Panic attacks in an individual with bilateral selective lesions of the amygdala.

Posted on November 12, 2008 by Maurice Preter MD
Arch Neurol. 2006 Dec;63(12):1798-801. Related Articles, LinkOut
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Panic attacks in an individual with bilateral selective lesions of the amygdala.

Wiest G, Lehner-Baumgartner E, Baumgartner C.

Department of Neurology, Medical University of Vienna, Vienna, Austria. gerald.wiest@meduniwien.ac.at

OBJECTIVE: To describe the unique case of a patient with panic attacks and bilateral selective amygdala lesions due to Urbach-Wiethe disease. DESIGN: Case report. SETTING: Epilepsy Monitoring Unit, Medical University of Vienna. Patient A 38-year-old man with Urbach-Wiethe disease developed spontaneous panic attacks and depressive mood, which ceased after antidepressive treatment. INTERVENTIONS: Video electroencephalography monitoring, magnetic resonance imaging, and neuropsychological testing. RESULTS: Extended video electroencephalography monitoring excluded an epileptic etiology of the panic attacks. Results of cranial magnetic resonance imaging showed bilateral selective calcifications of the whole amygdaloid complex. Neuropsychological testing revealed selective memory impairment of autobiographic episodes with preserved memory for autobiographic facts. CONCLUSIONS: Our findings indicate that the occurrence of panic attacks does not critically depend on the integrity of the amygdala. Furthermore, the neuropsychological findings in our patient suggest that the amygdala represents an essential neural substrate for the processing of episodic autobiographic memories.

Publication Types:

  • Case Reports


PMID: 17172622 [PubMed – indexed for MEDLINE]

Posted in News | Tagged |

Treatment of nocturnal disturbances and excessive daytime sleepiness in Parkinson’s disease.

Posted on November 11, 2008 by Maurice Preter MD
Neurology. 2004 Oct 26;63(8 Suppl 3):S35-8. Related Articles, Substance (MeSH Keyword), LinkOut

Treatment of nocturnal disturbances and excessive daytime sleepiness in Parkinson’s disease.

Barone P, Amboni M, Vitale C, Bonavita V.

Department of Neurological Sciences, University of Napoli Federico II, Via Pansini 5, 80131 Naples, Italy.

Nocturnal disturbances are common in Parkinson’s disease (PD) patients, with almost 70% of these patients reporting nocturnal disturbances. The etiology of sleep disturbances in patients with PD is still controversial. They might be dependent on dopaminergic drugs, on disease progression, or on a combination of these two factors. Nocturnal disturbances can be categorized in four groups: 1) PD-related motor symptoms, including nocturnal akinesia, early-morning dystonia, painful cramps, tremor, and difficulty turning in bed; 2) treatment-related nocturnal disturbances; 3) psychiatric symptoms, including hallucinations, vivid dreams, depression, dementia, insomnia, psychosis, and panic attacks; 4) other sleep disorders, including insomnia, REM behavioral disorder (RBD), restless legs syndrome (RLS), periodic leg movements (PLMS), and excessive daytime sleepiness (EDS). Specific treatment options are supplied for every group. A global evaluation of nocturnal disturbances would provide clinicians with a valuable tool to establish an optimal regimen that could positively influence all nocturnal disturbance categories and thus improve PD management on. However, it is important to consider that management of some nocturnal disturbances in a group may worsen nocturnal symptoms of another group or may increase EDS. PD-related symptoms can be treated with long-acting DA agonists to obtain continuous DA receptor stimulation during the night. Both treatment-related nocturnal disturbances and psychiatric symptoms may be related to drug treatment, and therefore, in both cases, drug reduction or discontinuance should be considered. Some sleep disorders, such as RLS and PLMS, may be controlled by DA agents, and others, such as insomnia and EDS, may be improved by reducing dopaminergic stimulation.

Publication Types:

  • Review


PMID: 15505142 [PubMed – indexed for MEDLINE]

Posted in Psychiatry/Neurology |

Emptiness in agoraphobia patients.

Posted on November 11, 2008 by Maurice Preter MD
J Am Psychoanal Assoc. 2007 Summer;55(3):1007-26; discussion 1027-32.
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Emptiness in agoraphobia patients.

Milrod B.

Weill Cornell College of Medicine, USA. bmilrod@mail.med.cornell.edu

In light of new research findings about the efficacy of psychodynamic treatment for panic disorder and agoraphobia, it seems a prudent time to carefully address psychoanalytic thinking about the treatment of agoraphobia. The literature has highlighted oedipal contributions to its genesis and clinical unraveling in psychoanalysis. While those contributions are indeed central to the disorder, structural deficits in the self-representation often become a central focus of treatment once symptomatic remission has been achieved in psychoanalytic treatment. This aspect of the clinical presentation of agoraphobia has not yet been specifically addressed in the psychiatric literature. Some aspects of the phenomenon have been described by psychoanalysts. It is more difficult to treat this “emptiness” than the overt symptoms of agoraphobia, as described in DSM-IV. Nonetheless, this phenomenon may be one of the contributors to the chronicity of the disorder. Two clinical cases illustrate these points.

Publication Types:

PMID: 17915656 [PubMed – indexed for MEDLINE]

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Can carotid body perfusion act as a respiratory controller?

Posted on November 11, 2008 by Maurice Preter MD
J Theor Biol. 2007 Dec 21;249(4):737-48. Epub 2007 Sep 15.
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Can carotid body perfusion act as a respiratory controller?

Virkki A, Polo O, Gyllenberg M, Aittokallio T.

Biomathematics Research Group, Department of Mathematics, University of Turku, FIN-20014 Turku, Finland. arho.virkki@utu.fi

The carotid bodies contain chemoreceptor cells that respond to hypoxia and hypercapnia/acidosis of the arterial blood. Since the carotid bodies receive exceptionally high blood perfusion through branches of the external carotid artery, their impulse activity to the respiratory center is thought to be determined mainly by the arterial partial pressures of oxygen (O(2)) and carbon dioxide (CO(2)). However, this paradigm explains the observed increase in ventilation neither during mentally agitated states nor physical exercise. The objective of the work was to test whether physiologically feasible reductions in carotid body perfusion could explain such respiratory overdrive using a flow-sensitive mathematical model of the carotid body chemoreception. The model is based on the law of mass balance and on the description of the chemical reactions in the arterial blood and inside the receptor cells. The neural response to the arterial O(2) and CO(2) levels is assumed to be mediated via the controller’s intracellular O(2) partial pressure and pH. The model predicts that the O(2) response is affected even by moderate changes in blood flow, whereas the CO(2) response is not altered until blood flow is severely limited. Reducing blood flow increases neural stimulus but decreases sensitivity to changes in the partial pressures of arterial O(2) and CO(2). An example is given in which relatively small changes in blood flow significantly modify the carotid body sensitivity to CO(2). These results suggest that limiting perfusion of the carotid bodies through vasoconstriction can offer a powerful mechanism to drive breathing beyond metabolic needs. This observation may provide important insight into the control of ventilation, e.g., during transition from wakefulness to sleep, before physical exercise or during panic attack.

Publication Types:

PMID: 17936799 [PubMed – indexed for MEDLINE]

Posted in Health |

Orthostatic panic attacks among Vietnamese refugees.

Posted on November 11, 2008 by Maurice Preter MD
Transcult Psychiatry. 2007 Dec;44(4):515-44.
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Orthostatic panic attacks among Vietnamese refugees.

Hinton DE, Hinton L, Tran M, Nguyen M, Nguyen L, Hsia C, Pollack MH.

Harvard Medical School, Massachusetts General Hospital, Department of Psychiatry, Boston 02114, USA. devon_hinton@hms.harvard.edu

Viewed historically and cross-culturally, orthostatic-induced dizziness, i.e., dizziness caused by standing up from a sitting or a lying position, forms a key aspect of many syndromes: irritable heart (American Civil War), effort syndrome (World War I and World War II), chronic fatigue syndrome (contemporary USA), Gulf War syndrome (contemporary USA), and orthostatic dysregulation (contemporary Japan). Among Vietnamese refugees attending a psychiatric clinic, this study documents a high rate of orthostatic panic (OP), as well as certain processes seemingly generating these panic attacks, viz., flashbacks and culturally specific catastrophic cognitions. Case examples are used to demonstrate OP’s phenomenology and relevance to clinical care. To illustrate the mechanisms producing OP, we adduce the multiplex model of panic generation. Culturally appropriate care of Vietnamese refugees should include assessment and treatment of OP.

Publication Types:

PMID: 18089637 [PubMed – indexed for MEDLINE]

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