Introduction: Several clinical studies suggest antidepressive and anxiolytic effects of regular endurance training. The mechanisms by which exercise exerts these effects are still unclear. It was hypothesized that athletes might show a diminished reaction to psychosocial stress and noradrenergic stimulation.Methods: 12 male athletes and 12 healthy untrained male controls underwent a challenge paradigm on 3 separate days: the alpha-2-receptor antagonist yohimbine (0.4 mg/kg), placebo or a psychosocial stress test (SST) were administered. Responses were measured by psychometric scales, plasma cortisol, blood pressure and heart rate.Results: Before testing, psychometric variables and cortisol levels were not different between the 2 groups. In comparison to placebo conditions, both the social stress test and the administration of yohimbine were followed by significant increases of anxiety symptoms, plasma cortisol, heart rate and blood pressure in both groups. However, these responses were not significantly different between the group of athletes and the control group.Discussion: These results do not support the hypotheses that high aerobic fitness is associated with attenuated psychological and neuroendocrine responses to yohimbine or to psychosocial stress.

INTRODUCTION:Data on basal hypothalamo-pituitary-adrenomedullary (HPA) function over controlled treatment trials with serotonergic drugs in anxiety disorders are still rare.METHODS:29 patients with panic disorder participating in a 10 week randomized, controlled trial (paroxetine vs. placebo with exercise or relaxation; N=60) collected urine for cortisol excretion over 3 consecutive nights before start and before termination of the treatment episode. Urinary cortisol was measured by radioimmunoassay. Efficacy measures were the Clinical Global Impression Scale (CGI) and the Panic and Agoraphobia Scale (P&A). 83% were female (p<.05 vs. males). 55% received additional aerobic exercise, and 45% relaxation. 55% received paroxetine treatment, and 45% placebo. Significantly fewer males received placebo treatment (p<.05).RESULTS:All subjects improved significantly. Cortisol excretion did not differ between treatment groups or at pre-/post measurements. Females showed a significantly higher variability of cortisol excretion compared to males, at pre-(p<.005) and post (p=.015) assessments. Males displayed a trend to lower basal HPA function at end of treatment (p=.08). HPA variability after treatment showed a trend to be higher in the paroxetine (p=.052) -who clinically improved significantly better- compared to the placebo group. No relationship between HPA activity and treatment response or with exercise was detected.DISCUSSION:HPA function shows significant gender differences, with females having a higher HPA function variability. Future studies on HPA function in treatment trials should address gender and medication effects.

Objective: Evidence based on controlled studies is still limited for treatment strategies that prevent recurrence of suicide attempts. Findings from observational as well as meta‐analytic studies strongly suggest that lithium may have suicide‐protective properties. Method: Patients with a recent suicide attempt in the context of an affective spectrum disorder ( n = 167) were treated with either lithium or placebo during a 12‐month period. Results: Survival analysis showed no significant difference of suicidal acts between lithium and placebo‐treated individuals (adjusted hazard ratio 0.517; 95% CI 0.18–1.43). However, post hoc analysis revealed that all completed suicides had occurred in the placebo group accounting for a significant difference in incidence rates ( P = 0.049). Conclusion: Results indicate that lithium treatment might be effective in reducing the risk of completed suicide in adult patients with affective disorders. Our findings contribute to the growing body of evidence suggesting a specific antisuicidal effect of lithium.

The location of Salmonella typhimurium porins has been found in human monocytes and lymphocytes by means of high resolution autoradiography. The results indicate that tracers of porins are frequently visible on ultrathin sections of treated human lymphomonocytes and that they are located especially in the nuclear areas.

Präventive und therapeutische Auswirkungenvon körperlicher Aktivität auf Erkrankungendes Herz-Kreislauf-Systems oderdes Bewegungsapparates konnten in denletzten Jahrzehnten in vielen Studien eindrücklich belegt werden. Im Vergleich dazuwurde die Bedeutung einer regelmäßigenBewegung für den Erhalt der psychischenGesundheit bisher eher vernachlässigt.Insbesondere bei Angststörungenund depressiven Erkrankungen gibtes aber zunehmende empirische Belegedafür, dass die Symptomatik über ausreichendintensive körperliche Aktivität signifikantbeeinflusst werden kann. Für Suchterkrankungen,affektive Störungen oder Psychosenaus dem schizophrenen Formenkreissteht eine ausreichende empirischeAbsicherung sporttherapeutischer Effektenoch aus, es gibt aber eine Reihe klinischerAnhaltspunkte dafür, dass ein regelmäßigeskörperliches Training auch für diese Patientengruppensinnvoll ist. Die Mehrzahlder kontrollierten Studien verwendete Ausdauertraining, in einigen Studien zeigteKrafttraining aber vergleichbare Effekte. Nebenpsychologischen Wirkmechanismenwie Abnahme von Vermeidungsverhalten,Verbesserung des Selbstbewusstseins, Eigeninitiative und die Veränderung dysfunktionalerKognitionen spielen auch neurobiologischeAdaptationsprozesse eine wichtigeRolle (serotonerge Rezeptoren, neurotrope Faktoren). In dividuelle Anleitungund kontinuierliche Motivationsarbeit sindeine entscheidende Voraussetzung für denErfolg sporttherapeutischer Maßnahmen.Abschließend werden daher Empfehlungenfür die praktische Anwendung dieserMaßnahmen gegeben.

Patients with borderline personality disorder (BPD) were compared with a healthy control group with regard to traumatic life events during childhood. The patients (n=66) and controls (n=109) were investigated using a comprehensive retrospective interview with 203 questions about childhood traumatic life events, parental attitudes, family history of psychiatric disorders and birth risk factors. The frequency of reports of traumatic childhood experiences was significantly higher in patients than in controls, including sexual abuse, violence, separation from parents, childhood illness, and other factors. On a 0- to 10-point "severe trauma scale," patients had significantly more severe traumatic events (mean score=3.86, SD=1.77) than control subjects (0.61, SD=0.93). Only four (6.1%) of the BPD patients, but 67 (61.5%) of the controls did not report any severe traumatic events at all. Compared with controls, patients described the attitude of their parents as significantly more unfavorable in all aspects. Patients reported significantly higher rates of psychiatric disorders in their families in general, especially anxiety disorders, depression, and suicidality. Among birth risk factors, premature birth was reported more often in BPD subjects. In a logistic regression model of all possible etiological factors examined, the following factors showed a significant influence: familial neurotic spectrum disorders, childhood sexual abuse, separation from parents and unfavorable parental rearing styles. The present data support the hypothesis that the etiology of BPD is multifactorial and that familial psychiatric disorders and sexual abuse are contributing factors.

Background. In schizophrenia, affective disorders, and obsessive-compulsive disorder (OCD) dysfunction of frontal neuronal circuits has been suggested. Such impairments imply corresponding oculomotor deficits.Method. Eye movement response to foveofugal and foveopetal step-ramp stimuli was recorded within the same study design in patients with schizophrenia (N = 16), affective disorder (N = 15), and OCD (N = 18) and compared with controls (N = 23) using infra-red reflection oculography.Results. In the foveofugal task steady-state velocity was lower in all patient groups compared with controls. Post-saccadic eye velocity was also decreased in patients with schizophrenia and affective disorder. In the foveopetal stimulus steady-state velocity was reduced in schizophrenic patients, only. Changes of saccadic latencies or position errors were not found in any of the patient groups. Also, pursuit latency was unchanged and initial eye acceleration was not decreased.Conclusions. Unaltered saccadic parameters indicate intact motion perception in cortical visual area V5. Therefore, the observed deficit of pursuit maintenance implies a dysfunction of frontal networks in all patient groups including the pursuit region of the frontal eye field (FEF). In patients with schizophrenia and affective disorder reduced post-saccadic pursuit initiation may indicate an impaired interaction between the pursuit and the saccadic system.

OBJECTIVE:Childhood traumatic experiences, rearing styles, familial mental disorders and birth risk factors have been associated with the development of social anxiety disorder.METHOD:Patients with social anxiety disorder (n=50) and healthy controls (n=120) were investigated using a retrospective interview with 203 questions.RESULTS:The frequency of reports of traumatic childhood experiences was significantly higher in patients than in controls, including separation from parents, parents' marital discord, sexual abuse, familial violence, childhood illness, and other factors. On a 0-10 point 'severe trauma scale' patients had significantly higher mean scores (2.0; SD 1.28) than control subjects (0.82; SD 1.1; p<0.0001). Only 6 (12%) of the social phobic patients, but 63 (52.5%) of the controls did not report any severe traumatic events at all (chi2=24.0; p<0.0001). Compared to controls, patients described their parents' rearing styles as significantly more unfavourable. Patients reported higher rates of psychiatric disorders in their families in general, in particular anxiety disorders, depression, and suicidality. Birth risk factors did not differ between patients and controls. In a logistic regression model, the highest contribution was noted for familial anxiety disorders. Separation from parents also had a significant, but smaller influence. There was only a trend towards a significant contribution of childhood sexual abuse. Violence in the family, parental rearing styles and birth risk factors did not contribute significantly.CONCLUSIONS:The present data suggest that the aetiology of social anxiety disorder is multifactorial and that familial mental disorders and separation experiences are the most important contributing factors.

Obsessive-compulsive disorder (OCD) is characterized by obsessions, compulsions, or both, which cause significant personal distress or social dysfunction. OCD is a common psychiatric illness with a prevalence of 1-2%. Because most people have regular contact with primary health care services, the patient with OCD is likely to see their general practitioner even though psychological problems may not be the main reason for consultation. Early recognition of the disorder facilitates early intervention. This reduces distress, disability and burden of illness. Pharmacological treatment with serotonin reuptake inhibitors (SRI) and cognitive-behavioral therapy have both been proven to be effective and are evidence based.

Traumatic life events during childhood and parental attitudes are discussed as possible etiological factors for panic disorder (PD). Patients with PD (n = 115) and subjects without a history of psychiatric disorders (n = 124) were investigated using a comprehensive retrospective interview with 203 questions regarding childhood traumatic life events, parental attitudes, family history of psychiatric disorders, and birth risk factors. The frequency of reports of some traumatic childhood experiences was significantly different between patients and controls, including death of father, separation from parents, childhood illness, parents' alcohol abuse, violence in the family, sexual abuse, and other factors. On a 0 to 9 “severe trauma scale” patients had significantly more severe traumatic events (mean score, 1.31; SD 1.21) than control subjects (0.52; SD 0.80; P < .0001). Only 31.3% of the panic patients, but 62.9% of the controls, did not report any severe traumatic events at all (P < .0001). Compared to controls, patients described the attitude of their parents as more restricting and providing less loving care and attention. Patients reported significantly higher rates of psychiatric disorders in their families in general, in particular PD and generalized anxiety disorder. Birth risk factors did not differ significantly. In a logistic regression model, the following possible etiological factors showed a significant influence: family history of anxiety disorders, severe traumatic events during childhood, and unfavorable parental attitudes. The present data support the hypothesis that the etiology of PD is multifactorial and that traumatic life events may be a contributing factor. Owing to the retrospective nature of the data, the results have to be interpreted with caution. Copyright 2002, Elsevier Science (USA). All rights reserved.

Reduced 5-HT1A-receptor responsiveness has been reported in patients with panic disorder(PD) and/or agoraphobia (PDA). Although many of these patients are regular smokers, it has not been examined whether psychological or neurobiological effects induced by the selective 5-HT1A-receptor agonist, ipsapirone, are affected by the smoking status of the patients. In order to clarify this question neuroendocrine challenges with oral doses of ipsapirone (0.3 mg/kg) and placebo were performed in 39 patients with PDA, and results were compared between patients who smoked (>10 cigarettes per day, n = 17) and patients who had been non-smokers for at least two years (n = 22). Patients who were smokers (but did not smoke during the challenge procedure) had significantly reduced baseline concentrations of cortisol and a significantly lower body temperature. In comparison to placebo, administration of ipsapirone was associated with significant increases of various psychological symptoms and plasma cortisol concentrations. The subgroup of PD patients who were smokers showed significantly higher cortisol responses to ipsapirone than non-smokers. In conclusion, smoking status has to be taken into account when assessing the responsiveness of 5-HT1A receptors in patients with psychiatric disorders. The prevention of smoking during challenge sessions might not be the ideal approach in heavy smokers, since sudden abstinence from smoking is likely to affect neurobiological and possibly psychological responses to ipsapirone.

Evaluating the Efficacy of Psychological Therapy In this article, general principles, theoretical backgrounds, methodological issues and possible flaws in planning and conducting efficacy trials of psychological therapies are described. These include sources of variance contributing to improvement of a psychic disorder under psychological therapy (spontaneous remission, regression to the mean, placebo effects, non-specific and specific factors), appropriate control groups, assessment of treatment success with rating scales, study designs, statistical issues and problems of follow-up investigations. The article includes practical suggestions for researchers planning efficacy trials. Ethical problems and critical issues regarding the transfer of the results of controlled trials to practice are also discussed.

Objective: The association between separation anxiety in childhood and actual separation experiences during childhood has not yet been investigated in patients with panic disorder. Methods: In 115 patients with panic disorder with or without agoraphobia and in 124 control subjects without a history of psychiatric illness, we assessed separation anxiety during childhood, retrospectively, using DSM-IV and ICD-10 criteria and the Separation Anxiety Symptom Inventory (SASI). In addition, actual separation experiences from age 0 to 15 years were assessed, retrospectively. Results: A total of 22.6% of the patients and 4.8% of the control subjects fulfilled both DSM-IV and ICD-10 criteria for childhood separation anxiety (χ2 =11.8; P < 0.0001). Further, 57.4% of the patients and 37.9% of the control subjects reported actual separation experiences during their childhood (χ2 = 9.09, P < 0.003). Separation anxiety and actual separation experiences, however, were independent of each other. Conclusion: These results suggest that separation anxiety during childhood is not a consequence of actual traumatic separation experiences in panic disorder patients.

Background: A new 13-item scale has been developed for measuring severity of illness in patients with panic disorder and agoraphobia, the Panic and Agoraphobia Scale (P & A). The scale has five subscales covering the main factors that reduce quality of life in panic disorder patients (panic attacks, avoidance, anticipatory anxiety, disability and worries about health). The application of this scale in a double-blind placebo-controlled panic disorder trial is described. At the same time, the aim of the study was to compare the therapeutic effects of aerobic exercise with a treatment of well-documented efficacy. Methods: Patients with Panic disorder (DSM-IV) were randomly assigned to three treatment modalities: running (n = 45), clomipramine (n = 15) or placebo (n = 15). Treatment efficacy was measured with the Panic and Agoraphobia Scale (P & A) and other rating scales. Results: According to the P & A and other scales, both exercise and clomipramine led to a significant decrease of symptoms in comparison to placebo treatment. Clomipramine was significantly more effective and improved anxiety symptoms significantly earlier than exercise. The evaluation of the P & A subscales revealed that exercise exerted its effect mainly reducing anticipatory anxiew and panic-related disability. Conclusions: The new Panic and Agoraphobia Scale was shown to be sensitive to differences between different panic treatments. Analysis of the scales five subscores may help to understand mechanisms of action of panic disorder treatments.

In patients with panic disorder (n=23), daytime salivary cortisol levels were determined in 2-h spans on 3 consecutive days and compared with 23 age- and sex-matched healthy controls. Additionally, nocturnal urinary free cortisol levels were measured. Daytime salivary cortisol levels were numerically higher in the patients, although the difference did not reach statistical significance. In a subgroup of 14 patients with higher illness severity (as expressed by a score ≥22 on the Panic and Agoraphobia Scale), salivary cortisol levels were significantly higher than in the controls. Mean nocturnal urinary cortisol levels were significantly higher in the whole group of patients and also in the more severely ill subgroup when compared with controls. Cortisol elevations seem to be more pronounced during the night and occurred mainly in more severely ill panic patients.