A Randomized Naturalistic Open Long-term Treatment of Panic Disorder with Clonazepam or Paroxetine

Objective:To describe with prospective methodology the therapeutic response to clonazepam or paroxetine in a 3-year treatment of panic disorder (PD).Methods:A total of 120 PD outpatients (DSM-IV) were openly treated with clonazepam or paroxetine for 8 weeks. Those who responded entered a 3-year follow-up. Demographic and clinical features were compared in the two groups.Results:Efficacy was evaluated by Intent to treat, last value carried forward. The Hamilton Scale for Anxiety (HAMA) did not differ between the groups at baseline and during the first two months. In the acute treatment phase and at the end of the long-term follow-up both groups had a significant and similar response - 86.8% of the clonazepam group and 73.0% of the paroxetine group had a complete remission of panic attacks. The mean dose for clonazepam was 1.9 ± 0.2 mg/day and for paroxetine 33.8 ± 9.8 mg/day. There was no difference in the scale scores, and the reduction in panic attacks from baseline to end-point did not differ significantly between the groups. The most common adverse events during treatment were tremor/shaking, nausea/vomiting, sexual dysfunction and appetite/weight change in the paroxetine group and drowsiness, sexual dysfunction and memory/concentration complains in the clonazepam group.Conclusion:PD patients using clonazepam or paroxetine had an equivalent response during acute and long term treatment. The patients using clonazepam had significantly less side effects than the paroxetine group.Acknowledgements: Brazilian Council for scientific and technological development (CNPq).Grant: 554411/2005-9.

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Long-term outcome in pharmacotherapy-resistant patients with panic disorder treated with cognitive-behavior therapy: 5-year follow-up

European Psychiatry ◽

10.1016/s0924-9338(11)71868-5 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 157-157

Author(s):

E. Heldt ◽

C. Blaya ◽

L. Kipper ◽

G. Salum Junior ◽

V.N. Hirakata ◽

...

Keyword(s):

Panic Disorder ◽

Treatment Response ◽

Life Events ◽

Stressful Life Events ◽

Panic Attacks ◽

Stressful Life ◽

Cognitive Behavior ◽

Long Term Treatment

BackgroundThere is a limitation of data about factors associated with treatment response in panic disorder (PD) patients at long-term follow-up period. The aim of this study was to evaluate the long-term treatment response of pharmacotherapy-resistant patients with PD after 5 years of cognitive-behavior group therapy (CBGT) and to identify factors that predict this outcome.MethodSixty-four patients who completed 12 sessions of CBGT were followed for 5-year. Outcome measures were evaluated by the Clinical Global Impression (CGI) and quality of life (QoL) using WHOQOL-bref. Demographic and clinical features, stressful life events were the variables investigated as predictors of CBGT response across follow-up period.ResultsTreatment was associated with significant reduction in symptoms severity (agoraphobia, anticipatory anxiety and panic attacks) with maintenance of gains at 5-year of follow-up (p < 0.05). Twenty-four (40%) of the sample remained in remission after 5 years, 12 (20%) relapsed during the follow-up period and 24 (40%) were non-responder to CBGT. The poor CBGT response had an important negative impact in QoL. Regression analyzes showed that comorbidity with dysthymia (p = 0.017) and stressful life events (p = 0.012) as the most important predictors to worse response.ConclusionsThe improvement in all evaluations suggested that brief CBGT for pharmacotherapy-resistant patients could be an alternative as next-step strategy for residual symptoms with maintenance of the gains after 5 years as assessed across follow-up period. New strategies should be tried for resistant patients, such as those with dysthymia comorbidity, and some specific tool in order to cope with adverse events.

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Prospective, Open, Randomized 3-years Long-term Treatment of Panic Disorder with Clonazepam, Paroxetine, or Their Combination and Follow-up During Additional 6 Years

European Psychiatry ◽

10.1016/s0924-9338(15)31846-0 ◽

2015 ◽

Vol 30 ◽

pp. 170 ◽

Cited By ~ 2

Author(s):

A. Nardi ◽

M.D. Mochcovitch ◽

R.C. Freire ◽

S. Machado ◽

A.C. Silva ◽

...

Keyword(s):

Panic Disorder ◽

Term Treatment ◽

Long Term Treatment

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WCA Recommendations for the Long-Term Treatment of Panic Disorder

CNS Spectrums ◽

10.1017/s109285290000691x ◽

2003 ◽

Vol 8 (S1) ◽

pp. 17-30 ◽

Cited By ~ 39

Author(s):

Mark H. Pollack ◽

Christer Allgulander ◽

Borwin Bandelow ◽

Giovanni B. Cassano ◽

John H. Greist ◽

...

Keyword(s):

Panic Disorder ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Term Treatment ◽

Integrated Treatment ◽

Panic Attacks ◽

Cognitive Behavioral ◽

Increased Risk ◽

Long Term Treatment

ABSTRACTWhat are the symptoms of panic disorder and how is the disorder most effectively treated? One of the most commonly encountered anxiety disorders in the primary care setting, panic disorder is a chronic and debilitating illness. The core symptoms are recurrent panic attacks coupled with anticipatory anxiety and phobic avoidance, which together impair the patient's professional, social, and familial functioning. Patients with panic disorder have medically unexplained symptoms that lead to overutilization of healthcare services. Panic disorder is often comorbid with agoraphobia and major depression, and patients may be at increased risk of cardiovascular disease and, possibly, suicide. Research into the optimal treatment of this disorder has been undertaken in the past 2 decades, and numerous randomized, controlled trials have been published. Selective serotonin reuptake inhibitors have emerged as the most favorable treatment, as they have a beneficial side-effect profile, are relatively safe (even if taken in overdose), and do not produce physical dependency. High-potency benzodiazepines, reversible monoamine oxidase inhibitors, and tricyclic antidepressants, have also shown antipardc efficacy. In addition, cognitive-behavioral therapy has demonstrated efficacy in the acute and long-term treatment of panic disorder. A n integrated treatment approach that combines pharmacotherapy with cognitive-behavioral therapy may provide the best treatment. Long-term efficacy and ease of use are important considerations in treatment selection, as maintenance treatment is recommended for at least 12–24 months, and in some cases, indefinitely.

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Long-Term Treatment Outcomes for Heroin Dependence: The 11-Year Follow-Up of the ATOS Study

PsycEXTRA Dataset ◽

10.1037/e612192013-001 ◽

2013 ◽

Author(s):

Christina Marel ◽

Maree Teesson ◽

Shane Darke ◽

Katherine Mills ◽

Joanne Ross ◽

...

Keyword(s):

Treatment Outcomes ◽

Term Treatment ◽

Heroin Dependence ◽

Long Term Treatment

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Faculty Opinions recommendation of Long-term treatment follow-up of children with sickle cell disease monitored with abnormal transcranial Doppler velocities.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726126988.793518505 ◽

2016 ◽

Author(s):

Adlette Inati ◽

Hussein Abbas

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Transcranial Doppler ◽

Term Treatment ◽

Cell Disease ◽

Long Term Treatment

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The changes of corneal biomechanical properties with long-term treatment of prostaglandin analogue measured by Corvis ST

10.21203/rs.3.rs-22280/v3 ◽

2020 ◽

Author(s):

Na Wu ◽

Yuhong Chen ◽

Yaping Yang ◽

Xinghuai Sun

Keyword(s):

Open Angle Glaucoma ◽

Corneal Thickness ◽

Biomechanical Properties ◽

Term Treatment ◽

Prostaglandin Analogue ◽

Corvis St ◽

Long Term Treatment ◽

Corneal Biomechanical Properties

Abstract Background: To investigate the corneal biomechanical changes in primary open angle glaucoma (POAG) patients treated with long-term prostaglandin analogue (PGA). Methods: 111 newly diagnosed POAG patients, including 43 high tension glaucoma (HTG) and 68 normal tension glaucoma (NTG), were measured by Corvis ST to obtain intraocular pressure (IOP), central corneal thickness (CCT) and corneal biomechanical parameters at baseline and at each follow-up visit after initiation of PGA treatment. The follow-up measurements were analyzed by the generalized estimate equation model with an exchangeable correlation structure. Restricted cubic spline was employed to estimate the dose-response relation between follow-up time and corneal biomechanics．Results: The mean follow-up time was 10.3 ± 7.02 months. Deformation amplitude (β=-0.0015, P=0.016), the first applanation velocity (AV1, β=-0.0004, P=0.00058) decreased and the first applanation time (AT1, β=0.0089, P<0.000001) increased statistically significantly with PGA therapy over time after adjusting for age, gender, axial length, corneal curvature, IOP and CCT. In addition, AT1 was lower (7.2950 ± 0.2707 in NTG and 7.5889 ± 0.2873 in HTG, P=0.00011) and AV1 was greater (0.1478 ± 0.0187 in NTG and 0.1314 ± 0.0191 in HTG, P=0.00002) in NTG than in HTG after adjusting for confounding factors.Conclusions: Chronic use of PGA probably influences the corneal biomechanical properties directly, which is to make cornea less deformable. Besides, corneas in NTG tended to be more deformable compared to those in HTG with long-term treatment of PGA.

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Long term dual antiplatelet therapy after myocardial infarction: retrospective analysis in an outpatient population

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2021.1881 ◽

2021 ◽

Author(s):

Gennaro Ratti ◽

Antonio Maglione ◽

Emilia Biglietto ◽

Cinzia Monda ◽

Ciro Elettrico ◽

...

Keyword(s):

Myocardial Infarction ◽

Term Treatment ◽

Multivessel Disease ◽

Coronary Syndrome ◽

Anticoagulant Drugs ◽

Long Term Treatment ◽

Risk Condition ◽

History Of

Long term treatment with ticagrelor 60 mg and low-dose aspirin are indicated after acute coronary syndrome (ACS). We retrospectively reviewed aggregate data of 187 patients (155 M and 38 F) (mean age 63.8±9 years) in follow up after ACS with at least one high risk condition (Multivessel disease, diabetes, GFR<60 mL/min, history of prior myocardial infarction, age >65 years) treated with ticagrelor 60 mg twice daily (after 90 mg twice daily for 12 months). The results were compared with findings (characteristics of the patients at baseline, outcomes, bleeding) of PEGASUS-TIMI 54 trial and Eu Label. The highrisk groups were represented as follows: multivessel disease 105 pts (82%), diabetes 63 pts (33%), GFR< 60 mL/min 27 pts (14%), history of prior MI 33 pts (17%), >65 year aged 85 pts (45%). Treatment was withdrawn in 7 patients: 3 cases showed atrial fibrillation and were placed on oral anticoagulant drugs, one developed intracranial bleeding, in three patients a temporary withdrawal was due to surgery (1 colon polyposis and 2 cases of bladder papilloma). Chest pain without myocardial infarction occurred in 16 patients (revascularization was required in 9 patients). Dyspnea was present in 15 patients, but was not a cause for discontinuation of therapy. Long term treatment with ticagrelor 60 mg twice daily plus aspirin 100 mg/day showed a favourable benefit/risk profile after ACS. In this study all patients had been given ticagrelor 90 mg twice daily for 12 months and the 60 mg twice daily dosage was started immediately thereafter, unlike PEGASUS-TIMI 54 trial in which it was prescribed within a period ranging from 1 day to 1 year after discontinuation of the 90 mg dose. This makes our results more consistent with current clinical practice. However, a careful outpatient follow-up and constant counseling are mandatory to check out compliance to therapy and adverse side effects.

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