摘要:

Obsessive‐Compulsive Disroder and Panic Disroder with or without agoraphobia are emphasized as specific entities that are easily accessible to pharmacological treatment, while more unspecific and heterogeneous syndromes are less predictable in their reaction to treatment. The DSM‐III system, not yet official in Sweden, is described and commented on. Agoraphobia has undergone a re‐evaluation and should be coupled with Panic Disorder, although the two illness componenets may have somewhat different genetic and biochemical mechanisms. Obsessive‐Compulsive Disorder, on the other hand, should bot be listed under Anxiety States, but have a place of its own. The relatioship between anxiety and depression is discussed, and it is suggested that there is a clear break between specifica affective disorders and specifica anxiety disorders, while there may be continuity between Generalized Anxiety and Neurotic‐reacitve (dysthymic) depression, with mixed cases in between. Still, much work needs to be done in the classification of these

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb07744.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

Theories on the aetiology of pathological anxiety abound. A critical review is given of the most influential apporaches (e.g. psychonalytical, “somatogenic” behavioural, psychophysiological and “biological theories), with emphasis on panic and agoraphobic disorders. Eviudence is presented from epidemiological and genetic research and from observations on the course of illness. A surprisingly constant prevalence of anxiety syndormes, and a familial distribution suggesting a pivotal importance of genetic factors, speak in favour of a biological model. The course of illness, however, points to the importance of environmental influences as triggering factors, and to congnitive and behavioural mechanisms for the perpetuation of the symptoms. Treatment responses hitherto documented support the biological and behagioural concepts, but the cognitive and psychophysiological theories are also supported to some extent. An attempt is made to combine these findings with biochemical and pharmacological findings in an intergrated model of panic and agoraphobia. This model takes the form of a vicious circle, and is compatible with biological and neuropharmacological as well as evolutionary and psychological con

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb07745.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

For two decades it has been hypothesized that schizophrenia and depression are related to alterations in the activity of specific neurotransmitters in brain; to a great extent, these theories are based on the assumed mode of action of antipsychotic and antidepressant drugs. With the available knowledge of how panic anxiety can be effectively treated (and elicited) with drugs, it is now reasonable to formulate hypotheses also regarding the contribution of central neurotransmitters to the generation of panic. As will be discussed in this brief review, three substances seem to be of particular importance in this context: serotonin, noradrenaline and GABA. In view of this concept, the putative mode of action of the atypical benzodiazepine derivative alprazolam, which in contrast to other benzodiazepines has been attributed effectiveness in the treatment of panic, will also be discussed.

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb07746.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

ABSTRACTDifferent aspects on the structure‐activity relationships, the pharmacokinetic and the pharmacodynamic properties of the benzodiazepines (BDZs) are briefly outlined, followed by a more thorough description of the current hypothesis on the mode of action of these drugs, focusing on the supramolecular GABA‐BDZ‐chloride‐ionophore receptor complex. The existence of different synthetic ligands for the receptor exerting opposite effects is discussed together with the recent finding in mammals of an endogenous ligand with anxiogenic‐like effects. The possibility of the anxiolytic effects of the BDZs being related to actions on monoaminergic systems is also briefly mentioned. A new group of BDZs, the triazolo‐BDZs, is described. One of these compounds, alprazolam (APZ), exhibits a different clinical profile as compared to traditional BDZs. Apart from being effective in the treatment of generalized anxiety, it has been proven effective also in the treatment of panic disorder. Some studies also indicate anti‐depressant effects of the compound. The reason for these apparent unique effects of APZ is not clear.A brief description of a commonly applied animal model (the Vogel conflict model) for the study of anxiety‐related mechanisms is given and original animal data from experiments aiming at elucidating the mechanism behind the anti‐panic effect of APZ are presented. The results indicate that tolerance to different pharmacodynamic effects of APZ and the traditional BDZ diazepam (DIZ) develop to different extents. Thus, tolerance development to the ataxic/sedative effects of APZ was pronounced, whereas no significant tolerance developed to the anxiolytic‐like effects. For DIZ, however, tolerance development was pronounced to both the anxiolytic‐like and the ataxic/sedative effects. Hence, in the rat, the “therapeutic range” with regard to anxiolytic‐like effects is more favourable for APZ than for DIZ after long‐term treatment. Evidence for the possibility of a similar mechanism also in man has been reported. It is suggested that the efficacy of APZ, in contrast to DIZ, on panic disorder seems due to the former drug possessing more anxiolytic potency in relation to its side‐effects at long‐term treatment, hence enabling a sufficien

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb07747.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

ABSTRACTThe prevalence of anxiety disorders in a psychiatric sense is 5–10%. If all available data are summed up, it seems evident that about half of these disorders have a prolonged, often chronic course, and thus require some form of long‐term or continuous treatment. Accomplishment of long‐term treatment will often be prevented by a general fear of dependence and abuse, risk factors that have been strongly emphasized. General restrictivity has also been urged regarding the dosage level, often resulting in a sub‐optimal treatment, more harmful than beneficial to the patient. The prescription figures for anxiolytics in relation to the prevalence and course of anxiety disorders do not suggest an unreasonably high prescription rate, on the contrary, the prescribed amount would not be sufficient for treating more than 2.5 % of the pop

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb07748.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

ABSTRACTThe efficacy of tricyclic antidepressants and monoamine oxidase inhibitors (MAOI) in the treatment of panic syndromes(panic disorder and agoraphobia with panic attacks) and obsessive‐compulsive disorders is reviewed. Imipramine has been reported as significantly more effective against panic attacks than placebo or other psychoactive drugs in 12 of 16 studies. Clomipramine has been found superior to placebo or other psychoactive drugs in 5 controlled studies. The effectivenessof these drugs is also reflected in a large number of open trials. The MAOUI phenelzine has been reported to be effectivein 5 controlled studies. Clomipramine is the best documented drug in the treatment of obsessive‐compulsive disorders. Itseffectiveness has been documented in 7 controlled studies. Most investigators consider the effects in panic syndromes as well as in obsessive‐compulsive disorders to be unrelated to the antidepressant e

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb07749.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb07750.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

ABSTRACT‐The focus of this paper is the treatment of panic disorder with alprazolam. Drug treatments alone are sometimes not sufficient by themselves, to adequately control all of the symptoms or components of this disorder. In the typical case we can identify four targets of treatment: The first target is the biological core of the condition, that is characterized by the unexpected, unprovoked attacks of anxiety. This responds best to medication. The second target is the phobic avoidance behaviour. It appears to be a conditioned or learned complication of the biological core, and appears to follow the laws of learning theory. Unlearning treatments, like behaviour therapy (notablyin vivoexposure) are usually necessary to make a full impact against the phobic avoidance behaviour. Thirdly, there is no drug that reverses the psycho‐social problems these patients have. Not all of them have such problems, but those that do may need psychotherapy to deal with their conflicts and stresses. Finally, the evidence in several chronic studies, suggest that this is a chronic relapsing disorder in the majority of cases. It is not enough to treat these patients acutely. They must be followed chronically and monitored carefully over many years, if they are to be protected against rela

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb07751.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb07752.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

ABSTRACT‐A model for the development of agoraphobia with panic attacks is proposed. The initiating clinical manifestation is the sudden appearance of spontaneous panic. The inter‐panic chronic anxiety may have several components: i.e. conditioning, increasing autonomic distress, and sensitization to the panic leading to avoidance. The illness course is quite variable but usually chronic. The spontaneous panic is blocked by imipramine with primary pharmacological anti‐panic effects. However, no direct effect of imipramine upon either anticipatory anxiety or avoidance behaviour is hypothesized. Among the psychotherapies, direct in vivo exposure mobilizes the patient more rapidly than office based therapy. Our data are consonant with the theory that the avoidances of agoraphobia are secondary to spontaneous panic attacks, and that the primary benefits of imipramine and exposure therapy are in their respective effects on panic and avoidance. Moreover, laboratory challenge studies, brain imaging studies, and genetic studies all point to a biological diathesis for panic dis

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb07753.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY