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Objective: To evaluate the efficacy, safety, and tolerability of venlafaxine extended release (ER) in short-term treatment of panic disorder.
Method: In this multicenter, double-blind study, conducted from April 2001 to December 2002, 343 adult outpatients who met criteria for panic disorder (with and without agoraphobia) according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were randomly assigned to flexible-dose venlafaxine ER (75Â225 mg/d) or placebo for 10 weeks (N = 155 per group, intent-to-treat population). The primary outcome measure was the percentage of panic-free patients as assessed using the Sheehan Panic and Anticipatory Anxiety Scale. Key secondary measures included the Panic Disorder Severity Scale (PDSS) score and Clinical Global Impressions-Improvement (CGI-I) scale response (score = 1 or 2). Last-observation-carried-forward data were analyzed, and statistical significance was set at p ≤.05.
Results: At week 10, the percentage of patients who were free from full-symptom panic attacks was 52% in the venlafaxine ER group and 43% in the placebo group (p = .11). Mean change from baseline in PDSS total score was significantly (p = .006) greater for the venlafaxine ER group (-9.3) than for the placebo group (-7.5), and significantly (p = .03) more venlafaxine ER-treated patients achieved CGI-I response (71%) than did those receiving placebo (59%) at week 10. Treatment with venlafaxine ER was generally safe and well tolerated. Adverse events were the primary or secondary cause for discontinuation for 7 placebo patients (4%) and 12 venlafaxine ER patients (7%).
Conclusion: Venlafaxine ER appears to be effective, safe, and well tolerated in short-term treatment of panic disorder, although the results fell just short of significance on the primary outcome measure.
Trial Registration: clinicaltrials.gov Identifier: NCT00038896
Letter to the Editor
Panic Disorder After the End of Chronic Alcohol Abuse: A Report of 2 Cases
Objective: Cognitive-behavioral therapy (CBT) is well documented as an efficacious treatment for panic disorder. We provided open CBT treatment to patients who subsequently participated in a maintenance treatment study. This article reports on predictors and trajectory of response in 381 participants who completed treatment at 4 sites.
Method: Participants who met criteria for panic disorder with or without agoraphobia (N = 381) completed assessment and entered treatment. Of these, 256 completed 11 sessions of CBT delivered by trained and supervised research therapists. Raters trained to reliability obtained demographic data and administered structured diagnostic interviews and the Hamilton Rating Scales for Depression and Anxiety and the Panic Disorder Severity Scale (PDSS) measures at baseline and posttreatment. We obtained self-report (SR) measures of anxiety sensitivity and adult separation anxiety at baseline and posttreatment and PDSS-SR ratings weekly. The study was conducted between November 1999 and July 2002.
Results: Treatment response rate was 65.6% for completers and 44.1% for the intent-to-treat sample. Greater severity of panic disorder and lower levels of adult separation anxiety predicted response. Beginning at week 4, responders showed greater mean decreases in PDSS scores than nonresponders and maintained the advantage throughout the treatment. By week 6, 76% of responders, compared to 36% of nonresponders, recorded PDSS scores at least 40% below baseline on 2 consecutive weeks (odds ratio = 5.42, 95% CI = 3.10 to 9.48).
Conclusion: These results suggest that CBT is just as effective for more severe panic disorder patients as it is for those with less severe panic disorder, regardless of other comorbid disorders, including agoraphobia. However, patients experiencing adult separation anxiety disorder are less likely to respond. Our results further inform clinicians that many people who will respond to 11 weeks of treatment will have done so by the middle of the treatment.
Objective: Craving for benzodiazepines has never been examined as a factor of relapse after successful benzodiazepine discontinuation. In this study, we examined the predictive value of craving on benzodiazepine relapse.
Method: A stepped-care intervention trial aimed to discontinue long-term benzodiazepine use in general practice. The first step was the sending of a letter to users advising them to gradually quit their use by themselves (i.e., minimal intervention). The second step, a supervised tapering-off program, was offered to those unable to discontinue by themselves. Craving was assessed by means of the Benzodiazepine Craving Questionnaire (BCQ). Multiple Cox proportional hazards regression analyses were performed to examine the effect of craving on subsequent relapse during a 15-month follow-up period in patients who had successfully quit their benzodiazepine use by themselves after the minimal intervention (N = 79) and in those patients who had successfully quit after the supervised tapering-off program (N = 45). Data were collected from August 1998 to December 2001.
Results: Thirty-five (44%) and 24 (53%) patients had relapsed after the minimal intervention and tapering-off program, respectively. Patients able to quit by themselves experienced very little craving. In this sample, craving was not related to relapse (p = .82). In patients who needed an additional supervised tapering-off program, higher craving scores were significantly related to relapse (hazard ratio = 1.26, 95% CI = 1.02 to 1.54, p = .029), when corrected for benzodiazepine characteristics, psychopathology, and personality characteristics.
Conclusion: Craving is an independent factor of subsequent relapse after successful benzodiazepine discontinuation in long-term benzodiazepine users who are not able to quit their usage of their own accord.
Panic disorder is a common, disabling condition that affects 3% to 5% of the world's population. Althoughit is treatable, panic disorder goes unrecognized and untreated in many patients.Patients with panic disorder have an increased risk for other psychiatricdisorders, especially other anxiety disorders, and panic disorder is associatedwith other medical conditions such as migraines, fibromyalgia, and irritablebowel syndrome. Clinicians treating panic disorder must be able to recognizethe disorder, differentiate it from other disorders in which panic attacks arepart of the symptomatology, and map out an individualized treatment plan foreach patient. This presentation discusses the importance of collaborationbetween doctor and patient and details available treatment options, includingantidepressants, benzodiazepines, and cognitive-behavioral therapy.
Because this piece has no abstract, we have provided for your benefit the first 3 sentences of the full text.
Because this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.
Sir: Although paradoxical effects of γ-aminobutyric acid (GABA)-ergic medications (excitation instead of sedation) are well-known, they have received no satisfactory explanation. We report the case of a 54-year-old woman with schizophrenia, in which we were able to observe this clinical pattern and its neural correlates.
Case report. The patient was in her forties, working as an assistant professor at a university, when she developed mostly negative symptoms.' ‹