Alcohol and depression in panic disorder

Bidirectional Association between First-Episode Panic Disorder and Major Depressive Disorder in a Nationwide General Population Survey in Korea

BACKGROUND

Panic disorder (PD) and major depressive disorder (MDD) can occur concurrently, despite different clinical manifestations. Because MDD and PD patients tend to have more complicated conditions, understanding the co-occurrence and pattern of these conditions is important. Here, we investigated the influence of PD and MDD on each other, with respect to time interval.

METHODS

Data from three national representative surveys were pooled (total 18,807 respondents), and the age of onset (AOO) of PD and MDD was analyzed. We performed Kaplan-Meier analysis to estimate separate survival functions, using the AOO of MDD and PD as the outcome. To understand the temporal effect of other disorders, we used a Cox proportional hazard model to estimate the hazard ratios for the onset of MDD/PD with other comorbidities as time-dependent covariates.

RESULTS

PD elevated the risk of subsequent MDD by 1.5-fold, whereas MDD elevated the risk of subsequent PD by 3.8-fold. The effect of such an elevation risk was significant for up to 2 years.

CONCLUSION

The results revealed a bidirectional relationship between MDD and PD. Each disease represents a risk of a subsequent occurrence of the other, which lasts for a considerable duration.

A history of aggression is a risk factor for postoperative confusion in elderly male drinkers

PURPOSE

We investigated the relationship between preoperative psychological state and postoperative confusion in elderly drinkers.

METHODS

We studied 81 male patients, ranging in age from 65 to 80 years, who were scheduled to undergo total hip arthroplasty and total knee arthroplasty. The patients were divided into two groups; non-drinkers and patients who drank 25 g or more of alcohol daily. All patients were given a neuropsychological screening evaluation, including a Mini-Mental State test, the Japanese version of the State-Trait Anxiety Inventory (STAI), a depression scale test, and evaluation of a history of aggression and postoperative confusion.

RESULTS

Postoperative confusion during the first 72 h after the end of the operation occurred in 7 of the 50 non-drinkers (14%) and in 11 of the 31 drinkers (35%) (P = 0.01). There were no significant differences in STAI (state anxiety and trait anxiety), Mini-Mental State, and depression scale scores between the non-drinkers and drinkers, or between patients with and without postoperative confusion. All 8 patients who had a history of aggression developed postoperative confusion. There was no significant difference in the incidence of postoperative confusion between drinkers who did not have a history of aggression and non-drinkers.

CONCLUSION

A history of aggression in elderly male drinkers is associated with postoperative confusion.

Phobic anxiety and depression as predictor variables for treatment outcome. A LISREL analysis on treated female alcoholics

The study focuses on the relationship between phobic anxiety and depression, alcohol abuse, treatment and drinking outcome in female alcoholics. A structural equation analysis (LISREL) was used to test the strength and direction of predictor variables, enabling the development of models for the process of change taking place following treatment. Participants were patients attending a specific treatment programme for women with alcohol problems at Karolinska Hospital, Stockholm, Sweden. One hundred and twenty female alcoholics consecutively admitted during 1991-1993 were followed up 2 years after treatment. The Alcohol Use Inventory (AUI) and Symptom Check List-90 were used at intake and follow-up. Duration of problem drinking and depression at follow-up affected drinking outcome directly and negatively, whereas duration of treatment affected drinking outcome directly and positively in all our models. Phobic anxiety on the other hand affected drinking outcome negatively and indirectly, via shorter treatment duration and higher depression at follow-up. Using different outcome variables as an end product resulted in only minor changes. Thus, the model presented is viewed as robust and clinically meaningful. The results underscore the importance of phobic anxiety and recurrent or sustained depression--in addition to the pre-treatment duration of problem drinking--for the drinking outcome among female alcoholics.

Influence of age and of pre-treatment with D-cycloserine on the behavior of ethanol-treated rats tested in the elevated plus-maze apparatus

There is evidence that ethanol is able to influence central functions through the antagonism of the NMDA-receptor system. It has been shown that this system is also involved in the modulation of anxiety-related behavior in rats. Recently, we observed gender- and age-related behavioral influences in rats tested on the elevated plus-maze apparatus The present study was undertaken in order to investigate: (1) the effects of ethanol (0.8, 1.0 or 1.2 g/kg, i.p.) on the behavior of male and female rats tested on the elevated plus-maze at 2, 3, 4 or 5 months of age; (2) the effect of the pre-treatment with D-cycloserine (3.0 or 6.0 mg/kg), an agonist of the glutamate NMDA-receptor system, 30 min before the ethanol (1.2 g/kg) injections, in rats tested in the elevated plus-maze at 2 months or 4 months of age. The results demonstrated that ethanol did not affect the time spent and the frequency of entries on the open arms of the elevated plus-maze in rats tested at 2 months of age, but increased these parameters in older animals. Moreover, the results showed that D-cycloserine, at doses that did not affect the behavior of control animals, antagonized the increased frequency of entries and time spent on open arms produced by ethanol in rats tested at 4 months of age. Our results suggest an age-related influence on the anxiolytic action of ethanol in rats tested in the elevated plus-maze. Moreover, the results suggest that the NMDA-receptor system can be involved in this effect, and strengthens the evidence for the participation of the NMDA-receptor system in anxiety-related behavior.

Factors influencing the relation between alcohol and mortality--with focus on wine

The impact of alcohol intake on mortality has been described in a large number of prospective population studies from many countries. Most have shown a J-shaped relation between alcohol intake and subsequent mortality, indicating that there are both beneficial and harmful effects of ethanol on health. In exploring the French paradox, it has been suggested that wine may have beneficial effects additional to that of ethanol. Recently, several prospective population studies have supported this idea. However, it is also likely that the apparent additional beneficial effect of wine on health is confounding.

Panic disorder in a Spanish sample of 89 patients with pure alcohol dependence

High rates of anxiety disorders, including panic disorder (PD), have been found in patients suffering from alcohol dependence (AD). It has been suggested that alcoholic subjects with PD represent a more severe subgroup of patients. Eighty-nine patients with 'pure' AD (without abuse of other drugs) were examined and compared for the presence of PD. Several clinical scales were administered to assess symptomatology and severity. Twenty-three patients (25.8%) met the criteria for PD. The mean age at onset for alcohol use was 18.7 versus 28.5 years for PD onset. Our finding of an earlier onset for alcoholism than for PD in a sample of Spanish patients illustrates the potential importance of transcultural factors. These patients were more likely to be women and to have first-degree relatives with PD. Overall, alcoholic patients with comorbid PD showed greater clinical severity. They were found to have more comorbidity with axis I disorders (major depression and dysthymia), greater clinical severity, and a history of more suicide attempts.

Effects of central and systemic injections of peripheral benzodiazepine receptor ligands on the anxiolytic actions of ethanol in rats

The influence of peripheral benzodiazepine receptor ligands Ro5-4864 (0.05 or 1.0 mg/kg, i.p.) or PK11195 (0.05 or 1.0 mg/kg, i.p.) on the anxiolytic effect of ethanol (1.2 g/kg; 14% p/v; i.p.) was investigated in rats tested on the elevated plus-maze. Other animals were injected through intrahippocampal administrations of the ligands (0.5 or 1.0 nmol/0.5 &mgr;l) before ethanol (1.2g/kg; 14% p/v; i.p.) and submitted to the elevated plus-maze test. The results showed that the systemic administration of either ligands 24 hours before the ethanol treatment resulted in a reduced anxiolytic effect of this drug. Only PK11195 reversed the effect of ethanol after intrahippocampal injection. These data suggest that peripheral benzodiazepine receptors play a role in ethanol anxiolysis.

Pharmacologic treatment of generalized anxiety disorder

GAD is a severe, chronic, and distressing illness that often requires long-term management. Considerable progress has been made in the ability to help these patients. New antidepressants, such as venlafaxine, and the SSRIs provide an important treatment alternative to "traditional" anxiollytic treatments, which include the benzodiazepines, buspirone, and the TCAs; however, comparative efficacy and the effects of psychiatric comorbidity, long-term treatment, and relapse prevention are areas requiring further investigation.

Alcohol Withdrawal, Psychological Symptoms, and Treatment Success

Twenty-nine chronic male alcoholics were examined with the Profile of Mood States (POMS). Tests with the POMS scale were carried out on the ward on Days 1 and 5 and after 21 days of sobriety. Our aim was to study the mood change in chronic alcoholics during detoxification and after 3 weeks of sobriety compared with a standard group (college students) and with psychiatric outpatients. A further aim was to study whether the patients who later underwent a Minnesota treatment program(n = 6) differed in mood compared with those who did not. An improvement was observed over time regarding all six POMS factors. The results for Day 21 were generally better than the expected normal values for the POMS profile sheet with regard to both psychiatric outpatients and college norms. The follow-up based on the patients' records 1.5-2 years after the detoxification occasion in question showed that 18 patients had been hospitalized, generally for alcohol detoxification. The 6 patients who participated in a Minnesota treatment program had no documented relapses. A comparison of these 6 patients with the rest showed that the former had significantly lower values on five of the subscales.

Dexamethasone reverses the ethanol-induced anxiolytic effect in rats

The effects of intraperitoneal and intrahippocampal administration of the glucocorticoid dexamethasone were assessed regarding ethanol-induced anxiolysis in the elevated plus-maze in rats. Animals pretreated with systemic injections of dexamethasone (0.5, 1. 0, or 2.0 mg/kg, IP) 15 min before ethanol (1.2 g/kg, 14% w/v, IP) administration showed a significant dose-dependent attenuation of the increased percentage of frequency and time spent on open arms of the maze. However, IP dexamethasone treatment 4 h before the test had no effect. Unilateral intrahippocampal injection of dexamethasone (2 and 20 nmol in 0.5 microl) also significantly attenuated the increased exploration of the open arms induced by ethanol. The results are interpreted in terms of the modulation of the anxiolytic effects of ethanol by glucocorticoids and the possible involvement of hippocampus in this response. The rapid blockade of ethanol induced anxiolysis by dexamethasone strengthens the suggestion that a nongenomic mechanism may underlie this response.

Symptomatology of depression and anxiety in female "social drinkers"

Self-reported alcohol use, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scores were obtained during on-site interviews of 172 female applicants for paid participation in behavioral research. Mood symptomatology as reflected in BDI and BAI scores was analyzed as a function of alcohol use and other demographic variables. Women reporting even light alcohol use (up to three drinks per week) were significantly more symptomatic than abstinent women. In contrast, no significant differences in symptomatology were observed due to race or education level. This analysis extends previous findings of depressed mood in women (while sober) whose lifestyle includes moderate alcohol consumption and suggests that even light alcohol use is related to depressed and/or anxious mood.