Unaltered Oxytocin and Vasopressin Plasma Levels in Patients with Schizophrenia After 4 Months of Daily Treatment with Intranasal Oxytocin.

The neuropeptide oxytocin (OXT) has been proposed as a treatment for a number of neuropsychiatric disorders characterised by impaired social behaviour, including schizophrenia. Although several studies have reported the chronic administration of OXT to be safe and tolerable, its effects on circulating levels of OXT, as well as the related neuropeptide arginine vasopressin (AVP), have not been assessed. In the present study, in a within-subjects cross-over, double-blind, randomised controlled trial, we assayed the plasma levels of OXT and AVP in 31 patients with schizophrenia who were treated daily for 4 months with 40 IU of intranasal OXT or placebo. Our data indicate a mean ± SD baseline OXT concentration of 1.62 ± 0.68 pg/ml, as determined by radioimmunoassay, which did not display any significant variation after chronic treatment with OXT or placebo. Similarly, the mean ± SD baseline AVP value of 2.40 ± 1.26 pg/ml remained unchanged. The present study also assessed cardiovascular and body fluid indicators (osmolality, plasma sodium concentration and systolic blood pressure), as well as a parameter for food intake (body mass index), with all observed to remain stable. By reporting that daily treatment with 40 IU of intranasal OXT or placebo for 4 months does not impact on OXT and AVP plasma levels, nor on cardiovascular, body fluids and food intake parameters, the present study represents an important step towards developing OXT as a safe treatment.

Benzodiazepines and anxiety sensitivity in panic disorder.

1. Benzodiazepines were discontinued in 16 patients who had recovered from panic disorder with agoraphobia after exposure treatment. 2. Drug discontinuation yielded a significant decrease in anxiety sensitivity and state anxiety in these long-term users. 3. Several likely explanations for the findings are discussed. 4. In the short term, treatment of panic disorder with benzodiazepines may lower anxiety symptoms. However, in the long run, it may decrease the individual tolerance to anxiety and discomfort.

Neurocirculatory asthenia: a reassessment using modern psychosomatic criteria.

The purpose of this study was to assess the prevalence of mental illness and to evaluate the quality of life of patients with neurocirculatory asthenia. A consecutive series of 80 patients who satisfied the diagnostic criteria developed by Kannel et al. for neurocirculatory asthenia was included in this study. Patients underwent a psychiatric diagnostic research interview and extensive psychometric evaluation, with both observer and self-rated scales for depression, anxiety, phobic symptoms, quality of life and abnormal illness behavior. In 47 patients (59%), a psychiatric diagnosis (mainly an anxiety disorder) antedated the onset of neurocirculatory asthenia, which was thus defined as secondary, also because cardiorespiratory symptoms were part of the mental symptoms. In the remaining 33 patients (41%) neurocirculatory asthenia was the primary disorder. Patients with secondary neurocirculatory asthenia reported significantly higher levels of anxiety, depression, social phobia, abnormal illness behavior and an impaired quality of life compared with patients with primary neurocirculatory asthenia. This latter did not significantly differ in these variables (except for depression) from healthy control subjects matched for sociodemographic variables. At a 1-year follow-up, patients with primary neurocirculatory asthenia had a much better prognosis than those with secondary neurocirculatory asthenia. The results indicate the feasibility of the primary/secondary distinction based on the time of onset of mental and cardiorespiratory symptoms in neurocirculatory asthenia. Since only about one quarter of the patients were found to suffer from decreased energy and fatigue according to specified criteria, the terms neurocirculatory asthenia and effort syndrome should probably be discarded.

Hostility and irritable mood in panic disorder with agoraphobia.

Twenty patients suffering from panic disorder with agoraphobia were administered the hostility subscale of Kellner's Symptom Questionnaire and the irritability scales of Paykel's Clinical Interview for Depression and of Kellner's Anxiety Rating Scale before and after behavioral treatment of agoraphobia. A matched control group of normal subjects had the same assessments at two similar points in time. Hostility and irritable mood decreased and friendliness increased in patients with panic disorder after treatment; upon recovery, there were no significant differences in hostility between patients and controls, whereas such differences were striking during the illness. The results suggest that increased hostility and irritable mood may be symptoms of panic disorder and improve with the treatment of agoraphobia.

Characterological traits of recovered patients with panic disorder and agoraphobia.

Three self-rating personality inventories were administered to 33 patients who had recovered from panic disorder associated with agoraphobia and to 33 healthy subjects matched for sociodemographic variables. The personality inventories comprised the Tridimensional Personality Questionnaire (TPQ), which provides three major dimensions (novelty seeking, harm avoidance and reward dependence), the Anxiety Sensitivity Index (ASI) and the Emotional Inhibition Scale (EIS). Agoraphobic patients reported significantly more TPQ harm avoidance and anxiety sensitivity than controls. Although these findings might have been influenced by residual anxiety symptoms in panic-free patients and could also apply to patients with other anxiety disorders, they suggest that harm avoidance and anxiety sensitivity may be risk factors for developing agoraphobia and panic disorder. There may be overlap between this characterologic cluster and prodromal symptoms of panic disorder with agoraphobia, such as anxiety, phobias and hypochondriasis.

Rating depression and anxiety after mastectomy: observer versus self-rating scales.

Paykel's Clinical Interview for Depression (CID), an observer-rated scale, and Kellner's Symptom Questionnaire (SQ), a self-rating inventory, were administered to twenty-six patients with breast cancer: 1) the day prior to discharge after mastectomy or lumpectomy, 2) after six months, during a follow-up outpatient visit. There were no significant changes in depression and anxiety (except for self-rated anxiety) and, indeed, there were very high test-retest correlations. Observer and self-rated assessments were significantly related, and these correlations improved on outpatient follow-up. DSM-III-R diagnoses of affective illness (mood and anxiety disorders) based on pre-established cut-offs of the CID, showed considerable stability, particularly as to major depressive illness.

Hypochondriacal symptoms in pregnancy.

Illness attitudes were evaluated in 26 pregnant women and 26 control subjects matched for sociodemographic variables, by means of a self-rating scale, on three different occasions. In each trimester of pregnancy, women displayed more hypochondriacal fears and beliefs and conviction of disease (disease phobia) than normal controls (p less than 0.001). The findings should alert physicians to ask their pregnant patients whether they are preoccupied with fear of dying, or are concerned that they suffer from an undiagnosed physical illness, or dread a specific illness such as cancer or heart disease. Hypochondriacal fears and beliefs are liable to affect the well-being and health attitudes of pregnant women. If properly recognized, they may effectively be treated.

Cardiac neurosis and psychopathology.

Psychiatric illness according to DSM-III-R criteria was investigated in 54 consecutive patients suffering from cardiac neurosis (neurocirculatory asthenia or Da Costa's syndrome). Thirty-seven of the 54 patients (68.5%) were found to suffer from a psychiatric disorder. Generalized anxiety disorder, social phobia and panic disorder accounted for most of the diagnoses. Panic disorder was frequently preceded by (and associated with) generalized anxiety, phobic avoidance and hypochondriasis. The results should alert the physician to inquire for symptoms of an anxiety disorder when a patient presents with cardiac neurosis.