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Short-term treatment response in panic disorder was studies in 66 subjects who had completed 3 weeks of treatment with fluvoxamine (n = 23), cognitive therapy (n = 20), or placebo (n = 23). Clinical and self-rated assessments were gathered at baseline, during, and after treatment. Using multiple logistic regression, treatment with fluvoxamine, a low panic attack severity score, and absence of a comorbid personality disorder were identified as significant predictors of recovery. Personality disorder was an important negative predictor to outcome with cognitive therapy. The results support the efficacy of fluvoxamine, and show that patients with low symptom severity and a normal personality respond well to treatment.

Fourteen subjects with illness phobia, a subtype of hypochondriasis, were compared with an equal number of subjects with panic disorder who had been matched for age and sex. The illness phobic subjects differed from panic subjects in not having spontaneous panic attacks or agoraphobic symptoms, the characteristic features of panic disorder. The onset of illness phobia was related to experience with illness in half the subjects. Half of the illness phobic subjects also had family histories of anxiety disorders. The results suggest that illness phobia is distinct from panic disorder and that it is a disorder in which environmental and genetic factors are etiologically important.

Unipolar depression and alcoholism were tested for genetic linkage to esterase-D at 13q14.1. Tight linkage to esterase-D was ruled out for three phenotypes using three models of penetrance: (1) unipolar depression and alcoholism taken together as affected, (2) unipolar depression alone as affected with alcoholism considered unaffected and (3) alcoholism alone as affected with unipolar depression considered unaffected. This study does not support an earlier finding of possible linkage between the esterase-D locus at 13q14.1 and alcoholism.

Ten subjects with illness phobia were treated with imipramine for 8 weeks. All of the eight subjects who remained on the drug for 4 weeks or more reported at least moderate improvement. Overstimulatory reactions occurred in four subjects causing two to discontinue medication. Imipramine appears to be a potentially useful treatment for this subtype of hypochondriasis.

To determine the validity of the DSM-IIIR category organic mood disorder, we compared 50 psychiatric consultations with this diagnosis to 50 psychiatric consultations diagnosed with major depression in the medically ill. Organic mood disorder patients were more likely to be in the index affective disorder episode and have a negative family history of depression. Despite similar pharmacologic treatment between groups, the organic mood disorder group was less likely to be completely recovered at 4 years follow-up. This study suggests organic mood disorder is a valid diagnosis in the psychiatry consultation service.

The relationship between alcohol use and anxiety is complex. From a clinical standpoint, it is clear that psychiatrists caring for anxious patients must be aware of the possibility of secondary alcohol abuse. For the most part, anxiety disorders are highly treatable conditions, whereas alcoholism is less successfully treated. With this in mind, it is important for the clinician to accurately diagnose anxiety disorders in their patients. Failure to do so may lead a high percentage of patients to the major complication of substance abuse, which itself may be very difficult to treat. Further research to understand the relationship between anxiety and alcohol use is warranted. Future studies should focus on discovering which anxious patients are likely to abuse alcohol. Studies screening patients for the presence of alcoholic traits, such as antisocial behavior or a family history of alcoholism, may help identify anxiety disorder patients who are likely to go on to become alcohol abusers. Researchers interested in the treatment of substance abusers should become acutely interested in the recognition and treatment of anxiety disorder in their patients. Identifying patients with anxiety disorders would be a first step in individualizing treatment for a given alcoholic patient.

A questionnaire was given to the students and faculty of the University of Iowa School of Music to learn about their experiences with and attitudes about performance anxiety. Forty-nine (16.5%) of the 302 respondents indicated that their musical performance was impaired by anxiety. Over 21% of the respondents indicated that they experienced marked distress while performing and 16.1% indicated that performance anxiety had adversely affected their careers. Women more frequently reported distress and impairment due to performance anxiety than men. Age was not found to affect problems with performance anxiety. Poor concentration, rapid heart rate, tremor, sweating, and dry mouth were the most commonly reported anxious symptoms. Drug and alcohol use among this group of musicians was minimal. The findings suggest that performance anxiety is an important problem that may in some instances warrant medical treatment.

Eighteen families informative for c-Harvey-ras-1 and INS DNA markers were tested for linkage to unipolar depression and alcoholism. No evidence of linkage was found between these DNA markers and the disorders observed in the families. This study fails to replicate the Old Order Amish Study and suggests that a significant degree of genetic heterogeneity may be present among psychiatric disorders.

Many medications have been reported to produce attacks of acute intermittent porphyria (AIP). Nortriptyline has been reported to be safe in porphyric patients. We present a case of AIP exacerbated by nortriptyline.

Tolerance to the therapeutic effects of phenelzine developed in three patients with panic disorder. A central dysfunction of neurotransmitters or a change in receptor function may have been involved.

A patient is presented who developed diffuse T-wave inversion during a course of ECT. Review of the literature suggests that prolonged T-wave inversion associated with ECT is an uncommon and probably benign finding not warranting an interruption of a course of electrotherapy.

Recent developments in neurobiology, diagnostic classification, and drug/psychotherapy trials have increased our ability to manage patients with anxiety disorders. These recent developments, along with epidemiologic surveys showing the high frequency of anxiety disorders in the general population as well as in the primary care population, have reemphasized the importance of anxiety disorders in family practice. This review presents treatment recommendations, including dosage, products, guidelines for monitoring, and discontinuation. Advances in the neurobiology of anxiety are also included.

In this archival study, 58 patients with unipolar depression who were 55 years of age or older were compared to 155 depressed control patients age 54 years or less. The older patients with unipolar depression had a significantly worse outcome, with only 51.7% experiencing a period of full remission during follow-up. Medical disorders were common, and older depressed patients showed a clear excess of cardiovascular disorders. Clinical symptoms did not separate the two groups, with the exception of psychomotor retardation and agitation. Electroconvulsive therapy was associated with less continuous hospitalization and an overall superior outcome.

The influence of age on the natural history of unipolar depression when treated with electroconvulsive therapy (ECT) was studied using a naturalistic/archival study design. A sample of 125 patients who received no somatic treatment were compared with 128 patients who all received a course of ECT with at least four treatments. Patients were separated according to age at admission. Treated patients, aged 40 or older, who were clearly remitters showed no differences in previous episodes, subsequent episodes, subsequent hospitalizations, or likelihood of experiencing a period of full recovery when compared with a similar group of untreated patients. Hospitalization greater than 1 year and chronicity were significantly more common in the untreated older subjects. Treated patients aged 39 or younger, who also were clearly remitters, showed significant increases in subsequent episodes and subsequent hospitalizations when compared with a group of depressed patients of similar age who received no somatic treatment. Hospitalization greater than 1 year was also more common in the untreated younger patients. ECT clearly reduces the rate of chronicity in older patients but may be associated with an increase in episodes after treatment in the younger population.