Increased risk of acute myocardial infarction for patients with panic disorder: a nationwide population-based study.

Posted on October 5, 2009 by Maurice Preter MD
Psychosom Med. 2009 Sep;71(7):798-804. Epub 2009 Jul 10.Click here to read Links

Increased risk of acute myocardial infarction for patients with panic disorder: a nationwide population-based study.

Chen YH, Tsai SY, Lee HC, Lin HC.

School of Public Health, Taipei Medical University, Taipei, Taiwan.

OBJECTIVE: To examine prospectively the relationship between a diagnosis of panic disorder and the risk of acute myocardial infarction within 1 year of follow-up. Panic disorder is associated prospectively with coronary artery disease, but the risk of acute myocardial infarction associated with panic disorder has not been specifically investigated. METHOD: This nationwide population-based study used data from the Taiwan National Health Insurance Research Database covering the years 2000 to 2005. A total of 9641 patients diagnosed with panic disorder in 2004 were included, together with 28,923 matched nonpanic disorder enrollees as a comparison cohort. Cox proportional hazard regressions were conducted to compute hazard ratios, after adjustment for comorbid medical disorders and sociodemographic characteristics. RESULTS: Results indicated that 4.77% of patients with panic disorder (approximately one in 21) experienced an acute myocardial infarction episode within a year, compared with 2.73% of patients in the comparison cohort. The adjusted hazard of acute myocardial infarction was significantly higher (1.75 times, 95% Confidence Interval = 1.55-1.97) for patients with panic disorder, relative to the comparison cohort. The association persisted in further analyses stratified by hypertension, coronary heart diseases, and age. CONCLUSION: Panic disorder was identified as an independent risk factor for subsequent acute myocardial infarction. Comprehensive multidisciplinary approaches are needed to optimize primary and secondary prevention of acute myocardial infarction among patients with panic disorder.

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Primary focal dystonia: evidence for distinct neuropsychiatric and personality profiles.

Posted on October 5, 2009 by Maurice Preter MD
J Neurol Neurosurg Psychiatry. 2009 Oct;80(10):1176-9. Epub 2009 May 21.Click here to read Links
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J Neurol Neurosurg Psychiatry. 2009 Oct;80(10):1059.

Primary focal dystonia: evidence for distinct neuropsychiatric and personality profiles.

Lencer R, Steinlechner S, Stahlberg J, Rehling H, Orth M, Baeumer T, Rumpf HJ, Meyer C, Klein C, Muenchau A, Hagenah J.

Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany. rebekka.lencer@psychiatrie.uk-sh.de

BACKGROUND: Primary focal dystonia (PFD) is characterised by motor symptoms. Frequent co-occurrence of abnormal mental conditions has been mentioned for decades but is less well defined. In this study, prevalence rates of psychiatric disorders, personality disorders and traits in a large cohort of patients with PFD were evaluated. METHODS: Prevalence rates of clinical psychiatric diagnoses in 86 PFD patients were compared with a population based sample (n = 3943) using a multiple regression approach. Furthermore, participants were evaluated for personality traits with the 5 Factor Personality Inventory. RESULTS: Lifetime prevalence for any psychiatric or personality disorder was 70.9%. More specifically, axis I disorders occurred at a 4.5-fold increased chance. Highest odds ratios were found for social phobia (OR 21.6), agoraphobia (OR 16.7) and panic disorder (OR 11.5). Furthermore, an increased prevalence rate of 32.6% for anxious personality disorders comprising obsessive-compulsive (22.1%) and avoidant personality disorders (16.3%) were found. Except for social phobia, psychiatric disorders manifested prior to the occurrence of dystonia symptoms. In the self-rating of personality traits, PFD patients demonstrated pronounced agreeableness, conscientiousness and reduced openness. CONCLUSIONS: Patients with PFD show distinct neuropsychiatric and personality profiles of the anxiety spectrum. PFD should therefore be viewed as a neuropsychiatric disorder rather than a pure movement disorder.

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Prevalence of anxiety disorders and anxiety subtypes in patients with

Posted on October 5, 2009 by Maurice Preter MD
Mov Disord. 2009 Jul 15;24(9):1333-8.Click here to read Links

Prevalence of anxiety disorders and anxiety subtypes in patients with Parkinson’s disease.

Pontone GM, Williams JR, Anderson KE, Chase G, Goldstein SA, Grill S, Hirsch ES, Lehmann S, Little JT, Margolis RL, Rabins PV, Weiss HD, Marsh L.

Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.

Anxiety disorders are common in Parkinson’s disease (PD), but are not well characterized. This study determined the prevalence and clinical correlates of all DSM-IV-TR anxiety disorder diagnoses in a sample of 127 subjects with idiopathic PD who underwent comprehensive assessments administered by a psychiatrist and neurologist. A panel of six psychiatrists with expertise in geriatric psychiatry and/or movement disorders established by consensus all psychiatric diagnoses. Current and lifetime prevalence of at least one anxiety disorder diagnosis was 43% (n = 55) and 49% (n = 63), respectively. Anxiety disorder not otherwise specified, a DSM diagnosis used for anxiety disturbances not meeting criteria for defined subtypes, was the most common diagnosis (30% lifetime prevalence, n = 38). Compared with nonanxious subjects, panic disorder (n = 13) was associated with earlier age of PD onset [50.3 (12.2) vs. 61.0 (13.7) years, P < 0.01], higher rates of motor fluctuations [77% (10/13) vs. 39% (25/64), P = 0.01] and morning dystonia [38% (5/13) vs. 13% (8/62), P < 0.03]. This high prevalence of anxiety disorders, including disturbances often not meeting conventional diagnostic criteria, suggests that anxiety in PD is likely underdiagnosed and undertreated and refined characterization of anxiety disorders in PD is needed. In addition, certain anxiety subtypes may be clinically useful markers associated with disease impact in PD. 2009 Movement Disorder Society.

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Dizziness: anxiety, health care utilization and health behavior–results from a representative German community survey.

Posted on October 5, 2009 by Maurice Preter MD
J Psychosom Res. 2009 May;66(5):417-24. Epub 2008 Dec 16.Click here to read Links

Dizziness: anxiety, health care utilization and health behavior–results from a representative German community survey.

Wiltink J, Tschan R, Michal M, Subic-Wrana C, Eckhardt-Henn A, Dieterich M, Beutel ME.

Clinic of Psychosomatic Medicine and Psychotherapy, Johannes Gutenberg-University Mainz, Germany.

BACKGROUND: Due to the lack of epidemiological data on the relation of dizziness and anxiety, we investigated the prevalence of dizziness and anxiety in a representative sample of the German population. We explored the consequences of comorbid anxiety for emotional distress, functional impairment, health care utilization, and health behavior in dizziness. METHODS: By the end of 2006, we surveyed a total of 1287 persons between 14 and 90 years of age in their homes by trained interviewers with standardized self-rating questionnaires on anxiety (Patient Health Questionnaire, Generalized Anxiety Disorder Scale, Mini-Social Phobia Inventory) and dizziness (Vertigo Symptom Scale). The sample was representative for the German population in terms of age, sex, and education. RESULTS: Symptoms of dizziness were reported by 15.8% of the participants. Of the participants with dizziness, 28.3% reported symptoms of at least one anxiety disorder (generalized anxiety, social phobia, panic). Persons with dizziness reported more somatic problems such as hypertension, migraine, diabetes, etc. Comorbid anxiety was associated with increased health care use and impairment. CONCLUSION: Dizziness is a highly prevalent symptom in the general population. A subgroup with comorbid anxiety is characterized by an increased subjective impairment and health care utilization due to their dizziness. Because treatment options for distinct neurotologic disorders are also known to reduce psychological symptoms, and in order to avoid unnecessary medical treatment, early neurologic and psychiatric/psychotherapeutic referral may be indicated.

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Non-fearful panic disorder in gastroenterology.

Posted on October 5, 2009 by Maurice Preter MD
Psychosomatics. 2008 Nov-Dec;49(6):543-5.Click here to read Links

Non-fearful panic disorder in gastroenterology.

Porcelli P, De Carne M.

Unità di Psicosomatica, IRCCS Ospedale De Bellis, Via della Resistenza, 70013 Castellana Grotte, Bari, Italy. porcellip@media.it

BACKGROUND: Nonfearful panic disorder (NFPD) is a panic condition masked under the appearance of somatic symptoms only, without the component of fear, and it represents a challenging diagnostic task. METHOD: This is the first case report of NFPD in a male patient with acute gastric pain and gastrointestinal disease (atrophic gastritis and H. pylori infection). RESULTS: The patient showed atypical panic symptoms and demoralization on the Diagnostic Criteria for Psychosomatic Research screening. He was successfully treated with anti-panic medication and cognitive-behavioral therapy. DISCUSSION: The case report shows that accurate psychosomatic assessment may help clinicians avoid diagnostic delay, prevent the administration of unnecessary medications, and give patients more appropriate treatment.

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