Inflammatory markers changes following acceptance-based behavioral psychotherapy in generalized anxiety disorder patients: Evidence from a randomized controlled trial.

Introduction: Generalized anxiety disorder (GAD) has been associated with elevated levels of C-reactive protein (CRP) and proinflammatory cytokines. Despite robust evidence as an effective treatment for GAD, research on the effects of cognitive-behavioral therapies (CBT) in the inflammatory profile of patients with clinical anxiety has presented mixed results. Objective: The present study aimed to investigate the effect of an acceptance-based behavior therapy (ABBT) on inflammatory biomarkers and their association with anxiety levels in GAD patients in comparison to supportive therapy as an active control. Methods: Peripheral inflammatory biomarkers (CRP, IL-1ß, IL-4, IL-6, IL-10, TNF-α) were measured in 77 GAD patients who participated in a 14-week 10-session randomized clinical trial of group ABBT (experimental, n = 37) or supportive group therapy (ST: active control group, n = 40). Results: The concentrations of IL-1ß decreased in the control group and the concentrations of IL-6 increased in the experimental group from baseline to post-treatment, whereas no difference was identified in IL-4, IL-10, TNF, or CRP. Although anxiety and depression levels decreased in both treatment conditions, no correlation with inflammation markers was found for most clinical and biological variables. A negative correlation between changes in IL-6 and IL-10 and anxiety symptom score changes was identified. Conclusions: The present study results found that a short trial of acceptance-based behavior therapy did not change the proinflammatory profile which may be associated with GAD. Additional research is needed to evaluate the influence of other inflammation-related variables, longer periods of follow-up as well as the effect of supportive therapy on peripheral inflammatory biomarkers in GAD patients.

Primary headaches in patients with generalized anxiety disorder.

Although anxiety disorders and headaches are comorbid conditions, there have been no studies evaluating the prevalence of primary headaches in patients with generalized anxiety disorder (GAD). The aim of this study was to analyze the lifetime prevalence of primary headaches in individuals with and without GAD. A total of 60 individuals were evaluated: 30 GAD patients and 30 controls without mental disorders. Psychiatric assessments and primary headache diagnoses were made using structured interviews. Among the GAD patients, the most common diagnosis was migraine, which was significantly more prevalent among the GAD patients than among the controls, as were episodic migraine, chronic daily headache and aura. Tension-type headache was equally common in both groups. Primary headaches in general were significantly more common and more severe in GAD patients than in controls. In anxiety disorder patients, particularly those with GAD, accurate diagnosis of primary headache can improve patient management and clinical outcomes.

Clomipramine demethylation rate is important on the outcome of obsessive-compulsive disorder treatment.

The aim of this study was to investigate the influence of demethylation rate on the outcome of obsessive-compulsive disorder patients treated with clomipramine. Eighteen patients meeting the DSM-IV criteria for obsessive-compulsive disorder received 150-300 mg of clomipramine daily in a single-blind design for 12 weeks. The patients were evaluated with the Clinical Global Impression scale and the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Clinical assessment and serum measurements of clomipramine and desmethylclomipramine were carried out at baseline and after 3, 6, 8, 10, and 12 weeks. A greater improvement in Clinical Global Impression scale rating was associated with a lower desmethylclomipramine/daily dose and the total clomipramine and desmethylclomipramine/daily dose. Moreover, an improved response on the YBOCS-obsession score was associated with higher serum levels of clomipramine and the total clomipramine and desmethylclomipramine/daily dose. Patients with a greater reduction in baseline YBOCS rating had a lower desmethylclomipramine/clomipramine ratio. These data suggest that a lower demethylation rate correlates with better clinical outcome.

Panic disorder and exercise avoidance.

OBJECTIVES: 1) To identify whether patients with panic disorder in general and those with the respiratory subtype in particular actively avoid exercise; 2) to investigate physiological differences in cardiopulmonary function parameters in patients with panic disorder in general, patients with the respiratory subtype of panic disorder, and healthy controls upon exercise challenge. METHODS: Patients with panic disorder were classified as having either the respiratory or the non-respiratory subtype. Both groups were compared to controls in terms of exercise avoidance patterns and performance on cardiopulmonary exercise testing. RESULTS: Patients with panic disorder exhibited higher exercise avoidance scores and worse performance on cardiopulmonary exercise testing as compared with controls. No differences were found between patients with the respiratory and non-respiratory subtypes. CONCLUSIONS: Exercise avoidance is present in panic disorder and is associated with poorer performance on cardiopulmonary exercise testing. These findings are not limited to patients with the respiratory subtype of the disorder.

Sensitivity to aversive stimulation, posttraumatic symptoms and migraines: what do they have in common?

Studies have suggested that the high comorbidity observed between chronic migraine and anxiety disorders can be mediated through a third factor namely increased sensitivity to aversive stimulation. This trait may predispose for both chronic migraines, through medication overuse as an avoidance response, and anxiety disorders. Additional studies have shown that hyper sensitivity to aversive stimulation, migraine chronification and anxiety disorders share other characteristics such as serotonergic mediation and personality traits. Preliminary analysis of empirical data comparing the frequency the impact of traumatic events over chronic [CM] and episodic migraine [EM] patients gives further support to this hypothesis. In spite of CM and EM did not differ in terms of the occurrence of traumatic events, CM patients that had experienced at least one traumatic event during their lives had higher scores in re-experiencing and avoidance (but not in hyperarousal) symptoms than CM patients. These observations suggest that traumatic events have greater impact over CM than over EM patients.

Panic disorder and exercise avoidance

Objectives: 1) To identify whether patients with panic disorder in general and those with the respiratory subtype in particular actively avoid exercise; 2) to investigate physiological differences in cardiopulmonary function parameters in patients with panic disorder in general, patients with the respiratory subtype of panic disorder, and healthy controls upon exercise challenge. Methods: Patients with panic disorder were classified as having either the respiratory or the non-respiratory subtype. Both groups were compared to controls in terms of exercise avoidance patterns and performance on cardiopulmonary exercise testing. Results: Patients with panic disorder exhibited higher exercise avoidance scores and worse performance on cardiopulmonary exercise testing as compared with controls. No differences were found between patients with the respiratory and non-respiratory subtypes. Conclusions: Exercise avoidance is present in panic disorder and is associated with poorer performance on cardiopulmonary exercise testing. These findings are not limited to patients with the respiratory subtype of the disorder. .

Cephalalgiaphobia: a possible specific phobia of illness.

Psychiatric comorbidity, mainly anxiety and depression, are common in chronic migraine (CM). Phobias are reported by half of CM patients. Phobic avoidance associated with fear of headache or migraine attack has never been adequately described. We describe 12 migraine patients with particular phobic-avoidant behaviours related to their headache attacks, which we classified as a specific illness phobia, coined as cephalalgiaphobia. All patients were women, mean age 42, and all had a migraine diagnosis (11 CM, all overused acute medications). Patients had either a phobia of a headache attack during a pain-free state or a phobia of pain worsening during mild headache episodes. Patients overused acute medication as phobic avoidance. It is a significant problem, associated with distress and impairment, interfering with medical care. Cephalalgiaphobia is a possible specific phobia of illness, possibly linked to progression of migraine to CM and to acute medication overuse headache.

Panic attacks in the differential diagnosis and treatment of resistant epilepsy.

The authors present four patients displaying panic disorder and a history of epileptic seizures to illustrate difficulties regarding differential diagnosis between epileptic seizures and panic attacks. The cases describe the aversive properties of epileptic seizures, the role of visual seizure-triggering stimuli as phobic cues, and the effectiveness and safety of clomipramine treatment of panic attacks as an adjunct to concurrent antiepileptic medication.

Transtornos de esquiva fóbica / Phobic avoidance disorders

Os autores conceituam transtornos de esquiva fóbica, sua classificaçäo e sistematizam os princípios teóricos dos tratamentos cognitivo-comportamentais. É enfatizado o papel da exposiçäo aos estímulos eliciadores de ansiedade no tratamento.

Aderência ao tratamento em fóbicos sociais: um estudo qualitativo / Adherence to social phobia treatment: a qualitative essay

A aderência é um fator importante tanto por influenciar resultados de pesquisas, como para a prática clínica. Durante um estudo sobre Fobia Social, detectou-se uma pobre aderência entre pacientes submetidos a psicoterapia em grupo, tendo os pacientes abandonado a terapia em etapas diferentes. Essa diferença sugeriu a possibilidade de tratar-se de grupos de pacientes com características diferentes entre si, que pudessem motivar esse abandono em etapas diferentes. Pacientes que abandonaram o tratamento antes de sua conclusão foram convocados para uma entrevista que visava à identificação de fatores que poderiam predizer a baixa aderência. Os dados colhidos pelas entrevistas foram categorizados e apontaram fatores comuns: pacientes com antecedentes de baixa aderência, percepção distorcida dos resultados do tratamento e de seu status clínico, falta de motivação para o tratamento e a atribuição dos sintomas à personalidade ao invés de encará-los como uma doença. A partir destas constatações, recomendam-se intervenções terapêuticas no sentido de melhorar a aderência como educar o paciente sobre aspectos de sua doença e do tratamento, fornecer ao paciente indícios objetivos de sua melhora, garantir a motivação dos pacientes e avaliar a aderência ao longo do tratamento de modo a detectar pacientes que poderão abandonar o tratamento

Os benzodiazepínicos sao realmente inócuos? / Are benzodiazepines really harmless?

Neste estudo foram avaliados os efeitos a longo prazo dos benzodiazepínicos (BDZ) nas funçöes psicomotoras e cognitivas em 28 usu rios de doses terapêuticas baixas de diazepam (13,6+-4,9mg/dia, faixa: 5-20-mg/d) por cinco a 20 anos (10,1+-5,0 anos), em comparaçäo com o desempenho de dois grupos controles: 53 pacientes ansiosos näo usu rios cr"nicos de BDZ e 56 volunt rios sadios. Os usu rios cr"nicos foram testados antes e após a descontinuaçäo do diazepam (três semanas: curto prazo; em média, dez meses: descontinuaçäo prolongada). O desempenho dos usu rios cr"nicos de diazepam foi consistentemente pior do que o dos grupos controles, sugerindo a existência de prejuízo nas funçöes psicomotoras e cognitivas nestes pacientes. O desempenho dos usu rios de diazepam näo foi relacionando com a dose ou exposiçäo cumulativa ao BDZ e foi também independente do diagnóstico e níveis de ansiedade e depressäo. Mais ainda, estes déficits foram persistentes, uma vez que näo houve reversäo após a interrupçäp da droga. Estes resultados sugerem que o uso cr"nico de BDZ est associado com prejuízos cognitivos persistentes