Serum anti-neural immunoreactivity in patients with fibromyalgia. Preliminary study.

INTRODUCTION: Fibromyalgia (FM) is a non-degenerative syndrome characterized by generalized, chronic musculoskeletal pain, as well as mood, memory and sleep disorders. OBJECTIVE: To search for serum anti-neural antibodies (ANeuA) in patients with FM (FMP) in order to rule out autoimmune etiology. METHODS: The Fibromyalgia Impact Questionnaire (FIQ) and Beck's depression inventory (BDI) were applied. Immunoreactivity and the target recognized on the sera from FMPs and healthy subjects were analyzed by indirect immunofluorescence and Western blot. RESULTS: Both FIQ and BDI values were significantly altered in FMPs in comparison with those of controls (FIQ, 70 ± 25 vs. 12 ± 12, p < 0.0001; BDI, 17 ± 11 vs. 4 ± 3, p < 0.0002). Only five out of 15 FMP sera had ANeuA specifically directed against neurons from the medial vestibular nucleus of the brainstem. This immunoreactivity was not detected in the sera from the 14 controls. ANeuA recognized a 45 kDa protein. CONCLUSIONS: 30% of FMPs have ANeuA that have not been described before. In future studies, it will be necessary for anti-neural immunoreactivity to be determined in a larger sample and for the role of ANeuAs in the pathophysiology of FM to be established.

INTRODUCCIÓN: La fibromialgia (FM) es un síndrome no degenerativo caracterizado por dolor musculoesquelético crónico y generalizado; así como por alteraciones anímicas, de memoria y sueño. OBJETIVO: Buscar anticuerpos antineurales (AANeu) séricos en pacientes con FM para descartar etiología autoinmune. MÉTODOS: Se aplicó el Cuestionario de Impacto en Fibromialgia (FIQ) y el Inventario de Depresión de Beck (BDI). La inmunorreactividad y el blanco reconocido por los sueros de pacientes con FM y sujetos sanos se analizó con inmunofluorescencia indirecta y Western blot. RESULTADOS: Los valores de FIQ y BDI estuvieron significativamente alterados en los pacientes con FM, en comparación con los de los controles (FIQ, 70 ± 25 versus 12 ± 12, p < 0.0001; BDI, 17 ± 11 versus 4 ± 3, p < 0.0002). Solo cinco de 15 sueros de pacientes con FM tuvieron AANeu dirigidos específicamente contra las neuronas del núcleo vestibular medio del tronco encefálico; estos no se detectaron en los 14 sueros de los controles. Los AANeu reconocieron una proteína de 45 kDa. CONCLUSIONES: El 30 % de los pacientes con FM tiene AANeu no descritos antes. Será necesario evaluar la inmunorreactividad antineural en una muestra más grande y determinar el papel de los AANeu en la fisiopatología de la FM.

Screening of SERT and p11 mRNA Levels in Airline Pilots: A Translational Approach.

Airline pilots are frequently exposed to numerous flights per week, changes in their circadian rhythms, and extended periods away from home. All these stressors make pilots susceptible to developing psychiatric disorders. Recently, emphasis has been placed on the need for molecular tests that help in the diagnosis of depression. The genes SLC6A4 and S100A10 encode serotonin transporter (SERT) and p11 protein, respectively. Their expression has been frequently associated with stress and depression. In this work, we quantified, by quantitative PCR, the expression of SERT and p11 in peripheral mononuclear cells of airline pilots compared to patients with depression and healthy volunteers. Moreover, by mass spectrometry, we quantified the serum serotonin levels in the same three groups. We found that SERT and p11 were overexpressed in the mononuclear cells of airline pilots and depressed patients compared to healthy volunteers. Although serum serotonin was not different between healthy volunteers and airline pilots, a decreasing trend was observed in the latter. As expected, serum serotonin in the patients was significantly lower. Alterations in SERT and p11 in airline pilots could be related to professional stress, a condition that could potentially affect their long-term mental health.

Inmunorreactividad antineural sérica en pacientes con fibromialgia. Estudio preliminar / Serum anti-neural immunoreactivity in patients with fibromyalgia. Preliminary study

Resumen Introducción: La fibromialgia (FM) es un síndrome no degenerativo caracterizado por dolor musculoesquelético crónico y generalizado; así como por alteraciones anímicas, de memoria y sueño. Objetivo: Buscar anticuerpos antineurales (AANeu) séricos en pacientes con FM para descartar etiología autoinmune. Métodos: Se aplicó el Cuestionario de Impacto en Fibromialgia (FIQ) y el Inventario de Depresión de Beck (BDI). La inmunorreactividad y el blanco reconocido por los sueros de pacientes con FM y sujetos sanos se analizó con inmunofluorescencia indirecta y Western blot. Resultados: Los valores de FIQ y BDI estuvieron significativamente alterados en los pacientes con FM, en comparación con los de los controles (FIQ, 70 ± 25 versus 12 ± 12, p < 0.0001; BDI, 17 ± 11 versus 4 ± 3, p < 0.0002). Solo cinco de 15 sueros de pacientes con FM tuvieron AANeu dirigidos específicamente contra las neuronas del núcleo vestibular medio del tronco encefálico; estos no se detectaron en los 14 sueros de los controles. Los AANeu reconocieron una proteína de 45 kDa. Conclusiones: El 30 % de los pacientes con FM tiene AANeu no descritos antes. Será necesario evaluar la inmunorreactividad antineural en una muestra más grande y determinar el papel de los AANeu en la fisiopatología de la FM.

Abstract Introduction: Fibromyalgia (FM) is a non-degenerative syndrome characterized by generalized, chronic musculoskeletal pain, as well as mood, memory and sleep disorders. Objective: To search for serum anti-neural antibodies (ANeuA) in patients with FM (FMP) in order to rule out autoimmune etiology. Methods: The Fibromyalgia Impact Questionnaire (FIQ) and BECK’s depression inventory (BDI) were applied. Immunorreactivity and the target recognized on the sera from FMPs and healthy subjects were analyzed by indirect immunofluorescence and Western blot. Results: Both FIQ and BDI values were significantly altered in FMPs in comparison with those of controls (FIQ, 70 ± 25 vs. 12 ± 12, p < 0.0001; BDI, 17 ± 11 vs. 4 ± 3, p < 0.0002). Only five out of 15 FMP sera had ANeuA specifically directed against neurons from the medial vestibular nucleus of the brainstem. This immunoreactivity was not detected in the sera from the 14 controls. ANeuA recognized a 45 kDa protein. Conclusions: 30% of FMPs have ANeuA that have not been described before. In future studies, it will be necessary for anti-neural immunoreactivity to be determined in a larger sample and for the role of ANeuAs in the pathophysiology of FM to be established.

Evaluation of quality of life and depression in patients with rheumatoid arthritis in a General Hospital / Evaluación de la calidad de vida y depresión en pacientes con artritis reumatoide en un hospital general

abstract Introduction: Rheumatoid arthritis (RA) is a chronic, inflammatory, and multisystemic disease that has an impact on the quality of life and is associated with depressive symptoms. Objectives: To evaluate the quality of life, overall health status, and depression in patients with RA. Patients and methods: A cross-sectional study was conducted in the outpatient Rheumatology Outpatient Department of a General Hospital in Mexico City. All patients met the criteria for rheumatoid arthritis according to the American Rheumatism Association, 1987. Clinical and sociodemographic characteristics were recorded. Four measurement tools were used: Arthritis Impact Measurement Scale (AIMS), Dunbar Questionnaire, a Visual Analog Scale, and the Beck Depression Inventory. Results: A total of 43 patients aged ≥ 18 years were evaluated. The highest AIMS scores were in social activity (6.49±1.93), pain (4.70±2.04), depression (4.70±2.23), and physical activity (4.03±2.10). The mean score with the Dunbar questionnaire was 6.48±1.87, the mean Visual Analog Scale score was 69.41±24.67, and the mean of the Beck inventory was 15.74±9.85. Conclusions: The presence of anxiety and depression has an impact on the quality of life of patients with RA, but not on the presence of comorbidity or disease activity. Depressive symptoms are common in patients with RA, and should therefore be considered when evaluating this rheumatological disease.

resumen Introducción: La artritis reumatoide (AR) es una enfermedad que afecta la calidad de vida de quienes la padecen y se asocia a sintomatologia depresiva. Objetivos: Evaluar la calidad de vida, el estado global de salud y depresión en pacientes con AR. Pacientes y métodos: Se trata de un estudio transversal y comparativo. Se incluyeron 43 adultos mayores, ≥ de 18 anos, con diagnóstico de AR según los criterios de la American Rheumatism Association de 1987, que acudían al servicio de consulta externa de Reumatologia de un hospital general en la ciudad de México. Se determinaron características clínicas y sociodemográficas. Se les aplicaron 4 índices: Escala de Medición del Impacto de la Artritis (AIMS), Cuestionario de Dunbar, Escala Análoga Visual y el Inventario de Depresión de Beck. Resultados: Se evaluaron 43 pacientes mayores de 18 anos, en su mayoría del sexo femenino. Para la AIMS, las puntuaciones más altas fueron en actividad social (6, 49 ± 1, 93), dolor (4,70 ± 2,04), depresión (4,70 ± 2,23) y actividad física (4,03 ± 2,10). Para el cuestionario de Dunbar la puntuación promedio fue de 6, 48 ± 1, 87, en la escala análoga visual la puntuación media fue de 69,41 ± 24,67, finalmente, en el inventario de Beck el promedio fue de 15,74 ±9,85. Conclusiones: La presencia de ansiedad y depresión se relacionan con la calidad de vida de los pacientes con AR mas no con la presencia de comorbilidad o actividad de la enfermedad. Los síntomas depresivos son comunes en pacientes con AR por lo que deben considerarse al evaluar esta enfermedad reumatológica.

Disminución del influjo parasimpático en fibromialgia: Su relación con la Psiquiatría en un centro especializado de referencia nacional / Reduction of the parasympathetic influx in fibromyalgia: Its relationship with Psychiatry in a national referral specialized center

Antecedentes La fibromialgia (FM) se caracteriza por dolor crónico generalizado, fatiga, alteraciones del sueño, depresión, ansiedad y disautonomía (hiperactividad simpática). Objetivo Comparar la variabilidad de la frecuencia cardiaca (VFC) en mujeres: 20 pacientes con FM vs. 20 controles, mediante Holter de 24 hrs. Método La medición consistió en segmentos de cinco minutos. El dominio de la frecuencia se determinó por logaritmo natural de la razón LF/HF (Low/High Frecuencies). Se utilizó ANOVA simple para dos grupos de variables dimensionales. Resultados El rango de edad fue de 30 a 60 años. Nueve mujeres presentaron comorbilidad psiquiátrica: depresión (77.7%) y ansiedad (22.3%). Hubo diferencias (F=24.45, p<0.0001) en LF/HF entre los grupos en la fase nocturna del registro (22 hrs a 2 am), mostrándose mayor activación simpática en las pacientes. En el índice SDNN (desviación estándar de intervalos entre latidos) existieron diferencias significativas en 9 de 12 periodos del registro. En el índice pNN50 (porcentaje de intervalos que difieren en más de 50 milisegundos), el grupo control mostró valores más altos de 6 a 12 hrs. La variación nocturna se observó de 22 hrs. (F=22.37, p=0.0001) hasta las 6 am (F=30.27, p=0.0001). El indicador rMSSD (raíz cuadrada de la media de las diferencias de la frecuencia cardiaca) mostró valores más altos para el grupo control desde las 22 hrs. (F=67.71, p=0.0001) hasta las 6am (F=80.35, p=0.0001). Discusión y conclusión Los resultados reflejan la disminución del influjo parasimpático en las pacientes con FM. Esto confirma la participación del sistema nervioso parasimpático en la fisiopatología de la FM.

Background Fibromyalgia (FM) is characterized by chronic widespread pain, fatigue, sleep disturbances, depression, anxiety and dysautonomia (sympathetic hyperactivity). Objective To compare the heart rate variability (HRV) in women: 20 patients with FM vs. 20 controls by Holter 24 hrs. Method The measurement consisted of segments of five minutes. The frequency domain is determined by the natural logarithm of the LF/HF (Low/ High Frecuencies) reason. Simple ANOVA was used for two groups of dimensional variables. Results The age range was 30-60 years. Nine presented psychiatric comorbidity: depression (77.7%) and anxiety (22.3%). There were differences (F = 24.45, p <0.0001) in LF/HF between groups in the nocturnal phase of registration (22 pm to 2 am) showing increased sympathetic activation in patients. In the SDNN index (standard deviation of intervals between heartbeats) there were significant differences on December 9 periods of record. In pNN50 index (percentage of intervals which differ by more than 50 milliseconds), the control group showed higher values of 6 to 12 hrs. Nocturnal variation was observed in 22 hrs (F = 22.37, p = 0.0001) until 6am (F = 30.27, p = 0.0001). The rMSSD indicator (square root of the mean of the differences in heart rate) showed higher values for the control group from 22 hrs (F = 67.71, p = 0.0001) until 6am (F = 80.35, p = 0.0001). Discussion and conclusion The results reflect the decreased parasympathetic influence in patients with FM. This confirms the participation of parasympathetic nervous system in the pathophysiology of FM.

Estudio preliminar de la expresión del mensaje genético del transportador de serotonina en células mononucleares de sangre periférica en pacientes con dependencia al alcohol con y sin depresión mayor comórbida / Preliminary study of the genetic message expression of serotonin transporter in peripheral blood mononuclear cells in patients with alcohol dependence with and without comorbid major depression

The 2008 National Addiction Survey demonstrated the existence of 39 million alcohol drinkers, of whom 4.2 million are excessive drinkers and 4.8 million are alcohol dependents. No reports of the comorbidity of psychiatric disorders in alcohol consumers in our country exist. Nevertheless, 40% to 50% of alcohol-dependent patients from other countries have some sort of psychiatric disorder, such as major depression. Serotonergic function is a key mediator of mood states, impulsiveness, and addictive behavior, including alcohol consumption. Several studies have noted alterations in the serotonergic system in alcoholics (as demonstrated by an increase in the shooting frequency of raphe nuclei serotonergic neurons, an increase in serotonin levels in the accumbens nuclei, and a loss in serotonergic neurons in the raphe nuclei) and depressed patients (decreases in the density of serotonin reuptake transporter [5-HTT] and serotonin levels [5-HT]). Clinical studies have documented that excessive alcohol intake reduces 5-HT levels and that this condition potentiates psychiatric disorders, such as anxiety, major depression, and alcohol dependence. These data demonstrate an association between alcoholism, psychiatric disorders, and alcohol dependence. By molecular biology techniques, genetic risk factors have been identified and candidate genes, such as 5-HTT, have been selected. This gene is associated with a greater susceptibility to onset of alcohol-dependence and major depression. The 5-HTT gene lies in the SLC6A4 locus of 1 7q1 1.1-q12 and encodes a 600-amino-acid integral membrane protein. This transporter regulates serotonergic neurotransmission through removal of 5-HT from the synaptic space. Pharmacological research has shown that selective reuptake inhibitors (5-HTT blockers) reduce alcohol intake in alcohol-dependent and major depression patients. Serotonergic system receptors, such as 5-HTT, 5-HT1, and 5-HT2, are expressed in nervous system and immune system cells; thus it is likely that both systems have functional similarities. Due to this property, peripheral blood mononuclear cells (PBMCs) can be used to research neurodegenerative, psychiatric, and alcohol dependence disorders. The aim of this study was to assess 5-HTT expression levels in the PBMCs from alcohol-dependent patients and patients with comorbid alcohol-dependence and major depression disorder. Materials and methods The Outpatient Consultative Service from the Centro de Ayuda a Alcohólicos y Familiares (CAAF) and the Centro de Alcohólicos y Drogadictos <

La Encuesta Nacional de Adicciones 2008 reportó que en México existen 39 millones de personas que consumen alcohol y 4.8 millones presentan dependencia. A nivel mundial varios estudios indican que los pacientes con dependencia al alcohol (40 a 50%) presentan comorbilidad con algún tipo de padecimiento psiquiátrico. La función serotoninérgica es un mediador clave en los estados de ánimo, la impulsividad y las conductas adictivas, entre ellas el consumo de alcohol. Se ha reportado que el consumo excesivo de alcohol etílico disminuye los niveles de serotonina, aumenta la frecuencia de disparo de las neuronas serotoninérgicas en el núcleo del rafé y aumenta los niveles de serotonina en el núcleo accumbens. Las técnicas de biología molecular han permitido identificar factores de riesgo genético y se han seleccionado genes candidatos del sistema serotoninérgico, siendo uno de ellos el gen para el transportador de serotonina (5-HTT), el cual se ha demostrado que se encuentra asociado tanto a una mayor susceptibilidad para el establecimiento de la dependencia al alcohol como a la depresión mayor. Los receptores del sistema serotoninérgico como el 5-HTT, el 5-HT1 y el 5-HT2 se expresan tanto en las células del Sistema Nervioso como en las células del sistema inmunológico, lo que sugiere una similitud funcional de ambos sistemas. Es por ello que las células mononucleares de sangre periférica (PBMC) han sido utilizadas como un modelo de estudio en los trastornos de dependencia al alcohol y en los psiquiátricos. El objetivo de este estudio fue evaluar los niveles de expresión del gen 5-HTT en células mononucleares de sangre periférica de pacientes con dependencia al alcohol con y sin depresión mayor comórbida. En el Servicio de Consulta Externa del Centro de Ayuda a Alcohólicos y Familiares (CAAF) y en el Centro de Alcohólicos y Drogadictos <

Evaluación de funciones cognitivas: atención y memoria en pacientes con trastorno de pánico / Cognitive function evaluation: attention and memory in panic disorder patients

Evidence from recent studies about the epidemiology of panic disorder (PD) indicates that it is present in 4.7% of general population. In Mexico City, 2.9% of females and 1.9% of males are affected by this disease. Due to the incidence cited above, it is considered an important mental health problem that has impacted social, labor and familiar areas. On the other hand, PD is frequently present in comorbidity with other disorders like major depression, social phobia and generalized anxiety disorder. Moreover, in some cases, it may lead to a suicide risk. PD is characterized by recurrent, unexpected panic attacks, and is commonly associated with agoraphobia. A panic attack is defined as a discrete period of fear or discomfort that includes physical, cognitive and behavioral symptoms. Physical symptoms comprise short breath, palpitations, sweating, dizziness, gastrointestinal discomfort, and chest pain. Cognitive symptoms are associated with catastrophic interpretation of bodily sensations; behavioral symptoms are mainly avoidant of different places, situations and actions that patient had associated with fear of loss of control. In the past few years there has been a growing interest in the neuropsychology of anxiety disorders. Neuropsychological evaluation is relevant because it implies an objective assessment of the cognitive and behavioral abilities and weaknesses that make possible the prediction of the course of the disorder and the effects of treatment modalities. One of the most important contributions of neuropsychological evaluation is the identification of stable patterns of cognitive profiles of a specific disorder considered as neurocognitive endophenotypes. Some recent studies have demonstrated the relationship between neuropsychological alterations and anxiety; nevertheless, most of them were observed in obsessive-compulsive disorder patients. On the other hand, studies examining neuropsychological functioning in PD patients are scarce and report conflicting results. The main objective of the present study was to evaluate whether PD patients with and without agoraphobia, who attended the National Institute of Psychiatry <

De acuerdo a Kessler, el 4.7% de la población general presenta Trastorno de Pánico (TP) a lo largo de la vida, específicamente en la Ciudad de México el TP tiene una prevalencia en la vida de 1.1% en los hombres y de 2.5% en las mujeres, por lo que se considera un problema de gran relevancia. Aunado a esto, uno de los grandes problemas de este padecimiento es el alto índice de comorbilidad que presenta con otros trastornos psiquiátricos como la depresión mayor, la fobia social, el trastorno por ansiedad generalizada y el abuso de sustancias. De acuerdo con el DSM-IV-TR, el TP se caracteriza por la aparición de crisis de angustia inesperadas y recurrentes, inquietud persistente por la posibilidad de tener más crisis, preocupación por las implicaciones de las mismas o sus consecuencias y/o un cambio significativo del comportamiento relacionado con ellas. La evaluación neuropsicológica es relevante, ya que a través de ésta es posible obtener una valoración objetiva que permite conocer las habilidades y déficits cognoscitivos y conductuales de los pacientes con trastornos psiquiátricos para hacer una predicción sobre el curso de la enfermedad, elegir el tipo de tratamiento de forma objetiva, identificar patrones estables de déficits neuropsicológicos así como establecer estrategias que mejoren el pronóstico del trastorno. Diversos estudios han demostrado recientemente la relación entre algunas alteraciones neuropsicológicas y la ansiedad; sin embargo, la mayoría de éstos se han centrado en el trastorno obsesivo-compulsivo. Aunado a esto, los resultados encontrados en investigaciones que han evaluado las funciones cognitivas en el TP, no han sido consistentes. El objetivo del presente estudio fue determinar si existen déficits neuropsicológicos en pacientes diagnosticados con TP con o sin agorafobia que acudieron al servicio de preconsulta del Instituto Nacional de Psiquiatría Ramón de la Fuente, en comparación con sujetos control en los dominios de atención, memoria y funciones ejecutivas. Se seleccionaron dos grupos: uno de 24 sujetos diagnosticados con TP, de acuerdo al DSM-IV-TR, sin tratamiento farmacológico y/o psicoterapéutico previo; y otro de 24 sujetos sanos comparados formando pares por sexo, edad y escolaridad con el primero. Se les aplicó una batería neuropsicológica (Neuropsi Atención y Memoria) que evalúa orientación, atención y concentración, memoria de trabajo, memoria verbal y visual, y funciones ejecutivas y motoras. El Neuropsi Atención y Memoria cuenta con normas obtenidas en la población mexicana, considerando la edad y la escolaridad. Las diferencias en el desempeño cognitivo entre el grupo control y el grupo con TP fueron analizadas por medio de un Análisis de Varianza (con p<0.05). Los resultados mostraron que los sujetos con TP puntuaron significativamente más bajo que los controles en el puntaje total de atención y memoria, en el puntaje del total de atención y funciones ejecutivas, y el total de memoria. El análisis de las subpruebas específicas reveló déficits en la memoria verbal, la memoria visoespacial inmediata y la evocada, y en diversas funciones ejecutivas: formación de categorías, fluidez verbal semántica y fonológica, y fluidez no verbal. Los hallazgos encontrados en este estudio apoyan la noción de que la ansiedad (específicamente el TP) afecta la memoria verbal y la visoespacial así como las funciones ejecutivas. Los pacientes con TP mostraron alteraciones significativas en tareas que requieren de la capacidad de cambiar de foco de atención, flexibilidad en los procesos cognitivos, capacidad de inhibir respuestas inadecuadas, memoria a corto plazo y memoria de trabajo.

Tratamiento psicofisiológico y conductual del trastorno de ansiedad

resumen está disponible en el texto completo

Abstract: Panic disorder is a complex phenomenon according to its biochemical and psychosocial etiology. Therapeutic interventions of panic disorder are aimed to promote effectiveness through the combined use of medication and behavioral cognitive therapy. Anxiety is a normal human response. Moderate levels of anxiety are well accepted because they act as an aid to improve performance, and high levels of anxiety are experienced as normal if they are consistent with the demands of the situation. Persons with anxiety disorders complain of experiencing anxiety too often but they seek help also to overcome fears they recognize as irrational and intrusive. From a psychological point of view, behavioral cognitive techniques -such as hyperventilation control, exposure, and cognitive therapy- and structured problem solving have been successful in the treatment of the symptoms associated to anxiety. It is worth to emphasize that graded exposure is perhaps the most powerful technique assisting patients to overcome fearful situations. Cognitions are also important because it has been found that panic attacks occur when people process information in the external environment, as well as internal somatic stimuli, as though they were threatening experiences. In other words, they feel they have no control over their sensations. Panic attacks prevalence in Mexico City is 1.1% in men and 2.5% in women. It is more frequent among 25-to 34- year old single men and married women, with an average scholarity between 7 and 9 years. From a biological point of view, it is suggested that the etiology of panic attacks involves the participation of the serotonergic and adrenergic neurotransmitter systems, as well as the GABA/ benzodiacepine. Studies based on the noradrenergic theory had lead to conclude that panicking patients have more sensitive brainstem carbon dioxide receptors than normal control subjects. At the same time, other lines of work indicate that serotonergic transmission may also play an important role in the genesis of panic attacks. It has been found that patients with panic disorder may have a lower tolerance threshold to methoclorophenylpiperazine response than control subjects because of hypertensive serotonergic receptors. The accumulated laboratory evidence seems to support the idea that panic attacks begin with the stimulation of irritable foci in one of three brainstem areas: the medullary chemoreceptors, the noradrenergic pontine locus coeruleus, or the serotonergic midbrain dorsal raphe. On the other hand, biofeedback is a psychophysiological intervention that allows in the first place for the external control of some of the physical symptoms involved in this disorder, which is later transferred to internal control of psychophysiological cognitions and behaviors that enable the patient to prevent symptom's occurrence. Based on the principles of the General Systems Theory, biofeedback utilizes the concepts of self regulation and disregulation to describe the conditions under wich normally integrated self-regulatory systems may become imbalanced with regard to their positive and negative feedback loops. Technically, all that a person needs to do is to attend to the signals feedback and not to "try" to control them; the effects of a positive feedback loop should occur automatically, without conscious awareness, as long as the person processes the stimuli. Biofeedback has been effectively used in the treatment of essential hypertension, migraine headaches, Raynaud's disease, tension headaches, temporomandibular joint syndrome, asthma, primary dysmenorrhea, peptic ulcers, fecal incontinence, and conditioning of electroencephalographic rhythms, among other problems. The present study reports data from 32 panic disorder outpatients from the National Psychiatry Institute, Mexico City. They were randomly assigned to: Control Group (N = 14): daily doses of 75 milligrams of imipramine. The participants of this group were required to assist to the psychology department in order to obtain a baseline (pre-test and post-test) with the biofeedback equipment. In addition, every two weeks they visited a psychiatrist who verified that there were no collateral effects from the medicament. Experimental Group (N = 18): besides daily doses of imipramine, and visits to the psychiatrist, these patients went through eight multimodal biofeedback and behavioral cognitive techniques which were assisted with relaxation training sessions. All biofeedback sessions lasted 30 minutes divided in six five-minute trails. The first and final trials served to stabilize the biological responses, and the four middle trials were used to give biofeedback and reinforcement to the response being trained in addition to the verbal explanation of the changes occurring on the screen of the computer. All patients were assessed with the Anxiety Sensitivity Index, and with Beck's Anxiety and Depression Inventories. Results showed that patients in the experimental group reported significant lower scores in the anxiety sensitivity index than the control group. Post-test differences showed that the electromiographic and electrodermic activity from the experimental group was lower than the one from the control group. Diaphragmatic respiration training and progressive muscular relaxation and imagery proved to be effective in reducing the symptoms associated to panic attacks. The overall final result is that all patients improved clinically. They verbally reported that the intensity, frequency and evitative behaviors derived from panic attacks had almost disappeared. However, the cognitive factor of anxiety sensitivity changed significanty only in the experimental group. These findings support the hypothesis that clinical improvement results from a symptom "reattribution" which gives them cognitive skills to cope with stressing stimuli. Further studies should reassess the effectiveness of the combined treatment (imipramine and behavioral cognitive techniques). It is also recommended to expand the study to generalized anxiety disorder and to adjust the experimental design in order to incorporate a second phase with neurofeedback as independent variable. Equally important is to investigate the mechanisms of the hypnotic ability and its impact on the clinical improvement of anxiety disorders.