI: 10.1016/j.resp.2020.103530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022]
Abstract
COVID-19 could increase the rates of the respiratory subtype of panic disorder.
Collapse
Affiliation(s)
- Hervé Javelot
- Établissement Public De Santé Alsace Nord, Brumath, France, Laboratoire De Toxicologie Et Pharmacologie Neuro Cardiovasculaire, Université De Strasbourg, Strasbourg, France.
| | - Luisa Weiner
- Clinique De Psychiatrie, CHU De Strasbourg, France, Laboratoire De Psychologie Des Cognitions, Université De Strasbourg, Strasbourg, France
| | - Coraline Hingray
- Pôle Hospitalo-Universitaire De Psychiatrie d'Adultes Du Grand Nancy, Centre Psychothérapique De Nancy, Laxou, France, CHU De Nancy, Département De Neurologie, Nancy, France
| | - Rafael C Freire
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio De Janeiro, Rio De Janeiro, Brazil
| | - Antonio E Nardi
- Department of Psychiatry and Centre for Neuroscience Studies, Queen's University, Kingston, Canada
| |
Collapse
|
8
|
Freire RC, Santos VA. Features shared between fear of missing out on rewarding experiences (FOMO) and internet gaming disorder. Braz J Psychiatry 2020; 43:129-130. [PMID: 33053071 PMCID: PMC8023157 DOI: 10.1590/1516-4446-2020-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 11/22/2022]
Affiliation(s)
- Rafael C Freire
- Department of Psychiatry and Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Laboratório do Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Veruska A Santos
- Laboratório do Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| |
Collapse
|
9
|
Carta MG, Moro MF, Piras M, Ledda V, Prina E, Stocchino S, Orrù G, Romano F, Brasesco MV, Freire RC, Nardi AE, Tondo L. Megacities, migration and an evolutionary approach to bipolar disorder: a study of Sardinian immigrants in Latin America. ACTA ACUST UNITED AC 2020; 42:63-67. [PMID: 31269095 PMCID: PMC6986479 DOI: 10.1590/1516-4446-2018-0338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/08/2019] [Indexed: 11/25/2022]
Abstract
Objective: To determine whether people with a Sardinian genetic background who live in the megacities of South America have a higher frequency of hypomania than residents of Sardinia. Methods: A community survey of Sardinian immigrants was carried out in four Brazilian metropoles (n=218) and Buenos Aires (n=306). The results were compared with those of a study involving a similar methodology (Mood Disorder Questionnaire [MDQ] as a screening tool) conducted in seven Italian regions, including a sub-sample from Sardinia. Results: There was a higher prevalence of lifetime hypomania among Sardinians living in the Brazilian metropoles than among those living in Sardinia. This result was also consistent with Sardinian immigrants in Buenos Aires. After stratification by sex and age, the lifetime prevalence of MDQ scores ≥ 8 among Sardinians in South-American megacities and Sardinia was 8.6% vs. 2.9%, respectively (p < 0.0001). Conclusions: The higher frequency of hypomania in migrant populations appears to favor an evolutionary view in which mood disorders may be a maladaptive aspect of a genetic background with adaptive characteristics.
Collapse
Affiliation(s)
- Mauro G Carta
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Maria F Moro
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Martina Piras
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Vanessa Ledda
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Eleonora Prina
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Serena Stocchino
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Germano Orrù
- Dipartimento di Scienze Chirurgiche, Università di Cagliari, Cagliari, Italy
| | | | - Maria V Brasesco
- Facultad de Humanidades, Universidad del Museo Social Argentino, Buenos Aires, Argentina
| | - Rafael C Freire
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Antonio E Nardi
- Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Leonardo Tondo
- Centro Lucio Bini Cagliari, Cagliari/Rome, Italy.,McLean Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
10
|
Okuro RT, Freire RC, Zin WA, Quagliato LA, Nardi AE. Panic disorder respiratory subtype: psychopathology and challenge tests - an update. ACTA ACUST UNITED AC 2020; 42:420-430. [PMID: 32074230 PMCID: PMC7430397 DOI: 10.1590/1516-4446-2019-0717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/01/2019] [Indexed: 02/06/2023]
Abstract
Panic disorder (PD) pathophysiology is very heterogeneous, and the discrimination of distinct subtypes could be very useful. A subtype based on respiratory symptoms is known to constitute a specific subgroup. However, evidence to support the respiratory subtype (RS) as a distinct subgroup of PD with a well-defined phenotype remains controversial. Studies have focused on characterization of the RS based on symptoms and response to CO2. In this line, we described clinical and biological aspects focused on symptomatology and CO2 challenge tests in PD RS. The main symptoms that characterize RS are dyspnea (shortness of breath) and a choking sensation. Moreover, patients with the RS tended to be more responsive to CO2 challenge tests, which triggered more panic attacks in this subgroup. Future studies should focus on discriminating respiratory-related clusters and exploring psychophysiological and neuroimaging outcomes in order to provide robust evidence to confirm RS as a distinct subtype of PD.
Collapse
Affiliation(s)
- Renata T Okuro
- Laboratório Pânico e Respiração, Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Rafael C Freire
- Laboratório Pânico e Respiração, Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Walter A Zin
- Instituto de Biofísica Carlos Chagas Filho, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Laiana A Quagliato
- Laboratório Pânico e Respiração, Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Antonio E Nardi
- Laboratório Pânico e Respiração, Instituto de Psiquiatria (IPUB), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| |
Collapse
|
11
|
Garakani A, Murrough JW, Freire RC, Thom RP, Larkin K, Buono FD, Iosifescu DV. Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Front Psychiatry 2020; 11:595584. [PMID: 33424664 PMCID: PMC7786299 DOI: 10.3389/fpsyt.2020.595584] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/13/2020] [Indexed: 12/20/2022] Open
Abstract
Anxiety disorders are the most prevalent psychiatric disorders and a leading cause of disability. While there continues to be expansive research in posttraumatic stress disorder (PTSD), depression and schizophrenia, there is a relative dearth of novel medications under investigation for anxiety disorders. This review's first aim is to summarize current pharmacological treatments (both approved and off-label) for panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and specific phobias (SP), including selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), azapirones (e.g., buspirone), mixed antidepressants (e.g., mirtazapine), antipsychotics, antihistamines (e.g., hydroxyzine), alpha- and beta-adrenergic medications (e.g., propranolol, clonidine), and GABAergic medications (benzodiazepines, pregabalin, and gabapentin). Posttraumatic stress disorder and obsessive-compulsive disorder are excluded from this review. Second, we will review novel pharmacotherapeutic agents under investigation for the treatment of anxiety disorders in adults. The pathways and neurotransmitters reviewed include serotonergic agents, glutamate modulators, GABAergic medications, neuropeptides, neurosteroids, alpha- and beta-adrenergic agents, cannabinoids, and natural remedies. The outcome of the review reveals a lack of randomized double-blind placebo- controlled trials for anxiety disorders and few studies comparing novel treatments to existing anxiolytic agents. Although there are some recent randomized controlled trials for novel agents including neuropeptides, glutamatergic agents (such as ketamine and d-cycloserine), and cannabinoids (including cannabidiol) primarily in GAD or SAD, these trials have largely been negative, with only some promise for kava and PH94B (an inhaled neurosteroid). Overall, the progression of current and future psychopharmacology research in anxiety disorders suggests that there needs to be further expansion in research of these novel pathways and larger-scale studies of promising agents with positive results from smaller trials.
Collapse
Affiliation(s)
- Amir Garakani
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Silver Hill Hospital, New Canaan, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - James W Murrough
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Rafael C Freire
- Department of Psychiatry and Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Robyn P Thom
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kaitlyn Larkin
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Frank D Buono
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Dan V Iosifescu
- Clinical Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States.,Department of Psychiatry, New York University School of Medicine, New York, NY, United States
| |
Collapse
|
12
|
Nardi AE, Freire RC, Kahn JP. The Master of Psychopharmacology: an inspiration for future generations - Donald F. Klein (1928-2019). Braz J Psychiatry 2019; 41:465-466. [PMID: 31826089 PMCID: PMC6899354 DOI: 10.1590/1516-4446-2019-4112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio E Nardi
- Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Rafael C Freire
- Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Department of Psychiatry, Queen's University, Kingston, Canada
| | - Jeffrey P Kahn
- Department of Psychiatry, Weill Cornell Medical College, New York, USA
| |
Collapse
|
13
|
Quagliato LA, Cosci F, Shader RI, Silberman EK, Starcevic V, Balon R, Dubovsky SL, Salzman C, Krystal JH, Weintraub SJ, Freire RC, Nardi AE. Selective serotonin reuptake inhibitors and benzodiazepines in panic disorder: A meta-analysis of common side effects in acute treatment. J Psychopharmacol 2019; 33:1340-1351. [PMID: 31304840 DOI: 10.1177/0269881119859372] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Benzodiazepines (BZs) and selective serotonin reuptake inhibitors (SSRIs) are effective in the pharmacologic treatment of panic disorder (PD). However, treatment guidelines favor SSRIs over BZs based on the belief that BZs are associated with more adverse effects than SSRIs. This belief, however, is currently supported only by opinion and anecdotes. AIM The aim of this review and meta-analysis was to determine if there truly is evidence that BZs cause more adverse effects than SSRIs in acute PD treatment. METHODS We systematically searched Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and clinical trials register databases. Short randomized clinical trials of a minimum of four weeks and a maximum of 12 weeks that studied SSRIs or BZs compared to placebo in acute PD treatment were included in a meta-analysis. The primary outcome was all-cause adverse event rate in participants who received SSRIs, BZs, or placebo. RESULTS Overall, the meta-analysis showed that SSRIs cause more adverse events than BZs in short-term PD treatment. Specifically, SSRI treatment was a risk factor for diaphoresis, fatigue, nausea, diarrhea, and insomnia, whereas BZ treatment was a risk factor for memory problems, constipation, and dry mouth. Both classes of drugs were associated with somnolence. SSRIs were associated with abnormal ejaculation, while BZs were associated with libido reduction. BZs were protective against tachycardia, diaphoresis, fatigue, and insomnia. CONCLUSION Randomized, blinded studies comparing SSRIs and BZs for the short-term treatment of PD should be performed. Clinical guidelines based on incontrovertible evidence are needed.
Collapse
Affiliation(s)
- Laiana A Quagliato
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Richard I Shader
- Department of Immunology, Tufts University School of Medicine, Boston, MA, USA
| | | | | | - Richard Balon
- Departments of Psychiatry and Behavioral Neurosciences and Anesthesiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Steven L Dubovsky
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA
| | - Carl Salzman
- Harvard Medical School, Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, USA
| | | | | | - Rafael C Freire
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antonio E Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | |
Collapse
|
14
|
Balon R, Silberman EK, Starcevic V, Cosci F, Freire RC, Nardi AE, Rickels K, Shader R. Benzodiazepines, antidepressants and addiction: A plea for conceptual rigor and consistency. J Psychopharmacol 2019; 33:1467-1470. [PMID: 31556796 DOI: 10.1177/0269881119878171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Richard Balon
- Department of Psychiatry, Wayne State University, Detroit, MI, USA.,Department of Behavioral Neurosciences, Wayne State University, Detroit, MI, USA.,Department of Anesthesiology, Wayne State University, Detroit, MI, USA
| | | | - Vladan Starcevic
- Sydney Medical School, University of Sydney, Sydney, nsw, Australia
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Firenze, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Rafael C Freire
- Department of Psychiatry, Queens University, Kingston, on, Canada.,Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antonio E Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Karl Rickels
- University of Pennsylvania, Philadelphia, PA, USA
| | - Richard Shader
- Department of Immunology, Tufts University, Boston, MA, USA
| |
Collapse
|
15
|
Quagliato LA, Freire RC, Nardi AE. Elevated peripheral kynurenine/tryptophan ratio predicts poor short-term auditory memory in panic disorder patients. J Psychiatr Res 2019; 113:159-164. [PMID: 30959226 DOI: 10.1016/j.jpsychires.2019.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/24/2019] [Accepted: 03/28/2019] [Indexed: 01/04/2023]
Abstract
Abnormalities in the kynurenine pathway (KP) have been implicated in the cognitive deficits of psychiatry disorders, possibly through cytokines that increase the activity of indoleamine-2,3 dioxygenase (IDO), a key enzyme for tryptophan-to-kynurenine conversion. Some studies on panic disorder (PD) have detected elevated cytokines in blood. We aimed to determine the extent to which elevated peripheral cytokine levels and kynurenine/tryptophan (kyn/tryp) ratio (1) are biological markers for PD patients and (2) are related to cognition in PD. Seventy-eight PD patients and matched healthy controls were assessed for peripheral serum levels of interleukin (IL)-2R, IL-1β, IL-10, kynurenine and tryptophan. The subjects were evaluated for episodic and short-term memory, selective attention and cognitive flexibility. In patients, IL-2R levels, which are involved in the regulation of IDO, were significantly associated with levels of kynurenine (p = .029), but this association was not observed in controls. Importantly, an elevated kyn/tryp ratio significantly predicted poor digit span forward (p = .004) and total (p = .004) scores in individuals with PD. This study is the first to link blood biomarkers of infiammation and the KP with cognitive deficits in PD subjects, suggesting that those with an elevated kyn/tryp ratio might have short-term auditory memory impairment. These findings indicate that treatments targeting the KP may ameliorate cognitive abnormalities in PD patients.
Collapse
Affiliation(s)
- Laiana A Quagliato
- Laboratory of Panic & Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rua Ataulfo de Paiva 135 S. 609, 22440-901, Brazil.
| | - Rafael C Freire
- Laboratory of Panic & Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rua Ataulfo de Paiva 135 S. 609, 22440-901, Brazil
| | - Antonio E Nardi
- Laboratory of Panic & Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rua Ataulfo de Paiva 135 S. 609, 22440-901, Brazil
| |
Collapse
|
16
|
Zugliani MM, Cabo MC, Nardi AE, Perna G, Freire RC. Pharmacological and Neuromodulatory Treatments for Panic Disorder: Clinical Trials from 2010 to 2018. Psychiatry Investig 2019; 16:50-58. [PMID: 30696238 PMCID: PMC6354041 DOI: 10.30773/pi.2018.12.21.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/21/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Treatment for panic disorder (PD) have evolved, although there is still a strong unmet need for more effective and tolerable options. The present study summarizes and discusses recent evidence regarding the pharmacological and neuromodulatory treatment of PD. METHODS MEDLINE, Cochrane Library, PsycINFO and Thomson Reuters's Web of Science were searched for clinical trials published between 2010 and 2018. We included all prospective experimental studies including randomized controlled trials (RCT) and other clinical trials with more than 10 patients. RESULTS Only 11 articles met the inclusion criteria, including 4 RCT, 3 open clinical trials and 5 comparative clinical trials. RCT demonstrated efficacy of transcranial magnetic stimulation (TMS) in only one of two trials. Neither pindolol nor d-fenfluramine were effective in blocking flumazenil-induced panic attacks. Augmentation with quetiapine was not superior to placebo. Open trials indicated that escitalopram, vortioxetine and TMS may be effective. Comparative trials did not demonstrate superiority from any drug, but confirmed tranylcypromine, paroxetine, clonazepam and alprazolam as effective options. CONCLUSION The current study confirmed the efficacy of tranylcypromine, paroxetine, clonazepam, alprazolam and escitalopram. Vortioxetine and TMS, with duration of 4 or more weeks, also seems to be effective. Quetiapine, pindolol and d-fenfluramine were not considered effective compounds.
Collapse
Affiliation(s)
- Morena M Zugliani
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana C Cabo
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antonio E Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Giampaolo Perna
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy.,Department of Clinical Neurosciences, Villa San Benedetto Menni, Hermanas Hospitalarias, FoRiPsi, Albese con Cassano, Italy
| | - Rafael C Freire
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
17
|
Balon R, Chouinard G, Cosci F, Dubovsky SL, Fava GA, Freire RC, Greenblatt DJ, Krystal JH, Nardi AE, Rickels K, Roth T, Salzman C, Shader R, Silberman EK, Sonino N, Starcevic V, Weintraub SJ. International Task Force on Benzodiazepines. Psychother Psychosom 2018; 87:193-194. [PMID: 29788029 DOI: 10.1159/000489538] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/21/2018] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | - Steven L Dubovsky
- University of Buffalo, Buffalo, New York, USA.,University of Colorado, Denver, Colorado, USA
| | - Giovanni A Fava
- University of Buffalo, Buffalo, New York, USA.,University of Bologna, Bologna, Italy
| | - Rafael C Freire
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Antonio E Nardi
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Karl Rickels
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | - Nicoletta Sonino
- University of Buffalo, Buffalo, New York, USA.,University of Padua, Padua, Italy
| | | | | |
Collapse
|
18
|
Laurito LD, Loureiro CP, Dias RV, Vigne P, de Menezes GB, Freire RC, Stangier U, Fontenelle LF. Predictors of benzodiazepine use in a transdiagnostic sample of panic disorder, social anxiety disorder, and obsessive-compulsive disorder patients. Psychiatry Res 2018; 262:237-245. [PMID: 29475102 DOI: 10.1016/j.psychres.2018.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 01/13/2018] [Accepted: 02/02/2018] [Indexed: 01/04/2023]
Abstract
We investigated the rates of current and past benzodiazepine (BZD) use in a sample of 102 subjects attending specialized anxiety disorder clinics, including panic disorder (PD; N = 36), social anxiety disorder (SAD; N = 28) and obsessive-compulsive disorder (OCD; N = 38) patients. Almost 56% of the entire sample was using BZDs at the moment of the assessment, and 74.5% described having used them at some point during their lifetimes. The duration of psychiatric treatment and a lifetime history of PD, but not any other "transdiagnostic" measure of severity (such as the Panic and Agoraphobia Scale, the Social Phobia Inventory, the Dimensional Obsessive-Compulsive Scale, the Anxiety Sensitivity Index-36, and the Beck Inventories) were independent risk factors for current prescription of BZDs. Patients who continued to use BZDs differed from patients who stopped them by being older (both currently and when firstly seen in the clinic), by having a later age at onset of their most significant anxiety disorder, by being more agoraphobic/avoidant, and by believing to be less capable of stopping their BZDs for the fear of not being able to sleep.
Collapse
Affiliation(s)
- Luana D Laurito
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Carla P Loureiro
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Rafaela V Dias
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Paula Vigne
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Gabriela B de Menezes
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
| | - Rafael C Freire
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ulrich Stangier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt, Germany
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil; D'Or Institute for Research and Education, Rio de Janeiro, Brazil; Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia.
| |
Collapse
|
19
|
Quagliato LA, Freire RC, Nardi AE. Risks and benefits of medications for panic disorder: a comparison of SSRIs and benzodiazepines. Expert Opin Drug Saf 2018; 17:315-324. [DOI: 10.1080/14740338.2018.1429403] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Laiana A. Quagliato
- Laboratory of Panic & Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael C. Freire
- Laboratory of Panic & Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antonio E. Nardi
- Laboratory of Panic & Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
20
|
Levitan MN, Papelbaum M, Soares G, Simões P, Zugliani M, Freire RC, Mochcovitch M, Nardi AE. Agomelatine in Panic Disorder: A 6-Week Follow-Up Case Series. J Clin Psychopharmacol 2016; 36:395-6. [PMID: 27285660 DOI: 10.1097/jcp.0000000000000524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Michelle N Levitan
- Institute of Psychiatry Federal University of Rio de Janeiro Rio de Janeiro, Brazil Institute of Psychiatry Federal University of Rio de Janeiro Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
21
|
|
22
|
de Carvalho MR, Velasques BB, Freire RC, Cagy M, Marques JB, Teixeira S, Thomaz R, Rangé BP, Piedade R, Akiskal HS, Nardi AE, Ribeiro P. Frontal cortex absolute beta power measurement in Panic Disorder with Agoraphobia patients. J Affect Disord 2015; 184:176-81. [PMID: 26093831 DOI: 10.1016/j.jad.2015.05.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/28/2015] [Accepted: 05/29/2015] [Indexed: 01/29/2023]
Abstract
UNLABELLED Panic disorder patients are hypervigilant to danger cues and highly sensitive to unpredictable aversive events, what leads to anticipatory anxiety, that is one key component of the disorder maintenance. Prefrontal cortex seems to be involved in these processes and beta band activity may be related to the involvement of top-down processing, whose function is supposed to be disrupted in pathological anxiety. The objective of this study was to measure frontal absolute beta-power (ABP) with qEEG in panic disorder and agoraphobia (PDA) patients compared to healthy controls. METHODS qEEG data were acquired while participants (24 PDA patients and 21 controls) watched a computer simulation (CS), consisting of moments classified as "high anxiety" (HAM) and "low anxiety" (LAM). qEEG data were also acquired during two rest conditions, before and after the computer simulation display. The statistical analysis was performed by means of a repeated measure analysis of variance (two-way ANOVA) and ABP was the dependent variable of interest. The main hypothesis was that a higher ABP in PDA patients would be found related to controls. Moreover, in HAM the ABP would be different than in LAM. RESULTS the main finding was an interaction between the moment and group for the electrodes F7, F8, Fp1 and Fp2. We observed a higher ABP in PDA patients when compared to controls while watching the CS. The higher beta-power in the frontal cortex for the PDA group may reflect a state of high excitability, together with anticipatory anxiety and maintenance of hypervigilant cognitive state. CONCLUSIONS our results suggest a possible deficiency in top-down processing reflected by a higher ABP in the PDA group while watching the CS and they highlight the recruitment of prefrontal regions during the exposure to anxiogenic stimuli. LIMITATIONS the small sample, the wide age range of participants and the use of psychotropic medications by most of the PDA patients.
Collapse
Affiliation(s)
- Marcele Regine de Carvalho
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil; National Institute of Translational Medicine (INCT-TM), Rio de Janeiro, Brazil; Brain Mapping and Sensory Motor Integration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil; Institute of Psychology of Federal University of Rio de Janeiro (IP/UFRJ), Rio de Janeiro, Brazil.
| | - Bruna Brandão Velasques
- Brain Mapping and Sensory Motor Integration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil; Institute of Applied Neuroscience (INA), Rio de Janeiro, Brazil; Neuromuscular Research Laboratory, National Institute of Traumatology and Orthopedics (NITO), Rio de Janeiro, Brazil
| | - Rafael C Freire
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil; National Institute of Translational Medicine (INCT-TM), Rio de Janeiro, Brazil
| | - Maurício Cagy
- Brain Mapping and Sensory Motor Integration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil; Division of Epidemiology and Biostatistics, Institute of Community Health, Federal Fluminense University (UFF), Rio de Janeiro, Brazil
| | - Juliana Bittencourt Marques
- Brain Mapping and Sensory Motor Integration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Silmar Teixeira
- Brain Mapping and Sensory Motor Integration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil; Physiotherapy Department - Piquet Carneiro Policlinic - State University of Rio de Janeiro, Brazil; Laboratory of Physical Therapy, Veiga de Almeida University, Rio de Janeiro, Brazil
| | - Rafael Thomaz
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil; National Institute of Translational Medicine (INCT-TM), Rio de Janeiro, Brazil
| | - Bernard P Rangé
- Institute of Psychology of Federal University of Rio de Janeiro (IP/UFRJ), Rio de Janeiro, Brazil
| | - Roberto Piedade
- Brain Mapping and Sensory Motor Integration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | | | - Antonio Egidio Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil; National Institute of Translational Medicine (INCT-TM), Rio de Janeiro, Brazil
| | - Pedro Ribeiro
- Brain Mapping and Sensory Motor Integration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil; Institute of Applied Neuroscience (INA), Rio de Janeiro, Brazil; Bioscience Department (EEFD/ UFRJ), School of Physical Education, Rio de Janeiro, Brazil
| |
Collapse
|
23
|
Nardi AE, Machado S, Almada LF, Paes F, Silva AC, Marques RJ, Amrein R, Freire RC, Martin-Santos R, Cosci F, Hallak JE, Crippa JA, Arias-Carrión O. Clonazepam for the treatment of panic disorder. Curr Drug Targets 2013; 14:353-64. [PMID: 23256724 DOI: 10.2174/1389450111314030007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 12/10/2012] [Accepted: 12/11/2012] [Indexed: 11/22/2022]
Abstract
Clonazepam was initially licensed as an anti-epileptic agent, but its use in a wide variety of psychiatric conditions, including panic disorder (PD) has now been well established. This overview evaluates the current role of clonazepam alone or in combination with antidepressants and/or behavioral therapy in the treatment of PD. We review the data establishing the use of clonazepam in the treatment of PD as well as new information, particularly confirmation of longterm efficacy and safety. We also discuss a regimen for safely tapered withdrawal of clonazepam, the characteristics of the respiratory subtype of PD, and CO2-induced panic attacks as a diagnostic measure and predictor for therapeutic success. It has been shown that panic attacks can more readily be induced by CO2 in PD patients with the respiratory subtype than those with the non-respiratory subtype. More than 25 years after the first report of efficacy in PD in 1984, clonazepam, alone or combined with selective serotonin reuptake inhibitors (SSRIs) and/or behavioral therapy, remains an important therapeutic modality for the management of PD.
Collapse
Affiliation(s)
- Antonio E Nardi
- Panic and Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, National Institute for Translational Medicine (INCT-TM), Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
E. Nardi A, Machado S, Ferreira Almada L, Paes F, Cardoso Silva A, Jose Marques R, Amrein R, C. Freire R, Martin-Santos R, Cosci F, E. Hallak J, A. Crippa J, Arias-Carrion O. Clonazepam for the Treatment of Panic Disorder. Curr Drug Targets 2013. [DOI: 10.2174/138945013804999025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
25
|
Abstract
INTRODUCTION Respiratory changes are associated with anxiety disorders, particularly panic disorder (PD). The stimulation of respiration in PD patients during panic attacks is well documented in the literature, and a number of abnormalities in respiration, such as enhanced CO2 sensitivity, have been detected in PD patients. Investigators hypothesized that there is a fundamental abnormality in the physiological mechanisms that control breathing in PD. METHODS The authors searched for articles regarding the connection between the respiratory system and PD, more specifically papers on respiratory challenges, respiratory subtype, and current mechanistic concepts. CONCLUSIONS Recent evidences support the presence of subclinical changes in respiration and other functions related to body homeostasis in PD patients. The fear network, comprising the hippocampus, medial prefrontal cortex, amygdala and its brainstem projections, may be abnormally sensitive in PD patients, and respiratory stimulants like CO2 may trigger panic attacks. Studies indicate that PD patients with dominant respiratory symptoms are particularly sensitive to respiratory tests compared to those who do not manifest dominant respiratory symptoms, representing a distinct subtype. The evidence of changes in several neurochemical systems might be the expression of the complex interaction among brain circuits.
Collapse
Affiliation(s)
- Rafael C Freire
- Laboratory of Panic and Respiration, National Institute for Translational Medicine Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | | |
Collapse
|
26
|
|
27
|
Nunes EA, Freire RC, Dos Reis M, de Oliveira E Silva AC, Machado S, Crippa JAS, Dursun SM, Baker GB, Hallak JEC, Nardi AE. Sulpiride and refractory panic disorder. Psychopharmacology (Berl) 2012; 223:247-9. [PMID: 22864966 DOI: 10.1007/s00213-012-2818-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 07/17/2012] [Indexed: 10/28/2022]
|
28
|
Cavedini P, Zorzi C, Baraldi C, Patrini S, Salomoni G, Bellodi L, Freire RC, Perna G. The somatic marker affecting decisional processes in obsessive-compulsive disorder. Cogn Neuropsychiatry 2012; 17:177-90. [PMID: 21991936 DOI: 10.1080/13546805.2011.614152] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Patients with obsessive-compulsive disorder (OCD) demonstrate impairment in decisional processes in which both cognition and emotion play a crucial role. METHODS We investigated the connection between decision-making performances and choice-related skin conductance responses (SCRs), to identify a somatic marker impairment affecting decisional processes in these patients. We explored SCRs during the Iowa Gambling Task in 20 OCD and 18 control, measuring anticipatory and posticipatory psychophysiological reactions according to card choices and to the outcomes of each selection. RESULTS Most patients exhibited weaker SCRs compared to HC, although there weren't substantial differences in magnitude between the two groups. In contrast with HC, patients with OCD showed no significant differences of SCRs activation according to card selections; they chose cards from neither favourable nor unfavourable decks. CONCLUSIONS The main finding of the study were the evidence of a dysfunctional biological marker in OCD subjects, affecting decision-making process. Dysfunctional patterns of SCRs could partially explain OCDs' impairment in this ability. Decision-making deficits in OCDs could be influenced in part by the lack of somatic differences in discriminating between advantageous and disadvantageous behaviour. These findings could lead to a more complete understanding of OCD.
Collapse
Affiliation(s)
- Paolo Cavedini
- Department of Clinical Neurosciences, Villa San Benedetto Hospital, Hermanas Hospitalarias, Albese con Cassano, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Freire RC, Nardi AE. Panic disorder and the respiratory system: clinical subtype and challenge tests. Revista Brasileira de Psiquiatria 2012. [DOI: 10.1016/s1516-4446(12)70053-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
30
|
Levitan MN, Crippa JA, Bruno LM, Pastore DL, Freire RC, Arrais KC, Hallak JE, Nardi AE. Postural balance in patients with social anxiety disorder. Braz J Med Biol Res 2011; 45:38-42. [PMID: 22086467 PMCID: PMC3854136 DOI: 10.1590/s0100-879x2011007500155] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 10/31/2011] [Indexed: 11/22/2022] Open
Abstract
Body stability is controlled by the postural system and can be affected by fear and anxiety. Few studies have addressed freezing posture in psychiatric disorders. The purpose of the present study was to assess posturographic behavior in 30 patients with social anxiety disorder (SAD) and 35 without SAD during presentation of blocks of pictures with different valences. Neutral images consisted of objects taken from a catalog of pictures, negative images were mutilation pictures and anxiogenic images were related to situations regarding SAD fears. While participants were standing on a force platform, similar to a balance, displacement of the center of pressure in the mediolateral and anteroposterior directions was measured. We found that the SAD group exhibited a lower sway area and a lower velocity of sway throughout the experiment independent of the visual stimuli, in which the phobic pictures, a stimulus associated with a defense response, were unable to evoke a significantly more rigid posture than the others. We hypothesize that patients with SAD when entering in a situation of exposure, from the moment the pictures are presented, tend to move less than controls, remaining this way until the experiment ends. This discrete body manifestation can provide additional data to the characterization of SAD and its differentiation from other anxiety disorders, especially in situations regarding facing fear.
Collapse
Affiliation(s)
- M N Levitan
- Laboratório do Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Nardi AE, Valença AM, Freire RC, Mochcovitch MD, Amrein R, Sardinha A, Levitan MN, Nascimento I, de-Melo-Neto VL, King AL, de O E Silva AC, Veras AB, Dias GP, Soares-Filho GL, da Costa RT, Mezzasalma MA, de Carvalho MR, de Cerqueira AC, Hallak JE, Crippa JA, Versiani M. Psychopharmacotherapy of panic disorder: 8-week randomized trial with clonazepam and paroxetine. Braz J Med Biol Res 2011. [PMID: 21344132 DOI: 10.1590/s0100‐879x2011007500020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of the present randomized, open-label, naturalistic 8-week study was to compare the efficacy and safety of treatment with clonazepam (N = 63) and paroxetine (N = 57) in patients with panic disorder with or without agoraphobia. Efficacy assessment included number of panic attacks and clinician ratings of the global severity of panic disorders with the clinical global impression (CGI) improvement (CGI-I) and CGI severity (CGI-S) scales. Most patients were females (69.8 and 68.4% in the clonazepam and paroxetine groups, respectively) and age (mean ± SD) was 35.9 ± 9.6 years for the clonazepam group and 33.7 ± 8.8 years for the paroxetine group. Treatment with clonazepam versus paroxetine resulted in fewer weekly panic attacks at week 4 (0.1 vs 0.5, respectively; P < 0.01), and greater clinical improvements at week 8 (CGI-I: 1.6 vs 2.9; P = 0.04). Anxiety severity was significantly reduced with clonazepam versus paroxetine at weeks 1 and 2, with no difference in panic disorder severity. Patients treated with clonazepam had fewer adverse events than patients treated with paroxetine (73 vs 95%; P = 0.001). The most common adverse events were drowsiness/fatigue (57%), memory/concentration difficulties (24%), and sexual dysfunction (11%) in the clonazepam group and drowsiness/fatigue (81%), sexual dysfunction (70%), and nausea/vomiting (61%) in the paroxetine group. This naturalistic study confirms the efficacy and tolerability of clonazepam and paroxetine in the acute treatment of patients with panic disorder.
Collapse
Affiliation(s)
- A E Nardi
- Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, RJ, Brasil.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Freire RC, Hallak JE, Crippa JA, Nardi AE. New treatment options for panic disorder: clinical trials from 2000 to 2010. Expert Opin Pharmacother 2011; 12:1419-28. [DOI: 10.1517/14656566.2011.562200] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
33
|
Nardi AE, Valença AM, Freire RC, Mochcovitch MD, Amrein R, Sardinha A, Levitan MN, Nascimento I, de-Melo-Neto VL, King AL, de O E Silva AC, Veras AB, Dias GP, Soares-Filho GL, da Costa RT, Mezzasalma MA, de Carvalho MR, de Cerqueira AC, Hallak JE, Crippa JA, Versiani M. Psychopharmacotherapy of panic disorder: 8-week randomized trial with clonazepam and paroxetine. Braz J Med Biol Res 2011; 44:366-73. [PMID: 21344132 DOI: 10.1590/s0100-879x2011007500020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 02/03/2011] [Indexed: 11/22/2022]
Abstract
The objective of the present randomized, open-label, naturalistic 8-week study was to compare the efficacy and safety of treatment with clonazepam (N = 63) and paroxetine (N = 57) in patients with panic disorder with or without agoraphobia. Efficacy assessment included number of panic attacks and clinician ratings of the global severity of panic disorders with the clinical global impression (CGI) improvement (CGI-I) and CGI severity (CGI-S) scales. Most patients were females (69.8 and 68.4% in the clonazepam and paroxetine groups, respectively) and age (mean ± SD) was 35.9 ± 9.6 years for the clonazepam group and 33.7 ± 8.8 years for the paroxetine group. Treatment with clonazepam versus paroxetine resulted in fewer weekly panic attacks at week 4 (0.1 vs 0.5, respectively; P < 0.01), and greater clinical improvements at week 8 (CGI-I: 1.6 vs 2.9; P = 0.04). Anxiety severity was significantly reduced with clonazepam versus paroxetine at weeks 1 and 2, with no difference in panic disorder severity. Patients treated with clonazepam had fewer adverse events than patients treated with paroxetine (73 vs 95%; P = 0.001). The most common adverse events were drowsiness/fatigue (57%), memory/concentration difficulties (24%), and sexual dysfunction (11%) in the clonazepam group and drowsiness/fatigue (81%), sexual dysfunction (70%), and nausea/vomiting (61%) in the paroxetine group. This naturalistic study confirms the efficacy and tolerability of clonazepam and paroxetine in the acute treatment of patients with panic disorder.
Collapse
Affiliation(s)
- A E Nardi
- Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, RJ, Brasil.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Freire RC, De Carvalho MR, Joffily M, Zin WA, Nardi AE. Anxiogenic properties of a computer simulation for panic disorder with agoraphobia. J Affect Disord 2010; 125:301-6. [PMID: 20100626 DOI: 10.1016/j.jad.2009.12.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 12/24/2009] [Accepted: 12/29/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are several useful methods to induce anxiety in patients with panic disorder with agoraphobia (PDA). Our aim was to ascertain if a computer simulation (CS) could induce anxiety and physiologic alterations in PDA patients. METHODS 10 healthy controls (HC) and 10 patients who fulfilled DSM-IV criteria for PDA were recruited for this study. The anxiety level was measured with the Subjective Units of Distress Scale (SUDS) and the Diagnostic Symptom Questionnaire (DSQ) was used to ascertain panic attack (PA) symptoms. The heart rate, skin conductance and respiration were monitored during exposure to the CS. The CS was a 3D computer animation of a short bus trip, from a first person perspective. RESULTS In PDA patients CS exposure increased anxiety levels, they also had higher scores in the DSQ and two of them had PA. Compared to the HC, the PDA patients had higher skin conductance level, electrodermal response magnitude, respiratory rate, tidal volume, and respiratory rate irregularities. The heart rate means were higher for PDA patients who had PA, followed by HC and PDA patients who did not have PA. There were no significant differences between the two groups regarding the sense of presence. LIMITATIONS The main limitations were the small sample size, and some PDA patients under medications. CONCLUSIONS This study indicated that CS exposure may induce anxiety, electrodermal and respiratory alterations in patients with PDA. CS exposure may be a useful tool in the research and treatment of PD patients.
Collapse
Affiliation(s)
- Rafael C Freire
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | | | | | | |
Collapse
|
35
|
Abstract
OBJECTIVE Our objective is to summarize the new findings concerning the respiratory subtype (RS) of panic disorder (PD) since its first description. METHODS Two searches were made in the Institute for Scientific Information Web of Science: with the keywords "panic disorder" and "respiratory symptoms," and all articles that cited Briggs and colleagues' 1993 article "Subtyping of Panic Disorder by Symptom Profile" (Br J Psychiatry 1993;163:201-9). Altogether, 133 articles were reviewed. RESULTS We describe and discuss RS epidemiology, genetics, psychopathology, demographic features, clinical features, correlations with the respiratory system, traumatic suffocation history, provocative tests, and nocturnal panic. Compared to patients with the nonrespiratory subtype (non-RS), the RS patients had higher familial history of PD, lower comorbidity with depression, longer duration of illness, lower neuroticism scores, and higher scores in severity scales, such as the Panic and Agoraphobia Scale, Panic-Agoraphobia Spectrum scale and the Clinical Global Impression scale. Tests to induce panic attacks, such as those with CO(2), hyperventilation, and caffeine, produce panic attacks in a higher proportion of RS patients than non-RS patients. Differences in the subtypes' improvement with the pharmacologic treatment were found. There are also some controversial findings regarding the RS, including the age of onset of PD, and alcohol and tobacco use in RS patients. CONCLUSIONS Some characteristics, such as the increased sensitivity to CO(2) and the higher familial history of PD, clearly distinguish the RS from the non-RS. Nevertheless, there are also controversial findings. More studies are needed to determine the validity of the RS subtype.
Collapse
Affiliation(s)
- Rafael C Freire
- Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil.
| | | | | |
Collapse
|
36
|
Lopes FL, Oliveira MM, Freire RC, Caldirola D, Perna G, Bellodi L, Valença AM, Nascimento I, Piedade RA, Ribeiro P, Zin WA, Nardi AE. Carbon dioxide-induced panic attacks and quantitative electroencephalogram in panic disorder patients. World J Biol Psychiatry 2010; 11:357-63. [PMID: 19958206 DOI: 10.3109/15622970903144012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The objective of the study was to investigate and compare the brain cortical activity, as indexed by quantitative electroencephalographic (qEEG) power, coherence and asymmetry measures, in panic disorder (PD) patients during an induced panic attack with a 35% CO(2) challenge test and also in a resting condition. Fifteen subjects with PD were randomly assigned to both 35% CO(2) mixture and atmospheric compressed air, in a double-blind study design, with EEG being recorded for a 20-min period. During induced panic attacks we found a reduced right-sided frontal orbital asymmetry in the beta band, a decreased occipital frontal intra-hemispheric coherence in the delta band at both right and left sides, a left-sided occipital delta inter-hemispheric asymmetry and an increased relative power in the beta wave at T4. Our data showed a disturbed frontal cortical processing, pointing to an imbalance of the frontal and occipital sites, common to both hemispheres, and an increased right posterior activity related to the high arousing panic attack condition. Those findings corroborate the Neuroanatomical hypothesis of PD.
Collapse
Affiliation(s)
- Fabiana L Lopes
- Panic and Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, INCT Translational Medicine (CNPq), Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
Virtual reality (VR) is as effective in inducing emotional responses as reality and its application is extremely valuable in exposure treatment. In virtual environments, the patients experience similar physiological symptoms and fear as they do in real life situations, thereby facilitating the habituation process. Our goal is to offer an overview of the current panorama of VR and psychotherapy, underlining the (virtual) exposure technique and the studies that focus on panic disorder treatment through the use of VR. The literature was revised through consultation to the ISI and PubMed databases. Virtual exposure treatment offers good results and great patient acceptability. However, despite the importance of this data for the evaluation of treatment efficacy, only a few studies measure physiological responses during exposure. Lack of controlled studies and standardized treatment protocols were observed. Despite the great advance of VR use in psychotherapy, a great deal of its potential is still unknown, therefore requiring the creation of new virtual environments so that controlled studies regarding its clinical application can be conducted. Throughout the process of elaboration and investigation, clinical experiences in virtual environments must be related to real experiences in a flexible context that combines relevant cultural, physical and cognitive aspects.
Collapse
Affiliation(s)
- Marcele Regine de Carvalho
- Laboratory of Panic and Respiration, Institute of Psychiatry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro (RJ), Brazil.
| | | | | |
Collapse
|
38
|
Lopes FL, Azevedo TM, Imbiriba LA, Freire RC, Valença AM, Caldirola D, Perna G, Volchan E, Nardi AE. Freezing reaction in panic disorder patients associated with anticipatory anxiety. Depress Anxiety 2010; 26:917-21. [PMID: 19582830 DOI: 10.1002/da.20593] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Anticipatory anxiety can be described as a conditioned response with a defensive posture of freezing and autonomic activation. The purpose of this study was to assess the postural control analysis and autonomic activation in panic disorder (PD) patients presented with visual stimuli. METHODS PD patients (n=29) and healthy controls (n=27) stood on a force platform while viewing a series of anxiogenic, mutilation, and neutral pictures. Skin conductance responses and the displacements of the center of pressure were measured. RESULTS Overall, the PD patients demonstrated significantly reduced body sway, increased mean power frequency, and increased skin conductance compared to control group throughout the experiment (P<.05). PD patients also showed a negative correlation between anticipatory anxiety and mean sway area throughout the experiment. However, there was no significant difference in body sway velocity compared to healthy controls while viewing the anxiogenic block of pictures or the neutral block. CONCLUSIONS Our data shows that PD patients experiencing anticipatory anxiety may present with lower mobility, consistent with the freezing behavior of the defense cascade. The data also shows that PD patients do not have a postural instability when confronted with specific anxiogenic context. The importance of this study is that it objectively demonstrates freezing-like behavior in PD patients.
Collapse
Affiliation(s)
- Fabiana L Lopes
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, INCT Translational Medicine, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Nardi AE, Lopes FL, Freire RC, Veras AB, Nascimento I, Valença AM, de-Melo-Neto VL, Soares-Filho GL, King AL, Araújo DM, Mezzasalma MA, Rassi A, Zin WA. Panic disorder and social anxiety disorder subtypes in a caffeine challenge test. Psychiatry Res 2009; 169:149-53. [PMID: 19698996 DOI: 10.1016/j.psychres.2008.06.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 07/29/2007] [Accepted: 06/12/2008] [Indexed: 11/17/2022]
Abstract
Studies have demonstrated the vulnerability of anxiety disorder patients to challenge tests. Our aim was to observe if panic disorder (PD) patients and generalized social anxiety disorder (GSAD) and performance social anxiety disorder (PSAD) patients respond in a similar way to the induction of anxiety symptoms and panic attacks by an oral caffeine challenge test. We compared 28 PD patients, 25 GSAD patients, 19 PSAD, and 26 control subjects after a 480-mg caffeine test. The patients had not received psychotropic drugs for at least a 4-week period. In a randomized double-blind experiment performed in two occasions 7 days apart, 480 mg of caffeine and a caffeine-free solution were administered and anxiety scales were administered before and after each test. A panic attack was induced in 17 (60.7%) PD patients, 4 (16.0%) GSAD patients, and 10 (52.6%) PSAD patients, during the caffeine test. None of the control subjects had a panic attack after the caffeine intake. Neither patients nor any control subject had a panic attack after drinking the caffeine-free solution. Our data suggest that there is an association between PD and PSAD hyperreactivity to an oral caffeine challenge test. The PD and PSAD patients had a higher number of induced panic attacks, some specific anxiety symptoms, and a more severe anxiety response than GSAD patients and normal volunteers.
Collapse
Affiliation(s)
- Antonio E Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, R. Visconde de Pirajá, 407/702, Rio de Janeiro, RJ-22410-003 Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Nardi AE, Freire RC, Zin WA. Panic disorder and control of breathing. Respir Physiol Neurobiol 2009; 167:133-43. [DOI: 10.1016/j.resp.2008.07.011] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 07/15/2008] [Accepted: 07/17/2008] [Indexed: 10/21/2022]
|
41
|
Nardi AE, Valença AM, Nascimento I, Freire RC, Veras AB, de-Melo-Neto VL, Lopes FL, King AL, Soares-Filho GL, Mezzasalma MA, Rassi A, Zin WA. A caffeine challenge test in panic disorder patients, their healthy first-degree relatives, and healthy controls. Depress Anxiety 2009; 25:847-53. [PMID: 17823963 DOI: 10.1002/da.20354] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Our aim was to observe the induction of anxiety symptoms and panic attacks by a caffeine challenge test in panic disorder (PD) patients (DSM-IV) and their healthy first-degree relatives. We randomly selected 25 PD patients, 27 healthy first-degree relatives of probands with PD, and 22 healthy volunteers with no family history of PD. In a randomized double-blind experiment performed over two occasions 7 days apart, 480 mg caffeine and a caffeine-free solution were administered in a coffee form. Using specific panic attack criteria, 52.0% (n=13) PD patients, 40.7% (n=11) first-degree relatives (chi2=1.81, df=1, P=0.179), and none of the control subjects had a panic attack after the test (chi2=51.7, df=2, P<0.001). In this caffeine challenge test, PD patients and their first-degree relatives were more sensitive than healthy volunteers to the panic attack symptoms but less sensitive to headache, increase in blood pressure, and insomnia. Our data suggest that there is an association between panic attacks after the intake of 480 mg of caffeine in PD patients and their first-degree relatives. There is a clear differentiation of PD patients and their first-degree relatives by a caffeine test from the healthy group.
Collapse
Affiliation(s)
- Antonio E Nardi
- Laboratory of Panic & Respiration, Institute of Psychiatry, Rio de Janeiro, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Soares-Filho GLF, Freire RC, Biancha K, Pacheco T, Volschan A, Valença AM, Nardi AE. Use of the hospital anxiety and depression scale (HADS) in a cardiac emergency room: chest pain unit. Clinics (Sao Paulo) 2009; 64:209-14. [PMID: 19330247 PMCID: PMC2666460 DOI: 10.1590/s1807-59322009000300011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 12/03/2008] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine the prevalence of anxiety and depression in patients complaining of chest pain who seek a chest pain unit attendance. INTRODUCTION Patients arriving at a Chest Pain Unit may present psychiatric disorders not identified, isolated or co-morbid to the main illness, which may interfere in the patient prognosis. METHODOLOGY Patients were assessed by the 'Hospital Anxiety and Depression Scale' as a screening instrument wile following a systematized protocol to rule out the diagnosis of acute coronary syndrome and other potentially fatal diseases. Patients with 8 or more points in the scale were considered 'probable case' of anxiety or depression. RESULTS According to the protocol, 59 (45.4%) of 130 patients studied presented Chest Pain of Determined Cause, and 71 (54.6%) presented Chest Pain of Indefinite Cause. In the former group, in which 43 (33.1%) had acute coronary syndrome, 33.9% were probable anxiety cases and 30.5% depression cases. In the second group, formed by patients without acute coronary syndrome or any clinical conditions involving greater morbidity and mortality risk, 53.5% were probable anxiety cases and 25.4% depression. CONCLUSION The high anxiety and depression prevalence observed may indicate the need for early and specialized approach to these disorders. When coronary arterial disease is present, this may decrease complications and shorten hospital stay. When psychiatric disorder appears isolated, is possible to reduce unnecessary repeated visits to emergency room and increase patient's quality of life.
Collapse
Affiliation(s)
- Gastão L. F. Soares-Filho
- Consultation-Liaison Psychiatry, Hospital Pró-Cardíaco - Rio de Janeiro/RJ, Brazil
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB), Panic & Respiration Laboratory - Rio de Janeiro/RJ, Brazil
| | - Rafael C. Freire
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB), Panic & Respiration Laboratory - Rio de Janeiro/RJ, Brazil
| | - Karla Biancha
- Emergency Department, Hospital Pró-Cardíaco - Rio de Janeiro/RJ, Brazil. Tel.: 55 21 2528.1442,
| | - Ticiana Pacheco
- Emergency Department, Hospital Pró-Cardíaco - Rio de Janeiro/RJ, Brazil. Tel.: 55 21 2528.1442,
| | - André Volschan
- Emergency Department, Hospital Pró-Cardíaco - Rio de Janeiro/RJ, Brazil. Tel.: 55 21 2528.1442,
| | - Alexandre M. Valença
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB), Panic & Respiration Laboratory - Rio de Janeiro/RJ, Brazil
| | - Antonio E. Nardi
- Institute of Psychiatry of the Federal University of Rio de Janeiro (IPUB), Panic & Respiration Laboratory - Rio de Janeiro/RJ, Brazil
| |
Collapse
|
43
|
Nardi AE, Nascimento I, Freire RC, Veras AB, de-Melo-Neto VL, Valença AM, Lopes FL, Soares-Filho GL, Levitan MN, de Carvalho MR, da Costa RT, King AL, Mezzasalma MA, Grivet LO, Rassi A, Versiani M. Demographic and clinical features of panic disorder comorbid with bipolar I disorder: a 3-year retrospective study. J Affect Disord 2008; 106:185-9. [PMID: 17604118 DOI: 10.1016/j.jad.2007.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 05/18/2007] [Accepted: 05/29/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND Mood disorders are considered related to anxiety disorders and their association may determine clinical course and prognosis. We aimed to describe with retrospective methodology the demographic, clinical, and treatment features in a group of panic disorder comorbid with bipolar I disorder (PD-BI) patients who were been treated for at least 3 year-period and compare them with bipolar I (BI) patients who were treated during the same period. METHOD We compared the demographic and clinical data of 26 PD-BI, 28 BI, and 25 panic disorder (PD) outpatients without history of comorbidity with mood disorder were diagnosed and treated for at least 3 years in the Federal University of Rio de Janeiro. RESULTS PD group have a higher educational level, are more married, and are more economically active. In the PD-BI and BI patients the disorders started earlier. They also turn out to have an equivalent pattern in the presence of drug abuse episodes, moderate or severe depressive episodes, psychotic episodes, suicide attempts, maniac episodes, mixed episodes, use of fewer days of antidepressants and benzodiazepines, and use of more days of antipsychotics and mood stabilizers. The PD-BI and the BI groups had a higher frequency of depressive episodes and psychotic episodes. LIMITATIONS It is a retrospective data description based on a naturalistic treatment. The sample has a small size and the some data could be different in a large sample. CONCLUSION PD-BI patients have demographic, clinical and therapeutic features similar to BI and the data support its validation as a special severe bipolar I disorder subgroup.
Collapse
Affiliation(s)
- Antonio Egidio Nardi
- Laboratory of Panic & Respiration, Federal University of Rio de Janeiro, Brazil.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Freire RC, Lopes FL, Valença AM, Nascimento I, Veras AB, Mezzasalma MA, de-Melo-Neto VL, Zin WA, Nardi AE. Panic disorder respiratory subtype: a comparison between responses to hyperventilation and CO2 challenge tests. Psychiatry Res 2008; 157:307-10. [PMID: 17964660 DOI: 10.1016/j.psychres.2007.07.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Revised: 04/12/2007] [Accepted: 07/15/2007] [Indexed: 11/17/2022]
Abstract
In this study 117 panic disorder patients were divided into a respiratory subtype group and a non-respiratory subtype group. The respiratory subtype patients were observed to be more sensitive to the 35% CO(2) inhalation challenge test and the hyperventilation test than the non-respiratory subtype patients.
Collapse
Affiliation(s)
- Rafael C Freire
- Laboratory of Panic & Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rua Visconde de Pirajá, 407/702, 22410-003, Rio de Janeiro, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Freire RC, Valença AM, Nascimento I, Lopes FL, Mezzasalma MA, Zin WA, Nardi AE. Clinical features of respiratory and nocturnal panic disorder subtypes. Psychiatry Res 2007; 152:287-91. [PMID: 17466382 DOI: 10.1016/j.psychres.2006.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Revised: 12/11/2005] [Accepted: 01/01/2006] [Indexed: 10/23/2022]
Abstract
Our aim is to compare the panic disorder (PD) respiratory subtype and the nocturnal panic subtype. A group of 193 PD patients (DSM-IV) was examined in the Laboratory of Panic and Respiration in the Institute of Psychiatry of the Federal University of Rio de Janeiro. The diagnoses were made using the SCID-I for DSM-IV. The subtypes were the respiratory (with 4 out of 5 prominent respiratory symptoms during the panic attacks [PA]) vs. non-respiratory, likewise PD with nocturnal (during sleep) PAs vs. PD with only diurnal PAs. The respiratory subtype accounted for 56.5% (n=109) of our sample; the non-respiratory subtype, 43.5% (n=84); the nocturnal subtype, 49.2% (n=95); and the non-nocturnal subtype, 50.8% (n=98). Despite a rich literature concerning correlations between the respiratory system and nocturnal panic attacks, our data do not support these findings, as the comparison of proportions in the respiratory and nocturnal groups did not differ. The non-nocturnal subtype was significantly associated with agoraphobia, and the respiratory subtype was not associated with these variables.
Collapse
Affiliation(s)
- Rafael C Freire
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rua Visconde de Pirajá, 407/702, 22410-003, Rio de Janeiro, Brazil.
| | | | | | | | | | | | | |
Collapse
|
46
|
Nardi AE, Valença AM, Lopes FL, de-Melo-Neto VL, Freire RC, Veras AB, Nascimento I, King AL, Soares-Filho GL, Mezzasalma MA, Zin WA. Caffeine and 35% carbon dioxide challenge tests in panic disorder. Hum Psychopharmacol 2007; 22:231-40. [PMID: 17407170 DOI: 10.1002/hup.840] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Our aim was to compare the demographic and clinical features of panic disorder (PD) patients with agoraphobia-DSM-IV-who had a panic attack after both an oral caffeine and the 35% carbon dioxide (CO2) challenge tests (responsive group) and compare them with PD patients who did not have a panic attack after both tests (non-responsive group). We examined 83 PD patients submitted to a 35% CO2 test and to an oral caffeine (480 mg) intake within 1 week interval. A panic attack was induced in 51 (61.4%) patients during the CO2 test (chi2=31.67, df=1, p<0.001) and in 38 (45.8%) patients during the caffeine test (chi2=18.28, df=1, p=0.023). All patients who had a panic attack during the caffeine test also had a panic attack during the CO2 test (n=38)-responsive group. The responsive had more (chi2=24.55, df=1, p=0.008) respiratory PD subtype, disorder started earlier (Mann-Whitney, p<0.001) had a higher familial prevalence of PD (chi2=20.34, df=1, p=0.019), less previous alcohol abuse (chi2=23.42, df=1, p<0.001), and had more previous depressive episodes (chi2=27.35, df=1, p<0.001). Our data suggest that there is an association between respiratory PD subtype and hyperreactivity to challenge tests: CO2 and oral caffeine.
Collapse
Affiliation(s)
- Antonio E Nardi
- Laboratory of Panic & Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Nardi AE, Lopes FL, Valença AM, Freire RC, Veras AB, de-Melo-Neto VL, Nascimento I, King AL, Mezzasalma MA, Soares-Filho GL, Zin WA. Caffeine challenge test in panic disorder and depression with panic attacks. Compr Psychiatry 2007; 48:257-63. [PMID: 17445520 DOI: 10.1016/j.comppsych.2006.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Our aim was to observe if patients with panic disorder (PD) and patients with major depression with panic attacks (MDP) (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) respond in a similar way to the induction of panic attacks by an oral caffeine challenge test. We randomly selected 29 patients with PD, 27 with MDP, 25 with major depression without panic attacks (MD), and 28 healthy volunteers. The patients had no psychotropic drug for at least a 4-week period. In a randomized double-blind experiment performed in 2 occasions 7 days apart, 480 mg caffeine and a caffeine-free (placebo) solution were administered in a coffee form and anxiety scales were applied before and after each test. A total of 58.6% (n = 17) of patients with PD, 44.4% (n = 12) of patients with MDP, 12.0% (n = 3) of patients with MD, and 7.1% (n= 2) of control subjects had a panic attack after the 480-mg caffeine challenge test (chi(2)(3) = 16.22, P = .001). The patients with PD and MDP were more sensitive to caffeine than were patients with MD and healthy volunteers. No panic attack was observed after the caffeine-free solution intake. The patients with MD had a lower heart rate response to the test than all the other groups (2-way analysis of variance, group by time interaction with Greenhouse-Geisser correction: F(3,762) = 2.85, P = .026). Our data suggest that there is an association between panic attacks, no matter if associated with PD or MDP, and hyperreactivity to an oral caffeine challenge test.
Collapse
Affiliation(s)
- Antonio E Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro RJ-22410-003, Brazil.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Freire RC, Lopes FL, Veras AB, Valença AM, Mezzasalma MA, Nascimento I, Nardi AE. Personality traits spectrum in panic disorder and major depression. Rev Bras Psiquiatr 2007. [DOI: 10.1590/s1516-44462006005000009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
49
|
Freire RC, Lopes FL, Veras AB, Valença AM, Mezzasalma MA, Nascimento I, Nardi AE. Personality traits spectrum in panic disorder and major depression. Rev Bras Psiquiatr 2007; 29:31-4. [PMID: 17435925 DOI: 10.1590/s1516-44462007000100010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Accepted: 09/04/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Our aim was to identify the personality traits in patients with panics disorder, major depression and with both disorders (comorbidity). METHOD Diagnoses were made with the Structured Clinical Interview for DSM-IV before the treatment, and the personality evaluation with the Maudsley Personality Inventory was made during the follow-up. Four groups were analyzed: a control group (n = 30), a major depression without panic disorder group (n = 45); a panic disorder without major depression group (n = 56) and a comorbidity group (n = 21), with major depression and panic disorder, simultaneously. RESULTS All disorder groups had significantly higher neuroticism means when compared to the control group. The highest mean was in the comorbidity group, followed by the major depression group and the panic disorder group. The difference of neuroticism means between the comorbidity group and the panic disorder group also reached statistical significance. The lowest extraversion mean was in the comorbidity group, followed by the major depression group, the panic disorder group, and the control group. Compared to normal controls, extraversion was significantly low in the comorbidity and major depression groups. CONCLUSION In our sample, there was a continuum of personality traits between panic disorder and major depression and, the co-occurrence of these disorders was associated with accentuated personality traits.
Collapse
Affiliation(s)
- Rafael C Freire
- Laboratory of Panic and Respiration,, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | | | | | | | | | | | | |
Collapse
|
50
|
Nardi AE, Valença AM, Mezzasalma MA, Lopes FL, Nascimento I, Veras AB, Freire RC, de-Melo-Neto VL, Zin WA. 35% Carbon dioxide and breath-holding challenge tests in panic disorder: a comparison with spontaneous panic attacks. Depress Anxiety 2006; 23:236-44. [PMID: 16528718 DOI: 10.1002/da.20165] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Respiration and its control mechanisms may represent an important system involved in abnormal anxiety. Our aim was to compare the demographic and clinical features of patients with panic disorder (PD) with agoraphobia (DSM-IV) who had a panic attack after both the 35% carbon dioxide (CO(2)) test and the breath-holding test (CPA group), and compare them with PD patients who did not have a panic attack after both tests (NPA group). We examined 76 patients with PD who were administered a 35% CO(2)test and a breath-holding test within a 1-week interval. Anxiety scales were applied before and after each test. A panic attack was induced in 50 (65.8%) patients during the CO(2)test (chi(2) = 28.44, df = 1, P<.001) and in 40 (52.6%) patients during the breath-holding test (chi(2) = 15.35, df = 1, P = .036). All patients who had a panic attack during the breath-holding test also had a panic attack during the CO(2)test (n = 40; CPA group). Twenty-six (34.2%) patients with PD did not have a panic attack after both respiratory tests (NPA group). The CPA group had more (chi(2) = 21.67, df = 1, P = .011) respiratory PD subtype. In the CPA group, the disorder started earlier (Mann-Whitney, P<.001), had a higher familial prevalence of PD (chi(2) = 18.34, df = 1, P = .028), and had more previous depressive episodes (chi(2) = 23.59, df = 1, P<.001). Our data suggest that there is an association between respiratory PD subtype and the response to respiratory challenge tests: CO(2)and breath-holding. The CPA may be confirmed as a subgroup of respiratory PD subtype.
Collapse
Affiliation(s)
- Antonio E Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|