Alprazolam and Exposure for Panic Disorder with Agoraphobia

1994 ◽  
Vol 164 (5) ◽  
pp. 652-659 ◽  
Author(s):  
Metin Başoglu ◽  
Isaac M. Marks ◽  
Cengiz Kiliç ◽  
Richard P. Swinson ◽  
Homa Noshirvani ◽  
...  
Keyword(s):  
Side Effects ◽  
Panic Disorder ◽  
Drug Treatment ◽  
Psychological Treatment ◽  
Illness Severity ◽  
Withdrawal Symptoms ◽  
Severe Withdrawal ◽  
End Of Treatment

Patients with panic disorder plus agoraphobia had 8 weeks of drug treatment (alprazolam or placebo) plus psychological treatment (exposure or relaxation). At the end of treatment at week 8, 40 patients who had become much/very much improved rated how much their gains were attributable to medication or to their own efforts. During the tapering-off to week 16, and treatment-free follow-up to week 43, patients who at week 8 had attributed their gains to medication and felt less confident in coping without tablets had more severe withdrawal symptoms and greater loss of gains than did patients who at week 8 had attributed their gains to their own efforts during treatment. Baseline illness severity, greater age, higher expectations from drug treatment, and more side-effects of drugs during treatment all predicted more external attributions (i.e. to the effect of drugs) but did not independently predict relapse. Patients on alprazolam compared with placebo had more drug attributions. Though drug attributions predicted relapse in both alprazolam and placebo groups, predictions were stronger in the alprazolam group.

Combination of Hormonal and Psychological Treatment for Female Sexual Unresponsiveness: a Comparative Study

1978 ◽  
Vol 133 (4) ◽  
pp. 339-346 ◽  
Author(s):  
Anthony Carney ◽  
John Bancroft ◽  
Andrew Mathews
Keyword(s):  
Drug Therapy ◽  
Side Effects ◽  
Comparative Study ◽  
Factorial Design ◽  
Psychological Treatment ◽  
Controlled Study ◽  
Testosterone Therapy ◽  
End Of Treatment

SummaryThirty-two couples with the presenting problem of female sexual unresponsiveness were treated in a controlled study using a balanced factorial design. Treatment involved a combination of drug therapy and counselling. Half the subjects received testosterone and half diazepam, half received weekly and half monthly counselling. They were assessed before treatment, at the end of treatment and at six months follow-up.Those receiving testosterone did significantly better on a number of behavioural and attitudinal measures than the diazepam group. There were no notable differences in outcome between the two counselling regimes. There were no undesirable side-effects with the testosterone.Further work is needed to establish the indications for testosterone therapy for unresponsive women.

Withdrawal Reactions Associated with Venlafaxine

1998 ◽  
Vol 32 (2) ◽  
pp. 291-294 ◽  
Author(s):  
Gordon Parker ◽  
Jenny Blennerhassett
Keyword(s):  
Single Dose ◽  
Side Effects ◽  
Clinical Picture ◽  
Withdrawal Syndrome ◽  
Withdrawal Symptoms ◽  
Selective Serotonin ◽  
Short Acting ◽  
Severe Withdrawal ◽  
Uptake Inhibitors

Objective: The aim of this paper is to describe discontinuation syndromes associated with abrupt and tapered withdrawal of venlafaxine, and to document that withdrawal symptoms may occur after missing a single dose. Clinical picture: We report on two patients prescribed venlafaxine. One developed a broad range of serious side effects after reaching a dose of 300 mg a day, and a severe withdrawal syndrome (including hallucinations) during a slow taper regime. The second had severe discontinuation symptoms during and aborting a slow taper regime, and described withdrawal responses after missing a single dose of venlafaxine. Conclusions: As for the short-acting selective serotonin re-uptake inhibitors, severe discontinuation reactions may occur with venlafaxine, seemingly marked most distinctly by headache, nausea, fatigue, dizziness and dysphoria, and may make cessation of the drug extremely difficult. Two strategies for addressing the concern are considered.

Alprazolam and Exposure Alone and Combined in Panic Disorder with Agoraphobia

1993 ◽  
Vol 162 (6) ◽  
pp. 776-787 ◽  
Author(s):  
Isaac M. Marks ◽  
Richard P. Swinson ◽  
Metin Başoǧlu ◽  
Klaus Kuch ◽  
Homa Noshirvani ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Combined Treatment ◽  
Randomised Trial ◽  
Treatment Groups ◽  
End Of Treatment ◽  
Group A ◽  
Contrast Group ◽  
Drop Outs ◽  
Cross National

A cross-national randomised trial of alprazolam for chronic panic disorder with agoraphobia was run. Compared with previous trials it had three new features: an exposure therapy contrast group, a six-month treatment-free follow-up, and a low rate of early placebo drop-outs (‘non-evaluables’). The dose of alprazolam was high (5 mg/day). The 154 patients had eight weeks of: alprazolam and exposure (combined treatment); or alprazolam and relaxation (a psychological placebo); or placebo and exposure; or placebo and relaxation (double placebo). Drug taper was from weeks 8 to 16. Follow-up was to week 43. Results were similar at both sites. Treatment integrity was good. All four treatment groups, including double placebo, improved well on panic throughout. On non-panic measures, by the end of treatment, both alprazolam and exposure were effective, but exposure had twice the effect size of alprazolam. During taper and follow-up, gains after alprazolam were lost, while gains after exposure were maintained. Combining alprazolam with exposure marginally enhanced gains during treatment, but impaired improvement thereafter. The new features put previous trials in a fresh light. By the end of treatment, though gains on alprazolam were largely as in previous studies, on phobias and disability they were half those with exposure. Relapse was usual after alprazolam was stopped, whereas gains persisted to six-month follow-up after exposure ceased. Panic improved as much with placebo as with alprazolam or exposure.

scholarly journals Neurocognitive mechanisms of d-cycloserine augmented single-session exposure therapy for anxiety

2019 ◽  
Author(s):  
Andrea Reinecke ◽  
Alecia Nickless ◽  
Michael Browning ◽  
Catherine J. Harmer
Keyword(s):  
Panic Disorder ◽  
Anxiety Disorders ◽  
Exposure Therapy ◽  
Psychological Treatment ◽  
Self Report ◽  
Clinical Effects ◽  
Single Session ◽  
Threat Bias ◽  
Fearful Faces

AbstractObjectiveDrugs targeting the N-Methyl-D-aspartic acid (NMDA) system and the ability to learn new associations have been proposed as potential adjunct treatments to boost the success of exposure therapy for anxiety disorders. However, the effects of the NMDA partial agonist d-cycloserine on psychological treatment have been mixed. We investigated potential neurocognitive mechanisms underlying the clinical effects of d-cycloserine-augmented exposure, to inform the optimal combination of this and similar agents with psychological treatment.MethodsUnmedicated patients with panic disorder were randomised to single-dose d-cycloserine (250mg; N=17) or matching placebo (N=16) 2hrs before one session of exposure therapy. Neurocognitive markers were assessed one day after treatment, including reaction-time based threat bias for fearful faces and amygdala response to threat. Clinical symptom severity was measured using self-report and clinician-rated scales the day before and after treatment, and at 1- and 6-months follow-up. Analysis was by intention-to-treat.ResultsOne day after treatment, threat bias for fearful faces and amygdala threat response were attenuated in the drug compared to the placebo group. Lower amygdala magnitude predicted greater clinical improvement during follow-up across groups. D-cycloserine led to greater clinical recovery at 1-month follow-up (d-cycloserine 71% versus placebo 25%).DiscussionD-cycloserine-augmented single-session exposure therapy reduces amygdala threat response, and this effect predicts later clinical response. These findings highlight a neurocognitive mechanism by which d-cycloserine may exert its augmentative effects on psychological treatment and bring forward a marker that may help understand and facilitate future development of adjunct treatments with CBT for anxiety disorders. (D-cycloserine Augmented CBT for Panic Disorder; clinicaltrials.gov;NCT01680107)

BRIEF PSYCHOLOGICAL TREATMENT FOR THE RELIEF OF PANIC DISORDER

2002 ◽  
Vol 30 (4) ◽  
pp. 423-430 ◽  
Author(s):  
Karin Elsesser ◽  
Angelika Mosch ◽  
Gudrun Sartory
Keyword(s):  
Treatment Outcome ◽  
Panic Disorder ◽  
Cognitive Therapy ◽  
Psychological Treatment ◽  
Management Training ◽  
Clinical Change ◽  
Treatment Groups ◽  
Cognitive Behavioural ◽  
Before And After

This study compared complaints management training and cognitive therapy (reattribution) in treating panic disorder. Both treatment groups received three sessions with initial psychoeducation. Thirty patients with panic disorder took part in the study. Assessments were carried out before and after treatment and again at a 4-week follow-up. Both groups showed similarly significant improvements and maintenance of the clinical change over the follow-up period. It is concluded that the initial psychoeducation, which conveyed to patients the cognitive-behavioural model of panic disorder, contributed to the treatment outcome.

scholarly journals An open trial of individualized face-to-face cognitive behavior therapy for psychological distress in parents of children after end of treatment for childhood cancer including a cognitive behavioral conceptualization

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e4570 ◽  
Author(s):  
Lisa Ljungman ◽  
Martin Cernvall ◽  
Ata Ghaderi ◽  
Gustaf Ljungman ◽  
Louise von Essen ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Childhood Cancer ◽  
Psychological Treatment ◽  
Cognitive Behavioral ◽  
Depression And Anxiety ◽  
Face To Face ◽  
The Core ◽  
End Of Treatment ◽  
Post Assessment

ObjectiveA subgroup of parents of children who have been treated for childhood cancer report high levels of psychological distress. To date there is no empirically supported psychological treatment targeting cancer-related psychological distress in this population. The aim of the current study was to test the feasibility and preliminarily evaluate the effect of individualized face-to-face cognitive behavior therapy (CBT) for parents of children after the end of treatment for childhood cancer. A secondary aim was to present a cognitive behavioral conceptualization of cancer-related distress for these parents.MethodsAn open trial was conducted where 15 parents of children who had completed successful treatment for cancer three months to five years earlier and who reported psychological distress related to a child’s previous cancer disease were provided CBT at a maximum of 15 sessions. Participants were assessed at baseline, post-intervention, and three-month follow-up using self-reported psychological distress (including posttraumatic stress symptoms (PTSS), depression, and anxiety) and the diagnostic Mini-International Neuropsychiatric Interview. Feasibility outcomes relating to recruitment, data collection, and delivery of the treatment were also examined. Individual case formulations for each participant guided the intervention and these were aggregated and presented in a conceptualization detailing core symptoms and their suggested maintenance mechanisms.ResultsA total of 93% of the participants completed the treatment and all of them completed the follow-up assessment. From baseline to post-assessment, parents reported significant improvements in PTSS, depression, and anxiety with medium to large effect sizes (Cohen’sd= 0.65–0.92). Results were maintained or improved at a three-month follow-up. At baseline, seven (47%) participants fulfilled the diagnostic criteria for major depressive disorder and four (29%) fulfilled the criteria for posttraumatic stress disorder, compared to none at a post-assessment and a follow-up assessment. The resulting cognitive behavioral conceptualization suggests traumatic stress and depression as the core features of distress, and avoidance and inactivity is suggested as the core maintenance mechanisms.ConclusionThe treatment was feasible and acceptable to the participants. Significant improvements in distress were observed during the study. Overall, results suggest that the psychological treatment for parents of children after end of treatment for childhood cancer used in the current study is promising and should be tested and evaluated in future studies.

scholarly journals Treating winter depressive episodes in bipolar disorder: an open trial of light therapy

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Lotte J. E. van Hout ◽  
Lisette E. P. Rops ◽  
Claudia J. P. Simons
Keyword(s):  
Bipolar Disorder ◽  
Side Effects ◽  
Depressive Symptomatology ◽  
Light Therapy ◽  
Open Trial ◽  
Winter Depression ◽  
End Of Treatment ◽  
Depressive Episodes ◽  
Therapy Protocol

Abstract Background Light therapy has been used to treat winter depression in bipolar disorder, although the dose, duration, and timing of treatment have differed. The present study is an open trial of light therapy for depressive episodes in autumn/winter using a Dutch protocol specific for patients with a bipolar disorder. Methods Data were collected for the seasons September–April 2017–2018 and September–April 2018–2019. In total, 58 patients received light therapy for a minimum of 7 days and a maximum of 21 days; there was a follow-up measurement after two weeks. Outcomes were quick inventory of depressive symptomatology (QIDS) scores and side effects. Results QIDS scores were significantly lower at the last day of therapy (B = − 6.00, p < 0.001) and 2 weeks after the end of treatment (B = − 6.55, p < 0.001) compared with pre-intervention. Remission (QIDS ≤ 5) was reached in 55% of the treatments and response (50% symptom reduction) in 57% of the treatments. Side effects were mild; two hypomanic periods occurred. Conclusions The Dutch light therapy protocol for patients with a bipolar disorder may be effective in treating a seasonal depression and side effects are mild. Light therapy deserves a prominent place in the treatment because effects may be large and quick.

scholarly journals COMPARISON BETWEEN TWO INTENSE PULSED LIGHT DEVICES USED FOR PHOTOEPILATION

2019 ◽  
pp. 1-3
Author(s):  
Honório Sampaio Menezes ◽  
Roberto Chacur ◽  
Simone Merceo Bacchi Cirino ◽  
Miguel D'Avilla Sobrinho ◽  
Nívea Maria Bordin da Silva Chacur
Keyword(s):  
Patient Satisfaction ◽  
Side Effects ◽  
Intense Pulsed Light ◽  
Hair Removal ◽  
Pulsed Light ◽  
Hair Density ◽  
Patient Satisfaction Scores ◽  
End Of Treatment

Background: Unwanted hair growth is a common aesthetic problem. Intense pulsed light hair removal has emerged as a leading treatment option for long-term depilation. Material and methods: Patients with phototypes I to III (n = 800) were subjected to 4 regular sessions (n=3200) of intense pulsed light, with 2 months follow-up at the end of treatment. Two devices (Silk'n, and Rejuvene) were analyzed about adverse effects and satisfaction. Observation and results: This study of 3.200 ILP sessions did not show any serious side effects and the number of side effects was minimal (8.75% to 10.5%). Patient satisfaction was over 90%. Both devices provided a similar and signicant reduction in hair density. Conclusions: Both tested sources proved its safety and efcacy for hair removal. Patient satisfaction scores were in agreement with the treatment efcacy. The incidence of side effects has no difference between devices. Axillary bromhidrosis was an unexpected side effect.

Comparative and Non-Comparative Studies of the Efficacy and Tolerance of Tioconazole Cream 1% versus Another Imidazole and/or Placebo in Neonates and Infants with Candidal Diaper Rash and/or Impetigo

1987 ◽  
Vol 15 (1) ◽  
pp. 23-31 ◽  
Author(s):  
D. L. Gibbs ◽  
P. Kashin ◽  
S. Jevons
Keyword(s):  
Side Effects ◽  
Mycological Cure ◽  
Cure Rate ◽  
Treatment Area ◽  
Disease Symptoms ◽  
End Of Treatment ◽  
Long Term Follow Up ◽  
Neonates And Infants

Eleven open multicentre studies were conducted to evaluate the efficacy of tioconazole cream 1% as a treatment for diaper rash with or without fungal ( Candida) involvement, or impetigo in neonates and infants. In the dermal candidiasis/diaper rash group, 320 patients had either tioconazole ( n = 220), a comparative imidazole ( n = 43), or vehicle cream ( n = 57) applied to the affected area twice daily. Twenty-one impetigo patients had only tioconazole cream 1% applied three times daily to lesions. The overall cure rate (patients with both clinical and mycological cure) at the end of treatment for tioconazole treated patients was 78%, for the comparative imidazole group it was 76% and for vehicle cream it was 39%. At the long-term follow-up evaluation approximately 6 weeks after treatment for patients with diaper rash, the overall cure rate was about the same in both tioconazole- and comparative imidazole-treated patients (87% and 90%, respectively), and 14% in patients using vehicle cream. Side-effects were coincident with disease symptoms and consisted primarily of erythema localized to the treatment area; they occurred in 5.4% (13/241) of the patients who received tioconazole and in 21% (9/43) of the patients who received comparative imidazole (econazole or miconazole). No side-effects were reported in this open study for the 57 patients who used vehicle cream. The results of these studies show that tioconazole cream 1% is safe and effective for the treatment of neonates and infants with dermal candidiasis, diaper rash and impetigo.

The DoloTest® in a specialized headache center among patients receiving psychological treatment. A pilot study

2018 ◽  
Vol 18 (3) ◽  
pp. 431-439
Author(s):  
Marianne Kromann Nielsen ◽  
Maria Lurenda Westergaard ◽  
Dorte Kjeldgaard Nielsen ◽  
Trine Zimmer ◽  
Rigmor Hoejland Jensen
Keyword(s):  
Psychological Treatment ◽  
Monitoring Instrument ◽  
Qualitative Feedback ◽  
Strenuous Activity ◽  
End Of Treatment ◽  
Related Quality ◽  
Health Related ◽  
Headache Center

Abstract Background The DoloTest is a newer health-related quality of life (HRQoL) monitoring instrument for pain, not yet validated for headache. Aims To examine the usefulness of the DoloTest in a specialized headache center. Methods The sample consisted of patients referred to psychologists from the Danish Headache Center (DHC) for whom the test was carried out at start of, end of, and 6 months after treatment. Points on eight scales of the test were measured (values ranged from 0 to 100), then totaled (0 to 800). Scores were analyzed using Wilcoxon Signed Ranks test. The correlation between headache days and DoloTest scores were computed using linear regression adjusted for age. Qualitative feedback on usefulness of the test were gathered from psychologists. Results Of 135 patients included, 105 completed treatment. On average, headache days decreased from 22 days per month at start of treatment (SD 9.0, median 29) to 18 days at end of treatment (SD 10.8, median 19) (p<0.001). At end of treatment, DoloTest scores improved for pain (p=0.015) and reduced energy and strength (p=0.034). At 6 months’ follow-up, total scores improved (p=0.034), as well as component scores for pain (p=0.010), problems with strenuous activity (p=0.045) and reduced energy and strength (p=0.012). Correlation between reduced headache days and improved DoloTest scores was 0.303 (p=0.028). Psychologists found the test useful in monitoring and evaluating patients. Conclusions The DoloTest was useful for psychoeducation and for monitoring the effect of headache treatment. Implications The DoloTest is a potential HRQoL monitoring instrument for headache patients. We recommend further validation studies.

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