BACKGROUND: Although serotonin reuptake inhibitors are effective in panic disorder, questions concerning whether doses associated with antidepressant efficacy are also effective for panic disorder remain. AIMS: To assess the efficacy of the usual antidepressant dose of fluoxetine in treating full panic attacks. METHOD: Patients with panic disorder were randomised to placebo or to fluoxetine initiated at 10 mg daily for 1 week and then increased to 20 mg daily. The trial lasted 12 weeks, but after 6 weeks patients who had failed to achieve a satisfactory response were eligible for dose escalation to a maximum of 60 mg of fluoxetine daily. RESULTS: Fluoxetine was associated with a statistically significantly greater proportion of panic-free patients compared with placebo after 6 weeks and at end-point. CONCLUSIONS: Fluoxetine at a dose of 20 mg daily is safe and efficacious in reducing symptoms of panic disorder. Patients who fail to obtain a satisfactory response at 20 mg daily may benefit from further dose increases.
Antidepressive Agents, Second-Generation/administration & dosage , Fluoxetine/administration & dosage , Panic Disorder/drug therapy , Selective Serotonin Reuptake Inhibitors/administration & dosage , Adult , Antidepressive Agents, Second-Generation/adverse effects , Double-Blind Method , Drug Administration Schedule , Female , Fluoxetine/adverse effects , Humans , Male , Middle Aged , Psychiatric Status Rating Scales , Selective Serotonin Reuptake Inhibitors/adverse effects , Single-Blind Method , Treatment Outcome
A rare case of a folie a deux in a married couple is presented. The inducing partner (IND) suffered from paranoid hallucinatory psychosis and induced similar symptomatology in his wife. Different from most cases reported in the literature, the induced partner (recipient, REC) also experienced auditory hallucinations (commenting and conversing voices). While the IND recovered fully with a combination of psychotherapeutic as well as neuroleptic treatment, the REC was cured by the psychotherapeutic intervention and the recovery of the IND alone. According to the criteria of current diagnostic systems (DSM, ICD), both patients should have been classified as schizophrenic, due to the presence of the described auditory hallucinations. We conclude that the presence of hallucinations is less specific for a certain diagnosis than implied by such categorical systems and should be regarded as nosologically non-specific symptoms. Modern neurocomputational models of psychopathology, dimensional approaches in the description of hallucinations, as the findings of new functional brain imaging studies support this view. We propose a multidimensional diagnostic process of hallucinations and to classify cases such as the one presented as 'induced hallucinatory psychosis' or 'folie a deux hallucinatoire'.
Hallucinations/psychology , Shared Paranoid Disorder/psychology , Adult , Antipsychotic Agents/therapeutic use , Electroencephalography , Female , Hallucinations/diagnosis , Hallucinations/drug therapy , Humans , MMPI , Male , Psychiatric Status Rating Scales , Rorschach Test , Shared Paranoid Disorder/diagnosis , Shared Paranoid Disorder/drug therapy , Sulpiride/therapeutic use
We report on a patient who suffered from treatment-resistant sudden arousals from sleep for 30 years and eventually developed daytime panic attacks. Polysomnography recorded three sudden arousals from sleep stage 4, with intense anxiety that was not associated with confusion or dream recall. While resting wakeful electroencephalogram (EEG) was normal, sleep-deprived EEG revealed increased left temporal theta activity and brain magnetic resonance imaging showed left hemispheric atrophy. Complete remission of symptoms could be obtained only with a combination therapy of carbamazepine and clonazepam. Relations between atypical sleep disorders, panic disorder and ictal brain activity are discussed. We conclude that in patients with atypical sleep and anxiety disorders anticonvulsants could be a successful treatment approach.
Anticonvulsants/therapeutic use , Arousal/physiology , Panic Disorder/drug therapy , Sleep Wake Disorders/drug therapy , Adult , Anticonvulsants/adverse effects , Arousal/drug effects , Brain/physiopathology , Electroencephalography , Epilepsy/diagnosis , Female , Functional Laterality , Humans , Magnetic Resonance Imaging , Panic Disorder/psychology , Sleep Stages , Treatment Outcome , Wakefulness
Anticonvulsants/therapeutic use , Carbamazepine/therapeutic use , Cerebral Infarction/psychology , Clonazepam/therapeutic use , Koro/drug therapy , Neurocognitive Disorders/drug therapy , Panic Disorder/drug therapy , Cerebral Cortex/pathology , Cerebral Infarction/diagnosis , Cerebral Infarction/drug therapy , Drug Therapy, Combination , Electroencephalography/drug effects , Humans , Koro/diagnosis , Koro/psychology , Magnetic Resonance Imaging , Male , Middle Aged , Neurocognitive Disorders/diagnosis , Neurocognitive Disorders/psychology , Panic Disorder/diagnosis , Panic Disorder/psychology
