Showing papers by "Eberhard H. Uhlenhuth published in 1993"

Comorbidity in Panic Disorder: II. Chronology of Appearance and Pathogenic Comorbidity

Abstract: Ages of onset and the sequence of appearance of panic disorder (PD) and comorbid conditions were determined in a sample of 54 patients with the principal DSM-III-R diagnosis of PD. The onset of PD was earlier in patients with moderate to severe agoraphobia (AG) than in panic patients without AG. Patients with alcohol abuse and drug abuse before the onset of PD also had a tendency to develop PD earlier, which suggests that these conditions might have specifically predisposed to PD. All comorbid disorders, except for major depression, were more likely to precede the onset of PD so that, more often than not, PD appeared as a chronologically secondary condition. However, it was found that only for primary substance abuse such a temporal relationship might denote etiologic relatedness to PD, because of the reduced temporal distance between the onset of primary substance abuse and secondary PD.

International study of expert judgment on therapeutic use of benzodiazepines and other psychotherapeutic medications: I. Current concerns

Abstract: Although clinical experience influences psychotropic drug treatment world-wide, it has been underutilized because it has not been systematically gathered and widely disseminated. An international survey was conducted to help remedy this situation. One of the major objectives was to develop a representative body of expert judgment and opinion on the clinical use of benzodiazepines in relation to other psychotherapeutic medications that might be used for the same purposes. A select international panel of psychiatric experts on the pharmacotherapy of the anxiety and depressive disorders (N = 73) was constituted on the basis of progressive peer nominations. The peer selection process began with primary nominators from 44 countries. Judgments and opinions about psychotherapeutic medications were elicited from the Expert Panel via a self-administered questionnaire. Completion rate: 90 per cent (66/73). Outcomes bear directly on current therapeutic and regulatory concerns. Topics addressed include: special indications for use, abuse liability, dependence potential, duration of treatment, high-risk treatments, and adverse effects. Although sometimes divided, agreement was generally high and indicative of a good benefit to risk ratio for the benzodiazepines. Expert judgments were more positive than would have been anticipated from media reports, public concern, and recent regulatory postures. The following inferences can be drawn from this body of expert judgment and opinion: (1) qualitative differences in abuse liability among the benzodiazepines are minimal; (2) physical dependence at therapeutic doses is not a major clinical problem; (3) when physical dependence occurs, it can be readily managed clinically by the treating physician; (4) the relative abuse liability of the benzodiazepines as a class is low. These expert evaluations do not support or justify the imposition of stronger or differential restrictions on the benzodiazepines. The data help define the reasonable limits within which clinical guidelines and regulatory mandates can be meaningfully promulgated.