Surreptitious drug use by patients in a panic disorder study

Article Abstract:

Surreptitious drug use has been reported in patients with panic disorders. The possibility exists that patients who participate in research studies and are given placebos are also taking other unprescribed drugs. Much of the information that clinicians rely upon is derived from patient reports, which may be inaccurate; this phenomenon has not been adequately assessed. To further investigate the occurrence of this behavior, the frequency of surreptitious drug use by panic disorder patients in a placebo-controlled trial was measured using serum (blood) analyses. Characteristics of these patients were assessed and the impact that this behavior had on the study results was evaluated. A total of 79 patients participated in this study. The subjects were asked to remain drug-free for two weeks before the trial began, and were advised not to take any other drugs during the study period. Initial blood samples were taken, which were followed by additional measurements at four and eight weeks. The patients were randomly assigned to placebos (26), to imipramine (27), or to alprazolam (26) and daily doses were carefully monitored. The result of the initial blood sample measurements for drugs revealed that 17 (22 percent) of the patients had been taking drugs during a period they said they were drug-free. Five of these patients dropped out of the study and the remaining eight continued to take drugs through the duration of the trial. During the trial period a similar percentage of patients in each subgroup also took prohibited drugs. A less significant effect of surreptitious drug use on the results was observed in the subgroups that were given medication. However, the unauthorized drug use in the placebo group definitely distorted the results. Based on the outcome of this study, the researchers have recommended that standard screening procedures be used to test urine and blood samples for drugs in participants in controlled drug studies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Patient compliance, Drug use, Psychotherapy patients

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Plasma lipid levels in patients with panic disorder or agoraphobia

Article Abstract:

Prior studies have indicated that blood levels of fatty acids and in some cases cholesterol can be increased by acute emotional arousal. Also, higher mortality rates attributed to circulatory disease are observed in male patients with panic disorders. Therefore a connection between panic attack sufferers and incidence of high plasma lipid levels has been hypothesized. High blood cholesterol poses a major risk factor for developing cardiovascular disease and traditionally, little attention has been given to this factor by the clinician when treating patients for mental disorders. Plasma lipid levels were measured in a group of 102 patients (74 women and 28 men) with panic disorder or agoraphobia, a fear of being in places and situations from which escape might be difficult. Total cholesterol was measured along with levels of LDL (low density lipids) and HDL (high density lipids) against national reference values, taking sex and age into account. The women but not the men showed significantly higher overall cholesterol levels, which exceeded the 75th percentile. LDL levels in particular were elevated. The difference in the lipid measurements of men and women was not anticipated. It was suggested that the small number of men involved in the study may account for disproportionate numbers in the data. Closer attention should be paid to the cholesterol counts of those who suffer from panic attacks or agoraphobia. The authors also recommended that more concern be given to cardiac risk factors in psychiatric patients.

Psychological aspects, Physiological aspects, Blood lipids, Blood cholesterol

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Use of medication and in vivo exposure in volunteers for panic disorder research

Article Abstract:

The treatment history of individuals who applied to participate in panic disorder research was studied. Panic disorder, a common psychiatric problem, causes sudden intense periods of fearfulness and a sense of impending doom; symptoms during attacks include shortness of breath, palpitations, chest discomfort and fear of losing control. Panic disorder may occur with or without phobic avoidance, in which the patient fears and avoids a particular situation, typically open spaces (agoraphobia). Effective treatments for panic disorder are now available. Medication and behavioral therapies can successfully reduce the frequency and severity of attacks and avoidance behaviors. The 794 volunteers for research on panic disorders were surveyed on their past treatment history. Most had had counselling and had used benzodiazepine. Two valuable treatments were underutilized in this group which have been helpful either alone or used in combination; these were the behavior therapy called exposure therapy and the drug imipramine. Exposure therapy was rarely used, which is surprising because it is safe and effective; therapists may not know how to apply this technique. Another effective therapy, the class of drugs known as monoamine oxidase inhibitors (MAOIs), had been used only occasionally. The subjects surveyed were significantly disabled by panic disorder. Approximately half experienced moderate or severe anxiety during activities such as driving or shopping, and half were unemployed.

Care and treatment, Evaluation, Behavior therapy, Imipramine, Phobias

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