1,721,002 research outputs found
Evaluating the efficacy of psychological therapy
No full textEvaluating the Efficacy of Psychological Therapy In this article, general principles, theoretical backgrounds, methodological issues and possible flaws in planning and conducting efficacy trials of psychological therapies are described. These include sources of variance contributing to improvement of a psychic disorder under psychological therapy (spontaneous remission, regression to the mean, placebo effects, non-specific and specific factors), appropriate control groups, assessment of treatment success with rating scales, study designs, statistical issues and problems of follow-up investigations. The article includes practical suggestions for researchers planning efficacy trials. Ethical problems and critical issues regarding the transfer of the results of controlled trials to practice are also discussed
Increased psychobehavioral responsiveness to M-chlorophenylpiperazine (m-CPP) and ipsapirone (IPS) in patients with panic disorder (PDA)
No full textSalivary, total plasma and plasma free cortisol in panic disorder
No full textBackground. Research on basal HPA axis activity in patients with panic disorder showed inconsistent results. Methods. Basal total plasma, plasma free and salivary cortisol levels were compared in patients with panic disorder (n = 47) and in healthy individuals (n = 23). Correlations between these fractions were calculated. Results. All three basal cortisol fractions were significantly elevated in patients compared to controls. There were significant correlations between all three cortisol fractions. Conclusions. Nonsignificant differences between cortisol levels of patients and healthy controls in previous studies may have been due to inclusion of less severely ill patients or to small sample sizes (96 words)
Increased psychobehavioral responsiveness to M-chlorophenylpiperazine (m-CPP) and ipsapirone (IPS) in patients with panic disorder (PDA)
No full textSmoking modulates neuroendocrine responses to ipsapirone in patients with panic disorder
No full textSeparation anxiety and actual separation experiences during childhood in patients with panic disorder
No full textObjective: The association between separation anxiety in childhood and actual separation experiences during childhood has not yet been investigated in patients with panic disorder. Methods: In 115 patients with panic disorder with or without agoraphobia and in 124 control subjects without a history of psychiatric illness, we assessed separation anxiety during childhood, retrospectively, using DSM-IV and ICD-10 criteria and the Separation Anxiety Symptom Inventory (SASI). In addition, actual separation experiences from age 0 to 15 years were assessed, retrospectively. Results: A total of 22.6% of the patients and 4.8% of the Control subjects fulfilled both DSM-IV and ICD-10 criteria for childhood separation anxiety (chi(2) = 11.8; P < 0.0001). Further, 57.4% ofthepatients and 37.9% of the control subjects reported actual separation experiences during their childhood (chi(2) = 9. 09, P < 0.003). Separation anxiety and actual separation experiences, however, were independent of each other. Conclusion: These results suggest that separation anxiety during childhood is not a consequence of actual traumatic separation experiences in panic disorder patients
Nocturnal Urinary Cortisol Excretion Over a Randomized Controlled Trial with Paroxetine vs. Placebo Combined with Relaxation Training or Aerobic Exercise in Panic Disorder
No full textIntroduction: Data on basal hypothalamo-pituitary-adrenomedullary (HPA) function over controlled treatment trials with serotonergic drugs in anxiety disorders are still rare. Methods: 29 patients with panic disorder participating in a 10 week randomized, controlled trial (paroxetine vs. placebo with exercise or relaxation; N=60) collected urine for cortisol excretion over 3 consecutive nights before start and before termination of the treatment episode. Urinary cortisol was measured by radioimmunoassay. Efficacy measures were the Clinical Global Impression Scale (CGI) and the Panic and Agoraphobia Scale (P&A). 83% were female (p<.05 vs. males). 55% received additional aerobic exercise, and 45% relaxation. 55% received paroxetine treatment, and 45% placebo. Significantly fewer males received placebo treatment (p<.05). Results: All subjects improved significantly. Cortisol excretion did not differ between treatment groups or at pre-/post measurements. Females showed a significantly higher variability of cortisol excretion compared to males, at pre-(p<.005) and post (p=.015) assessments. Males displayed a trend to lower basal HPA function at end of treatment (p=.08). HPA variability after treatment showed a trend to be higher in the paroxetine (p=.052) -who clinically improved significantly better-compared to the placebo group. No relationship between HPA activity and treatment response or with exercise was detected. Discussion: HPA function shows significant gender differences, with females having a higher HPA function variability. Future studies on HPA function in treatment trials should address gender and medication effects
Advances in the pharmacotherapy of depression by new antidepressants
No full textDuring the last decade several new agents have been introduced in the treatment of depressive disorders. In comparison to classical tricyclic antidepressants, these agents have less side effects and a very low toxicity. Selective inhibitors of serotonin reuptake do not produce sedation; however, in the initial phase of treatment this is not always an advantage. In contrast, receptor antagonists, such as mirtazapin and nefazodone have moderate sleep-inducing properties. Selective agents are also characterized by certain pharmacologic interactions which can lead to considerable inhibition of the metabolism of other drugs. Classical antidepressants still play an important role in the treatment of severe depressive episodes. Different synaptic effects of new antidepressants lead to an increased availability of monoaminergic neurotransmitters. The article summarizes the most important neurobiological consequences of these acute synaptic effects which might be more closely associated with neurobiological correlates of depression. The authors conclude about the advantages and disadvantages of the different classes of antidepressants from a clinical point of view
Effect of aerobic exercise on behavioral and neuroendocrine responses to meta-chlorophenylpiperazine and to ipsapirone in untrained healthy subjects
No full textRationale: Several clinical studies suggest antidepressive and anxiolytic effects of regular aerobic exercise. Objectives: The present study examines the effects of a 10-week protocol of moderate aerobic exercise (3-4 miles jogging 3 times per week) on central serotonergic receptor sensitivity. Methods: Neuroendocrine challenges using oral doses of meta-chlorophenylpiperazine (m-CPP; 0.4 mg/kg), ipsapirone (0.3 mg/kg), and placebo were performed in 12 untrained healthy volunteers before and after 10 weeks of moderate aerobic exercise. Results: Before training, administration of the non-selective serotonergic agonist m-CPP, which exerts a number of well-reproducible effects mainly via its action on 5-HT2C receptors, was associated with a significant increase of cortisol and prolactin (but not adrenaline or noradrenaline) in comparison with the placebo condition. After the 10-week training period, administration of m-CPP was followed by a blunted cortisol response which was not significantly increased in comparison to the placebo challenge, In contrast, the increases of cortisol observed after administration of the 5-HT1A agonist ipsapirone were of the same magnitude during the pre- and post-training challenge sessions. The behavioral response to ipsapirone and the mean maximal increases of plasma adrenaline and noradrenaline did not change during the training period. Conclusions: Regular aerobic exercise is associated with a blunted cortisol response to m-CPP, which might reflect a downregulation of central 5-HT2C receptors
Panic disorder during pregnancy and postpartum period
No full textBackground. - Earlier studies on the influence of pregnancy and postpartum period on the course of panic disorder have been inconsistent. The present study aims to quantify panic manifestations in these periods in large sample of women. Method. - Panic manifestations, including exacerbations and new manifestations of panic disorder, were assessed retrospectively in a sample of 128 women with panic disorder with or without agoraphobia, 93 of whom had had 195 pregnancies. Results. - Panic manifestations were fewer during pregnancy and more frequent in the postpartum period when compared with the control period. Women who had never been pregnant had significantly more panic manifestations than women with prior pregnancies. Breastfeeding and miscarriages did not have a significant effect. Women with postpartum panic reported more psychosocial stress events during this period. Conclusions. - Possible reasons for postpartum panic and the protective effects of pregnancy are discussed, including psychosocial or hormonal factors and other neurobiological changes. Postpartum panic coincides with a sudden drop of hormones after delivery. (c) 2006 Elsevier Masson SAS. All rights reserved
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