Our findings indicate that the occurrence of panic attacks does not critically depend on the integrity of the amygdala.

Posted on May 13, 2007 by Maurice Preter MD
 
Arch Neurol. 2006 Dec;63(12):1798-801. Related Articles, Links
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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.

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PMID: 17172622 [PubMed – indexed for MEDLINE]

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A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder.

Posted on May 13, 2007 by Maurice Preter MD
 
Am J Psychiatry. 2007 Feb;164(2):265-72. Related Articles, Links
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Erratum in:

  • Am J Psychiatry. 2007 Mar;164(3):529.

A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder.

Milrod B, Leon AC, Busch F, Rudden M, Schwalberg M, Clarkin J, Aronson A, Singer M, Turchin W, Klass ET, Graf E, Teres JJ, Shear MK.

Weill Medical College of Cornell University, 525 East 68th St., New York, NY 10021, USA. bmilrod@med.cornell.edu

OBJECTIVE: The purpose of this study was to determine the efficacy of panic-focused psychodynamic psychotherapy relative to applied relaxation training, a credible psychotherapy comparison condition. Despite the widespread clinical use of psychodynamic psychotherapies, randomized controlled clinical trials evaluating such psychotherapies for axis I disorders have lagged. To the authors’ knowledge, this is the first efficacy randomized controlled clinical trial of panic-focused psychodynamic psychotherapy, a manualized psychoanalytical psychotherapy for patients with DSM-IV panic disorder. METHOD: This was a randomized controlled clinical trial of subjects with primary DSM-IV panic disorder. Participants were recruited over 5 years in the New York City metropolitan area. Subjects were 49 adults ages 18-55 with primary DSM-IV panic disorder. All subjects received assigned treatment, panic-focused psychodynamic psychotherapy or applied relaxation training in twice-weekly sessions for 12 weeks. The Panic Disorder Severity Scale, rated by blinded independent evaluators, was the primary outcome measure. RESULTS: Subjects in panic-focused psychodynamic psychotherapy had significantly greater reduction in severity of panic symptoms. Furthermore, those receiving panic-focused psychodynamic psychotherapy were significantly more likely to respond at treatment termination (73% versus 39%), using the Multicenter Panic Disorder Study response criteria. The secondary outcome, change in psychosocial functioning, mirrored these results. CONCLUSIONS: Despite the small cohort size of this trial, it has demonstrated preliminary efficacy of panic-focused psychodynamic psychotherapy for panic disorder.

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PMID: 17267789 [PubMed – indexed for MEDLINE]

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High plasma concentrations of paroxetine impede clinical response in patients with panic disorder.

Posted on May 13, 2007 by Maurice Preter MD
 
Ther Drug Monit. 2007 Feb;29(1):40-4.
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High plasma concentrations of paroxetine impede clinical response in patients with panic disorder.

Watanabe T, Ueda M, Saeki Y, Hirokane G, Morita S, Okawa M, Akiyama K, Shimoda K.

Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan.

Selective serotonin reuptake inhibitors are thought to interact with serotonergic neurons and be effective for treatment of panic disorder. In the present study, the authors investigated an association between plasma concentrations of paroxetine in patients with panic disorder and clinical response to initial treatment with paroxetine. Subjects were 21 unrelated Japanese patients who fulfilled DSM-IV-TR criteria for a diagnosis of panic disorder (6 males, 15 females, mean age 35.9 +/- 11.3 years). Subjects were administered 10 mg/day of paroxetine for 2 weeks as initial treatment. Improvement of the symptoms of the disorder was assessed with the Panic and Agoraphobia Scale (PAS). In the range of plasma levels >20 ng/mL, none of the subjects showed the reduction ratio in PAS score >0.2. The subjects whose plasma concentrations of paroxetine were less than 20 ng/mL had a significantly higher mean reduction ratio in PAS score than the subjects whose plasma concentrations of paroxetine were >20 ng/mL. Multiple regression analysis showed that the plasma concentration of paroxetine was the only significant factor and accounted for 28.0% of the variability in the reduction ratio of PAS score of the subjects. The final model of correlation was: reduction ratio in PAS score = 0.423 – 0.009 x (plasma concentrations of paroxetine) (R = 0.529, P = 0.014, coefficient of determination (R2) = 0.280). Assuming that the reduction ratio in PAS score was 0.2 in the equation above, plasma concentration of paroxetine is calculated to be about 25 ng/mL, which is suggested to be the upper end of the therapeutic window for the initial phase of the treatment with paroxetine for panic disorder.

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PMID: 17304148 [PubMed – in process]
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Siri Hustvedt女士与裴莫许博士之间的讨论

Posted on May 12, 2007 by Maurice Preter MD

Siri Hustvedt女士与裴莫许博士之间的讨论 

在2006年，小说家兼散文家Siri Hustvedt女士在其父亲的追悼会上发言时突发莫名的癫痫症状，此后该症状时有发生但原因仍未得到明确诊断。她新出了一本名为《颤抖的女人和她神经的 故事》的书，该书通过多学科交叉的方式描述了她所处的环境与她对该症状成因的探寻，内容涉及医学病史、精神病学、精神分析、现代神经科学、哲学以及文学等 多个方面。Siri Hustvedt女士拥有哥伦比亚英国文学博士学位，在纽约佩恩惠特尼精神病诊所从事精神病患者的写作教师工作。她的个人网站为：sirihustvedt.net.

裴莫许医师是一位执业神经学家，精神学家，心理治疗师。他在阿尔伯特爱因斯坦医学院接受神经病学和精神病学相关课程训练，并获得这两个专业的资格认证。研 究方向为紧张、焦虑、惊恐状态和心理创伤。同时作为哥伦

大学的内科医学和外科医学院精神病学教员之一，他尤其致力于突破精神医学，神经医学和普通医学 常规与边界限制的多学科交叉疗法的创新和发展。他的个人网站为：psychiatryneurology.net.

欢迎加入Siri Hustvedt女士与裴莫许博士之间展开的关于 “医学无法解释症状”的讨论，该讨论旨在说明：无论情况如何神秘莫测，对医生、病人以及解释疾病本原的重要性而言，互相坦诚的叙述和交流是解决问题的关键。

该讨论为“叙事医学”节目的一个单元，主持为丽塔·查农博士

5月12日，星期三5:00 PM在内科学教员俱乐部，外科楼4楼#446房间。

点击这里下载讨论录音

[audio:https://psychiatryneurology.net/wp-content/uploads/SHMPCU051210.mp3]
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Drug related problems with Antiparkinsonian agents: consumer Internet reports versus published data.

Posted on May 10, 2007 by Maurice Preter MD
 
 
Pharmacoepidemiol Drug Saf. 2007 May 8; [Epub ahead of print] Related Articles, Links
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Drug related problems with Antiparkinsonian agents: consumer Internet reports versus published data.

Schroder S, Zollner YF, Schaefer M.

Institute of Clinical Pharmacology, Charite University Medicine, CCM, Berlin, Germany.

PURPOSE: There is currently a lack of detailed information concerning drug related problems in the outpatient treatment of Parkinson’s disease. METHODS: Problems associated with drug treatment communicated anonymously in Parkinson’s disease online forums were therefore retrospectively searched and documented for 1 year. RESULTS: Based on postings concerning 12 drugs for the treatment of Parkinson’s disease, a total of 238 drug related problems were identified and categorised using the Problem Intervention Documentation (PI-Doc). Of these, 153 were adverse drug reactions. Adverse drug reactions associated with the skin were relatively common, but central effects such as cognitive or psychiatric changes, effects on the sleep/waking system and other problems like headache and dizziness accounted for the highest percentage of adverse events. A comparison with data from scientific literature revealed a number of differences. This means that an analysis of online forums detected a number of drug related problems that were otherwise largely invisible. These were mainly associated with the qualitative aspects of treatment such as medication handling, dosage and individual problems concerning adverse events. In addition, the described method of identifying and classifying drug related problems in Internet forums may also be seen as a contribution to the international discussion about consumer reports and pharmacovigilance. The information about adverse drug reactions given by Internet users can be seen as a valuable adjunct to clinical trial data and as being very timely with regard to the event itself. CONCLUSION: Online forums may be considered as a suitable source of observational information to complement data from randomised clinical trials. Copyright (c) 2007 John Wiley & Sons, Ltd.

PMID: 17486665 [PubMed – as supplied by publisher]

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