Cognitive-behavior therapy for panic disorder delivered by psychopharmacologically oriented clinicians

Article Abstract:

There is considerable evidence that cognitive-behavioral psychotherapy can provide a useful alternative to drugs for treating panic disorder and related syndromes. However, most studies that have demonstrated the benefit of cognitive-behavioral therapy have been conducted by cognitive-behavioral therapists. Therefore, it is difficult to rule out potential bias within the study results favoring this approach. A study was designed in which 24 patients with panic attacks were treated by therapists who were not experienced in cognitive-behavioral therapy. The therapists included the staff of a psychiatric center that was oriented towards the use of psychoactive drugs. The staff members were briefly trained by a behavioral therapist on the application of cognitive-behavioral methods to panic disorder. Nineteen of the 24 patients completed the program. Fourteen reported being free of panic at the end of the treatment, and three more patients reported a significant reduction in the frequency and severity of panic attacks. These results indicate that it is likely to be the method of cognitive-behavioral therapy, rather than the orientation of the therapist, that is the most important factor in determining successful treatment of panic disorder. The authors provide a discussion of methods for training mental health personnel in cognitive-behavioral methods and a discussion of the problems of introducing these methods to psychiatric centers that emphasize drug therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Usage, Cognitive therapy, Behavior therapy, Agoraphobia, Panic attacks

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Hypersensitivity to carbon dioxide in panic disorder

Article Abstract:

Studies have shown that inhalation of carbon dioxide can induce panic in panic disorder patients, the point of panic coinciding with high carbon dioxide concentrations in the blood. Panic patients may be hypersensitive to carbon dioxide. Patients with a history of panic attacks and control subjects were placed under a clear plastic canopy and told that carbon dioxide would be added to the air they were breathing and that they might experience anxiety. The patients were given room air for 20 minutes; five percent carbon dioxide was added to the room air for another 20 minutes without their knowledge. Blood samples were monitored for carbon dioxide concentrations, and the patients were told to report any symptoms as soon as they occurred. The male panic patients were significantly more sensitive to carbon dioxide than the male control subjects, but anxiety levels in both groups were low and did not differ significantly. The data also suggested that there may be sex differences in panic disorder and that female panic patients may not be hypersensitive to carbon dioxide. Psychological factors known to affect carbon dioxide sensitivity were not controlled, but all subjects received the same instructions and experienced the same degree of anxiety. The physiologic differences that were recorded did not seem to be related to the levels of anxiety experienced by the subjects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Physiological aspects, Carbon dioxide

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Treatment of body-dysmorphic disorder with serotonin reuptake blockers

Article Abstract:

The Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) is the standard classification manual used in diagnosing mental disorders. A new diagnosis in the DSM-III-R called body-dysmorphic disorder is described as the preoccupation with some imagined defect in appearance in a normal-appearing person. Very commonly the complaint refers to facial flaws, with slight physical anomalies often producing excessive concern. This study describes five cases in which serotonin reuptake inhibitors, drugs normally used to treat obsessive-compulsive disorders, relieved body-dysmorphic disorder after other therapies had failed. Four of these patients were known also to have a family history of mental and emotional illness. Serotonin is a chemical nerve signal transmitter found in the brain, and these drugs are selective for specific serotonin receptors. On the basis of previous studies, patients with obsessive-compulsive disorder are thought to have abnormal serotonergic functioning. The authors feel that serotonin reuptake inhibitors should be the treatment of choice in body-dysmorphic disorder, and the overlap between this disorder and obsessive-compulsive disorder should be investigated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Evaluation, Drug therapy, Obsessive-compulsive disorder, Obsessive compulsive disorder, Serotonin antagonists

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