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

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.

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

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A.E. Nardi ◽  
A.M. Valença ◽  
R.C. Freire ◽  
F.L. Lopes ◽  
I. Nascimento ◽  
...  
Keyword(s):  
Sexual Dysfunction ◽  
Panic Disorder ◽  
Technological Development ◽  
Treatment Phase ◽  
Term Treatment ◽  
Panic Attacks ◽  
Similar Response ◽  
Long Term Treatment

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.

scholarly journals Adverse life events and coping skills in panic disorder

2004 ◽  
Vol 59 (6) ◽  
pp. 337-340 ◽  
Author(s):  
Mariângela Gentil Savoia ◽  
Márcio Bernik
Keyword(s):  
Panic Disorder ◽  
Life Events ◽  
Stressful Life Events ◽  
Rating Scale ◽  
Coping Skills ◽  
Stressful Events ◽  
Panic Attacks ◽  
Stressful Life ◽  
Life Event ◽  
The Impact

Research literature and clinical experience shows that panic patients are often able to identify stressors that preceded the onset of their first attacks. In this study we investigated the relation between life events, coping skills, and panic disorder. METHODS: Forty-tree panic patients were compared with 29 control subjects regarding the occurrence and the impact of stressful life events in a 1-year period preceding the onset of panic attacks using the Social Readjustment Rating Scale and London Life Event and Difficulty Schedule. Coping skills were measured using the Ways of Coping Questionnaire. RESULTS: No differences were observed between panic patients and controls regarding the number of reported stressful life events in the previous year. Panic patients compared to controls reported loss of social support as the most meaningful class of events significantly more often. In response to stressful situations, panic patients more often used coping skills judged as ineffective. CONCLUSIONS: The present study suggests that the type of life event and the coping skills used in response to them, more than the occurrence of stressful events itself, may be associated with the onset of panic disorder.

scholarly journals Stressful life events are not associated with the development of dementia

2013 ◽  
Vol 26 (1) ◽  
pp. 147-154 ◽  
Author(s):  
Anna Sundström ◽  
Michael Rönnlund ◽  
Rolf Adolfsson ◽  
Lars-Göran Nilsson
Keyword(s):  
Life Events ◽  
Stressful Life Events ◽  
Negative Life Events ◽  
Emotional Adjustment ◽  
Population Based ◽  
Stressful Life ◽  
Emotional Impact ◽  
Population Based Study ◽  
Positive Life Events

ABSTRACTBackground:The impact of stressful life events as a risk factor of dementia diseases is inconclusive. We sought to determine whether stressful negative life events are associated with incidental dementia in a population-based study with long-term follow-up. We also tested the hypothesis that the occurrence of positive life events could mitigate or overcome the possible adverse effects of negative life events on dementia conversion.Methods:The study involved 2,462 dementia-free participants aged 55 years and older. Information on life events was ascertained at baseline from a comprehensive Life Event Inventory, which included 56 questions about specific life events. For each life event, the emotional impact (both positive and negative) and emotional adjustment were asked for.Results:During follow-up, 423 participants developed dementia; of these, 240 developed Alzheimer's disease (AD). Cox regression analysis showed no association between the total number of negative life events and the incidence of dementia when adjusted solely for age and gender (hazard ratio = 0.97, 95% CI = 0.92–1.02), or with multiple adjustments for a range of covariates (hazard ratio = 0.96, 95% CI = 0.91–1.01). Similarly, neither emotional impact nor emotional adjustment to these life events was associated with incident dementia. A separate analysis of AD did not alter the results.Conclusions:The result of this population-based study finds no association between negative or positive life events and dementia. Accordingly, our results reject the hypothesis that stressful life events trigger the onset of dementia diseases.

scholarly journals 0554 Insomnia Disorder Predicts Stressful Life Events in Individuals Who Have Recently Experienced Involuntary Job Loss

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A212-A213
Author(s):  
I Skobic ◽  
G Howe ◽  
P L Haynes
Keyword(s):  
Life Events ◽  
Job Loss ◽  
Stressful Life Events ◽  
Secondary Analysis ◽  
Structured Interview ◽  
Stress Generation ◽  
Stressful Life ◽  
Involuntary Job Loss ◽  
Insomnia Disorder

Abstract Introduction The stress generation hypothesis posits that depressed (versus non-depressed) individuals generate more stressful life events, especially events for which they are at least partly responsible (i.e., dependent events). Insomnia disorder interferes with emotion regulation, potentially leading to impaired decision-making and increased stress generation. We hypothesized that insomnia disorder would lead to an increased number of stressful life events in our sample of adults who have recently experienced involuntary job loss. Methods Assessing Daily Activity Patterns through Occupational Transitions is a longitudinal study examining linkages between job-loss, sleep, obesity, and mental health. We used baseline and 3-month follow-up data from 137 participants who completed the Life Events and Difficulties Schedule, a contextual life event measure. Insomnia disorder was coded yes if participants met ICSD-3 criteria for a current chronic or acute insomnia disorder on the Duke Structured Interview for Sleep Disorders. Covariates included age, gender, and race. Linear and logistic regression were employed to assess changes in number of events over time. Secondary analysis examined the relationship between insomnia and dependent stressful life events specifically. Results When controlling for covariates, insomnia disorder at study baseline predicted the number of stressful life events generated between baseline and 3-month follow-up (β =.60, se=.30, t=1.99, p=.05). Conversely, events at baseline did not predict insomnia disorder at follow-up when controlling for baseline insomnia disorder (OR=.98, CI=.82-1.17). Secondary analysis revealed a trend toward increased generation of dependent events among individuals with insomnia disorder (β =.37, se=.23, t = 1.6, p=.11). Conclusion Our analyses provide preliminary evidence for a causal relationship between insomnia disorder and stress generation. Additional research is needed to replicate and examine the mechanisms behind this relationship. This extension of the stress generation hypothesis may have important implications for harm reduction interventions for insomnia disorder. Support #1R01HL117995-01A1.

Childhood sexual abuse, stressful life events and risk for major depression in women

2004 ◽  
Vol 34 (8) ◽  
pp. 1475-1482 ◽  
Author(s):  
KENNETH S. KENDLER ◽  
JONATHAN W. KUHN ◽  
CAROL A. PRESCOTT
Keyword(s):  
Sexual Abuse ◽  
Major Depression ◽  
Childhood Sexual Abuse ◽  
Life Events ◽  
Stressful Life Events ◽  
Population Based ◽  
Stress Sensitivity ◽  
Stressful Life ◽  
Increased Risk

Background. In animals, early trauma can produce long-lasting changes in sensitivity to the pathogenic effects of stress. To explore whether similar processes occur in humans, we examine whether childhood sexual abuse (CSA) in women alters sensitivity in adulthood to the depressogenic effects of stressful life events (SLEs).Method. A history of CSA was obtained from a population-based sample of 1404 female adult twins. Cox Proportional hazard models were used to predict onsets of episodes of DSM-III-R major depression (MD) in the past year from previously assessed levels of neuroticism (N), CSA and past-year SLEs scored on long-term contextual threat.Results. In the best-fit model, onset of MD was predicted by CSA, SLEs and N. Individuals with CSA (and especially with severe CSA) had both an overall increased risk for MD and a substantially increased sensitivity to the depressogenic effects of SLEs. A ‘dose–response’ relationship between severity of CSA and sensitivity to SLEs was clearer in those with low to average levels of N than in those with high levels of N.Conclusion. As documented with physiological responses to a standardized laboratory stressor, CSA increases stress sensitivity in women in a more naturalistic setting. Both genetic and early environmental risk factors can produce long-term increase in the sensitivity of individuals to depressogenic life experiences.

scholarly journals Impact of stressful life events on the course of panic disorder in adults

2011 ◽  
Vol 134 (1-3) ◽  
pp. 373-376 ◽  
Author(s):  
Ethan Moitra ◽  
Ingrid Dyck ◽  
Courtney Beard ◽  
Andri S. Bjornsson ◽  
Nicholas J. Sibrava ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Life Events ◽  
Stressful Life Events ◽  
Stressful Life

Anxiety Sensitivity and Panic-Related Symptomatology in a Representative Community-Based Sample: A 1-Year Longitudinal Analysis

2008 ◽  
Vol 22 (1) ◽  
pp. 48-56 ◽  
Author(s):  
Brian J. Cox ◽  
Steven Taylor ◽  
Ian P. Clara ◽  
Lance Roberts ◽  
Murray W. Enns
Keyword(s):  
Life Events ◽  
Anxiety Sensitivity ◽  
Stressful Life Events ◽  
Longitudinal Research ◽  
Community Sample ◽  
Panic Attacks ◽  
Stressful Life ◽  
Sensitivity Index ◽  
Community Based ◽  
The Impact

Anxiety sensitivity is the fear of anxiety sensations based on beliefs that they have harmful physical, psychological, or social consequences. Anxiety sensitivity may represent a psychological vulnerability for panic attacks, but much of the research to date has been limited to selective college student or treatment-seeking samples. There is a paucity of research based on representative community-based samples. There is also a lack of longitudinal research in this regard. The current study addressed both of these issues by investigating the impact of anxiety sensitivity in a large community sample (N = 585) assessed longitudinally over a 1-year period. A hierarchical regression model was used to determine whether baseline scores on the Anxiety Sensitivity Index (ASI) could prospectively predict scores on the Beck Anxiety Inventory (BAI), a continuous scale that is largely a measure of panic-related symptomatology. Baseline BAI scores, neuroticism and stressful life events’ main effects, their interaction, and the ASI were all significant predictors of Time 2 BAI scores. The results thereby show that anxiety sensitivity predicts subsequent panic-related symptomatology even after adjusting for the effects of neuroticism, stressful life events, and their interaction.

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