Clonazepam and imipramine in the treatment of panic attacks: a double-blind comparison of efficacy and side effects.

Data from 12 patients (in two control study groups) provide preliminary results of an ongoing double-blind comparison of clonazepam and imipramine in the treatment of panic disorder. In both treatment groups, the patients' global improvement was substantial over the first few weeks and persisted over the 6-month treatment period based on assessments by the therapist and the patient; side effects were mild. Faintness was slightly more prevalent among patients on clonazepam treatment but disappeared after the first few weeks. Mild, persistent tachycardia was reported among patients receiving imipramine. No tolerance emerged, and discontinuation was successful in 2 patients from each group after 6 months of treatment. Eight patients needed continued medication (25-50 mg/day of imipramine, 0.5-2.0 mg/day of clonazepam) to maintain substantial improvement. Findings confirm earlier reports from open studies that low doses of both drugs eliminate panic attacks (about 50 mg/day for imipramine and 1.5 mg/day for clonazepam).

The effect of task difficulty and threat of aversive electric shock upon tonic physiological changes.

Thirteen subjects volunteered in an experiment which tested the relative effect of task difficulty and threat of aversive electric shock upon tonic changes in skeletal muscle (somatic) tension, respiration, heart rate (HR), and skin conductance level (SCL). They all performed two versions of a continuous perceptual-motor task (which is different from the reaction time task paradigm currently being preferred in related research), one difficult and one easy, under conditions of threat and no-threat. Electromyographic activity increased over the course of a task and, thus, showed clear physiological gradients which were steeper with the difficult task and threat. Initial HR activation was marked for the threat condition, and task difficulty added to this activation. SCL revealed a marked initial peak-response for all treatments, but was unresponsive to experimental manipulations. It was argued that a respiratory-somatic parallelism occurred during performance of both tasks for the no-threat (low effort) condition, and that threat (high effort) acted to dissolve this coupling in favour of a respiratory-cardiac parallelism.

The personality of the cardiac responder: interaction of seriousmindedness and type A behavior.

Forty healthy university students were recruited from a larger sample to form subgroups of seriousminded and playful Type A and Type B individuals according to their responses to the Telic Dominance Scale and Jenkins Activity Survey. The experiment made use of a factorial design and tested the hypothesis that cardiovascular reactivity during a continuous perceptual motor task is highest in individuals who are characterized by a combination of seriousmindedness and Type A behavior pattern. Relatively low levels of sympathetic reactivity were expected in playful Type B individuals. Heart rate (HR) and pulse transit time (PTT) scores from baseline and task performance periods supported the conclusions that: (1) Cardiovascular activation appeared during task performance; and that (2) seriousmindedness and Type A behavior exerted particularly significant additive effects upon HR, whereas Type A behavior showed a stronger association than did seriousmindedness with PTT scores. Analyses using pre-task score as covariate to task-scores, indicated stronger reactivity for HR in Type A than in Type B subjects.

Psychotherapy in functional dyspepsia.

Patients with functional dyspepsia were assigned at random to cognitive psychotherapy (10 sessions of 50 min duration, n = 50) or to a control group (no treatment, n = 50). Before treatment all patients were assessed on psychological, somatic and lifestyle factors. If allocated to the therapy group all patients were also asked to define the main problems they wanted to discuss in therapy ('target complaints'). The patients were evaluated at the end of therapy (after 4 months) and at 1 yr follow-up. Outcome measures were dyspeptic symptoms, scores on 'target complaints' and psychological parameters. Both groups showed improvement in dyspeptic and psychological parameters after 1 yr. The improvement in the control group was attributed to a non- specific effect of increased interest and attention. The therapy group showed greater reduction than the control group on dyspeptic symptoms [days of epigastric pain (p = 0.050), nausea (p = 0.024), heartburn (p = 0.021), diarrhoea (p = 0.002) and constipation (p = 0.047)]; and on scores on 'target complaints' (p = 0.001).

Psychological factors and somatic symptoms in functional dyspepsia. A comparison with duodenal ulcer and healthy controls.

One hundred patients with functional dyspepsia, 100 patients with duodenal ulcer and 100 healthy controls were assessed on anamnestic factors, somatic symptoms and psychological measures. Patients with functional dyspepsia had significantly higher levels of state-trait anxiety, general psychopathology, depression, a lower general level of functioning and more somatic complaints from different organ systems, especially the musculo-skeletal system, compared to patients with duodenal ulcer and healthy controls. Patients with functional dyspepsia had more frequent dyspepsia symptoms and a longer disease history than duodenal ulcer patients. Discriminant analyses using a model of fifteen psychological and anamnestic variables, classified correctly 71.5% of the subjects due to diagnoses. The test for multiple somatic complaints (Giessener Beschwerdebogen) was the most important discriminating factor (Eigenvalue 0.78). Seventy-five per cent of the patients were correctly classified, 71% by diagnosis with respect to diagnoses of duodenal ulcer and functional dyspepsia using frequency of dyspeptic symptoms as discriminating factor (Eigenvalue 0.40). Functional dyspepsia seems to be a disease entity of its own, distinct from duodenal ulcer and strongly associated with psychological factors.

Active and passive forearm flexor tension patterns in the continuous perceptual-motor task paradigm: the significance of motivation.

The psychophysiology of skeletal muscle tension patterns during goal-directed behavior was investigated by using the continuous perceptual-motor task paradigm. Subjects were recruited to form serious-minded and playful extreme groups according to their responses to the Telic Dominance Scale (10 subjects in each group). They all performed a continuous perceptual-motor task 5 times at a 'slow' speed followed by a final 'fast' task. All performance periods lasted for 150 s. Measures of passive (tonic) and active (phasic) forearm flexor EMG activity were derived. It was concluded that serious-mindedness was significant to a tonic build-up of tension in the passive forearm flexor over the course of task performance. In contrast, the playful state was associated with high phasic response amplitudes in the active forearm flexor contingent upon changing the position of the joy-stick. Training moderated the range of state-specific EMG activation. State measures confirmed that the subjects maintained their state dominance during task performance. Error-scores and scores on felt level of arousal did not discriminate between the groups.

Cardiac and somatic activation in the continuous perceptual-motor task: the significance of threat and serious-mindedness.

The significance of serious-mindedness and task-contingent threat for cardiac and somatic activation were tested in a mixed design. Ten serious-minded and 10 playful state-dominant subjects were recruited from a larger sample to form extreme-groups according to their responses to the Telic Dominance Scale. They all performed a continuous perceptual-motor task with and without threat of aversive electric shock as punishment for inferior performance (counterbalanced). Results supported the following conclusions: serious-mindedness was associated with passive forearm EMG activity, whereas playfulness was related to active forearm EMG activity. Threat of shock interacted with serious-mindedness to cause particularily high HR with threat versus low HR in the no-threat treatment. Error-scores and scores on perceived task difficulty did not explain group differences in physiological activation. The results were discussed in relation to a hypothesis of cardiac-somatic uncoupling during effortful active coping, the pyramidal and extrapyramidal pathways to the skeletal muscles, and to effort expended in the serious-minded and playful motivational states.

Psychogenic muscle tension: the significance of motivation and negative affect in perceptual-cognitive task performance.

Nineteen subjects volunteered to represent a stratified recruitment of serious-minded (goal-directed) and playful (impulsive) individuals balanced for gender. They all performed a perceptual-cognitive task under a neutral condition and with the contingency of monetary reward for good performance (counterbalanced order). Integrated electromyographic (IEMG) recordings were made from the biceps and triceps muscles of both upper arms, and from prebaseline, task performance and postbaseline periods. Verbal reports on motivational state during task performance (serious-minded/playful) and hedonic tone were also recorded. Results verified and extended earlier findings that IEMG activity increases over the course of task performance when a task is performed in the serious-minded state and even more so when a negative hedonic tone coincides with this motivational state. The increased IEMG occurred in all 4 recording sites under both incentive contingencies, although it was particularly marked in the right triceps muscle. These findings should be viewed in the light of the fact that both arms were allowed to remain in a passive resting condition during performance periods.

Task-induced tonic and phasic EMG response patterns and psychological predictors in elite performers of endurance and explosive sports.

Highly skilled performers of endurance and explosive sports as well as 'mixed' sports (total n = 26) were recruited to perform perceptual-motor tasks in the laboratory. These subjects represented 'models' for testing of motivational and affective moderators of task-related tonic and phasic electromyographic (EMG) changes. They all performed a car-racing video task with their preferred hand operating the joy-stick. Surface electrodes recorded EMG activity from both legs and forearms. Psychological predictors included type of sport and self-reports on involvement during performance in the laboratory. Tonic EMG changes in the legs were not strongly related to predictor variables, whereas 'passive' forearm EMG elevations were high in the endurance sport subjects (25% of variance explained). Stepwise multiple regression analyses stated that 70% of the variance in phasic increases of active forearm EMG power was explained by four predictor variables: marked increases occurred in (1) performers of endurance sports, those who (2) felt relatively low levels of 'arousal', (3) enjoyed the task, and (4) reported being 'stressed' while performing the task. In these subjects, therefore, psychological variables related more strongly to EMG reflecting pyramidal than extrapyramidal discharges.

Electromyographic activation and proportion of fast versus slow twitch muscle fibers: a genetic disposition for psychogenic muscle tension?

17 right-handed males volunteered for an experiment that compared task-related patterns of electromyographic (EMG) activation with data from muscle biopsy on proportion of slow-twitch ((ST) aerobic) to fast-twitch ((FT) anaerobic) muscle fibers. The biopsy was taken from the right-leg gastrocnemius muscle after EMG measurement from that area of the leg muscle. EMG was also recorded from the left forearm flexor carpi radialis area. Recordings were obtained from pre- and post-task resting periods and during 150 s of video-task performance when the right hand operated a joy-stick. The results showed a highly significant tonic EMG activation in the leg muscle of subjects with predominance of ST fibers, and this relationship generalized to the EMG from the 'passive' forearm. The proportion of ST to FT fibers is genetically defined and not altered by exercise. Therefore, our results lend support to a genetic differentiation between individuals with high vs. low probability of unintended build-up of muscle tension during perceptual-motor task performance.

Comparison of two physical exercise programs for the early intervention of pain in the neck, shoulders and lower back in female hospital staff.

The aim of the present study was to compare the effect of increased aerobic capacity versus muscle strength rehabilitation of female hospital staff with long-lasting musculoskeletal back pain. Seventy-nine women agreed to participate in the intervention study. After a medical examination, 65 individuals were assigned to one of three balanced groups: Endurance training (aerobic capacity promoting training: ET: n = 22), strength promotion exercise (SP: n = 24) or a control group (CON: n = 19). The active groups met twice a week for 60 minutes of exercise over 15 weeks. Aerobic capacity (VO2max) and musculoskeletal pain were measured immediately before (T1) and after the intervention period (T2). Aerobic capacity significantly increased in the ET group, whereas no change was observed in the SP group, and a significant reduction was found in the CON group from T1 to T2. Musculoskeletal pain was significantly reduced in both intervention groups, whereas minor changes were observed in the control group. Results from a 7-month follow-up (T3) survey confirmed the beneficial effects of interventions on musculoskeletal pain. In conclusion, improved aerobic capacity appeared not to be a necessary mechanism in musculoskeletal back pain reduction.

The effect of a threatening context upon motivation and task-induced physiological changes.

The effect of a threatening context upon tonic task-induced physiological changes was tested in an experiment where 14 male subjects performed a continuous perceptual motor task for 150 seconds, once with and once without threat of aversive electric shock (counterbalanced order). Results indicated that task-irrelevant muscular tension increased and skin temperature decreased over the course of a task, and these gradients were steeper with threat than for the no-threat treatment. Initial heart-rate increase was marked for the threat condition. For respiration, a trend parallel to muscular gradients emerged with no-threat as contrasted with a parallel respiratory-cardiac activation with threat. Subjects' ratings on items reflecting self-perception responded to the threat manipulation, but ratings on items reflecting task perception remained unaffected.

Assessment of musculoskeletal and other health complaints in female hospital staff.

Musculoskeletal and other health complaints were investigated in a sample of 586 female hospital staff. Health complaints, including musculoskeletal pain, were assessed by the Ursin Health Inventory (UHI). Factor analyses of the UHI favoured a seven-factor solution in which musculoskeletal pain emerged as an independent factor of complaints. Other complaint factors could be labelled lower digestive, upper digestive, cardiorespiratory, allergy, cold/influenza and headache. Factor analyses of the extended version of the Nordic Questionnaire (NQ-EV), which focuses specifically on musculoskeletal pain from nine body areas, favoured a three-factor solution in which complaints from the upper back, low back and extremities emerged as the independent factors. Product-moment coefficients of correlation between factor-based sum scores in the two survey measures stated that the UHI factor 'musculoskeletal pain' and the NQ-EV factor 'upper back' were significantly correlated. This indicated an orientation of the UHI 'musculoskeletal pain' factor to pain in the upper part of the back. Only very moderate coefficients of correlation emerged between the NQ-EV factor scores and the remaining UHI scores. The results support the assumption that musculoskeletal complaints are not closely related to other types of health complaints, and that musculoskeletal complaints among female hospital staff should be assessed with separate items for upper back (neck/shoulders), low back and the extremities.

Anxiety-item intensity-specificity hypothesis in a relaxed situation.

A test of the item intensity-specificity hypothesis is reported. The hypothesis was supported and may be extended to anxiety-trait measures as well. Other interpretations of the findings are also inspired.

Serious-mindedness and the effect of self-induced respiratory changes upon parietal EEG.

The role of serious-mindedness (so-called telic dominance) in regulation of parietal cortex EEG was investigated. Ten telic (serious-minded) and 10 paratelic (playful state-dominant) individuals were selected on the basis of their responses to the Telic Dominance Scale. They all performed instructed breathholding (hypopnea) and excessive breathing (hyperpnea) in counterbalanced order. The paratelic individuals yielded relatively high scores of integral EEG power; theta power was markedly increased in the left hemisphere during hyperpnea, and reduced in the right hemisphere during hypopnea. Both hyperpnea and hypopnea were reported to be more aversive to the paratelic than to the telic subjects, but no group difference in respiratory activity was found. The electrocortical and hedonic tone differences between the groups are discussed in relation to the distinction between the prefrontal (dopamine) activation pathway and frontoparietal (noradrenalin) arousal pathway, as well as in relation to changes in cortical blood flow and proprioceptive feedback.

The role of psychopathology and gender in respiratory self-regulation.

A group of 12 male and 12 female psychiatric patients were recruited among an anxiety-disordered population, and their performance on a respiratory modulation test was compared with that of a matched non-patient sample. Inferior performance was expected in the patient group, and males were expected to show better respiratory modulation than females. Results supported the conclusion that females were less able than males in modulating respiratory muscle behaviour according to requested patterns, and female psychiatric patients showed a relative lack of flexibility in the thorax or abdomen regions or in both trunk levels.

Fatigue and patterns of pain in fibromyalgia: correlations with anxiety, depression and co-morbidity in a female county sample.

This study explored the prevalence of fibromyalgia, the relationship of anxiety and depression with two major symptoms (pain and fatigue), and the role of co-morbidity. Participants were recruited from the Nord-Trøndelag Health Study (The HUNT Study) in Norway (N = 92,936). They were females given the diagnosis of fibromyalgia by their doctor (N = 1,816), divided into one sample without (N = 977) and another with (N = 839) co-morbidity. Owing to colinearity between anxiety and depression, extreme groups were defined according to high vs. low anxiety and depression scores. About four-fifths of the initial sample were excluded by this approach, which permitted a two x two factorial split-plot ANCOVA for the assessment of the relations of anxiety and depression with pain and fatigue. The overall prevalence was 3.2%, which obscured a highly biased sex difference with 5.2% for females and .9% for males. Results from the sample without co-morbidity (N = 977) supported the idea of independent partial correlations of anxiety and depression with pain and fatigue. A different trend was indicated in the co-morbidity sample (N = 839) where fatigue was only significantly associated with depression, whereas pain was associated with anxiety. The idea of widespread pain was supported consistently only in participants without co-morbidity who scored low on anxiety. Age, incident pain and depression contributed to a discriminant function reflecting the status of co-morbidity.

Components of type A behavior and task-induced cardiovascular activation.

The present study sought to determine whether there are subcomponents of the Type A behavior pattern that are more closely related to cardiovascular reactivity than others. The components studied were factor analytically derived subscales of the Jenkins Activity Survey denoting Irritation and Impatience, on the one hand, and Hard-Driving and Competitive, on the other. Heart rate, pulse transit time, forearm electromyography, and palmar skin conductance were measured while the subjects performed a continuous perceptual motor task, as well as during baselines before and after the task. The Irritation and Impatience dimension was consistently related to task-induced changes in heart rate, both in regression analyses and in extreme group analyses of variance. A significant relation was also observed for pulse transit time but not for electromyography. The Hard-Driving and Competitive dimension, on the other hand, was not related to any psychophysiological measures. These results were interpreted to mean that Irritable and Impatient subjects showed a cardiovascular reaction pattern indicative of active coping processes during task performance.

Quality of life, functional disability and lifestyle among subgroups of fibromyalgia patients: the significance of anxiety and depression.

This study explored the significance of anxiety and depression in quality of life, functional disability and lifestyle among fibromyalgia patients. Functional disability was defined by subjective work ability and activity-related discomfort. Lifestyle reflected habits of physical activity, regularity of meals, smoking and patterns of drinking coffee and alcohol. Members of two county divisions of fibromyalgia patients (N = 322) were investigated. Owing to colinearity between anxiety and depression scores, extreme groups were defined according to high vs. low anxiety and depression scores. Two-thirds of the initial sample were excluded by this approach which permitted a 2 x 2 factorial split-plot MANCOVA for the assessment of main effects and interaction of anxiety and depression upon quality of life, functional disability and lifestyle. Main effects of anxiety and depression were significant for index scores on activity-related discomforts, subjective work ability and quality of life, whereas depression was also significantly associated with regularity of meals. Anxiety and depression interacted to yield relatively high consumption of coffee and cigarettes among the anxious and depressed subgroup, and this effect emerged only after the elimination of confounding effects of age and duration of the fibromyalgia disease.

Gastric antral motility in functional dyspepsia. Effect of mental stress and cisapride.

BACKGROUND: Disordered gastric antral motor activity may be induced by mental stress. The effect of cisapride on these abnormalities has previously not been investigated. METHODS: Ten healthy subjects and 19 patients with functional dyspepsia (FD) and erosive prepyloric changes participated in the study. Antral motility was recorded with real-time ultrasonography after ingestion of 500 ml meat soup during i) a 4-min rest period, ii) 2.5 min of mental stress, and iii) a 4-min recovery period. Patients and controls were studied after 3 days of treatment with 10 mg cisapride three times daily and placebo in a double-blind crossover design. RESULTS: Mean postprandial amplitude of antral contractions was lower in patients than controls (p < 0.001). Antral amplitude was reduced by mental stress in healthy persons (p < 0.001) but not in patients. Both fasting and postprandial antral areas were larger in FD patients than controls (p < 0.001 and p = 0.02, respectively). Cisapride reduced the fasting (p < 0.001) and the postprandial (p = 0.05) antral area in the FD group but not in controls. The soup meal produced dyspeptic symptoms in 90% of the patients and in only 10% of the controls (p < 0.001). Cisapride had no significant effect on symptoms or antral contractions. CONCLUSIONS: Mental stress induced antral hypomotility in healthy subjects but not in patients with FD who had reduced motility at base line. Cisapride reduced the enlarged fasting and postprandial antral areas in the patients but had no effect on amplitudes of antral contractions or symptoms.