BACKGROUND: The 35% CO2 challenge is a well-established method triggering panic attacks under laboratory-controlled conditions. There is an ongoing debate whether single or the joined effects of the instructional set and anxiety sensitivity (AS) can alter the outcome of the challenge. OBJECTIVES: The present study investigated the effects of instruction manipulation and AS on panic-like response to the 35% CO2 challenge. METHODS: Eighty healthy subjects, with high or low levels of AS, were randomized into 4 groups based on standard/manipulated instructional sets as well as 35% CO2 mixture/room air inhalation. Subjects filled in the Visual Analogue Scale of Anxiety (VAAS), the Visual Analogue Scale of Fear (VAS-F), the VAS of Discomfort (VAS-D), and the Panic Symptom List (PSL). Blood pressure and heart rate were measured at pre- and posttest. RESULTS: Hierarchical multiple regression analyses showed greater psychological responses at VAAS, VAS-F, VAS-D, and PSL and higher systolic blood pressure under 35% CO2 challenge if compared to room air inhalation while instructional set and AS did not influence the response. CONCLUSIONS: The present study confirms that neither instructional test nor AS alter the outcome of the 35% CO2 challenge.
Anticipation, Psychological/physiology , Anxiety/psychology , Panic Disorder/psychology , Panic/physiology , Administration, Inhalation , Adolescent , Adult , Aged , Carbon Dioxide/administration & dosage , Female , Healthy Volunteers , Humans , Male , Middle Aged , Panic/drug effects , Young Adult
BACKGROUND: Smokers with major depressive disorder (MDD) or depressive symptoms (DS) represent a subgroup in need of attention, since they have specific clinical features and prognosis. METHODS: A systematic review of the literature (Cochrane, MEDLINE, ScienceDirect, Web of Science databases from inception to June 2017) of randomized clinical trials assessing the effectiveness of pharmacological, psychological, or combined interventions for smoking cessation in subjects with current or past MDD/DS without medical or comorbid psychiatric disorder(s) was run following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Twenty-seven studies met the inclusion criteria. Nicotine, varenicline, and staged-care intervention were more effective in smokers with current MDD; nicotine and fluoxetine plus nicotine were more effective in smokers with DS; naltrexone and nicotine plus fluoxetine were more effective in smokers with severe current DS. Cognitive-behavioral therapy and cognitive and behavioral cessation and relapse prevention skills training were superior to placebo in smokers with past MDD. CONCLUSIONS: More research is needed into effectively addressing smoking in people with concurrent mental disorder. Data currently available need to be confirmed in randomized trials aimed at replicating the results and disentangling the effects of each therapeutic ingredient when a combination therapy is proposed. Studies on tolerability of treatments are warranted, as well as those aimed at identifying factors of vulnerability to adverse effects.
Cigarette Smoking/drug therapy , Cigarette Smoking/prevention & control , Depression/complications , Depressive Disorder, Major/complications , Smoking Cessation/methods , Smoking Cessation/psychology , Antidepressive Agents/therapeutic use , Combined Modality Therapy , Depression/therapy , Depressive Disorder, Major/therapy , Humans , Psychotherapy , Smoking Cessation Agents/therapeutic use
BACKGROUND: Cigarette smoking may increase the likelihood of developing panic disorder. Periods of nicotine withdrawal, in particular, may promote panic in individuals high in anxiety sensitivity. We examined the importance of nicotine withdrawal in the occurrence of smoking and panic. METHODS: We utilized a placebo-controlled, double-blind, randomized, crossover design. Fifty smokers underwent a breath-holding (BH) challenge after the transdermal administration of nicotine on one test day and a placebo on another test day. Physiological and psychological variables were assessed at baseline as well as directly before and after the challenges. RESULTS: Nicotine abstinence induced a decrease in heart rate and systolic blood pressure (BP) before the BH procedure (heart rate: 78.80 ± 11.43 under nicotine, 70.88 ± 10.83 under placebo; systolic BP: 124.90 ± 11.34 under nicotine, 121.18 ± 13.44 under placebo) and shorter BH duration relative to the nicotine patch condition. Nicotine abstinence did not, though, increase fear reactivity to the challenge. CONCLUSIONS: The findings for heart rate and BP are consistent with the stimulant properties of nicotine. The reduced capacity to maintain apnea under placebo might be due to carbon dioxide (CO2 ) hypersensitivity during periods of nicotine abstinence. The negative findings regarding fear reactivity might be due to BH being a relatively weak anxiogen. Future researchers are encouraged to employ CO2 -inhalation procedures to study the relationship between nicotine withdrawal and panic.
Breath Holding , Nicotine/therapeutic use , Nicotinic Agonists/therapeutic use , Panic , Smoking Cessation/psychology , Substance Withdrawal Syndrome/prevention & control , Tobacco Use Cessation Devices , Administration, Cutaneous , Adolescent , Adult , Blood Pressure , Cross-Over Studies , Double-Blind Method , Female , Heart Rate , Humans , Male , Middle Aged , Nicotine/adverse effects , Nicotinic Agonists/adverse effects , Substance Withdrawal Syndrome/etiology , Substance Withdrawal Syndrome/psychology , Young Adult
Tobacco use is dramatically increasing among youth. Growing attention has been addressed towards possible predictors of smoking in such a population. We evaluated a sample of Italian adolescents to verify whether adults and peers might influence their smoking status. Cross-sectional study was conducted in 16 schools of North Italy. Data were collected from 2001 to 2010 by means of a self-administered questionnaire on sociodemographic data and individual/social possible predictors of smoking. 2,444 students (56.7% boys; 43.3% girls; mean = 14.32 ± 1.384 years) were analysed. 607 (24.8%) were current smokers; 1,837 (75.2%) were nonsmokers. The presence of smokers in the family, seeing teachers who smoke, the influence of friends, and the feeling of inferiority were predictors of youth smoking as well as unawareness of nicotine dangerous action to health. Running the logistic multivariate analysis with all the variables listed above in the same model, the strongest predictors of smoking were as follows: being unaware that pipe/cigar is harmful to health as cigarettes; not knowing that passive smoking is harmful to the growth of children; having seen teachers smoking. The present findings help to identify the variables that might favour smoking in youth. Such variables should become the target of prevention programs.
