Benzodiazepines and anxiety sensitivity in panic disorder

Background: Anxiety sensitivity (AS), the belief that bodily sensations have harmful consequences, is a reliable predictor of panic attacks in both clinical and nonclinical populations. Recently, a new measure of AS has been proposed. The AS profile (ASP) was designed to be a more comprehensive measure of AS, and to be more suitable for the measurement of different AS dimensions. Preliminary evidence (college student sample) suggests that the ASP has 4 dimensions. In the present study, the dimensional structure of the ASP was further investigated, as well as its relationship with temperament and character traits. Methods: Exploratory and confirmatory factor analysis of ASP scores in two large samples of psychiatric outpatients and nonclinical controls (combined n = 742). Correlations and partial correlations of ASP with temperament and character. Results: Exploratory factor analysis yielded a single AS factor. However, confirmatory factor analysis showed that the 6-dimensional structure, as Taylor and Cox had originally intended it, might be a defendable solution. However, the number of items is much too high, with many subscales consisting of semantic clusters. ASP scores were found to be weakly related to the temperament dimension harm avoidance, corroborating earlier findings that were not statistically significant because of small sample sizes. Conclusions: The ASP may be shortened from 60 to 24 items without loss of reliability or content. Future studies using challenge paradigms and studies with general hospital patients may further investigate the usefulness of a shortened version of the ASP.

Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Anxiety Sensitivity Profile: Dimensional Structure and Relationship with Temperament and Character

Does

Duijsens²,

Eurelings-Bontekoe³

et al. 2003

“…While there is a controlled comparison of different types of drugs of the same class (for instance, paroxetine, sertraline and fluoxetine), to the best of our knowledge there is no such comparison between BDZ and AD. Our research group performed a study on 16 patients on BDZ who had recovered from panic disorder upon exposure treatment and had drug treatment slowly tapered and discontinued under optimal conditions; 13 of the 16 patients (81%) reported a withdrawal reaction [52]. A subsequent study used the same methodology in a similar patient population treated with new AD [53]; 9 of the 20 patients (45%) experienced a discontinuation syndrome according to specific criteria.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Tolerability of Benzodiazepines versus Antidepressants in Anxiety Disorders: A Systematic Review and Meta-Analysis

Offidani¹,

Guidi²,

Tomba³

et al. 2013

152

103

Background: Placebo-controlled trials showed that both benzodiazepines (BDZ) and antidepressant drugs (AD) are effective in treating anxiety disorders. However, in the last years a progressive shift in the prescribing pattern from BDZ to newer AD has taken place. The aim of this systematic review and meta-analysis is to analyze whether controlled comparisons support such a shift. Methods: CINHAL, the Cochrane Library, MEDLINE, PubMed and Web of Science were searched from inception up to December 2012. A total of 22 studies met the criteria for inclusion. They were mostly concerned with tricyclic antidepressants (TCA; 18/22) and involved different anxiety disorders. In order to reduce clinical heterogeneity, only the 10 investigations that dealt with the comparison between TCA and BDZ in panic disorder were submitted to meta-analysis, whereas the remaining papers were individually summarized and critically examined. Results: According to the systematic review, no consistent evidence emerged supporting the advantage of using TCA over BDZ in treating generalized anxiety disorder (GAD), complex phobias and mixed anxiety-depressive disorders. Indeed, BDZ showed fewer treatment withdrawals and adverse events than AD. In panic disorder with and without agoraphobia our meta-analysis found BDZ treatments more effective in reducing the number of panic attacks than TCA (risk ratio, RR = 1.13; 95% CI = 1.01-1.27). Furthermore, BDZ medications were significantly better tolerated than TCA drugs, causing less discontinuation (RR = 0.40; 95% CI = 0.20-0.57) and side effects (RR = 0.41; 95% CI = 0.34-0.50). As to newer AD, BDZ trials resulted in comparable or greater improvements and fewer adverse events in patients suffering from GAD or panic disorder. Conclusions: The change in the prescribing pattern favoring newer AD over BDZ in the treatment of anxiety disorders has occurred without supporting evidence. Indeed, the role and usefulness of BDZ need to be reappraised.

“…Two psychiatrists performed the treatment in both groups. When patients were taking benzodiazepines on study ntry, in the course of treatment, according to a standardized protocol [33], these drugs were tapered and, whenever possible, discontinued. The therapists did not prescribe any new psychotropic drugs or increased dosages of benzodiazepines.…”

Section: Methodsmentioning

confidence: 99%

The Sequential Combination of Cognitive Behavioral Treatment and Well-Being Therapy in Cyclothymic Disorder

Fava

Rafanelli

Tomba

et al. 2011

Self Cite

135

Background: There is a lack of controlled studies of psychological treatment of cyclothymic disorder. The aim of this investigation was to examine the benefits of the sequential combination of cognitive behavioral therapy (CBT) and well-being therapy (WBT) compared to clinical management (CM) in DSM-IV cyclothymic disorder. Methods: Sixty-two patients with DSM-IV cyclothymic disorder were randomly assigned to CBT/WBT (n = 31) or CM (n = 31). Both CBT/WBT and CM consisted of ten 45-min sessions every other week. An independent blind evaluator assessed the patients before treatment, after therapy, and at 1- and 2-year follow-ups. The outcomes included total score of the change version of the Clinical Interview for Depression, and the Mania Scale. All analyses were performed on an intent-to-treat basis. Results: Significant differences were found in all outcome measures, with greater improvements after treatment in the CBT/WBT group compared to the CM group. Therapeutic gains were maintained at 1- and 2-year follow-ups. Conclusions: A sequential combination of CBT and WBT, which addresses both polarities of mood swings and comorbid anxiety, was found to yield significant and persistent benefits in cyclothymic disorder.