Increased brain serotonin turnover in panic disorder patients in the absence of a panic attack: reduction by a selective serotonin reuptake inhibitor

Since the brain neurotransmitter changes characterising panic disorder remain uncertain, we quantified brain noradrenaline and serotonin turnover in patients with panic disorder, in the absence of a panic attack. Thirty-four untreated patients with panic disorder and 24 matched healthy volunteers were studied. A novel method utilising internal jugular venous sampling, with thermodilution measurement of jugular blood flow, was used to directly quantify brain monoamine turnover, by measuring the overflow of noradrenaline and serotonin metabolites from the brain. Radiographic depiction of brain venous sinuses allowed differential venous sampling from cortical and subcortical regions. The relation of brain serotonin turnover to serotonin transporter genotype and panic disorder severity were evaluated, and the influence of an SSRI drug, citalopram, on serotonin turnover investigated. Brain noradrenaline turnover in panic disorder patients was similar to that in healthy subjects. In contrast, brain serotonin turnover, estimated from jugular venous overflow of the metabolite, 5-hydroxyindole acetic acid, was increased approximately 4-fold in subcortical brain regions and in the cerebral cortex (P < 0.01). Serotonin turnover was highest in patients with the most severe disease, was unrelated to serotonin transporter genotype, and was reduced by citalopram (P < 0.01). Normal brain noradrenaline turnover in panic disorder patients argues against primary importance of the locus coeruleus in this condition. The marked increase in serotonin turnover, in the absence of a panic attack, possibly represents an important underlying neurotransmitter substrate for the disorder, although this point remains uncertain. Support for this interpretation comes from the direct relationship which existed between serotonin turnover and illness severity, and the finding that SSRI administration reduced serotonin turnover. Serotonin transporter genotyping suggested that increased whole brain serotonin turnover most likely derived not from impaired serotonin reuptake, but from increased firing in serotonergic midbrain raphe neurons projecting to both subcortical brain regions and the cerebral cortex.     

Improving access to psychological therapy: Initial evaluation of two UK demonstration sites

Recently the UK Government announced an unprecedented, large-scale initiative for Improving Access to Psychological Therapies (IAPT) for depression and anxiety disorders. Prior to this development, the Department of Health established two pilot projects that aimed to collect valuable information to inform the national roll-out. Doncaster and Newham received additional funds to rapidly increase the availability of CBT-related interventions and to deploy them in new clinical services, operating on stepped-care principles, when appropriate. This article reports an evaluation of the new services (termed ‘demonstration sites’) during their first thirteen months of operation. A session-by-session outcome monitoring system achieved unusually high levels of pre to post-treatment data completeness. Large numbers of patients were treated, with low-intensity interventions (such as guided self-help) being particularly helpful for achieving high throughput. Clinical outcomes were broadly in line with expectation. 55-56% of patients who had attended at least twice (including the assessment interview) were classified as recovered when they left the services and 5% had improved their employment status. Treatment gains were largely maintained at 10 month follow-up. Opening the services to self-referral appeared to facilitate access for some groups that tend to be underrepresented in general practice referrals. Outcomes were comparable for the different ethnic groups who access the services. Issues for the further development of IAPT are discussed.     

The catastrophic misinterpretation model of panic disorder.

In the catastrophic misinterpretation model of panic Clark [Behav. Res. Ther. 24(1986)1461] proposes that panic attacks result from the misinterpretation of autonomic arousal stimuli as precursors to a physical or psychological emergency. The model has been widely examined, with many researchers suggesting that this specific cognitive bias is implicated in both the phenomenon of panic, and the aetiology and maintenance of panic disorder. Various research methodologies have provided only partial or inconclusive support for the model as being uniquely associated with panic, and as a cognitive process underpinning the experience of panic. This paper reviews the body of existing evidence and its implications for the model and proposes future research directions. The influence of implicit operational definitions of key terms in the catastrophic misinterpretation literature (e.g. 'catastrophe', 'threat', 'anxiety-related') are examined, and clarifications proposed. Inconsistencies and limitations in the measurement of catastrophic misinterpretation are highlighted, and subsequently developments to measurement instruments are proposed.     

How Separable Are Spirituality and Theology in Psychotherapy?

The authors respond to D. A. Helminiak's (2001) article “Treating Spiritual Issues in Secular Psychotherapy.” They focus particularly on Helminiak's argument for secular spirituality (whether spirituality can be independent of theology/religion) and his inherent biases in discussing the nature and existence of spirituality. The authors argue that all spiritual conceptions have theological implications—and thus a theology, broadly defined—and that theology, in this sense, pervades the theory and practice of all psychotherapists, whether or not they are religious.     

The influence of sphincter control and genital sensation on body image and gender identity in women.

The development of one aspect of feeling female is hypothesized to account for certain phenomena in the treatment of young women patients. Fear of loss of genital pleasure experienced as contractions of the anal and genital-urinary sphincters is seen as the central issue in conflicts manifested in genital, oral, and anal modalities. It is suggested that the female's awareness of her genital arises from the generalization of sphincter sensation in the little girl, which is then represented in the body image. The body image is postulated as a link between genital pleasure and the valuing of femininity.     

Distributional theories of impression formation

This paper examines theories of impression formation which represent stimulus information as distributions on subjective dimensions rather than points along a continuum. These theories explain why unfavorable information often overrides favorable information. Subjects were asked to imagine hypothetical persons described by single adjectives or adjective combinations and to estimate the probability that each person would have various degrees of likeableness. Three models were considered to describe how the likeableness distribution for the adjective combination depends on the distributions of the single adjectives. All three models assume that the mean of the distribution for the adjective combination is described by the equal probability criterion which, for symmetric distributions, implies a weighted average of the single adjective means with weights inversely proportional to their standard deviations. The models can be distinguished on the basis of the standard deviations of the adjective combinations. Estimated standard deviations of the single unfavorable adjectives were smaller than those for the single favorable adjectives. Furthermore, the standard deviation associated with an adjective combination tended to fall between the standard deviations of the single adjectives, consistent with the horizontal averaging model.     

Gender differences in the effectiveness of coping with dysphoria: A longitudinal study

This study examined whether men use more eflective means of coping with dysphoria on their own than do women. Forty-four male and female college students who reported feeling dysphoric were evaluated on their coping styles at three intervals in a six and a half week time span. The findings suggest that men and women do not use significantly different appraisal and coping techniques. For both sexes, problem-focused coping was associated with less dysphoria over time, whereas emotion-focused coping was associated with more dysphoria over time. Keeping anger in was associated with more dysphoria over time for women. In addition, the way in which the situation was appraised influenced the level of dysphoria over time for both sexes.     

Eysenck's incubation of fear hypothesis: an experimental test

The present experiment was designed to test Eysenck's hypothesis that repeated exposure to an unreinforced CS of brief duration following acquisition of a classical aversive CR may lead to a progressive increase in the strength of that CR, provided that the UCS is intense and the CR has drive-like properties. Using a between-groups design, normal human subjects were given identical classical acquisition trials, followed by extinction trials where CS duration was either 2, 8 or 16 sec. The UCS was of fixed high intensity. Dependent measures were tonic and phasic heart rate and skin conductance. No evidence of incubation was found as a function of CS duration. Nor was there any indication that CS duration differentially affected resistance to extinction. A small number of subjects showed evidence of incubation with heart rate measures during extinction. However, there was no indication that this enhancement was governed by the parameters suggested by Eysenck. UCR amplitude, which showed a positive correspondence with CS-bound activity throughout the trials, did not reliably predict incubation. Problems concerning both the definition and the demonstration of incubation are discussed.