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Refractory Panic Disorder

Camelia-Lucia Cimpianu, Wolfgang Strube, Peter Falkai, Ulrich Palm, Alkomiet Hasan
Invasive and non-invasive vagus nerve stimulation (VNS) is a promising add-on treatment for treatment-refractory depression, but is also increasingly evaluated for its application in other psychiatric disorders, such as dementia, schizophrenia, somatoform disorder, and others. We performed a systematic review aiming to give a detailed overview of the available evidence of the efficacy of VNS for the treatment of psychiatric disorders. Data derived from animal models, experimental trials without health-related outcomes, case reports, single-session studies, and reviews were excluded...
November 16, 2016: Journal of Neural Transmission
Christopher C Conway, Lauren A Rutter, Timothy A Brown
Both acute stressful life events and ongoing strains are thought to confer vulnerability to emotional disorders. Unremitting stressful conditions may be particularly pathogenic, but prior research has struggled to delimit chronic versus transient stressful experiences. We aimed to isolate stable stressors-theorized to be indicators of a latent stress proneness trait-and to examine their effects on the temporal course of depression and panic disorder. We recruited 677 patients diagnosed with an emotional disorder and administered interviews for psychopathology and life stress 3 times over 12-month intervals...
January 2016: Journal of Abnormal Psychology
C Marchesi, P Ossola, A Amerio, B D Daniel, M Tonna, C De Panfilis
BACKGROUND: In the last few decades, there has been a growing interest in anxiety disorders (AnxD) in the perinatal period. Although AnxD are diagnosed in 4-39% of pregnant women and in up to 16% of women after delivery, evidence on their clinical management is limited. METHODS: A systematic review was conducted on pharmacological and non-pharmacological treatment of AnxD in the perinatal period. Relevant papers published from January 1st 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library...
January 15, 2016: Journal of Affective Disorders
Marcelo B Sousa, Telmo Reis, Alexandre Reis, Paulo Belmonte-de-Abreu
No abstract text is available yet for this article.
April 2015: Revista Brasileira de Psiquiatria
Hee Ryung Wang, Young Sup Woo, Won-Myong Bahk
OBJECTIVE: Many studies have investigated the efficacy and tolerability of alternative pharmacotherapy for panic disorder. This study aims to provide a comprehensive review of the existing literature regarding the efficacy and tolerability of atypical antipsychotics for panic disorder. METHODS: We searched for relevant published articles using Medline, the Cochrane database, and EMBASE on 19 June 2013. Prospective studies that examined the efficacy and tolerability of atypical antipsychotics in the treatment of primary panic disorder or comorbid panic disorder (or symptoms) in other psychiatric disorders were included in this review...
September 2014: Human Psychopharmacology
Samantha Barton, Charlotta Karner, Fatima Salih, David S Baldwin, Steven J Edwards
BACKGROUND: Anxiety and related disorders include generalised anxiety disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder and phobic disorders (intense fear of an object or situation). These disorders share the psychological and physical symptoms of anxiety, but each disorder has its own set of characteristic symptoms. Anxiety disorders can be difficult to recognise, particularly in older people (those aged over 65 years). Older people tend to be more reluctant to discuss mental health issues and there is the perception that older people are generally more worried than younger adults...
August 2014: Health Technology Assessment: HTA
Helga Rodrigues, Ivan Figueira, Alessandra Lopes, Raquel Gonçalves, Mauro Vitor Mendlowicz, Evandro Silva Freire Coutinho, Paula Ventura
The treatment of anxiety is on the edge of a new era of combinations of pharmacologic and psychosocial interventions. A new wave of translational research has focused on the use of pharmacological agents as psychotherapy adjuvants using neurobiological insights into the mechanism of the action of certain psychological treatments such as exposure therapy. Recently, d-cycloserine (DCS) an antibiotic used to treat tuberculosis has been applied to enhance exposure-based treatment for anxiety and has proved to be a promising, but as yet unproven intervention...
2014: PloS One
Alex Iglesias, Adam Iglesias
This case study details how hypnosis aided fixed role therapy (HAFRT) was employed in the successful treatment of a case of social phobia with a history of refractory outcomes to previous therapy trials. The treatment consisted of 10 office sessions, scheduled every two weeks, of HAFRT along with twice a day self-hypnotic sessions where the patient performed multiple visualization rehearsals of the vignettes that were successfully mastered in hypnosis during office visits. The results indicated that this patient was able to engage in social and professional affairs that were impossible prior to treatment...
April 2014: American Journal of Clinical Hypnosis
Sergio Machado, Veruska Santos, Flávia Paes, Oscar Arias-Carrión, Mauro G Carta, Adriana C Silva, Antonio E Nardi
Panic disorder (PD) is an anxiety disorder that is highly disruptive to the patient's life and needs new options for effective treatments. In this case report, we present an application of repetitive transcranial magnetic stimulation (rTMS) in a refractory patient resistant to cognitive behavior therapy (CBT) and pharmacotherapy who was treated with a combined protocol of rTMS with a sequential stimulation of right and left dorsolateral prefrontal cortex (DLPFC). The protocol was conducted 3 times per week during 4 weeks, with one month follow-up...
2014: CNS & Neurological Disorders Drug Targets
Pamela J Horn, Lisa A Wuyek
Abstract Introduction. Patients with comorbid depression and anxiety disorders have a higher suicide risk, increased social and vocational dysfunction and more severe and refractory illness. Methods. This paper reviews the studies examining the temporal relationship between onset of anxiety disorders and depression. Results. The highest rates of subsequent depression have been found in generalized anxiety disorder, followed by panic disorder and social anxiety disorder. The largest numbers of studies have been done on social anxiety disorder...
November 2010: International Journal of Psychiatry in Clinical Practice
Batool F Kirmani, Diana Mungall
Partial seizures can be misdiagnosed as panic attacks. There is considerable overlap of symptoms between temporal lobe seizures and panic attacks making the diagnosis extremely challenging. Temporal lobe seizures can present with intense fear and autonomic symptoms which are also seen in panic disorders. This results in delay in diagnosis and management. We report an interesting case of a young woman who was diagnosed with right temporal lobe seizures with symptoms suggestive of a panic attack.
2013: Case Reports in Psychiatry
Melissa J Nirenberg
Dopamine agonists are effective treatments for a variety of indications, including Parkinson's disease and restless legs syndrome, but may have serious side effects, such as orthostatic hypotension, hallucinations, and impulse control disorders (including pathological gambling, compulsive eating, compulsive shopping/buying, and hypersexuality). The most effective way to alleviate these side effects is to taper or discontinue dopamine agonist therapy. A subset of patients who taper a dopamine agonist, however, develop dopamine agonist withdrawal syndrome (DAWS), which has been defined as a severe, stereotyped cluster of physical and psychological symptoms that correlate with dopamine agonist withdrawal in a dose-dependent manner, cause clinically significant distress or social/occupational dysfunction, are refractory to levodopa and other dopaminergic medications, and cannot be accounted for by other clinical factors...
August 2013: Drugs & Aging
Nir Lipsman, D Blake Woodside, Peter Giacobbe, Clement Hamani, Jacqueline C Carter, Sarah Jane Norwood, Kalam Sutandar, Randy Staab, Gavin Elias, Christopher H Lyman, Gwenn S Smith, Andres M Lozano
BACKGROUND: Anorexia nervosa is characterised by a chronic course that is refractory to treatment in many patients and has one of the highest mortality rates of any psychiatric disorder. Deep brain stimulation (DBS) has been applied to circuit-based neuropsychiatric diseases, such as Parkinson's disease and major depression, with promising results. We aimed to assess the safety of DBS to modulate the activity of limbic circuits and to examine how this might affect the clinical features of anorexia nervosa...
April 20, 2013: Lancet
A K Vora, H Ward, K D Foote, W K Goodman, M S Okun
OBJECTIVE: Deep brain stimulation (DBS) is a promising treatment for medication refractory obsessive compulsive disorder (OCD); however, there may be neuropsychiatric symptoms from unintended battery failure. BACKGROUND: Previous studies indicated rebound symptoms from impulse generator (IPG) failure in Parkinson's disease, dystonia, and essential tremor. Unique to OCD is that battery failure may precipitate neuropsychiatric symptoms rather than motor symptoms. METHODS: Six patients with medication refractory OCD received implants as part of the previously reported National Institutional Health (NIH) DBS cohort...
October 2012: Brain Stimulation
Neeltje M Batelaan, Anton J L M Van Balkom, Dan J Stein
The evidence-based pharmacotherapy of panic disorder continues to evolve. This paper reviews data on first-line pharmacotherapy, evidence for maintenance treatment, and management options for treatment-refractory patients. A Medline search of research on pharmacotherapy was undertaken, and a previous systematic review on the evidence-based pharmacotherapy of panic disorder was updated. Selective serotonin reuptake inhibitors remain a first-line pharmacotherapy of panic disorder, with the serotonin noradrenaline reuptake inhibitor venlafaxine also an acceptable early option...
April 2012: International Journal of Neuropsychopharmacology
Michele Fornaro
BACKGROUND: Serotonin reuptake inhibitors (SRIs) currently represent the cornerstone of obsessive-compulsive disorder (OCD) pharmacotherapy. However, OCD is characterized by high rates of partial and/or absent response to standard, recommended treatments, often prompting pharmacological and non-pharmacological augmentation or switching of strategies. Agomelatine, a novel melatonin agonist and selective serotonin antagonist (MASSA) antidepressant approved for major depressive disorder (MDD) has recently been additionally proposed as a treatment for anxiety disorders such as social anxiety disorder (SAD) and panic disorder (PD), but not yet OCD...
2011: Annals of General Psychiatry
Judith Dobesberger, Gerald Walser, Iris Unterberger, Klaus Seppi, Giorgi Kuchukhidze, Julia Larch, Gerhard Bauer, Thomas Bodner, Tina Falkenstetter, Martin Ortler, Gerhard Luef, Eugen Trinka
PURPOSE: Video-electroencephalography (EEG) monitoring plays a central role in the presurgical evaluation of medically refractory epilepsies and the diagnosis of nonepileptic attack disorders (NEADs). The aim of this study was to analyze safety and adverse events (AEs) during video-EEG monitoring. METHODS: We retrospectively evaluated 596 video-EEG sessions in 507 patients (233 men, mean age 36 years, standard deviation = 14, range 9-80 years) within a 6-year period...
March 2011: Epilepsia
J Diemer, N Vennewald, K Domschke, P Zwanzger
Panic disorder (PD) is characterized by recurrent panic attacks that are defined as distinct episodes of intense fear, accompanied by symptoms related to physical arousal. Because most patients interpret these symptoms as signs of serious somatic disease (e.g., a heart attack), utilization of healthcare services is high in PD sufferers. PD can become debilitating, interfering significantly with patients' lives. Fortunately, effective treatments are available, but a considerable proportion of patients do not respond sufficiently...
November 2010: European Archives of Psychiatry and Clinical Neuroscience
Christian Brandt, Martin Schoendienst, Monika Trentowska, Theodor W May, Bernd Pohlmann-Eden, Brunna Tuschen-Caffier, Mario Schrecke, Nora Fueratsch, Karin Witte-Boelt, Alois Ebner
Comorbid anxiety disorders severely affect daily living and quality of life in patients with epilepsy. We evaluated 97 consecutive outpatients (41.2% male, mean age=42.3+/-13.2 years, mean epilepsy duration=26.9+/-14.2 years) with refractory focal epilepsy using the German version of the anxiety section of the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Nineteen patients (19.6%) were diagnosed with an anxiety disorder (social phobia, 7.2%; specific phobia, 6.2%; panic disorder, 5.1%; generalized anxiety disorder, 3...
February 2010: Epilepsy & Behavior: E&B
Christina A Rabinak, Melissa J Nirenberg
OBJECTIVES: To report and characterize a dopamine agonist (DA) withdrawal syndrome (DAWS) in Parkinson disease. DESIGN: Retrospective cohort study. SETTING: Outpatient tertiary movement disorders clinic. Patients A cohort of 93 nondemented patients with Parkinson disease enrolled in a prospective study of nonmotor and motor disease manifestations. Main Outcome Measure The presence of DAWS, defined as a severe, stereotyped cluster of physical and psychological symptoms that correlate with DA withdrawal in a dose-dependent manner, cause clinically significant distress or social/occupational dysfunction, are refractory to levodopa and other Parkinson disease medications, and cannot be accounted for by other clinical factors...
January 2010: Archives of Neurology
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