Season of birth in siblings of patients with seasonal affective disorder

Recently we have published a report on seasonally varying birth rates in 553 patients with seasonal affective disorder (SAD). The present study is aimed to test the hypothesis of an idiosyncratic seasonal conception pattern of the parents of these patients to explain this phenomenon. We conducted a telephone interview with the patients to obtain information on the birth data of their siblings. Using the method of chart review to acquire information on the family history of our patients, we excluded those siblings with psychiatric disorders. We first compared the birth months and the quarters of birth of 435 healthy siblings with the general population. Secondly, we compared the birth distribution of the index SAD patients with that of their siblings. There was a significant deviation between the birth distribution of the siblings and the general population calculated on a monthly basis (p = 0.044). When comparing quarters we found less births than expected in the first (-14.1%) and fourth quarter of the year (-15.1%) and an excess of births in the second (+7.7%) and third quarter (+21.1%; p = 0.018). There were no significant differences between the group of SAD patients and their siblings regarding their birth patterns as calculated by months (p = 0.848) or quarters (p = 0.320). Our study provides support for the hypothesis of specific parental conception habits underlying the birth seasonality in SAD. Further research could be conducted in non-seasonal depression as there is still a lack of studies on seasonality of birth in affective disorders.     

Maternal panic disorder: Infant prematurity and low birth weight

The aim of this pilot research was to investigate whether infants of mothers with panic disorder (PD) would be at higher risk for prematurity and low birth weight (corrected for gestational age) than controls. Medical records were reviewed for 25 mothers with PD and 33 mothers without a lifetime history of anxiety disorders or other major psychopathology as determined by diagnostic interview. Mothers also completed questionnaires concerning demographic information and life stresses. Compared to controls, infants with PD mothers were not significantly more likely to be born prematurely or earlier than controls but did show smaller birth weight corrected for gestational age, even after accounting for possible confounding influences. Additional research is needed to confirm these preliminary findings. Studying PD mothers during pregnancy could provide insight concerning mechanisms for the development of low birth weight and psychopathology.     

Season of birth and Schneider-oriented diagnosis of affective disorder.

Most earlier studies and all recent studies on national samples have shown that compared with live births in the control population, schizophrenic patients have a significant excess of birth rates in the winter or early months of the year. In contrast, only some of the early research efforts and only some of the national studies (in England and Wales as well as for certain decades in Sweden) have demonstrated that the same holds true for patients with affective psychosis. The present German study, carried out on affective disorder diagnosed in a strongly Kurt Schneider-oriented clinic, found (as did most Scandinavian research on national samples) that there was no significant overrepresentation of births in the winter or early months of the year for all types of affective disorder, neurotic as well as psychotic. Thus, the findings on Schneider-diagnosed affective disturbances were similar to those on Schneider-diagnosed schizophrenia reported elsewhere.     

Photosensitivity in panic disorder

Background: The objective of this study is to evaluate abnormal light‐related behavior in patients with panic disorder (PD). Methods: We administered the Photosensitivity Assessment Questionnaire to 30 subjects with PD and to 40 healthy subjects. The Photosensitivity Assessment Questionnaire is a self‐report questionnaire that evaluates two dimensions of photosensitivity: photophilia and photophobia. Results: Compared to healthy controls, PD subjects reported significantly higher scores on the photophobia (P<.003) and significantly lower scores on the photophilia (P<.001) questions. Conclusions: Subjects with PD indicated that they tolerate and seek light to a significantly lower degree than normal controls. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.     

Fluoxetine in panic disorder

This paper presents the cases of two patients who suffered from panic disorder with agoraphobia and depression. One had been refractory to alprazolam and tricyclics and to behaviour therapy; she had responded to phenelzine, but due to a weight gain of 50 lbs, had discontinued treatment and she relapsed. The second patient, who also suffered from post-traumatic stress disorder, did not respond to alprazolam, imipramine or to phenelzine, but gained weight (33 lbs) on phenelzine. Both patients responded to fluoxetine 80 mg per day without concomitant weight gain.     

Hyperventilation-induced panic attacks in panic disorder with agoraphobia

Eight minutes of hyperventilation to an end-tidal PCO2 of less than 20 mmHg led to a panic attack in 7 of 12 patients with panic disorder with agoraphobia and only 1 of 12 normal controls. Patients experienced greater increases in panic symptoms than controls during hyperventilation. Patients who reported more distress from somatic symptoms of hyperventilation during the preceding week were more likely to panic during hyperventilation. Patients who panicked during hyperventilation exhibited a delayed recovery of normocapnia following hyperventilation. Hyperventilation by this protocol is an effective means of inducing panic attacks in the laboratory. A hyperventilation challenge may identify a subgroup of patients for whom hyperventilation symptoms are frequently associated with panic.     

Frequency of panic attacks and panic disorder in adolescents

By using data from the Bremer Adolescent Study, this report presents findings on the frequency, comorbidity, and psychosocial impairment of panic disorder and panic attacks among 1,035 adolescents. The adolescents were randomly selected from 36 schools in the province of Bremen, Germany. Panic disorder and other psychiatric disorders were coded based on DSM-IV criteria using the computerized-assisted personal interview of the Munich version of the Composite International Diagnostic Interview. Panic disorder occurred rather rare, with only 0.5% of all the adolescents met the DSM-IV criteria for this disorder sometimes in their live. Panic attack occurred more frequently, with 18% of the adolescents reported having had at least one panic attack. Slightly more girls than boys had panic attack and panic disorder. The occurrence of panic attack and panic disorder were the greatest among the 14–15 year olds. The experience of having a panic attack was associated with a number of problems, the most frequent being avoiding the situation for fear of having another attack. Four most common symptoms associated with a panic attack were that of palpitations, trembling/shaking, nausea or abdominal distress, and chills or hot flushes. Panic disorder comorbid highly with other psychiatric disorders covered in our study, especially with that of major depression. Among those with a panic disorder, about 40% of them were severely impaired during the worst episode of their illness. Only one out of five adolescents with panic disorder sought professional help for emotional and psychiatric problems. The implication of our findings for research and clinical practice are discussed. Depression and Anxiety 9:19–26, 1999. © 1999 Wiley-Liss, Inc.     

Thyroid hormones in panic disorder, panic disorder with agoraphobia, and generalized anxiety disorder

Fifty-two patients with generalized anxiety disorder who had symptoms persisting for at least 6 months, 41 patients suffering from either panic disorder (32 patients) or panic disorder with agoraphobia (9 patients), and 14 control subjects were screened for thyroid disease. Total serum thyroxine (TT4), serum-free thyroxine index (FT4I), and triiodothyronine resin uptake (T3RU), were examined for the entire sample, using a one-way analysis of variance (ANOVA). No significant differences were found in TT4 (p = .24), FT4I (p = .24), and T3RU (p = .19). Thyroid-stimulating hormone (TSH) was examined in a subsample of 10 patients with generalized anxiety disorder, 11 with panic disorder or panic disorder with agoraphobia, and 10 controls. One-way ANOVA again showed no significant differences, although there was a trend (p = .07). This is the first report that compares generalized anxiety disorder patients, panic disorder patients, and patients with panic disorder and agoraphobia with controls on measures of thyroid function. It is also the first to report normal values in the thyroid indices of generalized anxiety disorder patients.     

Management of panic disorder

Selective serotonin reuptake inhibitors are the first-line treatment for panic disorder. They are effective and well tolerated. Although tricyclic antidepressants are equally effective, they are less well tolerated than the selective serotonin reuptake inhibitors. Monoamine oxidase inhibitors can be efficacious but have a range of unwanted effects that preclude their use as first-line treatments. Benzodiazepines should be reserved for short-term use and for treatment-resistant patients who do not have a history of dependence and tolerance. Also, they can be combined with selective serotonin reuptake inhibitors in the first weeks of treatment to tide the patient over before the onset of the response. Cognitive behavioral therapy is the psychologic treatment of first choice. The methods of combining drug and nondrug treatments need careful and thorough exploration.     

Pharmacotherapy of panic disorder

Panic disorder (PD) is a common, persistent and disabling mental disorder. It is often associated with agoraphobia. The present article reviews the current status of pharmacotherapy for PD with or without agoraphobia as well as the current status of treatments combing pharmacotherapy with cognitive behavior therapy (CBT). The review has been written with a focus on randomized controlled trials, meta-analyses, and reviews that have been published over the past few years. Effective pharmacological treatments include tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, and various benzodiazepines. Treatment results obtained with CBT compare well with pharmacotherapy, with evidence that CBT is at least as effective as pharmacotherapy. Combining pharmacotherapy with CBT has been found to be superior to antidepressant pharmacotherapy or CBT alone, but only in the acute-phase treatment. Long term studies on treatments combining pharmacotherapy and CBT for PD with or without agoraphobia have found little benefit, however, for combination therapies versus monotherapies. New investigations explore the potential additional value of sequential versus concomitant treatments, of cognitive enhancers and virtual reality exposure therapy, and of education, self management and Internet-based interventions.     

Thyroid indices in panic disorder

Eighty-two patients suffering from panic attacks with or without phobias were examined for evidence of thyroid disease. None of the patients had abnormal total T4 or T3 resin uptake measurements, regardless of whether they were nonmedicated or treated with one of three antipanic drugs: alprazolam, phenelzine, or imipramine. A higher than expected incidence of undetectable TSH levels (22% overall) appeared in all groups. The clinical relevance of this finding is currently uncertain.     

Chronic pain in panic disorder

Studies indicate that panic disorder is often associated with high levels of somatic preoccupation, but the nature of these somatic complaints have not been investigated in detail. One hundred and forty-one consecutive panic disorder patients were administered a pain questionnaire and pain location diagram. Almost 40% of the patients reported chronic pain and 7·8% reported using analgesics daily. The most common locations of pain were the head, shoulders, and lower back. When compared with panic disorder patients with no reports of pain, these patients scored significantly higher on several measures of psychopathology. Panic patients with chronic pain may have more functional illness behaviors that require specific treatment considerations and may represent a subset of panic disorder that is particularly at risk for somatization, hypochondriasis, and excessive health care utilization.     

Cholecystokinin-tetrapeptide induces panic attacks in patients with panic disorder

Cholecystokinin-tetrapeptide (CCK-4) and placebo were injected to 11 panic disorder patients. CCK-4 induced a panic attack identical to spontaneous panic attacks in all patients; placebo did not induce any attacks. The role of CCK-4 in anxiety disorders is discussed.