Panic attacks and the dexamethasone suppression test.

Of 51 patients with panic attacks, 11.8% (7.8% with a correction factor) had a positive dexamethasone suppression test. This is significantly lower than the rate for melancholia. This difference suggests that panic attacks and major depression may be associated with different biological mechanisms.

Endogenous anxiety: implications for nosology and treatment.

Clinical and research findings are reviewed in relation to the distinction between endogenous and exogenous anxiety. The single most potent discriminating symptom between the two subtypes is the presence or absence of spontaneous (anxiety) symptom attacks. This concept avoids the diagnostic difficulties that can arise under current systems when patients present with symptoms that fulfill the criteria for multiple anxiety-related diagnosis. Patients in the endogenous category differ from those whose anxiety is reactive in age of onset, clinical course, and response to psychotherapy and medication. Thus, this distinction appears to have clinical merit.

Monoamine oxidase inhibitors: prescription and patient management.

The historical roots of the current avoidance of MAOIs are reviewed. A practical approach to the careful prescription of MAOIs is outlined. Medical contraindications, side effects and their management and drug and food interactions with MAOIs are discussed. With careful patient selection, adequate caution by the physican, and appropriate preparation of the patient, MAOIs are often uniquely effective (as in endogenous anxiety) and have an acceptably low potential for serious toxicity.