1
|
Levitan MN, Simoes P, Sardinha AG, Nardi AE. Agoraphobia Related to Unassertiveness in Panic Disorder. J Nerv Ment Dis 2016; 204:396-9. [PMID: 26915016 DOI: 10.1097/nmd.0000000000000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite developments in panic disorder (PD) research, a significant percentage of patients do not benefit from conventional treatments. Interpersonal factors have been identified as potential predictors of treatment failures. We aimed to evaluate assertiveness in a sample of patients with PD and its implications for treatment. Forty-six symptomatic patients with PD and 46 college students responded to assessment scales regarding assertiveness and clinical data. Seventy-five percent of the patients had a secondary diagnosis of agoraphobia. We found that the PD group was characterized as nonassertive and slightly less assertive than control subjects. Furthermore, the deficit in the level of assertiveness correlated with the severity of the PD. The diagnosis of agoraphobia was correlated with unassertiveness (p < 0.05). Agoraphobia predisposes individuals to dependency and insecurity about their ability to overcome anxiogenic situations. These data demonstrate the importance of managing assertiveness in patients with PD accompanied by agoraphobia.
Collapse
Affiliation(s)
- Michelle Nigri Levitan
- *Psychiatry Institute and †Social Work School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | |
Collapse
|
2
|
Abstract
BACKGROUND Although many generalized anxiety disorder (GAD) patients respond to the available pharmacological treatments, nearly half of them do not present the expected results. Besides, the side effects associated to some drugs have a negative impact on treatment adherence. Therefore, the aim of this review was to report the clinical profile of agomelatine, a selective melatonergic MT1/MT2 receptor agonist with serotonin 5-HT2c receptor antagonist activities, as a potential pharmacological option in the treatment of GAD. METHODS We performed a literature review regarding studies that evaluated the use of agomelatine in GAD treatment. RESULTS Two short-term, double-blinded studies and one prevention-treatment trial evaluated the efficacy of agomelatine in the treatment of GAD. Agomelatine was associated with higher rates of clinical response and remission, when compared to placebo. In addition, the long-term use of agomelatine decreased the risk of relapse of anxiety symptoms, even for the severely ill patients. Besides, the tolerability was satisfactory with the absence of discontinuation symptoms, as observed in previous studies. CONCLUSION The efficacy and tolerability profiles of agomelatine in the treatment of GAD were good. However, the scarce number of trials, the small sample sizes, and the use of patients without any comorbid conditions were some limitations that impaired the generalization of the results in the general population. Nevertheless, agomelatine is an attractive off-label option in the treatment of GAD that needs more conclusive evidences to establish its role in future guidelines.
Collapse
Affiliation(s)
- Michelle Nigri Levitan
- Laboratory of Panic and Respiration, Institute of Psychiatry of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcelo Papelbaum
- Laboratory of Panic and Respiration, Institute of Psychiatry of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil ; State Institute of Diabetes and Endocrinology of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Antonio Egidio Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry of the Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
3
|
Levitan MN, Chagas MH, Linares IM, Crippa JA, Terra MB, Giglio AT, Cordeiro JL, Garcia GJ, Hasan R, Andrada NC, Nardi AE. Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. Rev Bras Psiquiatr 2013; 35:406-15. [DOI: 10.1590/1516-4446-2012-0860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 01/30/2013] [Indexed: 11/22/2022]
Affiliation(s)
- Michelle Nigri Levitan
- Universidade Federal do Rio de Janeiro (UFRJ), Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Marcos H. Chagas
- Universidade de São Paulo (USP), Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Ila M. Linares
- Universidade de São Paulo (USP), Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - José A. Crippa
- Universidade de São Paulo (USP), Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Mauro B. Terra
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Centro de Estudos Jose de Barros Falcão, Brazil
| | | | - Joana L.C. Cordeiro
- Universidade de São Paulo (USP), Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Giovana J. Garcia
- Universidade de São Paulo (USP), Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Rosa Hasan
- Associação Brasileira de Neurologia, Brazil
| | | | - Antonio E. Nardi
- Universidade Federal do Rio de Janeiro (UFRJ), Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| |
Collapse
|
4
|
Abstract
Agomelatine is an antidepressant with a novel mechanism of being a selective melatonergic MT₁/MT₂ receptor agonist with serotonin 5-HT(2c) receptor antagonist activities. Although the vast majority of the clinical data concerning the effectiveness of agomelatine concern its antidepressant properties, there is also preliminary evidence of anxiolytic effects. The purpose of the study was to perform a review of studies that investigated the efficacy of agomelatine in the treatment of anxiety disorders (ADs) and a discussion of the clinical utility of agomelatine in this clinical population. Previous clinical data indicated that agomelatine was more efficacious than both placebo and comparator drugs in reducing anxiety symptoms in depressed patients. Moreover, agomelatine effectiveness in the treatment of AD patients was observed in 2 double-blind, randomized trials, in a case series and in 3 case reports. Greater clinical evidence was observed with generalized AD patients. Agomelatine was efficacious both in reducing anxiety symptoms and in preventing relapses after a 6-month follow-up. However, concerning other ADs, evidence of agomelatine's effects on anxiety was found only in isolated case descriptions. Nevertheless, those case reports emphasized the drug's favorable side effect profile (in comparison to serotonin reuptake inhibitors) and its effectiveness in treatment-refractory patients. Considering the high incidence of poor efficacy and tolerability of the first-line agents in the treatment of ADs, agomelatine seems to be a promising option in cases of treatment failure, and it could be used as a second or third option, as monotherapy or as augmentation treatment.
Collapse
Affiliation(s)
- Michelle Nigri Levitan
- Laboratory of Panic and Respiration, Institute of Psychiatry of the Federal University of Rio de Janeiro, Brazil.
| | | | | |
Collapse
|
5
|
Levitan MN, Falcone EM, Placido M, Krieger S, Pinheiro L, Crippa JA, Bruno LM, Pastore D, Hallak J, Nardi AE. Public Speaking in Social Phobia: A Pilot Study of Self-Ratings and Observers' Ratings of Social Skills. J Clin Psychol 2012; 68:397-402. [DOI: 10.1002/jclp.20868] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
6
|
Levitan MN, Crippa JA, Bruno LM, Pastore DL, Freire RC, Arrais KC, Hallak JE, Nardi AE. Postural balance in patients with social anxiety disorder. Braz J Med Biol Res 2011; 45:38-42. [PMID: 22086467 PMCID: PMC3854136 DOI: 10.1590/s0100-879x2011007500155] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 10/31/2011] [Indexed: 11/22/2022] Open
Abstract
Body stability is controlled by the postural system and can be affected by fear and anxiety. Few studies have addressed freezing posture in psychiatric disorders. The purpose of the present study was to assess posturographic behavior in 30 patients with social anxiety disorder (SAD) and 35 without SAD during presentation of blocks of pictures with different valences. Neutral images consisted of objects taken from a catalog of pictures, negative images were mutilation pictures and anxiogenic images were related to situations regarding SAD fears. While participants were standing on a force platform, similar to a balance, displacement of the center of pressure in the mediolateral and anteroposterior directions was measured. We found that the SAD group exhibited a lower sway area and a lower velocity of sway throughout the experiment independent of the visual stimuli, in which the phobic pictures, a stimulus associated with a defense response, were unable to evoke a significantly more rigid posture than the others. We hypothesize that patients with SAD when entering in a situation of exposure, from the moment the pictures are presented, tend to move less than controls, remaining this way until the experiment ends. This discrete body manifestation can provide additional data to the characterization of SAD and its differentiation from other anxiety disorders, especially in situations regarding facing fear.
Collapse
Affiliation(s)
- M N Levitan
- Laboratório do Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Nardi AE, Valença AM, Freire RC, Mochcovitch MD, Amrein R, Sardinha A, Levitan MN, Nascimento I, de-Melo-Neto VL, King AL, de O E Silva AC, Veras AB, Dias GP, Soares-Filho GL, da Costa RT, Mezzasalma MA, de Carvalho MR, de Cerqueira AC, Hallak JE, Crippa JA, Versiani M. Psychopharmacotherapy of panic disorder: 8-week randomized trial with clonazepam and paroxetine. Braz J Med Biol Res 2011. [PMID: 21344132 DOI: 10.1590/s0100‐879x2011007500020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of the present randomized, open-label, naturalistic 8-week study was to compare the efficacy and safety of treatment with clonazepam (N = 63) and paroxetine (N = 57) in patients with panic disorder with or without agoraphobia. Efficacy assessment included number of panic attacks and clinician ratings of the global severity of panic disorders with the clinical global impression (CGI) improvement (CGI-I) and CGI severity (CGI-S) scales. Most patients were females (69.8 and 68.4% in the clonazepam and paroxetine groups, respectively) and age (mean ± SD) was 35.9 ± 9.6 years for the clonazepam group and 33.7 ± 8.8 years for the paroxetine group. Treatment with clonazepam versus paroxetine resulted in fewer weekly panic attacks at week 4 (0.1 vs 0.5, respectively; P < 0.01), and greater clinical improvements at week 8 (CGI-I: 1.6 vs 2.9; P = 0.04). Anxiety severity was significantly reduced with clonazepam versus paroxetine at weeks 1 and 2, with no difference in panic disorder severity. Patients treated with clonazepam had fewer adverse events than patients treated with paroxetine (73 vs 95%; P = 0.001). The most common adverse events were drowsiness/fatigue (57%), memory/concentration difficulties (24%), and sexual dysfunction (11%) in the clonazepam group and drowsiness/fatigue (81%), sexual dysfunction (70%), and nausea/vomiting (61%) in the paroxetine group. This naturalistic study confirms the efficacy and tolerability of clonazepam and paroxetine in the acute treatment of patients with panic disorder.
Collapse
Affiliation(s)
- A E Nardi
- Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, RJ, Brasil.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Nardi AE, Valença AM, Freire RC, Mochcovitch MD, Amrein R, Sardinha A, Levitan MN, Nascimento I, de-Melo-Neto VL, King AL, de O E Silva AC, Veras AB, Dias GP, Soares-Filho GL, da Costa RT, Mezzasalma MA, de Carvalho MR, de Cerqueira AC, Hallak JE, Crippa JA, Versiani M. Psychopharmacotherapy of panic disorder: 8-week randomized trial with clonazepam and paroxetine. Braz J Med Biol Res 2011; 44:366-73. [PMID: 21344132 DOI: 10.1590/s0100-879x2011007500020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 02/03/2011] [Indexed: 11/22/2022]
Abstract
The objective of the present randomized, open-label, naturalistic 8-week study was to compare the efficacy and safety of treatment with clonazepam (N = 63) and paroxetine (N = 57) in patients with panic disorder with or without agoraphobia. Efficacy assessment included number of panic attacks and clinician ratings of the global severity of panic disorders with the clinical global impression (CGI) improvement (CGI-I) and CGI severity (CGI-S) scales. Most patients were females (69.8 and 68.4% in the clonazepam and paroxetine groups, respectively) and age (mean ± SD) was 35.9 ± 9.6 years for the clonazepam group and 33.7 ± 8.8 years for the paroxetine group. Treatment with clonazepam versus paroxetine resulted in fewer weekly panic attacks at week 4 (0.1 vs 0.5, respectively; P < 0.01), and greater clinical improvements at week 8 (CGI-I: 1.6 vs 2.9; P = 0.04). Anxiety severity was significantly reduced with clonazepam versus paroxetine at weeks 1 and 2, with no difference in panic disorder severity. Patients treated with clonazepam had fewer adverse events than patients treated with paroxetine (73 vs 95%; P = 0.001). The most common adverse events were drowsiness/fatigue (57%), memory/concentration difficulties (24%), and sexual dysfunction (11%) in the clonazepam group and drowsiness/fatigue (81%), sexual dysfunction (70%), and nausea/vomiting (61%) in the paroxetine group. This naturalistic study confirms the efficacy and tolerability of clonazepam and paroxetine in the acute treatment of patients with panic disorder.
Collapse
Affiliation(s)
- A E Nardi
- Laboratório de Pânico e Respiração, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, RJ, Brasil.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|