Panic Disorder - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

PANIC DISORDER A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AM...

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PANIC

DISORDER A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Panic Disorder: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84151-9 1. Panic Disorder-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on panic disorder. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON PANIC DISORDER ...................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Panic Disorder .............................................................................. 4 E-Journals: PubMed Central ....................................................................................................... 50 The National Library of Medicine: PubMed ................................................................................ 51 CHAPTER 2. NUTRITION AND PANIC DISORDER ............................................................................ 95 Overview...................................................................................................................................... 95 Finding Nutrition Studies on Panic Disorder ............................................................................. 95 Federal Resources on Nutrition ................................................................................................... 99 Additional Web Resources ......................................................................................................... 100 CHAPTER 3. ALTERNATIVE MEDICINE AND PANIC DISORDER .................................................... 101 Overview.................................................................................................................................... 101 National Center for Complementary and Alternative Medicine................................................ 101 Additional Web Resources ......................................................................................................... 112 General References ..................................................................................................................... 114 CHAPTER 4. DISSERTATIONS ON PANIC DISORDER ...................................................................... 115 Overview.................................................................................................................................... 115 Dissertations on Panic Disorder ................................................................................................ 115 Keeping Current ........................................................................................................................ 117 CHAPTER 5. CLINICAL TRIALS AND PANIC DISORDER ................................................................ 119 Overview.................................................................................................................................... 119 Recent Trials on Panic Disorder ................................................................................................ 119 Keeping Current on Clinical Trials ........................................................................................... 123 CHAPTER 6. PATENTS ON PANIC DISORDER................................................................................. 125 Overview.................................................................................................................................... 125 Patents on Panic Disorder ......................................................................................................... 125 Patent Applications on Panic Disorder ..................................................................................... 134 Keeping Current ........................................................................................................................ 144 CHAPTER 7. BOOKS ON PANIC DISORDER .................................................................................... 145 Overview.................................................................................................................................... 145 Book Summaries: Federal Agencies............................................................................................ 145 Book Summaries: Online Booksellers......................................................................................... 146 The National Library of Medicine Book Index ........................................................................... 149 Chapters on Panic Disorder ....................................................................................................... 150 CHAPTER 8. MULTIMEDIA ON PANIC DISORDER ......................................................................... 153 Overview.................................................................................................................................... 153 Bibliography: Multimedia on Panic Disorder............................................................................ 153 CHAPTER 9. PERIODICALS AND NEWS ON PANIC DISORDER ...................................................... 155 Overview.................................................................................................................................... 155 News Services and Press Releases.............................................................................................. 155 Academic Periodicals covering Panic Disorder.......................................................................... 157 CHAPTER 10. RESEARCHING MEDICATIONS................................................................................. 159 Overview.................................................................................................................................... 159 U.S. Pharmacopeia..................................................................................................................... 159 Commercial Databases ............................................................................................................... 160 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 165 Overview.................................................................................................................................... 165 NIH Guidelines.......................................................................................................................... 165 NIH Databases........................................................................................................................... 167

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Other Commercial Databases..................................................................................................... 170 The Genome Project and Panic Disorder ................................................................................... 170 APPENDIX B. PATIENT RESOURCES ............................................................................................... 175 Overview.................................................................................................................................... 175 Patient Guideline Sources.......................................................................................................... 175 Finding Associations.................................................................................................................. 180 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 183 Overview.................................................................................................................................... 183 Preparation................................................................................................................................. 183 Finding a Local Medical Library................................................................................................ 183 Medical Libraries in the U.S. and Canada ................................................................................. 183 ONLINE GLOSSARIES................................................................................................................ 189 Online Dictionary Directories ................................................................................................... 192 PANIC DISORDER DICTIONARY ........................................................................................... 193 INDEX .............................................................................................................................................. 255

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with panic disorder is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about panic disorder, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to panic disorder, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on panic disorder. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to panic disorder, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on panic disorder. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON PANIC DISORDER Overview In this chapter, we will show you how to locate peer-reviewed references and studies on panic disorder.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and panic disorder, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “panic disorder” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Dental Management of the Adolescent with Panic Disorder Source: Journal of Dentistry for Children. 60(6): 365-371. November-December 1993. Summary: This article explores the dental management of adolescents with panic disorder (PD), a psychiatric disease characterized by recurrent surges of severe anxiety without obvious cause. Panic disorder has special relevance for dentistry because it is often associated with mitral valve prolapse, a condition that may require endocarditis prophylaxis. In addition, the medications most often used to treat PD are associated with detrimental changes in the oral cavity and adverse interactions with dental therapeutic changes. Topics include characteristics of panic disorder, associated medical problems, epidemiology, etiology, the medical management of PD, and the dental management of children with PD, including anesthesia precautions. 60 references.

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Federally Funded Research on Panic Disorder The U.S. Government supports a variety of research studies relating to panic disorder. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to panic disorder. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore panic disorder. The following is typical of the type of information found when searching the CRISP database for panic disorder: •

Project Title: A CONTROLLED TRIAL OF PSYCHODYNAMIC TREATMENT FOR PANIC Principal Investigator & Institution: Milrod, Barbara L.; Psychiatry; Weill Medical College of Cornell Univ New York, Ny 10021 Timing: Fiscal Year 2001; Project Start 15-FEB-2000; Project End 31-JAN-2005 Summary: This mentored patient-oriented treatment development award is designed to assist Barbara Milrod, M.D. to become an independent physician investigator. It will also further the development of the psychotherapy research program at Cornell by expanding it into the area of panic disorder. The award will free Dr. Milrod from much of her present clinical responsibility and enable her to obtain the training and experience necessary to become a well-rounded investigator. The training plan is built on specific educational experiences dedicated to achieve specific educational aims, with close tutoring by expert clinical research faculty. The specific aims of the research plan are to: 1) Conduct a randomized controlled trial of PFPP in comparison with relaxation treatment (ART) for patients with panic disorder. 2) Building upon previous research, to test a set of instruments that can reliably distinguish between the already-manualized Panic-Focused Psychodynamic Psychotherapy (PFPP) and applied relaxation training (ART). The plan develops a method of testing the efficacy of an accessible and commonly practiced treatment, psychodynamic psychotherapy, for a specific DSM Axis I disorder, panic disorder. Psychodynamic psychotherapy is a widely-practiced, understudied treatment that deserves careful assessment in clinical populations. Panic disorder is a significant public health problem, from which some treatment responders may relapse after receiving therapies that have been researched to date. Academic and research activities will take place throughout the award period. Upon completion of the award, Dr. Millrod will serve as principle investigator in psychotherapy research studies, and as mentor to residents, child and adolescent psychiatry fellows, medical students and colleagues. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

2 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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Project Title: A LONGITUDINAL FOLLOW UP OF CHILDREN AT RISK FOR ANXIETY Principal Investigator & Institution: Rosenbaum, Jerrold F.; Associate Professor; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2001; Project Start 01-MAY-1993; Project End 31-JAN-2004 Summary: In the proposed study, we seek to address a basic scientific question: Is it possible to predict the development of anxiety disorders among young children whose parents have panic disorder (PD)? This question is straightforward, yet the answer has broad implications. Although it is well established that children of parents with PD are at high risk for anxiety disorders, only some of these children will develop psychopathology. The identification of a predictor would facilitate primary prevention by delineating a group of young children at very high risk for anxiety disorders among those already at risk by having a PD parent. During the prior funding period we have completed a cross-sectional study of over 200 children at risk for PD and comparison offspring of normal control parents. Our sample is unique in that the children have been identified and characterized extensively before they entered the age of risk for childhood anxiety disorders. These youngsters have already been assessed for behavioral inhibition, psychophysiological markers, and early signs of anxiety as well as for markers of psychosocial adversity. A subsample who have grown old enough to be reliably assessed for DSM-IV diagnoses, have already been assessed for psychopathology using structured clinical interviews. Therefore this valuable sample affords us the unique opportunity to track the development of dysfunction and psychopathology in prospectively followed children at risk for psychopathology. To our knowledge, this would represent the largest such sample followed longitudinally. As we describe in the Progress Report, our work suggests that multiple domains of measurement will be useful predictors of psychopathology in high risk children. These domains are: parental disorders, child temperament (as indexed by "behavioral inhibition to the unfamiliar" [BI]), psychophysiologic abnormalities, and psychosocial adversity. The proposed work seeks to validate these measures as predictors of subsequent psychopathology and dysfunction by following up the sample five years after their baseline evaluation. The main aims of this project were determined by our past 12 years of work studying BI and anxiety disorders among young children. Our three main aims are: l) to characterize the psychopathologic and functional outcomes of children at risk for panic disorder; 2) to determine predictors of adverse outcomes among children at risk for anxiety disorders; and 3) to characterize the developmental sequence of anxiety disorders in these children. Moreover, under separate funding, we are collecting DNA samples from this cohort of families. Thus, by assuring that DNA samples will be available in the future, we leave open the possibility that our sample will be useful for prospectively predicting psychiatric disorders and disability from putative anxiety genes. Given that we are also assessing adverse features of the environment, we will also be able to determine if gene-environment interactions play a role in the genesis of anxiety disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: A NOVEL THERAPY FOR DEPRESSION WITH CO-OCCURRING PANIC Principal Investigator & Institution: Frank, Ellen; Professor; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 01-APR-2001; Project End 31-MAR-2004

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Summary: Complication of major depression by the co-occurrence of panic attacks or panic disorder is both common and clinically significant. Patients with this condition show more severe symptom profiles, greater risk of suicidality, poorer psychosocial functioning, and a poorer response to traditional depression treatments. The primary aim of the current proposal is to develop an effective yet efficient psychotherapeutic intervention for patients with major depression complicated by panic symptoms. This new treatment, interpersonal psychotherapy for depression with panic symptoms (I PTPS), will adapt and integrate components of cognitive behavior therapy (CBT) for panic and anxiety (Barlow & Craske, 1989) into the therapeutic framework of interpersonal psychotherapy for depression (IPT, Kierman et al., 1984) to treat this clinically severe yet treatment-resistant condition. Conceptually, this integrated treatment approach will seek to promote active resolution of interpersonal problems while concurrently addressing symptoms of panic and anxiety that interfere with active interpersonal problem solving. In Phase I of the proposed study, 12 patients with major depression complicated by panic symptoms will be treated with a 16-session course of the newly developed treatment. Specific aims of Phase I include the development, elaboration, and iterative refinement of a treatment manual for IPT-PS; development of therapist training procedures; and the development of measures of treatment adherence, competence, and satisfaction. In Phase II, 24 patients with depression complicated by panic symptoms will be randomly assigned to treatment using IPT-PS, and will be compared with 12 patients randomly assigned to receive standard IPT. Specific aims of this pilot study include: finalizing the treatment manual and measures of treatment adherence, competence, and satisfaction; testing treatment satisfaction with IPT-PS; evaluating characteristics of treatment responders and non-responders; and generating treatment effect size estimates for use in planning a larger efficacy/effectiveness study of IPT-PS. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ALCOHOLISM: GENETIC EPIDEMIOLOGIC TWIN STUDY Principal Investigator & Institution: Heath, Andrew C.; Professor and Director; Psychiatry; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2001; Project Start 01-MAR-1994; Project End 31-MAR-2005 Summary: This resubmission seeks continued funding for the Missouri Adolescent Female Twin Study (MOAFTS), a prospective genetic-epidemiologic survey of alcohol use and abuse/dependence and co-morbid psychopathology in adolescent and young adult women. During the first five years of the project, using a cohort-sequential sampling design, cohorts of 13.5, 15.5, 17.5 and 19.5 year-old twins have been ascertained from birth records over a 2-year period, with continued recruitment of new cohorts of 13 year-olds and 11 year-olds. The twins, together with at least one parent information, have been assessed using telephone diagnostic interviews (N-1730 pairs, including 249 minority pairs; N=3651 parents), with brief 1-year follow up interventions and self-report questionnaire assessments of twin pairs (N=1378 pairs to date) and 2year follow-up interview assessments of twin pairs (N=477 pairs to date) and a parent informant (N=796 parents to date) still in progress. Detailed assessments of history of psychopathology (childhood inattention and hyperactivity, suicidality, lifetime histories of DSM-IV oppositional defiant and conduct disorders, major depression, social phobia and panic disorder) and alcohol and other substance use disorders (DSM-V alcohol dependence or abuse, nicotine dependence, illicit drug abuse/dependence), as well as other behavioral and environmental risk- factors (including parental psychopathology and perceived peer and sibling behaviors) have been made. In this competing continuation, we seek to continue detailed telephone diagnostic interview assessments

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with twin cohorts at ages 175, 19.5, 21.5, 23.5, and 25.5, as well as repeat assessments of mothers of 19-year olds, plus assessment of those fathers who have not previously been interviewed. Following these twin pairs through their period of highest risk for onse5t of alcohol dependence will provide a powerful basis for identifying mediators and riskmodifiers of genetic and environmental influences on alcohol dependence and harmful alcohol use in young women (see heuristic models in Figures a1 and bla- blc), including effects of partner influences and influences of peers at college or work, occupation and work environment and transitions to adult roles (full-time employment, marriage, parenthood) on drinking behavior and problems. It will provide preliminary data on genetic and environmental predictors of course and remission versus persistence on alcohol problems, issues that can be addressed with greatest power when the youngest cohorts are followed up in a proposal as they reach their mid to late 20s. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AMYGDALA IN BRAIN FUNCTION:BASIC AND CLINICAL APPROACHES Principal Investigator & Institution: Shinnick-Gallagher, Patricia; Professor; New York Academy of Sciences 2 E 63Rd St New York, Ny 10021 Timing: Fiscal Year 2002; Project Start 01-MAR-2002; Project End 28-FEB-2003 Summary: (provided by applicant): The amygdala is a brain area that has recently become one of the hottest topics in neuroscience. Interest in the amygdala is not limited to scientists but also includes the general public and business professionals who are actively seeking more information about the brain machinery governing emotions that control our coping with ongoing everyday life and impact on social signaling. The objective of this meeting is to provide a forum for presenting cutting edge information on the basic characteristics of amygdala function from neuroanatomical, electrophysiological, behavioral, and imaging studies in animals and humans and to integrate that data with the most recent findings in clinical human diseases in which the function of the amygdala is compromised. The desired outcome of the conference is to discuss and perhaps even to reach consensus on the important issues facing the field which impact on our basic understanding of amygdala function. Top experts in the field will meet together for 2.5 days (March 23-26, 2002) at Moody Gardens on Galveston Island, Texas, to discuss the important issues shaping our basic understanding of amygdala function. In plenary presentations and in discussions, critical questions regarding amygdala function at a basic and clinical level will be addressed. Specifically: 1. What is the functional significance of the specific nuclei of the amygdala? Can we use the term "amygdala" to attribute function to these brain areas? Does functional homogeneity between amygdala nuclei exist? Is the "extended" amygdala an anatomical or functional concept? How relevant is this definition for your results? 2. Is the amygdala a critical part of the neuronal circuitry for stimulus-reward associations? 3. Do drugs act at different sites in the amygdala to affect specific behaviors? Sessions will also address such issues as the nuclear structure and nomenclature of the amygdala between different species that is critical for extrapolation of data, for example, from rat/monkey studies to human studies as well as the organization of inhibition and excitation in the amygdala and the breadth of emotions controlled by the amygdala. Other important questions concern whether the amygdala is an integrator or repositor of memories and the role of the amygdala in withdrawal from drugs of abuse. The clinical implications of these functions will be addressed by discussion of symptomatology caused by amygdala damage in Alzheimer's disease and epilepsy and its function in mental illness including anxiety, depression, schizophrenia, and panic disorder. Throughout these discussions,

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pharmacological information will be presented to provide a foundation for designing drugs for treatment of amygdala pathology. Conference proceedings will be published as a volume of the Annals of the New York Academy of Sciences. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: AMYGDALA PRIMING MECHANISM UNDERLYING THE PANIC RESPONSE Principal Investigator & Institution: Thielen, Shelley K.; Psychiatry; Indiana UnivPurdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2001; Project Start 23-FEB-2001; Project End 31-JAN-2003 Summary: Anxiety disorders are the most common of all mental health illnesses. Panic disorder (PD), a DSM recognized anxiety disorder, has a lifetime prevalence of 3.5%. The delay of treatment of this illness is further complicated by comorbidity with alcohol abuse or depression. These patients are also at increased risk of suicide. Rats bilaterally implanted with guide cannulae into the basolateral nucleus of the amygdala and injected for a maximum of 6 days with a subthreshold dose of the GABAA antagonist bicuculline methiodide exhibit an increase in heart rate (> 50 beats per minute), blood pressure, respiratory rate, and anxiety- like behavior, measured using the social interaction test on day 4 to 6 of drug treatment. The response exhibited by these rats is reminiscent of the symptoms experienced by panic disorder patients. Further, the BLA nucleus has been identified to be involved in the defense reaction as well as in conditioned fear- both responses are relevant to the development of the panic response. The objective of this research is utilize the primed rat to study the mechanisms underlying the panic response. Specifically, this research is aimed to: 1) determine the whether the panic-provoking agents yohimbine and fenfluramine are able to provoke similar responses in the BLA- primed rat; 2) determine if drugs effective in treating human panic attacks attenuate the panic response in the primed rat; and, 3) determine if the primed rat exhibits conditioned place avoidance. The methods used to explore the first aim will involve quantitating any change in heart rate, blood pressure, or respiratory rate during and after intravenous infusion of the panic provoking agent. Infusion of the drugs will be randomized and behavior will be measured after the monitoring period using the social interaction test. In this test the experimental rat will be paired with an untreated weight-matched (within 10 grams) rat in a 91 square cm arena for five minutes. Each rat will have been habituated to the arena and the lighting conditions prior to testing. Test duration will be 5 minutes. For the second aim, a Pavlovian conditioning test called conditioned place avoidance will be used to determine whether repeated intra- amygdala injections of BMI are aversive and therefore possibly indicative of the development of avoidance of the floor associated with the stimulus. Animals will be conditioned using tactile cues- floors constructed from perforated stainless steel or from stainless steel rods. For the third aim, BLAprimed rats will be treated twice daily for seven days with a prototypical SSRI or TCA and then challenged with an intra- amygdala injection of BMW. Treatments will be administered intraperitoneally, both acutely and chronically. The animal will be assessed for changes in response to the intra- amygdala injection of BMI. These three points will be used to study the underlying mechanism of the panic response. This mechanism of provoking the panic response is potentially beneficial in further understanding the neurobiology of the panic response on both the behavioral and cellular level. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ANATOMY OF THE PRIMATE AMYGDALOID COMPLEX Principal Investigator & Institution: Amaral, David G.; Professor; Psychiatry; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 95616 Timing: Fiscal Year 2001; Project Start 01-SEP-1986; Project End 30-JUN-2005 Summary: (adapted from applicant's abstract): The amygdala is a complex medial temporal lobe structure that has been implicated in the mediation of emotion and social behavior. Pathology of the amygdala has been associated with psychiatric conditions including anxiety, panic disorder and social phobia. Social impairment, the core deficit in autism, may also involve dysfunction of the amygdala. The overarching goal of this program of functional neuroanatomical research has been to establish the major intrinsic and extrinsic connections as well as the chemical neuroanatomy of the macaque monkey amygdaloid complex. This information goes some way in defining the neural circuitry mediating social cognition and provides targets for pharmacological modulation of amygdala-based psychopathology. During the current funding period, we have identified virtually all of the cortical inputs to the amygdala. We have also identified new intrinsic connections as we mapped the intra-amygdaloid pathways of the lateral, basal and accessory basal nuclei. We have also conducted detailed immunohistochemical and in situ hybridization studies of the GABA system. In this application we propose to extend our studies of the mature amygdala and to begin research on the developing primate amygdala. We will also initiate studies of the human amygdala both in normal and autistic brains. In the mature monkey brain, we will use electron microscopy to examine the synaptic organization of amygdaloid projections to the neocortex. We will determine whether these projections terminate on principal neurons, interneurons or both. In the neonatal macaque monkey, we will use neural tract tracing techniques to examine the development of amygdaloid projections to the neocortex and neocortical projections to the amygdala. Our goal will be to determine when these connections are established in an adult fashion and how much reorganization occurs during the neonatal period. We will also investigate the distribution of serotonergic innervation of the mature and developing amygdala. Serotonin has been implicated in modulating social function, particularly aggression, but little is known concerning its normal distribution or development in the amygdala. For the first time, we will extend our observation in the monkey to the human amygdala. We hypothesize that the amygdala is dysfunctional in autism and we will attempt to determine whether a neuroanatomical/neurochemical abnormality can be established. We will conduct quantitative, stereological studies on the volume and cell number of the amygdala and its component nuclei and search for pathology of the GABA system, which may be particularly altered in the 30 percent of autistics who also have epilepsy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: BRAIN IMAGING IN PANIC DISORDER AT HIGH-FIELD Principal Investigator & Institution: Friedman, Seth D.; Radiology; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2004; Project Start 01-DEC-2003; Project End 30-NOV-2008 Summary: (provided by applicant): This five-year career development proposal will establish Dr. Seth D. Fdedman as an independent researcher who can develop, apply, and integrate rapid high-field multinuclear magnetic resonance spectroscopy (MRS) and peripheral physiological monitoring to study biological regulation in anxiety disorders. Towards this aim, a detailed curriculum of physics, digital signal processing,

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physiology, and statistical methods will be undertaken. Regular training visits to centers with critical expertise are also planned to facilitate technical and clinical skill development. The studies associated with this training experience will be conducted in three phases: (1) technical development and characterization of hyperventilation (HV) response in healthy control subjects, (2) clinical investigation of HV dysregulation in panic disorder subjects compared to healthy controls and social phobia subjects, and (3) pilot work focused on alternative challenges. In PD, a number of peripheral alterations are found at rest (increased sighing, low pCO2, and respiratory variability) and in response to HV, with delayed recovery of end-tidal pCO2 commonly demonstrated. Importantly, anxiety level per se is not sufficient to produce this delayed recovery, since SP subjects, who will be used as anxious controls in the proposed studies, do not demonstrated altered pCO2 recovery following HV. Central nervous system alterations of lactate production are also demonstrated in response to HV challenge in PD, a response suggested to be in excess of the observed metabolic alkalosis. By integrating time-resolved central and peripheral nervous system measures of physiological regulation, the components of altered physiology in PD will be elucidated. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BRAIN METABOLISM AND TREATMENT OUTCOME IN PANIC DISORDER Principal Investigator & Institution: Dager, Stephen R.; Professor and Associate Medical Director; Psychiatry and Behavioral Scis; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 30-SEP-1994; Project End 30-JUN-2005 Summary: Panic disorder is among the most common psychiatric disorders and is particularly prevalent among women. There is significant morbidity and mortality associated with panic disorder. Although effectively treated with medication or cognitive-behavioral therapy (CBT), an approximately 60 percent relapse rate after treatment discontinuation suggests that panic disorder is a chronic illness for a subpopulation of affected individuals. Relapse rates off treatment also appear to be influenced by treatment duration as longer treatment with medication reduces the risk for subsequent relapse when medication-free. Our studies to date suggest that individuals with panic disorder have brain metabolic abnormalities, manifested as abnormal lactate elevations in response to challenges, such as lactate infusion or hyperventilation, that appear to have a trait-specific component. There also is evidence that the magnitude of abnormal brain lactate response decreases in relationship to duration of treatment. The goal of this research is to apply a recently developed dynamic, metabolic imaging technique, protein echo- planar spectroscopic imaging (PEPSI), to measure brain metabolic changes in response to lactate infusion in order to better understand neuropathological mechanisms underlying panic disorder, treatment response and relapse both during treatment and after treatment discontinuation. Symptomatic, mediation-free panic subjects (n=80) and healthy controls (n=32) will be studied with PEPSI during a standard lactate infusion, and then again at 12 weeks following randomization of the panic subjects into treatment with CBT (n=40) or fluvoxamine (n=40). Panic subjects will be restudied during lactate reinfusion at 1 year while in ongoing treatment and then followed clinically for 1 year after discontinuation of treatment. A clinical rater blinded to treatment will be responsible for independent assessment of clinical status. It is hypothesized that persistence of brain metabolic abnormalities during medication treatment, but not CBT treatment, is predictive of treatment course and vulnerability to relapse following treatment discontinuation. An attempt will be made to reassign treatment nonresponders to the opposite treatment

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arm and restudy those individuals (not included as additional subjects in the opposite treatment arm), in order to better understand mechanisms underlying treatment failure. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CBT AND VENLAFAXINE TREATMENTS FOR ANXIETY IN ALCOHOLISM Principal Investigator & Institution: Ciraulo, Domenic A.; Professor of Psychiatry; Boston Medical Center Gambro Bldg, 2Nd Fl, 660 Harrison Ave, Ste a Boston, Ma 02118 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-JUL-2008 Summary: (provided by applicant): Deficits in anxiety management skills are frequent causes of relapse to alcohol use. Empirical data support the role of anxiety in alcohol relapse. Psychosocial and pharmacological treatments for alcohol problems increasingly address the role of negative affect in alcohol use disorders. Due to the lack of large, wellcontrolled treatment outcome trials, the optimal treatment (or combination of treatments) remains unknown. Real world practice in the treatment of alcohol use disorders frequently begins brief, intensive detoxification and stabilization, and is often followed by some combination of CBT and pharmacotherapy for patients complaining of mood difficulties while attempting early abstinence from alcohol. The proposed project is written as a "typical clinical practice" test in response to the Program Announcement PA-98-003, and is a fully-controlled trial of a combined anxiety-focused CBT and pharmacotherapy (venlafaxine; CBT-VEN) delivered for patients with comorbid alcohol-use and anxiety disorders. The CBT-VEN package will be administered in three forms depending upon the primary presenting anxiety disorder (i.e., PD, GAD, or SP) and will be contrasted with two single-active treatment conditions (CBT-PLA and REL-VEN), and one fully-controlled condition (relaxation training and placebo medication; REL-PLAC). One hundred and twenty eight participants will be recruited and, subsequent to a platform of intensive outpatient treatment for alcoholism, will be randomly assigned to a 12-week treatment condition. Both conditions will begin with a 1-week placebo run-in, and conclude with a 3-week medication taper. Follow-up assessments will be conducted at post-treatment and at 3, 6, 9, and 12-months. The longterm objectives of this research are to develop a real-world combination of psychosocial and pharmacological treatments for patients with comorbid alcohol-use and anxiety disorders that compromise prognosis, and to evaluate the effectiveness of combined psychosocial and pharmacological treatments that target anxiety among patients with this comorbidity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CBT AUGMENTATION OF PAROXETINE FOR SOCIAL ANXIETY Principal Investigator & Institution: Heimberg, Richard G.; Psychology; Temple University 406 Usb, 083-45 Philadelphia, Pa 19122 Timing: Fiscal Year 2003; Project Start 15-AUG-2003; Project End 31-MAY-2007 Summary: (provided by applicant): Social anxiety disorder is a prevalent, chronic and disabling condition. Paroxetine has received FDA approval on the basis of its acute efficacy for this disorder, but much about longer-term management remains uncertain. There are virtually no data regarding next steps in treatment despite evidence that most patients who receive acute paroxetine therapy still exhibit significant residual symptoms. Furthermore, there are also no data regarding methods for minimizing relapse when medication is discontinued despite evidence that relapse rates in such circumstances are high. Cognitive-behavioral therapy (CBT) is a good candidate for

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augmenting paroxetine response and reducing relapse after medication discontinuation as it has been shown to be an effective treatment in its own right and often associated with lesser relapse than medication alone. Although CBT has been found to be useful in these circumstances for depression and panic disorder, there have been no similar studies in social anxiety disorder. This application will examine the ability of CBT to augment acute paroxetine response and reduce relapse following paroxetine discontinuation in social anxiety disorder. It will also examine the degree of residual symptoms and disability as well as rates of remission and improvements in quality of life in response to paroxetine alone or with the addition of CBT. Predictors of acute response and relapse after treatment is discontinued will also be explored. To achieve these ends, two hundred fifty patients will receive 12 weeks of open treatment with paroxetine. Patients showing at least some benefit will be randomized to continued paroxetine with or without CBT for 16 additional weeks. All treatment will then be tapered and patients will be followed for 24 additional weeks. Overall, this study should provide important information about the augmentation of paroxetine treatment for patients with social anxiety disorder, effective methods for reducing relapse, and who may benefit from paroxetine treatment or relapse when medication is withdrawn. It will also increase understanding of the interplay of psychosocial and pharmacological treatment methods and psychological and biological factors in patients' total response to treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CBT TREATMENT OF PANIC DISORDER IN COMORBID ALCOHOLICS Principal Investigator & Institution: Kushner, Matt G.; Associate Professor; Psychiatry; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 31-AUG-2004 Summary: (provided by applicant): Alcohol use disorders are among the most serious and costly health problems of our time. Studies have been consistent in finding an increased risk of alcohol use disorder among those suffering with the anxiety syndrome, panic disorder "comorbidity". Further, studies suggest that panic disorder can contribute to risk for a new onset of alcohol disorder and to risk for relapse following alcoholism treatment. Both theory and research suggests that relapse in comorbid individuals stems, in part, from the tendency to drink as a means of coping with persistent anxiety and panic symptoms. These findings led us to hypothesize that addressing the panic symptoms of comorbid patients would improve the outcome of comorbid individuals undergoing alcoholism treatment Cognitive behavioral therapy (CBT) for panic disorder would appear to be an ideal intervention for testing this nypothesis; however, the effect of CBT treatment on panic disorder in comorbid individuals remains unknown. Further, conventional CBT treatments do not address the inter-relationship of panic symptoms and pathological alcohol use that is potentially relevant to the persistence of both disorders in comorbid individuals. Therefore, we are proposing an experimental/developmental program (P.21) with a series of research stages aimed at testing the value of CBT for panic among comorbid patients. In stage 1 (conducted in year 1), we will use approximately 4-6 comorbid alcoholism treatment patients as subjects in four separate pilot tests, each focused on one of the four core elements of the panic treatment program, Master your Anxiety and Panic (MAP), along with supplemental material pertinent to comorbidity. Pre- and post-tests along with expert consensus will be used to evaluate whether the material and techniques are working properly, with any problematic materials being modified as needed. In the

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stage 2 study (year 2 and 3), thirty comorbid patients undergoing a community-based alcoholism treatment will receive either the 10-session MAP program as modified in stage 1 (MMAP) or a 10-session control treatment (progressive muscle relaxation training; PMRT). (Note that PMRT is structured and credible but has been shown to have minimal effects on either alcoholism treatment outcome or panic disorder symptoms.) We hypothesize that those receiving fix MMAP program will demonstrate fewer panic attacks and less intense panic attacks following the study treatments. We also hypothesize that at a 3-month follow-up assessment, subjects in the MMAP group will demonstrate a lower overall rate of several standard alcohol use outcomes as well as time to those outcomes when present. Beyond these directional hypotheses, an important goal of the stage 2 study is to provide effect size parameters indicating the clinical importance of the MMAP intervention. It is expected that the stage 1 and 2 studies proposed here will provide the foundation for an RO1 application to conduct a larger-scale stage 3 study to confirm the value of supplementing standard alcoholism treatment with the MMAP program for comorbid patients. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHOLECYSTOKIN MODULATION OF ANXIETY AND HUMAN STRESS AXIS--MECHANISTIC STUDIES Principal Investigator & Institution: Abelson, James L.; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2002 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COGNITIVE/BEHAVIORAL ADOLESCENCE

TREATMENT

OF

PANIC

IN

Principal Investigator & Institution: Mattis, Sara G.; Psychology; Boston University Charles River Campus 881 Commonwealth Avenue Boston, Ma 02215 Timing: Fiscal Year 2001; Project Start 01-AUG-1998; Project End 31-JUL-2003 Summary: (Adapted from Applicant's Abstract): While Panic Control Treatment (PCT) has been found to be widely effective in the treatment of panic disorder in adults, no large-scale controlled treatment studies have evaluated the use of similar cognitivebehavioral approaches in the treatment of adolescents with panic disorder. Given that late adolescence has been suggested as the initial peak age for onset of panic disorder, the purpose of this project is to establish an empirically validated intervention aimed at treating panic disorder at its earliest stages. Specifically, the aims of this project are: to evaluate the effectiveness of a developmental adaptation of PCT for the treatment of panic disorder in adolescents; to determine the long-term impact of such treatment through follow-up assessment; and to assess the impact of treatment on the quality of life of adolescents beyond the specific symptoms of panic disorder. A total of 52 adolescents (aged 12 to 17) with a diagnosis of panic disorder, assessed via the Anxiety Disorders Interview Schedule, will be randomly assigned to either an immediate PCT treatment condition or to a self-monitoring waitlist in which participants will wait approximately 12 weeks prior to receiving PCT. All participants will undergo a pretreatment and a posttreatment/waitlist assessment, as well as three follow-up assessments, conducted 3-, 6-, and 12 months following completion of treatment. Assessments will consist of diagnostic interviews with adolescents and their parent(s), a behavioral and physiological assessment of response to symptom induction tasks

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designed to elicit sensations similar to naturally occurring panic, and self-report measures of anxiety, anxiety sensitivity, depression, and fear. Participants will also be asked to self-monitor their panic attacks as well as daily anxiety and depression. It is hypothesized that adolescents receiving PCT will evidence greater improvement than those in the waitlist group, and will continue to show improvement at follow-up, on panic-specific variables (e.g., frequency of panic attacks), psychopathology variables (e.g., anxiety sensitivity score), behavioral and physiological variables (e.g., average change in heart rate from baseline to the symptom induction tasks), and clinical severity ratings of panic disorder. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COGNITIVE-BEHAVIOR THERAPY FOR KHMER REFUGEES Principal Investigator & Institution: Hinton, Devon E.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2003; Project Start 07-FEB-2003; Project End 31-JAN-2008 Summary: (provided by applicant): This is an application for a Mentored PatientOriented Research Career Development Award with a focus on developing expertise in treatment development and outcome assessment for anxiety disorders in minority and refugee populations. The Candidate proposes to build upon his clinical and research experience treating refugee populations in order to develop cognitive-behavioral interventions for refugee populations and to test the outcome with standard assessment measures and measures of culture-specific anxiety psychopathology. Post-traumatic stress disorder and panic attacks are common in Southeast Asian refugee populations but there is relatively little research available to guide the provision of culturally sensitive treatment for affected individuals. The proposed study is designed as an early step in addressing this treatment gap in a systematic manner. Research Plan: The study investigates the efficacy of a 12-week cognitive-behavioral therapy intervention for Cambodian refugees with PTSD, the treatment guided by a manual, and outcome assessed with standard psychometric instruments, culturally specific scales, and orthostatic challenge. Environment: The proposed study will be based at a Southeast Asian Refugee Clinic affiliated with the Massachusetts General Hospital and will complement a program of training and supervised research under the mentorship of Dr. Mark Pollack with consultation from experts. Career Development Plan: Training will emphasize learning skills to develop culturally appropriate assessment and treatment for traumatized non-English speaking groups. To lay the foundation for future independent investigation by the candidate, training will include supervision with consultants regarding outcome assessment, cognitive behavioral therapy, instrument validation, a psychophysiological outcome measure (i.e., orthostatic challenge), and a structured ethnographic interview, as well as taking courses at the Harvard School of Public Health on statistics and instrument development and evaluation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DEVELOPMENTAL EFFECTS OF EARLY MATERNAL SEPARATION Principal Investigator & Institution: Hofer, Myron A.; Professor; New York State Psychiatric Institute 1051 Riverside Dr New York, Ny 10032 Timing: Fiscal Year 2001; Project Start 01-JUL-1984; Project End 30-NOV-2002 Summary: There are considerable evidence that genetic predisposition to Affective Disorders strongly interacts with early attachments experience to create vulnerability to separation anxiety in childhood and to panic disorder and major depression in

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adulthood. The proposed studies provide the first animal model system in which these intertwining influences can be experimentally analyzed and the neurobiological mechanisms delineated for the separation cry, the first known expression of anxiety in humans as well as in young mammals. This research will continue a line of work aimed at gaining knowledge about the basic behavioral, neural and developmental processes underlying the early anxiety-like state induced by isolation of the infant rat. The PI has focused on the separation distress calling rate as this has emerged to be the most specific and consistent of this behavioral state. During the last grant period, the PI discovered a novel maternal separation effect in which brief passive contact or certain active interactions of an isolated pup with its dam, doubles or triples its subsequent rate of ultrasonic vocalization (USV). This maternal potential of the isolation response reveals the existence of a hitherto unsuspected system of affective communications between the rat mother and her pups. The proposed studies will explore the central neuromodulator pathways mediating maternal potentiation, the behavioral processes that control it, and the course of its postnatal development. In doing so the PI will test a novel hypothesis for its adaptive role, based on potential costs and benefits of high and low USV rates for isolated rat pups. In addition, during the past grant period, the PI has begun a program of selective breeding for high and for low levels of USV response to isolation. The PI will study microevolution of differences, using neuropharmacologic techniques to reveal the central neural pathways primarily involved. Finally, he will explore the developmental continuity that may exist between this infantile trait and later affective responses in weanlings, juveniles and adults. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EMOTIONAL SUPPRESSION AND ANXIETY SENSITIVITY Principal Investigator & Institution: Feldner, Matthew T.; Psychology; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2002; Project Start 26-AUG-2002 Summary: (provided by applicant): A 2 [group: high Anxiety Sensitivity Index (ASI), low ASI] X 2 (condition: inhibition, experimental control) mixed model research design will be employed with one, prolonged administration of 10% CO2. Participants will be non-clinical persons selected on the basis of their ASI scores with half scoring one standard deviation above and half below the mean of the standardization sample. Dependent measures will include self-rated anxiety and bodily distress, interpretative biases for threat information, and physiological indices of autonomic arousal. It is expected individuals high in Anxiety Sensitivity (AS) will experience greater negative emotional consequences in the inhibition condition relative to low AS individuals. We also expect response inhibition to increase interpretative biases for threat-related information, particularly within the group high in AS. The proposed study represents the first experimental test of the emotional and cognitive consequences of response inhibition in a panic-relevant paradigm, which holds direct implications for understanding the role of emotion regulation processes in the onset and maintenance of anxious and fearful responding to bodily perturbation. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ETIOLOGIC CONNECTIONS OF AFFECTIVE AND ANXIETY DISORDERS Principal Investigator & Institution: Mackinnon, Dean F.; Psychiatry and Behavioral Scis; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218

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Timing: Fiscal Year 2002; Project Start 07-AUG-2002; Project End 31-JUL-2007 Summary: (provided by applicant): Affective disorder are common, severe, recurrent, heterogeneous psycniatric diseases with an elusive pathophysiology. Their clinical and etiological complexity may obscure efforts to uncover mechanisms and tc discover therapeutic agents against those mechanisms. One common clinical feature that heightens complexity is comorbid anxiety. Combined anxiety and affective disorder syndromes exacerbate functional morbidity and suffering of patients, but may also present an opportunity to discover shared etiologic factors The candidate for this career development award is an academic psychiatrist at a teaching hospital with a strong historical commitment to medical research. The candidate has already established a reputation as a clinical specialist in affective disorders and has a research background in the genetics of affective disorder; by the end of the award period he plans to have established firmly a clinical and research direction aimed a comorbid anxiety and affective disorders, with fluency in psychophysiological methods. The award will facilitate this process by providing the time and resources to pursue further training in psychophysiology, neuroscience, and genetics. The starting points for the proposed research are 1) epidemiological findings that bipolar and panic disorders commonly occur together (comorbid risk), 2) symptom provocation studies ir panic disorder that reveal latent panic vulnerability in relatives of panic disorder patients (familial risk), and 3 family study results that show both familial and comorbid risk for panic disorder. The research program proposed here will address further questions about the relationship of panic and bipolar disorders by the use of carbon dioxide inhalation to provoke panic symptoms in study subjects ascertained for genetic linkage study of bipolar disorder. Risk of panic response to carbon dioxide in subjects without prior panic disorder will be analyzed as a function of familial and comorbid risk (as compared to the risk in positive and negative control subjects). If there is a specific genetic risk factor for both bipolar and panic disorder in a subset of families, then familial and comorbid risk will interact to produce higher risk of provoked panic than will either risk factor alone. Results of this work will then be applied to ongoing genetic studies of bipolar disorder, and will inform the candidate's further research into affective and anxiety disorder etiology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FRONTOTEMPORAL LIMBIC CIRCUITS IN HUMAN FEAR RELATED DISORDERS Principal Investigator & Institution: Silbersweig, David A.; Associate Professor; New York University 15 Washington Place New York, Ny 10003 Timing: Fiscal Year 2001 Summary: (Adapted from applicant's abstract): The brain circuits that subserve fearful responses in animals are well worked out and will be the subject of intensive research within this proposed Center. It is now possible to study the degree to which the same neural circuits are involved in pathological human fear. We will study five groups of human patients (in addition to the normal subjects studied with identical paradigms in Project 1 by LeDoux and Phelps above): patients with panic disorder (off SSRIs), patients with panic disorder (successfully treated with SSRIs) (or CBT), patients with post traumatic stress disorder, acutely paranoid patients with schizophrenia, and nonparanoid patients with schizophrenia. We will use fMRI and targeted neurocognitive probes to evaluate the hypothesis that specific abnormal patterns of activation in fear circuitry (including ventromedial prefrontal cortex, amygdala and hippocampus) are associated with each of the three fear-related conditions--panic disorder, post traumatic

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stress disorder and paranoid schizophrenia. These probes will include both fear conditioning and syndrome-specific emotional memory tasks that have been designed and piloted in human subjects in collaboration with (and based upon preclinical and psychological models of) our basic science and cognitive psychology colleagues in the Center. These include LeDoux and Phelps from Project 1 and McEwen from Project 3. The resources and services of the Functional Neuroimaging Core will be used extensively by this project. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENERAL CLINICAL RESEARCH CENTER Principal Investigator & Institution: Mccurdy, Layton; None; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425 Timing: Fiscal Year 2001; Project Start 01-MAR-1977; Project End 01-MAR-2001 Summary: This renewal application is a request for continuing support of the General Clinical Research Center at the Medical University of South Carolina. The GCRC is composed of an eight-bed inpatient unit and an outpatient facility featuring eight examination rooms. Major areas of research include: the pathobiology and treatment of severe congenital osteopetrosis; the genetic basis of insulin resistance in noninsulin dependent diabetics; the pathophysiology and treatment of hypertension; the role of hyperhomocyteinemia in vascular disease; the biochemical, hormonal and genetic characterization of the difference in bone and mineral metabolism in blacks compared to whites, the etiology of growth failure in sickle cell disease; the treatment of advanced mitral insufficiency with beta blockers; the effect of pentoxyphylline on renal function after cardiac transplantation; the etiology of panic disorder, the psychobiology of depression in children; the treatment of alcoholism; the treatment of Raynaud's Phenomenon; the role of thromboxane A2 in prostate hypertrophy, the molecular basis of prostatic cancer; the molecular basis of pancreatic cancer; the role of nutrition in breast cancer therapy; immunotoxin therapy of T cell ALL, the role of CEA virus vaccination in treating lung, breast, and gastrointestinal adenocarcinoma; dietary therapy of obesity; the stereospecific metabolism of beta blockers; neonatal adrenal function; and treatment of patients with HIV infections. The goal of the GCRC is to support existing clinical research, provide facilities and programs which stimulate the development of new areas of clinical research, facilitate the movement of basic science to clinical reality, and to train clinical investigators and support staff to ensure that patient oriented studies continue to be the ultimate level of medical research. Molecular biology, immunotherapy, cytokine therapies, and computer technology complement the traditional strengths of this GCRC. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GENETIC LINKAGE STUDIES IN BIPOLAR DISORDERS Principal Investigator & Institution: Gershon, Elliot S.; Chairman; Psychiatry; University of Chicago 5801 S Ellis Ave Chicago, Il 60637 Timing: Fiscal Year 2002; Project Start 15-APR-2000; Project End 31-MAR-2004 Summary: This application is submitted under the Program Announcement "Collaborative Studies of Mental Disorders." The broad aims are to expand a unique, existing set of pedigrees and test candidate regions for linkage and association with bipolar disorder. For the Johns Hopkins site this represents a revised competing renewal application while for the University of Chicago site this is a new proposal. Together we propose to double the existing family resource by ascertaining an additional 80

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moderate-sized families through bipolar I probands with 2 or more siblings affected with recurrent major affective disorders. All participants will be interviewed by trained psychiatrists who have established excellent inter-rater reliability. Diagnoses will be assigned by 2 non-interviewing psychiatrists who review all clinical data. This sample has already proven to be of considerable value to the field. Among clinical findings that have spawned new research directions are our reports of anticipation, parent-of-origin effects, a high prevalence of BPII among the close relatives of the bipolar I probands, and high rates of comorbid panic disorder in a subset of families. This sample provided the first support for previous evidence of linkage to the peri-centromeric region of chromosome 18, the first evidence of linkage to 18q, and the first molecular evidence for a parent-of-origin effect in bipolar disorder. Findings from prospective studies of the 2nd half of this sample demonstrate strikingly high allele-sharing between bipolar II sib pairs at several loci in 18q2l. Exploratory analyses of comorbid panic disorder and alcoholism have also suggested methods for predicting heterogeneity between bipolar families. In addition to collecting more families, we propose to genotype the existing and additional family sets at candidate regions implicated by a recent genome-wide scan for linkage that has been completed on 68 pedigrees from this sample. We further propose to use standard and innovative linkage and association methods to extract the maximal genetic information needed to locate genes influencing susceptibility to bipolar disorder. This is the most carefully clinically assessed family set in the field. The studies generated from this family resource have already demonstrated its value and have provided testable hypotheses for further work. The enlargement, continued maintenance, and analysis of this unique family resource is important to the field and will form the basis for many future studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETIC LINKAGE STUDIES IN BIPOLAR FAMILIES Principal Investigator & Institution: Depaulo, J R.; Associate Professor; Psychiatry and Behavioral Scis; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2001; Project Start 01-JUL-1988; Project End 31-MAR-2004 Summary: (Adapted from investigator's abstract): This application is submitted as one of two collaborating 4-year proposals under the Program Announcement "Collaborative Studies of Mental Disorders." The broad aims are to expand a unique, existing set of pedigrees and test candidate regions for linkage and association with bipolar disorder. For the Johns Hopkins site, this represents a revised competing renewal application while for the University of Chicago site this is a new proposal. Together, the two sites propose to double the existing family resource by ascertaining an additional 80 moderate-sized families through bipolar I probands with 2 or major siblings affected with recurrent major affective disorders. All participants will be interviewed by trained psychiatrists who have established excellent inter-rater reliability. Diagnoses will be assigned by 2 non-interviewing psychiatrists who review all clinical data. This sample has already proven to be of value to the field of psychiatric genetics. Among clinical findings that have spawned new research directions are the reports of anticipation, parent-of-origin effects, a high prevalence of BPII among the close relatives of bipolar I probands, and high rates of co-morbid panic disorder in a subset of families. The sample provided the first evidence of linkage to 18q, and the first molecular evidence for a parent-of-origin effect in bipolar disorder. Findings from prospective studies of the 2nd half of this sample demonstrate high allele sharing between bipolar II sib pairs at the several loci in 18q21. Exploratory analyses of co-morbid panic disorder and alcoholism have suggested methods for predicting heterogeneity between bipolar

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families. In addition to collecting more families, the investigators propose to genotype the existing and additional family sets at candidate regions implicated by a recent genome-wide scan for linkage that has been completed on 68 pedigrees from this sample. It is also proposed to use linkage and association methods to extract the maximal genetic information needed to locate genes influencing susceptibility to bipolar disorder. This is a carefully clinically assessed family set. The studies generated from this resource have demonstrated its value and have provided testable hypotheses for further work. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETIC MODELING OF PSYCHOPATHOLOGY Principal Investigator & Institution: Vieland, Veronica J.; Professor of Biostatistics, Psychiatry a; Prev Med & Environmental Hlth; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2001; Project Start 01-MAY-1997; Project End 30-APR-2002 Summary: (Adapted from applicant's abstract): This is a request for a Career Development Award. The purpose of this application is to ensure the applicant adequate time for research, necessary to the continued development of her career as an independent investigator in statistical genetics with psychiatric applications, as well as to provide additional clinical training. The candidate is an expert in the application of statistical methods in psychiatric research. From 1990-1995 she has been supported by a prior NIMH Career Development Award. During the time she has acquired a broad background in human and psychiatric genetics and developed her skills in her own area of expertise, and she has already made several fundamental contributions to the field of statistical methods in psychiatric research. She has recently been recruited to join the faculty of The College of Medicine at the University of Iowa which has an outstanding research program in psychiatry and a strong commitment to genetics research. The discovery of genetic mechanisms underlying psychiatric disorders can facilitate diagnosis and prevention, aid in the development of more effective interventions, and broaden understanding of the contributions of both nature and nurture to psychopathology. Enormous technologic advances in recent years have made sophisticated modeling of complex genetic disorders feasible in principle. However, what is available in theory is not always feasible in practice. A fundamental source of difficulty involves proper procedures for sampling (ascertainment of families) and proper mathematical treatment of sampling in data analysis. Unresolved sampling problems can make planning and executing a genetic study of a complex disorder extremely difficult. The proposed research will address major sampling issues for complex genetic analysis using both analytic mathematical approaches and simulation studies. The candidate maintains ongoing established collaborations with clinicians on genetic studies of panic disorder, autism, and obsessive-compulsive disorder. All theoretical work will be both guided by and applied to the analysis of data from these studies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GENETIC STUDIES OF DEPRESSIVE DISORDERS Principal Investigator & Institution: Weissman, Myrna M.; Professor; New York State Psychiatric Institute 1051 Riverside Dr New York, Ny 10032 Timing: Fiscal Year 2001; Project Start 01-AUG-1987; Project End 30-JUN-2002 Summary: This is a give year competitive renewal to complete genetic studies begun in 1976. The goal has been to gain understanding of the etiology, heterogeneity and

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comorbidity of major depression (MDD) and its relationship to panic disorder. This last renewal focused efforts on two subtypes of depression (MDD with onset before age 30 and MDD with panic disorder) that our data showed resulted in increased morbidity of MDD in first-degree relatives and specificity in transmission. Over the past four years we have: (1) collected a new sample of 230 probands with early onset MDD, or panic disorder with and without MDD, and normal controls; (2) completed blind interviews with over 700 of their first degree relatives ages 6 and older, and spouses; obtained family history data from multiple informants on over 1,600 first-degree relatives, and collected three or more independent family histories on over 74% of the relatives; (3) identified 17 potentially informative extended pedigrees from the above groups for genetic linkage studies, obtained pedigree data, and conducted interviews with over 176 family members, and (4) established 96 permanent DNA cell lines, and began linkage analyses. In our last year we will complete interviews on another 400 relatives who have consented to be interviewed and will obtain another 50 cell lines. We are requesting funds to (I) conduct data analysis on this new sample of over 1,600 relatives and add it to our existing sample of 1,551 first-degree relatives collected in the same way during the first five years of the grant to determine the heterogeneity, familial patterns, risk and specificity of early onset MDD and of the relationship between MDD and panic disorder through examination of the rates and types of psychiatric disorders in families; to explore genetic models explaining the inheritance of early onset MDD, of panic disorder and the genetic relationship, if any, between panic and MDD; to complete genetic linkage studies using recombinant DNA techniques on the pedigrees already collected, and (II) collect extended pedigrees and establish DNA cell lines in 20 new informative families with panic disorder, with and without depression in order to increase our power to detect linkage, to test a large battery of polymorphic DNA markers against these families and search for locus (loci) that predispose to panic plus MDD or panic. Our preliminary findings suggest this direction may be most fruitful. It is more expedient to target a large number of families with panic disorder at the beginning of gene mapping and not lose momentum or later need to hire and retrain staff. We have collected a large and unique data set and have access to unstudied and potentially informative families that can answer questions about these disorders of relatively high prevalence and social morbidity. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HARVARD BROWN ANXIETY RESEARCH PROJECT Principal Investigator & Institution: Keller, Martin B.; Associate Professor; Psychiatry and Human Behavior; Brown University Providence, Ri 02912 Timing: Fiscal Year 2001; Project Start 01-APR-1995; Project End 30-JUN-2003 Summary: We propose to continue the Harvard/Brown Anxiety Research Program (HARP), a unique, naturalistic, prospective, multicenter study of 478 currently active subjects with anxiety disorders, for an additional 4 years of follow-up. This will enable us to create a complete master file with a minimum of 11 years of follow-up data on all active subjects and to incorporate new assessments and data analysis methods in order to address important unanswered questions and develop a comprehensive picture of the longitudinal course and outcome of 3 common anxiety disorders: panic disorder with and without a agoraphobia, generalized anxiety disorder, and social phobia. Our specific aims are to 1) comprehensively map patterns of course for the 3 anxiety disorders; 2) examine predictors/mediating variables, such as stressful life events, depression, substance abuse, and personality disorders, associated with the course of anxiety disorders; describe medication received and investigate the mediating effect of

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medication on course; 4) assess the relationship between psychosocial functioning and anxiety; symptom severity; and 5) examine the utility of a dimensional approach (i.e., anxiety - and mood-related traits) in characterizing the nature and course of the anxiety disorders and comorbid depressive disorders. Subjects will be evaluated at 6 month intervals with instruments that obtain detailed information on symptom status and severity, diagnostic status, treatment received, psychosocial functioning, and other domains. Since our earlier submission we have added new assessments that measure stressful life events, underlying mood- and anxiety-related traits, and symptom severity independent of diagnosis and functioning; we have also incorporated new data analysis methods in order to answer important questions about the anxiety disorders. To have sufficient statistical power to test our hypotheses, 4 more years of prospective observation are needed. The HARP data set is unique in its large number of subjects, comprehensiveness of assessment, and length of prospective follow-up. This proposal will allow us to more completely investigate the aims and hypotheses of the previously funded grant and to add new, previously unexplored aims and hypotheses generated by findings from HARP and other investigators during the past 4 years. Continuation of HARP is expected to shed new light on clinically and theoretically important, innovative questions about a group of common and impairing disorders which have not been adequately addressed by previous research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HPA AXIS IN DEPRESSION AND ANXIETY Principal Investigator & Institution: Young, Elizabeth Ann.; Professor; Psychiatry; University of Michigan at Ann Arbor 3003 South State, Room 1040 Ann Arbor, Mi 481091274 Timing: Fiscal Year 2001; Project Start 01-MAY-2001; Project End 30-APR-2006 Summary: (Applicant's abstract) This is a Research Scientist Award Application. I have received 15 years of salary support through the RSDA program and have become a leader in the area of HPA axis regulation in depression. Future studies proposed in this application will continue to explore hormonal abnormalities in depression and also in related anxiety disorders, panic disorder and PTSD. Current research indicates that depression is accompanied by abnormalities of the HPA axis, while anxiety disorders, particularly Panic Disorder, is accompanied by abnormalities of the central noradrenergic system, as reflected by a blunted growth hormone response to clonidine. Specific research aims in this proposal are I) to determine if abnormalities of central noradrenergic system are present in both pure depression, pure panic disorder and depression plus panic disorder. We will study a group of well characterized pure depressed, pure panic and mixed panic and depressed patients with the clonidine/growth hormone challenge to determine if all depressed patients manifest abnormalities in clonidine stimulated growth hormone release or if only those with comorbid panic symptoms manifest this abnormality. 2) To determine if abnormal activation of HPA axis secretion occurs in Panic Disorder patients. We will examine 24 hr urinary cortisol excretion, collected in 8 hrs segments in pure depressed, pure panic and and mixed panic and depressed patients. 3) To evaluate noradrenergic and HPA axis 'reactivity' to two simple challenges in pure depression, depression plus anxiety, panic disorder patients and normal controls. These challenges include orthostatic challenge and the Trier Social Stress Test (TSST). We hypothesize that panic disorder patients and depressed patients with co-morbid anxiety will demonstrate exaggerated catecholamine response to orthostatic challenge i.e increased reactivity. We hypothesize that depressed patients will have altered HPA axis responses to stress response while

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Panic Disorder patients will have normal HPA axis response to the TSST. 4 ) To determine if the abnormalities in basal HPA axis dysregulation, exaggerated responses to stress and blunted response to clonidine-growth hormone challenge studies occur in the same individuals and if the results of these biological studies support the nosological distinction between Panic Disorder, pure Major Depression and Major Depression with co-morbid Panic Disorder. Finally we will examine whether HPA axis and noradrenergic dysfunction reflect a common factor, degree of impairment, more than a specific mood and anxiety disorder. With regards to PTSD, we will explore whether decreases in urinary free cortisol and increases in urinary catecholamines are present in epidemiological sample of subjects exposed to trauma both with and without PTSD and normal subjects not exposed to trauma who are free of Psychiatric disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IDENTIFICATION AND CHARACTERIZATION OF LATE LIFE PANIC Principal Investigator & Institution: Apfeldorf, William J.; Psychiatry; Weill Medical College of Cornell Univ New York, Ny 10021 Timing: Fiscal Year 2001; Project Start 01-APR-1997; Project End 31-MAR-2003 Summary: The objective of this revised Academic Career Award, Development, application is to assist Dr. William Apfeldorf in his academic activities in the field of geriatric psychiatry and to develop a clinical research program in late life anxiety disorders at the New York Hospital - Cornell Medical Center. The award will free Dr. Apfeldorf from most of his present clinical responsibilities, allowing him to obtain the training and experience necessary to develop as an academician and scientist. The training plan focuses on forming strong collaborative relationships with experts in the fields of geriatric psychiatry, anxiety disorders, and behavioral neuroscience. The specific aims of the research plan are: 1) to describe the expression and course of late life panic disorder, and its impact on medical morbidity and functioning in elderly panic disorder patients and elderly normal controls, and 2) to describe the profile of panic symptoms and neuroendocrine responses to pentagastrin panic provocation in elderly panic disorder patients and elderly normal controls. The research plan addresses clinical concerns about the direct and indirect cost of late life panic disorder in term of morbidity, quality of life, and burden for patients and their families. The plan also introduces a biological model for evaluating late life panic symptoms, allowing pathophysiologic mechanisms implicated in late life panic disorder to be investigated. Academic and research activities will take place simultaneously throughout the award period. As a result of this program, hypotheses on the underlying relationships of aging, pathophysiologic mechanisms, and anxiety disorders will be formulated. Upon completion of the award period, Dr. Apfeldorf will function as a faculty scholar, as a principal investigator in late life anxiety disorders for NIMH-supported studies including R01 and First Award applications, and as mentor and resource to medical students, residents, fellows, and colleagues. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: IMPROVING CARE FOR PANIC DISORDER IN PRIMARY CARE Principal Investigator & Institution: Roy-Byrne, Peter P.; Professor; Psychiatry and Behavioral Scis; University of Washington Seattle, Wa 98195 Timing: Fiscal Year 2001; Project Start 01-JUL-1999; Project End 30-JUN-2003

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Summary: With the rise of managed care, the primary care setting is assuming increasing importance as a site for the detection and treatment of all mental health problems. In this setting, panic disorder is prevalent, poorly recognized, and inadequately treated. Because it is both disabling and often masquerades as a variety of other medical conditions, it increases both direct (physician visits and unnecessary testing) and indirect (disability days) costs. This is a multi-institutional collaborative research project designed to implement an intervention to identify and treat panic disorder in the primary care setting and to study its clinical and cost effectiveness over a one-year period. Three sites (UCSD, UCLA, UW) will screen and identify patients in a university primary care clinic who suffer from panic disorder and test an innovative model of service delivery for panic disorder in this setting. Patients will be randomized to receive either care as usual from their primary care physician or collaborative care (CC). CC employs a combination of cognitive-behavioral psychotherapy (delivered in six sessions over eight weeks by a behavioral health specialist [BHS]), expert pharmacotherapy (guided by a psychiatrist's recommendations relayed by the BHS to the prescribing primary care physician), and disease management elements (education and activation of patient and provider and more careful monitoring and sustained follow-up over the next year via phone contact). It is hypothesized that CC will have superior clinical effectiveness (measured in terms of symptom reduction, quality of life, and function). It is also hypothesized that although direct health care costs will be higher for CC than for usual care, indirect costs will be lower and cost-effectiveness analysis will support the adoption of CC as a preferred model of care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPROVING CARE OF PANIC DISORDER IN PRIMARY CARE Principal Investigator & Institution: Craske, Michelle G.; Professor; Psychology; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2001; Project Start 01-JUL-1999; Project End 30-JUN-2003 Summary: With the rise of managed care, the primary care setting is assuming increasing importance as a site for the detection and treatment of all mental health problems. In this setting, panic disorder is prevalent, poorly recognized, and inadequately treated. Because it is both disabling and often masquerades as a variety of other medical conditions, it increases both direct (physician visits and unnecessary testing) and indirect (disability days) costs. This is a multi-institutional collaborative research project designed to implement an intervention to identify and treat panic disorder in the primary care setting and to study its clinical and cost effectiveness over a one-year period. Three sites (UCSD, UCLA, UW) will screen and identify patients in a university primary care clinic who suffer from panic disorder and test an innovative model of service delivery for panic disorder in this setting. Patients will be randomized to receive either care as usual from their primary care physician or collaborative care (CC). CC employs a combination of cognitive-behavioral psychotherapy (delivered in six sessions over eight weeks by a behavioral health specialist [BHS]), expert pharmacotherapy (guided by a psychiatrist's recommendations relayed by the BHS to the prescribing primary care physician), and disease management elements (education and activation of patient and provider and more careful monitoring and sustained follow-up over the next year via phone contact). It is hypothesized that CC will have superior clinical effectiveness (measured in terms of symptom reduction, quality of life, and function). It is also hypothesized that although direct health care costs will be

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higher for CC than for usual care, indirect costs will be lower and cost-effectiveness analysis will support the adoption of CC as a preferred model of care. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPROVING QUALITY OF PRIMARY CARE FOR ANXIETY DISORDERS Principal Investigator & Institution: Rollman, Bruce L.; Associate Professor of Medicine; Medicine; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 10-SEP-1999; Project End 31-MAY-2003 Summary: Panic and generalized anxiety disorders (PD/GAD) are prevalent in primary care practice; responsible for significant morbidity; inadequately recognized and treated; and associated with excessive health services utilization. Given the availability of efficacious treatments for PD/GAD, this effectiveness study hypothesizes that enabling patients to participate in their care while simultaneously disseminating guideline-based treatments to their primary care physicians (PCP) via electronic medical record (EMR) will produce superior clinical outcomes to those achieved by simply notifying the physician and patient of the diagnosis alone. Our patient intervention will be based on public-domain and commercially available information/self-management materials modified for local use. PCPs will receive treatment advice based on the American Psychiatric Association's anxiety guideline and other evidence-based treatment algorithms presented to them via EMR. Approximately 20 board-certified PCPs at two study sites will be randomized to either our intervention or control ( usual care ) group. Research assistants using a validated rapid screening and interview procedure will identify 247 patients experiencing PD/GAD upon presentation for primary care over an 18-month period. All study patients and PCPs will receive notification of the anxiety diagnosis from the investigators. Afterwards, according to PCP assignment: (1) patients may receive additional information on anxiety disorders and a structured anxiety selfmanagement program administered over the telephone by a trained facilitator; and (2) PCPs may be exposed to guideline advice presented via EMR at the time of the clinical encounter. A research assistant blinded to the PCPs randomization status will conduct standardized telephone assessments with each study patient at 0, 2, 4, 8, and 12 months. The primary outcome criterion, a 50 percent reduction in subjects' levels of anxiety symptomatology at 4 months, will be assessed using the Hamilton Rating Scale for Anxiety. Secondary outcome criteria, such as functional status and health services utilization, will be assessed using parallel analyses at 12 months. This study will enhance our understanding of new methods to implement guideline-based care and the magnitude of benefits that can be expected. Study findings can: identify process factors that contribute to appropriate and effective care; stimulate the development of other patient self-management strategies; and distinguish patient subgroups most likely to respond to a collaborative-management approach for treatment of a debilitating chronic mental disorder. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INTERACTIVE COMPUTER TREATMENT FOR PANIC DISORDER Principal Investigator & Institution: Schmidt, Norman Brad.; Professor; Psychology; Ohio State University 1960 Kenny Road Columbus, Oh 43210 Timing: Fiscal Year 2002; Project Start 04-JAN-2002; Project End 31-DEC-2004

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Summary: (provided by applicant): This proposal requests funding through an Exploratory Development Grant for Mental Health Intervention Research. Panic disorder (PD) is a highly prevalent and debilitating condition. Research has suggested that cognitive-behavioral therapy (CBT) is a very effective treatment for PD with or without agoraphobia, however, a majority of patients with PD do not receive this type of therapy (or any recommended treatment). Some of the primary factors that limit patient participation in treatment include cost and treatment availability. Self-help treatments are a means to provide low-cost treatment to a much greater number of individuals, and available book-based self-help formats have been found to be effective. Interactive computer-based treatments offer additional advantages over a book-based approach because they are more engaging, thereby leading to greater compliance and decreased attrition. Moreover, computer treatments have the capacity to enhance learning through multiple modalities and interactive features. The purpose of the proposed investigation is to develop an interactive computer-administered version of the most recent genre of CBT treatments for panic disorder (treatment development phase) and to test the efficacy of this type of treatment relative to an established CBT bibliotherapy manual (pilot testing phase). The first phase of this proposal involves developing an interactive computer-based treatment that effectively emulates available CBT protocols for panic disorder. This development will involve translating manualized CBT interventions into a multimedia presentation with various interactive features designed to mimic the type of communication that typically occurs in live CBT. The second phase of this proposal involves refining the computer-administered treatment based on patient utilization from a small, representative sample of patients. Based on patient assessments, the treatment will be redesigned accordingly. The final phase of the proposal involves a clinical trial examining the relative efficacy of the refined computer treatment (about = 20) versus a book-based treatment (about = 20) and a delayedtreatment control group (about = 20). Outcomes will be compared at posttreatment and at 3-month follow-up. It is hypothesized that both active treatment groups will produce better outcomes relative to the control condition and that the computer-based treatment will produce superior outcomes relative to the book-based treatment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTERPERSONAL PSYCHOTHERAPY FOR SOCIAL PHOBIA Principal Investigator & Institution: Lipsitz, Joshua D.; Psychiatry; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2001; Project Start 01-AUG-1998; Project End 31-JUL-2003 Summary: (Applicant's abstract): Social phobia is a common and debilitating disorder. Because established treatments are effective for many but not all social phobia patients, research into alternative treatments in needed. In response to this need, this Mentored Clinical Scientist Development Award proposal pursues two distinct, yet interdependent goals. The first is to develop the principal investigator's ability to conduct independent research in the psychosocial treatments of anxiety disorders. Second, the proposed research tests the efficacy of interpersonal psychotherapy (IPT) for social phobia and expands on this question through additional projects. The training program will integrate: 1) course work in research design, statistics, and the ethical conduct of research, 2) intensive tutorials and ongoing training in specific psychotherapy approaches, 3) supervision by the primary mentor in carrying out the research plan, and 4) supervision from specialized preceptors in various aspects of research with IPT and psychotherapy research for the anxiety disorders. The planned research expands on promising preliminary results with interpersonal psychotherapy

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for social phobia through three projects. The primary project is a controlled clinical trial with randomized assignment to interpersonal psychotherapy for social phobia (IPT-SP) or a credible psychotherapy control. Comprehensive assessment will be conducted periodically during treatment and at 6 and 12 months following treatment. In a second project, IPT-SP will be modified for treatment of groups, and this treatment will be piloted in a group of social phobia patients. In a third project, available narrative summaries from 120 panic disorder patients will be analyzed to explore the relevance of IPT for panic disorder. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTERVENTION FOR CHILDREN AT RISK FOR ANXIETY DISORDERS Principal Investigator & Institution: Hirshfeld-Becker, Dina R.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2001; Project Start 01-MAR-1998; Project End 28-FEB-2003 Summary: This is an application for a Mentored Clinical Scientist Development Award with a focus on developing expertise in designing and evaluating early interventions for childhood anxiety disorders. The candidate proposes to build upon her experience studying behavioral inhibition as a risk factor for anxiety disorders by learning to apply this knowledge to benefit children at risk. Anxiety disorders represent the most prevalent category of childhood mental disorder. They have been shown to run in families, with children of parents with anxiety disorders at high risk to develop these disorders themselves. Studies by the candidate and her sponsors have identified behavioral inhibition as a temperamental risk factor for the development of childhood anxiety disorders. Children whose behavioral inhibition remains stable throughout early childhood and whose parents have multiple anxiety disorders appear at greatest risk. The ability to identify young children at high risk affords the opportunity for early intervention. Research Plan: The candidate proposes to refine and test an intervention for behaviorally-inhibited 4.0-5.9-year-old children of parents with panic disorder with agoraphobia to facilitate the children's learning strategies for reducing inhibition and managing anxiety. The twelve- week intervention includes parent-skills training and child anxiety management. It will be tested in a randomized controlled trial with proximal (three-month) and long-term (two-year) follow-up assessment for child behavioral inhibition and psychopathology. Environment: The proposed study will be based at the Massachusetts General Hospital and will complement a program of training and supervised research under the mentorship of Joseph Biederman, MD and cosponsored by Jerrold F. Rosenbaum, MD, with consultation from experts in the areas of behavioral inhibition, childhood anxiety disorders and intervention research. Career development plan: Training will emphasize skills necessary for designing and evaluating interventions for anxious children and assessing psychological and familial vulnerability factors including child temperament, psychopathology, cognitive risk factors and family interactions. Coursework at the Harvard School of Public Health and tutorials in intervention research design, statistical methods, and methodology for longitudinal follow-up will complement supervision by the consultants. In this manner, the candidate will develop a critical fund of knowledge in childhood anxiety disorders, developmental psychopathology, intervention research, and statistical methodology which will lay the foundation for future independent investigation of intervention strategies for high risk children. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MIDCAREER-INVESTIGATOR AWARD IN PATIENT-ORIENTED RESEARCH Principal Investigator & Institution: Mellman, Thomas A.; Associate Professor and Director; Psychiatry; Dartmouth College 11 Rope Ferry Rd. #6210 Hanover, Nh 03755 Timing: Fiscal Year 2001; Project Start 27-SEP-1999; Project End 31-AUG-2004 Summary: Thomas A. Mellman M.D. is an Associate Professor at the University of Miami School of Medicine, Department of Psychiatry and Behavioral Sciences and Director of the Anxiety Disorders Program. The programmatic focus of Dr. Mellman's research is the psychobiology of sleep disturbances in posttraumatic stress disorder. This interest evolved from work beginning during the candidate's training on phenomenological issues in PTSD and panic, and sleep in panic disorder. The focus of the work in sleep in PTSD has included laboratory evaluations documenting disturbed arousal regulation in combat veterans and Hurricane survivors, and has recently emphasized REM activity, dreaming, and implications for memory processing and treatment interventions. The focus of the candidate's active RO-1 funded study is PTSD and sleep acutely in subjects with recent severe traumatic injuries. During the candidate's 10 years as faculty in Miami he has mentored a number of trainees' projects that have been presented and published and for some, influenced the pursuit of academic careers. The proposed award would provide critical support toward the optimal development of the research program and maximize opportunities for mentoring trainees and early career investigators. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MOLECULAR GENETICS OF MENTAL DISORDER Principal Investigator & Institution: Crowe, Raymond R.; Professor; Psychiatry; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2001; Project Start 01-JUL-1988; Project End 30-JUN-2003 Summary: (Applicant's abstract): This is an application for a Research Scientist Award to support the applicant's research on the genetics of panic disorder and several other psychiatric conditions. Panic disorder is familial and twin studies indicate that genes are involved in its transmission, but the low relative risk of first-degree relatives suggests that individual loci make small contributions to overall liability. Indeed, we have completed a genome search for linkage with over 400 STRP markers and excluded a major locus from 85% of the genome. Over the next phase of the project we hope to accomplish several objectives. We need to create dense marker maps of the regions that resulted in positive evidence of linkage from the genome search. We will also collect a sample of panic disorder patients for disequilibrium studies. We will combine our pedigrees with those of our collaborators at Columbia University to increase power to detect loci of small effect. Both groups will study 35% CO2 inhalation, a potential biological marker for panic disorder, in their pedigrees in hopes of finding a more valid biological phenotype for linkage analysis. The applicant has identified a mutation in the promoter of the CCK gene, a candidate gene for panic disorder, that may be associated with panic disorder. This association will be studied in an epidemiological sample, and its effect on gene transcription will be studied using a reporter gene construct At the same time, the applicant is participating in collaborative linkage studies of three other disorders. I am the PI of the Iowa site on a six-center collaborative study on the genetics of alcoholism. I have also contributed schizophrenia pedigrees to a collaborative effort to search for genes for that disease. The applicant and PIs at four other sites are planning to submit an application for a linkage study of early-onset unipolar depression. Finally, I

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am the project director of a postdoctoral fellowship in psychiatric genetics at Iowa that has been continuously funded for over 20 years. All of these projects are time consuming. At the same time, demands on clinical faculty for service time are becoming increasingly pressing as a result of recent changes in the health care environment. The Research Scientist Award will free my time from service requirements to work on the above genetics projects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MOOD AND ANXIETY DISORDERS IN PREGNANCY AND LACTATION Principal Investigator & Institution: Stowe, Zachary N.; Associate Professor and Director; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2002; Project Start 01-SEP-2002; Project End 31-AUG-2007 Summary: The treatment of mental illness during pregnancy has gained considerable attention over the past decade. The majority of this attention has focused on antidepressants and major depression, with far less consideration of anxiety disorders and bipolar disorder. The treatment guidelines for mental illness during pregnancy and lactation remain empiric and continue to emphasize the risk/benefit assessment. The lack of data on the course of illness, the impact of pregnancy and lactation of the metabolism and distribution of pharmacological treatments, and the extent of fetal and neonatal medication exposure underscores the empiric nature and prematurity of such guidelines. The current project will enhance and extend the data derived from an ongoing collaborative R01 MH56555-01A2 (Stowe) focused on the relapse of major depression in pregnant women taking antidepressant proximate to conception and K23 MH 63507-01 (Newport) investigating psychosis during pregnancy. We will prospectively follow women with major depression (MID), bipolar disorder (BPD), panic disorder (PD), and obsessive-compulsive disorder (OCD) through pregnancy and the first postpartum year. Many of these women may chose to continue medications such as antidepressants, mood stabilizers, and antipsychotic medications either during pregnancy and/or take medications postpartum. Monthly serum sampling and GCRC admissions will provide novel data.regarding the metabolism, distribution, and fetal/neonatal exposure to these compounds. These PK/PD models will be expanded to include assessment of pharmacogenetic factors of metabolic capacity and protein binding. Similarly, prospective documentation of additional exposures, sex steroid concentrations, and psychosocial variables will further refine such models and provide preliminary assessment of factors (other than medication concentrations) that may influence the course of illness and obstetrical outcome. The current project will utilize the core components to address the deficits in the current literature, affords a diagnostically diverse group of women that may be germane to the results obtained in Project 2 with respect to co-morbidity and the use of similar medications in a nonepileptic population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEUROBIOLOGY AND GENETICS OF PANIC, TS, AND OCD Principal Investigator & Institution: Gelernter, Joel E.; Professor; Psychiatry; Yale University 47 College Street, Suite 203 New Haven, Ct 065208047 Timing: Fiscal Year 2001; Project Start 01-SEP-1996; Project End 28-FEB-2002 Summary: NEUROBIOLOGY AND GENETICS OF PANIC, TS, AND OCD. This is an application for an NIMH K02 (Independent Scientist) award. The goal of the proposal is

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to continue specialized training for the PI, a psychiatrist, in molecular and population genetics. The aims of the research are to (a) locate genes affecting risk for panic disorder by genetic linkage; (b) identify genes influencing risk for Tourette's syndrome and obsessive-compulsive disorder using the haplotype relative risk (HRR) family association method; (c) identify genes associated with specific phenotypes (recognized, eg, by imaging studies) within groups affected with illness using association methods; and (d) identify specific mutations associated with phenotype by mutational analysis and sequencing. Under some circumstances, genome scan- directed linkage studies are most useful in identifying genes predisposing to illness; under other circumstances, HRR studies may be more efficient. For very strong candidate gene hypotheses, mutational analysis may be employed directly. Preliminary results have been generated using all of these methods. For our panic disorder linkage project ("a"), we have obtained DNA from 201 individuals in 21 families, as of May 1995. We have used the HRR method to identify a genetic association between Tourette's syndrome and an allele at the D4 dopamine receptor locus ('b"). In the area of genotype/phenotype association, we have reported an association between cocaine-induced paranoia and dopamine transporter alleles; we have obtained preliminary data using SPECT imaging techniques regarding the relationship between alleles at the D2 dopamine receptor locus (DRD2) and brain D2 receptor density ("c". We propose to complete a genome scan for the panic disorder linkage project; attempt to identify other genes influencing risk for Tourette's syndrome and obsessive-compulsive disorder; and identify other genotype-phenotype relationships using imaging studies as a way to ascertain phenotype directly. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NEUROBIOLOGY OF ANXIETY AND PANIC DISORDERS Principal Investigator & Institution: Shekhar, Anantha; Professor; Psychiatry; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2002; Project Start 01-JUL-1996; Project End 30-JUN-2006 Summary: This abstract is not available. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: NEUROCHEMICAL CHALLENGES IN PTSD Principal Investigator & Institution: Yehuda, Rachel; Mount Sinai School of Medicine of Cuny New York, Ny 10029 Timing: Fiscal Year 2001 Summary: This study will use a well known panic-causing drug called CCK-4 (cholecystokinin-tetrapeptide) in individuals with posttraumatic stress disorder (PTSD). The purpose of this study is to see whether this naturally occurring poly-peptide will also cause flashbacks and panic attacks in patients with PTSD. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PANIC AND SMOKING CESSATION Principal Investigator & Institution: Zvolensky, Michael J.; Assistant Professor; Psychology; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2003; Project Start 15-JUL-2003; Project End 30-APR-2005

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Summary: (provided by applicant): Smokers with a history of panic attacks represent a common, albeit understudied, segment of the smoking population who may be at heightened risk for continued nicotine dependence and its associated morbidity and mortality. Though researchers have attempted to understand the impact of certain emotional disorders on the relative degree of success in smoking cessation, research has not examined the impact of panic-related problems on smoking cessation outcomes. To address this gap in the existing literature, the present R21 proposal seeks to test the extent to which a history of panic attacks interferes with successful smoking cessation. The project also will clarify theoretically relevant negative emotional processes involved with smoking cessation more generally. Findings from the proposed investigation should result in improved methods of identifying smokers at-risk for relapse, so that they may be targeted for nicotine dependence treatments that will meet their specific needs. The proposed study employs a prospective design to follow for three months a sample of 84 smokers with and without a history of panic attacks after they attempt to quit smoking on their own. Subjects will complete a diagnostic interview and a medical screening, provide saliva for cotinine analysis, and will complete a set of self-report measures assessing theoretically relevant emotional and smoking characteristics. They also will complete a well-established voluntary hyperventilation challenge procedure on a day prior to their cessation attempt on which they will come to the laboratory not smoking for a 12-hour experimental abstinence period. Beginning on quit day and also at days 3, 7, 14, 28, and 90, subjects will return to the study center for assessment of smoking outcomes, psychological/emotional status, and withdrawal symptoms. Because smokers with panic attacks may represent a recalcitrant group of smokers who are at-risk for continued nicotine dependence, these research findings should hold considerable clinical and public health significance and may result in the development of specialized treatment approaches for this population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PANIC CONTROL THERAPY IN A MANAGED CARE SETTING Principal Investigator & Institution: Addis, Michael E.; Assistant Professor; Psychology; Clark University (Worcester, Ma) 950 Main Street Worcester, Ma 01610 Timing: Fiscal Year 2001; Project Start 15-APR-1998; Project End 31-JAN-2003 Summary: (Applicant's Abstract): Panic Disorder (PD) is a serious psychiatric illness which, if left untreated, can be associated with significant life dysfunction and distress. Although a number of controlled experimental studies have supported the efficacy of Panic Control Therapy (PCT) as a cognitive-behavioral treatment for PD, no studies have evaluated the transportability of PCT to real-world clinical practice. Investigating the outcomes of an empirically validated manual-based psychotherapy in clinical practice is a crucial step in disseminating effective treatments and working towards empirically-based standards of care. The purpose of this study is to investigate the impact of training in PCT for master's level therapists working in a managed care context. Ten clinicians will be randomly assigned to PCT training or treatment as usual (TAU). Patients meeting criteria for PD = 120) with varying degrees of severity and with or without agoraphobia will be randomly assigned to PCT-trained or TAU therapists. Outcomes will be evaluated at post-treatment, 3 months 1 year, and 2 years following treatment. Blind ratings of therapist adherence to PCT will provide an assessment of how well clinicians can learn and implement the protocol in clinical practice following state of the art training. By maintaining random assignment of therapists and patients, this study will possess the necessary internal validity to draw conclusions regarding the effectiveness of PCT in clinical practice. The use of non- expert master's level clinicians,

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and a more heterogeneous sample of patients than previous studies, will greatly enhance the generalizability of the findings, and speak to the effectiveness of PCT in real-world clinical practice. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PANIC DISORDER, PARENTING AND INFANT NEUROBIOLOGY Principal Investigator & Institution: Warren, Susan L.; Assistant Professor; Psychiatry and Behavioral Scis; George Washington University 2121 I St Nw Washington, Dc 20052 Timing: Fiscal Year 2003; Project Start 01-APR-2003; Project End 31-JAN-2008 Summary: (provided by applicant): This research will test models concerning the impact of specified parenting behaviors in combination with severe symptoms of parental anxiety, environmental risk and protective factors, in a high-risk sample of children of parents with panic disorder (PD), in order to examine child fear arousal across the first two years of life. Four-month infants from two parental diagnostic groups will be studied in order to increment the likelihood of risk: eighty infants with PD mothers and eighty infants of mothers without psychopathology. Infant fearful behaviors in response to novel stimuli and neurobiological indicators of arousal (baseline and potentiated startle, salivary cortisol and sleep disturbances), along with parental anxiety symptoms, specified parenting behaviors, and environmental risk and protective factors, will be assessed at four, fourteen and twenty-four months of age. Caregiver-infant interactions are expected to play an important role in contributing to increasing infant fear-arousal for constitutionally vulnerable infants during this period. This research will provide information concerning which particular factors might contribute to increasing child fear-arousal across the first 2 years of life. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PANIC ETIOLOGY: A LABORATORY TEST Principal Investigator & Institution: Yartz, Andrew R.; Psychology; University of Vermont & St Agric College 340 Waterman Building Burlington, Vt 05405 Timing: Fiscal Year 2003; Project Start 17-SEP-2003; Project End 16-SEP-2006 Summary: (provided by applicant): The present proposal aims to fill a gap in the existing literature by developing theory and research on exposure to aversive life events and one's expectancies about those events, as applied to the etiology of panic disorder. The main purpose of the proposed research is to establish that the expectancy of anxiety in response to bodily sensations can result in acute emotional consequences akin to that commonly seen in panic disorder, and that such effects are potentiated when the onset of bodily stress is unpredictable compared to predictable. Anxiety expectancies will be experimentally manipulated before exposure to predictable and unpredictable episodes of bodily sensations. It is hypothesized that expectancies for anxiety will be associated with relatively more negative emotional consequences under conditions of unpredictable compared to predictable somatic perturbation. Additionally, it is hypothesized that an individual's preference for information regarding the onset of bodily perturbation is partially a function of the extent to which they expect somatic symptoms to elicit anxiety. The overall objective of this research program is to develop knowledge about the cognitive vulnerability processes of response expectancy and predictability as they apply to understanding the etiology of panic disorder. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PANIC OUTCOMES IN PRIMARY CARE--RACIAL DIFFERENCES Principal Investigator & Institution: Johnson, Michael R.; Assistant Professor; Psychiatry and Behavioral Scis; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425 Timing: Fiscal Year 2001; Project Start 01-JAN-1999; Project End 30-JUN-2001 Summary: This application is designed to provide the candidate with the skills necessary to improve the care of patients with anxiety disorders presenting to providers in primary care (PC) settings. While there is a growing body of work examining the need for care, processes of care, and outcomes of care for patients with depressive disorders in PC settings, there are few published studies providing similar information about patients with anxiety disorders. The focus of the proposed research is panic disorder(PD), a severely disabling condition which is highly prevalent in PC settings. PD is common among high utilizers of PC services and among PC patients who are perceived as "difficult-to- treat" by their clinicians. Yet the limited available data suggests that PD is frequently not recognized and that the rate of recovery from this illness in PC populations is low. We know little about the factors which contribute to these poor recognition and recovery rates. There is evidence to suggest that African American patients with PD experience unique barriers to care and are even more likely than other racial groups to present with panic symptoms to PC providers. Yet there is no available empirical work that sheds light on the process of care or illness outcomes for this group. Another barrier to research in this area is the absence of validated psychometric tools for assessing PD in PC settings. Finally, there is an absence of a practical approach to identification of the targeted population. Therefore, the major goals of this proposal are to (1) explore fundamental issues regarding the processes and outcomes of services provided to patients with PD served in PC settings; (2) validate instruments for clinical and research use in this population; and (3) to develop a practical approach to case identification. New knowledge gained from this research will subsequently inform the development of PC interventions that will improve the quality of care provided for patients with PD in PC settings. In order to develop the skills necessary for carrying out this research the candidate will implement a program which will provide an opportunity for mentoring from experts in PCservices research and anxiety disorders in African Americans, as well as supervision with research methods and statistics and the use of computer technologies for applying psychometric instruments. The candidate's short-term career goal is to become an independent investigator studying the processes, cultural appropriateness, and outcomes of care for patients with PD in PC settings. His long-term goal is to develop effective and efficient interventions to improve the quality of PC services for individuals of different racial groups with panic and other anxiety disorders. The proposed research will be carried out in a set of three PC clinics which together serve large patient populations of both African Americans and Caucasians from all socioeconomic groups. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PHOBIA, PANIC AND CONTROL OF BALANCE Principal Investigator & Institution: Jacob, Rolf; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002 Summary: The overall objective of Subproject 6 is to investigate thepossible link between anxiety disorders and altered vestibular processing. This is based on the observation that panic attack and phobic avoidance are often prevalent in patients who present with

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balance disorders. Conversely, these investigators note that there seems to be a high prelevance of vestibular and balance dysfunction observed in patients who present with panic disorder and agoraphobia. These investigators aim to use a case control design in which they will examine vestibular correlates of the manifestations proposed in patients with anxiety disorders. Four groups of patients (n = 30) and a group of normal control subjects will be incorporated into the design of this study. Vestibular parameters to be assessed include the lateral semicircular canal-ocular reflex, using earth vertical axis rotation, and the otolith-ocular reflex, using off vertical axis rotation. Additionally, visual dependence for upright balance will be examined. Finally, the role of proprioception will be inferred by examining the effect of sway referencing to support surfaces. The data to be obtained in the experiments incorporated into the design are clearly articulated and there is a strong data analysis plan. The physical resources relevant to this project seem to be in place and there is every expectation that the goals of this project are likely to be met. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PREVENTION OF POSTRAPE PSYCHOPATHOLOGY AND DRUG ABUSE Principal Investigator & Institution: Resnick, Heidi S.; Associate Professor; Psychiatry and Behavioral Scis; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425 Timing: Fiscal Year 2001; Project Start 01-JUL-1999; Project End 30-JUN-2004 Summary: (Applicant's Abstract) Data from the National Women's Study of 4,008 female Americans (Kilpatrick et al., 1992; Resnick et al., 1993) indicate that approximately 12,100,000 women have been lifetime victims of completed rape, and more than 683,000 women are raped in a given year. Findings from assessment studies indicate that sequelae of rape include PTSD, drug abuse, depression, panic sexual dysfunction and risky health behaviors. Unfortunately, resource limitations and difficulty maintaining contact with victim preclude offering comprehensive, multi-session treatments that address each of the identified risk areas to all reporting rape victims. Thus, attention is justifiably fumed toward preventive, hospital-based interventions. The ongoing (until 9/31198) two-year pilot treatment-development study on which this application is based represents the first economically feasible preventive hospital-based intervention designed to reduce risk of developing post-rape psychopathology and substance abuse. The intervention is delivered in the form of a two-part videotape. The initial component of the video describes the forensic rape exam and is designed to reduce immediate distress during the forensic evaluation. The second component of the video contains psychoeducational information formally targeting prevention of PTSD, substance abuse, and other psychopathology. Preliminary findings regarding the efficacy this preventive intervention is encouraging. The video appears to be helpful in reducing distress during forensic exams. Moreover, the video is associated with higher "quality" ratings of the forensic exam experience. The limited time frame of assessment and the study design of the original project precluded knowledge of either longer-term effects of the video and differential effects of the two major components of the video (i.e., the forensic exam review vs. the psychoeducational component). The present proposal, therefore, is to follow the initial treatment development pilot study with a large scale controlled mixes factorial study to fully assess the impact of the video intervention and each of its components on post-rape psychopathology substance abuse. Note that this intervention will be potentially available to all rape victims immediately during their first emergency room contact, and: (1) contains components to reduce anxiety and distress immediately

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during the forensic exam; (2) addresses risk of PTSD, drug abuse, and other psychopathology, (3) does not over-tax financial resources of rape victims o hospitals, (4) is brief and easily administered, (5) considers relevant cultural characteristics of rape victims; and (6) is offered in format that is easily standardized. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PSYCHIATRIC GENETIC EPIDEMIOLOGY--NIMH ISA Principal Investigator & Institution: Neale, Michael C.; Professor; Psychiatry; Virginia Commonwealth University Richmond, Va 232980568 Timing: Fiscal Year 2001; Project Start 01-JUN-1997; Project End 31-MAY-2003 Summary: (Adapted from applicant's abstract): This K02 Independent Scientist Award for Dr. Neale will enable him to expand and refocus his methodological efforts in psychiatric genetic epidemiology. From a background of developing software (the Mx package) to fit models to data from twins and families, the candidate will obtain further training in the areas of molecular genetics and clinical psychiatry. Skills in these areas will enhance the quality and increase the breadth of models that will be applied to datasets collected at MCV. These data include twin-family studies of adult female and male twins in Virginia, of schizophrenia in Ireland (PI Dr. K. Kendler), and of school-age twins in Virginia and North Carolina (PI Dr. L. Eaves). Specific foci for model development and application include: (I) models for comorbidity that use information on age at onset in relatives as well as familial comorbidity patterns to distinguish between alternative hypotheses; (ii) methods to control for variable age at onset in genetic studies of populations still at risk; (iii) environmental moderation of genetic risk; (iv) relapse and remission over time; (v) combination of information from multiple informants; (vi) the resolution of genetic heterogeneity and its relationship to psychiatric nosology; and (vi) the integration of data from genetic markers to partition genetic factors into those from specific quantitative trait loci and those from background polygenic variation. These models will be developed and tested with simulated data. They will be applied to data on generalized anxiety disorder, major depression, panic disorder, alcohol abuse/dependence, and schizophrenia in adults, and conduct disorder and attention deficit/hyperactivity disorder in the school-aged twins. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PSYCHIATRIC GENETICS AND FAMILY STUDIES--ROBUST METHODS Principal Investigator & Institution: Hodge, Susan E.; Professor; Psychiatry; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2001; Project Start 01-MAY-1992; Project End 30-APR-2004 Summary: In recent years, psychiatric genetics has eagerly appropriated the techniques of mathematical and statistical analysis. But methods are not static, and understanding of their strengths and weaknesses keeps evolving. Investigators are wrestling with issues of robustness, power, and appropriateness of new complex analysis methods. The human gene map is here, and scientists working in psychiatric genetics are ready to use the map, but it is not always clear how best to take advantage of this new information. Past work supported by this grant has not only developed new methods for genetic analysis but has tested and characterized those methods in rigorous theoretical analyses, supplemented by realistic computer simulations. The research focuses on linkage and segregation analysis, two of the major tools available for understanding complex diseases. Problems and complications will be quantified, and new methods to solve

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these problems will be developed. Results from this project will assist the genetic analysis of common psychiatric diseases with genetic components, such as autism, bipolar affective disorder, schizophrenia, Alzheimer's disease, and panic disorder.Greater understanding of the genetic contributions to psychiatric disease will lead, in turn, to improved counseling, treatment, and prevention. Research will proceed in four areas: I. Power and robustness of parametric and nonparametric linkage methods: Rigorously compare competing methods in this controversial area. II. Sex differences and linkage analysis: Quantify effects of sex differences in recombination fraction and/or in penetrance on a linkage analysis, as well as how imprinting will influence a linkage analysis. 111. Ascertainment: Develop and test good approximations for intractable ascertainment problems, particularly in the context of sequential sampling. IV. Anticipation: Develop and test accurate statistical methods for circumventing ascertainment and other biases. The project will not be restricted to the problems detailed above but is designed to be flexible and move rapidly to address new problems of pressing importance as they arise during the grant period. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHILDREN

PSYCHOBIOLOGY

AND

TEMPERAMENT

IN

HIGH

RISK

Principal Investigator & Institution: Fairbanks, Janet M.; Psychiatry; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2001; Project Start 01-MAY-1998; Project End 28-FEB-2003 Summary: (Adapted from applicant's abstract): This application for a Mentored Clinical Scientist Development Award has the long-term objective of developing the applicant's ability to conduct independent research in developmental psychopathology, specifically, temperamental risk factors and their biological correlates in children at risk for anxiety disorders. Rachel Klein, Ph.D., primary sponsor, will oversee training of the applicant in methodology, assessment and data interpretation. Jack Gorman, M.D. will supervise biological studies, and physiology training. Training will be accomplished by means of: 1) supervision with experienced researchers, 2) internships in cardiac physiology, respiratory physiology, and brain function, 3) formal instruction in statistics, and 40 implementation of the research project. Course work will provide the necessary background in biostatistics and epidemiology to conduct data analyses. Training in data collection processing and analysis will be obtained through carrying out the Research Plan. The purpose of the research is to further understanding of the developmental psychopathology of anxiety disorders through the study of early temperament. The goal is to conduct an in-depth examination of behaviorally inhibited temperament and its biological correlates in at-risk children. Specific aims are to examine the relationship between behavioral inhibition and 1) parental anxiety disorders, and 2) physiological function exploring the influence of parental diagnosis on these relationships. These aims will be addressed through a top-down, high-risk study of 3-5 year old offspring of adults with lifetime panic disorder, social phobia, or major depression, and offspring of normals. Behavioral inhibition will be qualified through direct observational protocols blind to parent diagnosis. Biological procedures examine autonomic dysregulation of cardiac function and skin temperature, asymmetries of brain electrical activation and skin temperature. HPA Axis, and respiratory function. Measures of autonomic function include: 1) heart rate (HR), 2) heart rate variability (HRV) and spectral analysis of HRF, 3) acceleration of HR, 4) blood pressure, and 5) skin temperature. Techniques of quantitative EEG measure brain activational asymmetry. Salivary cortisol measures HPA Axis dysregulation. Measures of respiratory function include end-tidal carbon

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dioxide, respiratory rate, tidal volume, and minute ventilation. These have been implicated in behavioral inhibition and anxiety disorders. The study of risk factors has important implications for early identification and ultimately prevention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PSYCHOBIOLOGY OF IV NALOXONE & LACTATE IN NORMALS Principal Investigator & Institution: Klein, Donald F.; Professor of Psychiatry; New York State Psychiatric Institute 1051 Riverside Dr New York, Ny 10032 Timing: Fiscal Year 2004; Project Start 01-DEC-2003; Project End 30-NOV-2005 Summary: (provided by applicant): Panic disorder (PD) is a serious public health burden. It is enmeshed with depression, alcoholism, tobacco dependence, pulmonary disease and has been linked to sudden cardiac death and stroke. The panic attack is distinctively characterized by acute dyspnea, tidal volume hyperventilation and surprising lack of HPA activation. Risk for developing PD is markedly increased by childhood Separation Anxiety Disorder. Both CO2 sensitivity and separation anxiety are regulated by the endogenous opioid system that I hypothesize malfunctions in PD. Normal unresponsiveness to I.V. lactate may stem from an intact endogenous opioid system. When a naloxone infusion preceded intravenous lactate, a pilot study of twelve normal subjects demonstrated a sharp increase in tidal volume and dyspneic distress. Extensive experience indicates that normal subjects do not have this reaction to I.V. lactate alone. Further, this paradigmatic increase in tidal volume and dyspneic distress was not reinstated when subjects were reinfused with naloxone alone. Therefore, we propose to extend this pilot study to definitively demonstrate that naloxone pretreatment is necessary for normal subjects to react as PD subjects do to I.V. lactate. We propose a double blind, randomized three group design in 90 normal subjects: 1) naloxone preceding lactate, 2) saline preceding lactate, 3) naloxone preceding saline. Measures of panic symptoms, air hunger, respiratory and cardiac variables will be analyzed. This will be amplified by our Co-investigator L. Mujica- Parodi, Ph.D., who will also assess a subset of these subjects in her ONR supported study of emotional arousability; a risk factor for lactate induced panic. It is known that PD has a low heart rate variability (HRV) that is lowered further during a lactate induced panic. This feature of PD has been considered an important cardiac risk factor. To further validate our model we will analyze its effects on normal HRV. Positive findings would provide the basis for a controlled study of specific anti-panic agents to test whether they can blockade this reaction. This would further validate this model. It may also suggest new approaches to anti-panic agents, such as mixed opiate agonist-antagonist. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: REGULATION OF THE SYNAPTIC VESICLE CYCLE Principal Investigator & Institution: Kelly, Regis B.; Executive Vice Chancellor; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2001; Project Start 01-SEP-2001; Project End 30-JUN-2002 Summary: Deficiencies in a single gene can cause dramatic effects in brain function and so behavior. Linking the known genetic defect with the observed brain disorder has proven to be challenging. Here we describe experiments to link the neurological properties of mocha mice, its aberrant balance, overanxiety, and sensitivity to anesthetics to its underlying molecular deficiency, the absence of the heterotrimeric adaptor protein nAP-3. We have established already that nAP-3 is required for the formation of synaptic vesicles from endosomes, by a pathway sensitive to brefeldin A

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and the casein kinase inhibitor CKI-7. We use these pharmacological agents to mimic the mocha phenotype in the neuroendocrine cell line PC12. We ask if the presence of "mocha-like" conditions reveals or induces the expression of a different class of synaptic vesicles. Because secretory granule membranes are recycled to synaptic vesicles by an nAP-3 dependent mechanism, we examine the regulated secretory pathway in "mochalike" PC12 cells. Finally, we initiate studies on mocha mice to determine if their properties are consistent with the findings from PC12 cells and if they are a valid model for the human disease, Panic Disorder Syndrome, which is a major portal to drug addiction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RESPIRATORY & AUTONOMIC PATHOPHYSIOLOGY--PANIC DISORDER Principal Investigator & Institution: Roth, Walton T.; Psychiatry and Behavioral Sci; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2001; Project Start 15-MAY-1997; Project End 30-APR-2003 Summary: As is now more widely recognized, Panic Disorder often results in considerable emotional suffering and a reduction in quality of life. Although progress has been made in identifying its biological substrates, much about its pathophysiology and etiology remains obscure. Latest research findings in our laboratory and laboratories of other research groups point towards a central role for respiratory mechanisms. Experiments are proposed to investigate markers and mechanisms of Panic Disorder in and outside the laboratory. Respiratory, sympathetic, and parasympathetic measures in Panic Disorder patients of two types, those with and without prominent respiratory symptoms, will be examined and compared to measures in two groups without panic attacks, Generalized Anxiety Disorder patients and controls. In the laboratory the relative importance of several possible respiratory mechanisms will be determined by examining probe-specific and group-specific effects of several kinds of probes: increased inspired CO2, increased inspiratory resistance load, and decreased inspired O2. Each is known to produce feelings of suffocation at moderate intensities, and sometimes panic in Panic Disorder patients at high intensities. Respiratory responses to a noise stressor not directly linked to suffocation fears will serve as a comparison. To resolve contradictions in the literature about slower recovery from voluntary hyperventilation in Panic Disorder, which was a specific marker for Panic Disorder in one of our recent experiments, the effects of different durations of hyperventilation will be examined. In another experiment, central and peripheral chemoreceptor thresholds and sensitivities will be distinguished in Panic Disorder for the first time. Outside the laboratory two ways of recording pCO2 (transcutaneous vs. nasal prongs) will be compared methodologically, and it will be determined whether valid indices of respiratory sinus arrhythmia that take into account variations in breathing will distinguish patients with panic attack-related driving phobia from controls. The significance of this proposal lies in the possibility of its establishing specific and sensitive physiological markers of Panic Disorder, which could lead to better diagnosis and more appropriate treatment, facilitate research in the molecular genetics of Panic Disorder, and lead to a better understanding of dysfunctional biological control mechanisms. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: RESPIRATORY PSYCHONEUROBIOLOGY OF ANXIETY Principal Investigator & Institution: Papp, Laszlo A.; Assoc. Prof. of Clinical Psychiatry; Psychiatry; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2001; Project Start 16-MAR-1998; Project End 28-FEB-2003 Summary: (Adapted from applicant's abstract): An Independent Scientist Award is requested from NIMH for Dr. Laszlo Papp who completed a SDAC in 1996. During the term of the SDAC the candidate made significant progress in establishing the respiratory psychoneurobiology of anxiety and late-life anxiety disorders as his independent areas of research. His publication record is extensive and includes highly influential original and theoretical papers. He is in charge of two research units, and is the recipient of substantial independent research support including an R01. The proposal for the next five years is a logical continuation and expansion of his work and will critically examine the evidence for respiratory abnormalities being central to panic disorder. First, respiratory challenges will be conducted in the laboratory with sophisticated monitoring and analysis of respiratory parameters in varying cognitive behavioral environments; differences in dynamic and static lung functions between patients and controls will be assessed; and the findings will be correlated with ambulatory in vivo observations of respiration. Second, in order to establish specificity, these experiments will be expanded to include patients with special characteristics with regard to psychiatric and medical diagnoses and gender. Substance specificity will be examined by comparing the effects of different concentrations of carbon dioxide (CO2) inhalation and by optimizing ratings of response. Third, particular attention will be devoted to the effects of aging on the course of anxiety and on the manifestations of respiratory abnormalities through the life-span. Fourth, treatment studies will be conducted in order to assess the correlation of symptomatic improvement and respiration and to compare the effects of cognitive/behavioral and medication treatments on respiration. A comprehensive plan for professional growth focusing on respiratory physiology and geriatrics is also included. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: ROLE OF AMYGDALAR CRF RECEPTORS IN REGULATING ANXIETY Principal Investigator & Institution: Sajdyk, Tammy J.; Psychiatry; Indiana Univ-Purdue Univ at Indianapolis 620 Union Drive, Room 618 Indianapolis, in 462025167 Timing: Fiscal Year 2001; Project Start 15-AUG-2001; Project End 31-JUL-2006 Summary: (provided by applicant): The following application is a request for a Mentored Research Scientist Development Award (K0l). The results of this proposal should lead not only to a broader knowledge of anxiety disorders, but also to the intellectual, analytical and technical skills needed to develop into a independent researcher within my chosen career field. The overall objective of the current proposal is to determine the role of corticotropin-releasing factor (CRF) and CRF-like peptides in the basolateral nucleus of the amygdala (BLA) as they relate to anxiety-like behavior. The specific hypotheses to be tested are (1) Acute stimulation of CRF receptors in the BLA by administration of CRF and Urocortin (Ucn) will produce a normal anxiety-like response in rats, (2) Repeated administration of Ucn into the BLA will induce a pathological state of anxiety-like behavior in rats, (3) Repeated administration of Ucn into the BLA of rats will induce intracellular changes similar to that described in calcium calmodulin kinase II-dependent (CaMKII) long-term potentiation (LTP) resulting in a pathological anxiety response, and (4) Repeated activation of CRF receptors in the BLA

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of rats will produce a long-term facilitation of the anxiety responses resembling a subtype of pathological anxiety, panic disorder. The behavioral paradigms utilized to measure anxiety for each set of experiments will be the social interaction (SI) test, elevated plus maze, and startle response. Microinjections of both agonists and antagonists of CRF receptors will be given into the BLA. The second hypothesis will be addressed by administering repeated injections of sub-threshold doses of a CRF agonist into the BLA. Both Ucn and CRF are able to 'prime' anxiety. Since Ucn has a higher affinity for CRF receptors, it was chosen as the peptide to conduct all the priming studies. To test the third hypothesis, I will administer the NMDA antagonist, AP5, or the non-NMDA antagonist, CNQX, along with Ucn to assess the development of an LTPlike phenomenon. KN-62 or AIP, CaMKII inhibitors, will be administered into the BLA to determine the role of CaMKII in the development of pathological anxiety. In addition, changes in CaMKII phosphorylation states within the BLA will be determined using western blots. Hypothesis four will be tested by determining whether the long term anxiety response seen in Ucn primed rats can be reversed with known anti-panic agents. Since some of my preliminary work has shown that the sodium lactate sensitivity seen in BMI primed animals is mediated via the subfornical organ (SFO, a circumventricular organ)-BLA connection, and it is known that individuals with panic disorder show a sensitivity to sodium lactate, we will examine this pathway in Ucn primed rats. Thus, a group of Ucn primed and sham primed rats will be administered sodium lactate infusions; then, using immunohistochemical staining for the immediate early gene product cfos, the brain areas involved in this abnormal response will be determined. Thus, the study will provide a greater understanding of the underlying neurobiology of pathological anxiety, in particular panic disorder. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SAFETY/EFFICACY OF LU26-054/CITALOPRAM/PLACEBO IN PANIC Principal Investigator & Institution: Mavissakalian, Matig R.; Professor; Case Western Reserve University 10900 Euclid Ave Cleveland, Oh 44106 Timing: Fiscal Year 2001 Summary: The objective of this study is to evaluate the safety and efficacy of Lu 26-054 and citalopram in the treatment of panic disorder with or without agoraphobia. The clinical trial will be conducted as a randomized, double-blind, placebo-controlled, multicenter, parallel, flexible dose study. The study consists of a two-week single-blind placebo lead-in period, followed by a ten-week double-blind treatment period. Approximately 120 patients will be randomized to each double-blind treatment group (Lu 26-054, citalopram, and placebo), for a total of approximately 360 patients. Patients who meet eligibility criteria at the screening visit will enter a two-week single-blind placebo lead-in period. Patients who complete the placebo lead-in and continue to meet all entry criteria will be randomized to ten weeks of double-blind treatment with placebo, Lu 26-054, or citalopram. After the baseline visit at the end of the placebo leadin, study visits will be conducted after 1,2,4,6,8, and 10 weeks of double-blind treatment. Patients who have missed two consecutive scheduled visits will be discontinued from the study and administered safety evaluations only. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SELECTIVE ANXIOLYTICS VIA BZR SUBTYPE SPECIFIC LIGANDS Principal Investigator & Institution: Cook, James M.; Professor; Chemistry; University of Wisconsin Milwaukee Box 413, 2200 Kenwood Blvd Milwaukee, Wi 53201

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Timing: Fiscal Year 2001; Project Start 01-SEP-1991; Project End 30-NOV-2005 Summary: Adapted from applicant's abstract): The understanding and treatment of pathological anxiety have long been a prime concern in regard to mental health. Alterations in GABAA function from controls are known to occur in anxiety disorders,6 including panic disorder, epilepsy,7 hypersensitive behavior,7b phobias,6 schizophrenia,8 alcoholism,9 Anglemans syndrome,7b and Rhetts syndrome,10 as well as effects which lead to/or complicate drug abuse.11 The 1,4-benzodiazepines, employed to treat anxiety disorders as well as sleep disorders exhibit anxiolytic, anticonvulsant, muscle relaxant/ataxic and sedative-hypnotic effects.5-12 Despite the clinical effectiveness of these drugs there is a need for selective anxiolytics and anticonvulsants which are devoid of myorelaxant/ataxic and sedative-hypnotic effects.5 Since BzR (benzodiazepine receptor) ligands allosterically modulate this system,1-5 the design of BzR subtype selective ligands5,25 is one means to generate better therapeutic agents.5 The combination of ligand affinities, molecular modeling and CoMFA analysis has been employed to determine the similarities and differences between BzR subtypes.25,26 This approach has permitted the synthesis of the most alpha5beta2gamma2 subtype selective agonist 5a reported to date,29 as well as several potent alpha5 selective inverse agonists 1a and 2a (50-75 fold more selective).25,28 Moreover, BCCt 6a (a neutral antagonist)31,32 and 3PBC 7a have been shown to be selective for alpha1beta2gamma2 subtypes, the former t-butylester is the most alpha1 selective agent in vitro reported to date.31,32 The alpha4/alpha6 "diazepaminsensitive" ligands 3a,b and 4a,b are again the most potent selective DI ligands reported to date. These ligands serve as lead compounds in the search for BzR subtype specific agents. Based on modeling, variation of the ligand substituents (chiral or achiral; polar or nonpolar) which occupy lipophilic pockets L1, L2, L3, or Ldi of the pharmacophore/receptor model will provide the desired subtype selectivity. The lead compounds are illustrated in Schemes I and II, while the target compounds are depicted in Schemes III-XI. The goal is to develop ligands that are > 150 times more selective for either alpha1,alpha5,alpha4, or alpha6 (later alpha2,alpha3) subtypes in order to determine which biological function is mediated by which subtype(s). Characterization of the pharmacology of BzR at the subtype level is crucial for understanding the physiological processes which underlie anxiety, including panic disorder,6 convulsions,7 sleep disorders and cognition,16 as well as the design of selective agents to treat these disease states with reduced abuse potential. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SLEEP IN PTSD/PANIC: A MULTIMODAL NATURALISTIC STUDY Principal Investigator & Institution: Sheikh, Javaid I.; Psychiatry and Behavioral Sci; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2003; Project Start 22-SEP-2003; Project End 30-JUN-2007 Summary: (provided by applicant): The past decade has seen exciting advances in our understanding of central fear systems, information regarding the extended amygdala, the broader limbic system, their targets and modulating structures, is providing new avenues for the formation of testable models of anxiety disorders that are amongst the most common psychiatric illnesses. Panic disorder (PD) and posttraumatic stress disorder (PTSD) are prime candidates for explication by reference to central fear systems. Further, because they converge and diverge in important ways, PD and PTSD challenge our understanding of how central fear systems can support related yet distinct anxiety syndromes. A strong version of this challenge is presented by the sleep disturbances of PD and PTSD. Both are associated with subjectively disturbed sleep

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continuity, nocturnal paroxysmal episodes (nocturnal panic attacks and trauma-related nightmares, respectively), and, our data would suggest, suppression of sleep movement. Nevertheless, these two anxiety disorders appear to exhibit divergent modifications of nocturnal respiration, elevated tidal volume variability in PD, versus accelerated respiration in association with nightmares in PTSD. The aim of this project is to lay the foundation for a more comprehensive account of the interaction of sleep and fear systems in PD and PTSD by optimally quantifying domains in which they converge and diverge: arousals from sleep, sleep movements and sleep respiration. In this study, sleep data will be obtained from 180 community-residents, unmedicated, female and male subjects with PD (30 with and 30 without a history of nocturnal panic attacks), PTSD (30 with and 30 without a history of trauma-related nightmares), comorbid PD and PTSD (30), and normal controls. The proposed methods represent an advanced approach to naturalistic sleep data acquisition, combining an initial phase of ambulatory polysomnography (PSG) with extended (21+days) actigraphy and auditory sonography. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STATISTICAL PSYCHIATRY

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Principal Investigator & Institution: Huang, Jian; Associate Professor; Statistics; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2001; Project Start 15-MAR-1998; Project End 28-FEB-2003 Summary: (Adapted from applicant's abstract): This is a Mentored Research Scientist Development Award proposal. The purpose of this application is to acquire a broad background in psychiatric and molecular genetics, and in particular the methods and models of human quantitative genetics, necessary to the long-term career goal of becoming an independent investigator specializing in the application of the statistical techniques of survival analysis to genetic modeling of the complex psychiatric disorders. There are now nine neurological disorders which have been confirmed to be caused by expanding triplet-repeat polymorphisms, and findings suggestive of such a mechanism have been reported for schizophrenia and bipolar disorder. Age-of-onset anticipation, wherein children tend to develop disease at earlier ages than their affected parents, is the primary evidence in favor of a triplet-repeat mechanism prior to the actual cloning of a disease gene. Establishing such an underlying mechanism can have profound implications for gene mapping protocols, as well as for clinical treatment and genetic counseling. However, proper statistical methods for the detection of age-of-onset anticipation remain to be developed and will need to draw on the mathematical field of survival analysis. The candidate, a theoretical statistician with extensive expertise in survival analysis, proposes to acquire this additional training in order to address the class of problems arising in human genetics in connection with triplet-repeat mechanisms, and especially, for those psychiatric disorders for which triplet-repeats have been implicated: schizophrenia and bipolar disorder. Training will be provided through course work at the University of Iowa; a formal tutorial; work in a molecular genetics laboratory; training in field methods in psychiatric epidemiology at Columbia University: and ongoing consultation with a panel of distinguished psychiatrists. The University of Iowa has an outstanding research program in psychiatric and statistical genetics. Initial research will concentrate on new statistical tests for age-of-onset anticipation. Subsequently more general segregation and linkage models incorporating age-of-onset distributions for complex disorders will be developed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: STRUCTURE AND ASSESSMENT OF SYMPTOMS OF DEPRESSION Principal Investigator & Institution: Watson, David B.; Professor; Psychology; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-APR-2008 Summary: (provided by applicant): Many of the most frequently used depression instruments were created more than 40 years ago, without the benefit of rigorous psychometric development and testing. Most of these measures were designed to provide only a single overall index of depression, so that they do not yield reliable and valid subscales assessing specific types of depressive symptoms. Furthermore, progress in this area is hampered by our limited understanding of the internal structure of depressive symptoms. The proposed work will result in a multi-dimensional measure of depression that will include a wide range of depression symptoms, as well as symptoms of related anxiety disorders such as generalized anxiety disorder, social phobia, and panic disorder. The scales comprising the final measure will be suitable for use in clinical outcome research as well as other studies of the etiology and consequences of depression. The process will begin with the creation of a comprehensive item pool; our review of the literature indicates that this pool should multiple groups of items assessing prominent symptoms of depression, another group of items measuring positive emotionality, and several clusters of anxiety-related items. These items will undergo extensive testing with diverse samples of both clinical and non-clinical adult populations. The goal of the initial phases of the proposed research is to determine the factor structure of depression and related symptoms so that appropriate subscales are modeled in the final measure. Further studies will assess the construct validity of the resulting factor-based measures through analyses of their (a) sensitivity to change and (b) convergence with other self-report and clinician-rated measures of depression and anxiety. The next group of proposed studies will use advanced psychometric methods (including confirmatory factor analysis and item response theory) to assess the suitability of the measure--at both the subscale and item level--in different populations (e.g., adolescents, pregnant and postpartum women, and older adults) and to modify the instrument as necessary for use with these populations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SYNAPTIC PLASTICITY AND EXTINCTION OF FEAR Principal Investigator & Institution: Ressler, Kerry J.; Psychiatry and Behavioral Scis; Emory University 1784 North Decatur Road Atlanta, Ga 30322 Timing: Fiscal Year 2004; Project Start 01-DEC-2003; Project End 30-NOV-2007 Summary: (provided by applicant): Kerry J. Ressler, MD, PhD is an assistant professor in the Department of Psychiatry and Behavioral Sciences at Emory University. As a psychiatrist trained in molecular biology and neurobiology, his driving interest has been the understanding of neural systems that undedie behavior and emotion. Following residency, he started a laboratory at Emory's Yerkes Research Center in the Center for Behavioral Neuroscience to focus on molecular mechanisms of amygdala functioning. Dr. Ressler is now in an optimal position to complete his training in behavioral neuroscience with Dr. Michael Davis, a leader in the field, as a mentor. The Mentored Research Scientist Development Award is perfectly suited to assist in his career development, so that he may become a productive researcher with full training in molecular and behavioral neurobiology that is also informed by his psychiatry training and experience. Dr. Ressler spends ~ 15% of his time directing a clinic specializing in the treatment of Post-traumatic Stress Disorder (PTSD), a disorder of fear dyregulation.

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Treatment of PTSD, as well as phobia, panic disorder, and other anxiety disorders depends upon the teaming process of extinction -- the primary mechanism by which learned fear is reduced. It is now known that extinction is an active process of inhibitory learning that involves synaptic plasticity and that may occur within the amygdala and the infralimbic prefrontal cortex, an area that modulates amygdata activity. The specific aims of this proposal will investigate the role of calcium dependent synaptic plasticity in mediating extinction learning in the amygdala and prefrontal cortex. It is thought that calcium entry through the NMDA receptor (NMDAR) and the L-type voltage gated calcium channel (VGCC) may have different functions during the consolidation of extinction. These experiments will first identify synaptic plasticity genes involved in the consolidation of extinction. This will be followed by behavioral and gene expression analyses of extinction following facilitation or inhibition of extinction with NMDAR and VGCC agonists and antagonists. Finally, gene expression and cell-type specificity will be examined by using viral mediated gene transfer of dominant negative or facilitatory mutant subunits of the NMDAR and VGCC channels. Understanding the molecular mechanisms of extinction will be important both for advancing the fundamental understanding of learning and memory as well as for providing novel approaches to treating human disorders of fear dysregulation. Furthermore, this project will provide opportunity to significantly develop Dr. Ressler's expertise and technical skills in behavioral neuroscience, including design, training, and testing of rodents, viral vector techniques, and analysis of gene expression using gene array techniques. Emory University and the Center for Behavioral Neuroscience provide an excellent environment for career development and training in the field of behavioral neuroscience. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TELEPSYCHIATRY SERVICE DELIVERY TO TRAUMA VICTIMS Principal Investigator & Institution: Frueh, B C.; Associate Professor; Psychiatry and Behavioral Scis; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425 Timing: Fiscal Year 2002; Project Start 05-JUL-2002; Project End 30-JUN-2005 Summary: There are serious workforce shortage problems in providing clinical mental health services for public sector consumers. In the mental health field, "telepsychiatry" has introduced a reasonably priced means of solving these long-standing workforce problems. This is of special significance for the public sector service system charged with providing healthcare to people living in geographical areas where provider experts are not readily available. A comprehensive review of extant empirical data indicates that psychiatric interviews conducted via telepsychiatry appear to be generally reliable, and that patients and clinicians generally report high levels of satisfaction with mental health services received via telepsychiatry. While this early research is encouraging and clearly demonstrates wide-ranging needs that might be met by using telepsychiatry, it is remarkably silent on whether mental health treatments can be effectively delivered via teleconferencing technology. In particular, it is not known whether specialty mental health treatments for specific disorders (e.g., PTSD, depression, panic disorder, schizophrenia) can be effectively delivered. Thus, the body of literature is strikingly undeveloped in this way. Because telepsychiatry programs are rapidly springing up all over the world (e.g., Australia, the U.S. Department of Defense), research that addresses the effectiveness of this mode of service delivery is desperately needed. Telepsychiatry research is needed that includes prospective, randomized evaluation of clinical outcomes for specific treatments with specific populations, such as individuals with

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PTSD. Specifically, this applicant aims: To test the hypothesis that a novel mode of mental health service delivery, using videoconferencing technology ("Telepsychiatry"), will be equally effective to a traditional mode of mental health service delivery ("SameRoom") for providing a mental health intervention to veterans who are trauma victims with PTSD. The study proposed in this application will allow a direct comparison of each mode of service delivery provided to veterans through a Veterans Affairs (VA) outpatient PTSD clinic on two categories of outcome variables: 1) clinical outcomes, such as symptom severity and social functioning; and 2) process outcomes, such as patient satisfaction/acceptance, treatment credibility, session attendance, treatment adherence, and treatment dropout. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE EFFECTS OF WORRY ON PANIC SYMPTOMS Principal Investigator & Institution: Behar, Evelyn; Psychology; Pennsylvania State University-Univ Park 201 Old Main University Park, Pa 16802 Timing: Fiscal Year 2003; Project Start 15-MAY-2003; Project End 14-MAY-2005 Summary: (provided by applicant): The avoidance theory of worry posits that worry is characterized by cognitive avoidance that occurs in response to internal threat-related cognitive and somatic stimuli. This cognitive avoidance and the temporary alleviation of affective and physiological arousal that results from it is theorized to preclude the emotional processing that is theoretically necessary for reduction of anxious symptoms. Although recent laboratory investigations of worry and GAD have contributed to elucidating the basic nature of worry and its role as an avoidance response, few studies have examined the potential role of worry in the maintenance of other anxiety disorders or the specific characteristics of GAD that contribute to its inhibitory role. The proposed experiment seeks to evaluate the effects of worry on levels of self-reported and autonomic arousal during repeated exposures to interoceptive cues by having anxious and nonanxious individuals engage in periods of relaxation, verbal linguistic worry, or imaginal worry and then exposing them to a breath holding procedure. This investigation is an important step in understanding the role of worry as an avoidance response, as well as the effects this avoidance response has on the affective and somatic experience of fear in other anxiety disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: THE NEUROENDOCRINOLOGY OF PANIC DISORDER Principal Investigator & Institution: Sinha, Smit S.; Psychiatry; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2003; Project Start 15-MAR-2003; Project End 29-FEB-2008 Summary: (provided by applicant): In this revised application for a Mentored Patient Oriented Research Career Development Award, the candidate, Smit S. Sinha, will develop expertise in the psychoneuroendocrinology of anxiety, with emphasis on the endogenous opioid system and its interactions with the hypothalamic-pituitary-adrenal axis in panic disorder. The endogenous opioid system is an integral aspect of the human stress response, and exerts widespread regulatory influence on specific neurotransmitter and neurohormonal systems located in key brain regions thought to regulate stress, anxiety and panic states. Of particular relevance to panic disorder is the evidence for opioid regulation of carbon dioxide sensitivity, which is abnormally heightened in panic and is a strong biological marker of the illness. Opioids also regulate attachment and separation behaviors, disruptions of which are strongly implicated in the development

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and maintenance of the illness. This proposal will also investigate HPA axis function in panic disorder. Disruptions of HPA function, particularly abnormal and increased central corticotropin releasing hormone (CRH) drive, have been implicated in the pathogenesis of major depressive disorder and PTSD. However, whether panic disorder involves central CRH dysregulation is not known. This is despite the prominent role of CRH in anxiogenesis and respiratory regulation. Preliminary data from the candidate and mentors suggest that panic disorder involves significant abnormalities in the opioid system and the CRH system. The candidate's research plan will 1. Assess the central functioning of both the endogenous opioid system and the CRH system with naloxone and metyrapone administration, respectively 2. Relate central opioid activity and CRH activity to CO2 sensitivity 3. Address functional interactions between these systems and 4. Assess the effects of medication treatment on these systems. The career development activities build on Dr. Sinha's background in clinical research and capitalizes on the resources of Columbia University. The overall goals are to acquire skills in the psychoneuroendocrinology of anxiety and stress with application to the pathophysiology of panic disorder. The comprehensive educational plan provides expert mentorship and didactic instruction in the key areas applied in the research plan: 1) neuroendocrinology 2) psychophysiology 3)research design and statistics and 4) clinical trials methodology. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TRAIT MARKER FOR PANIC DISORDER Principal Investigator & Institution: Coryell, William H.; Professor; Psychiatry; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2001; Project Start 01-APR-1997; Project End 31-MAR-2003 Summary: (Applicant's Abstract): According to substantial evidence, an abnormal threshold for suffocation alarm underlies panic disorder. This project aims to determine whether this abnormality, as manifested in panic attacks following carbon dioxide inhalation, constitutes a trait marker for panic disorder. The following describes a highrisk paradigm to test both sensitivity and specificity. The project also seeks to refine the definitions and thresholds used to identify meaningful hypersensitivity to CO2 and to explore relationships between such hypersensitivity and morbid childhood separation anxiety. Finally, it will assess the relationship between CO2 hypersensitivity, morbid childhood separation anxiety sensitivity. It will thus work toward a synthesis of etiological theories. Never-ill subjects will be grouped by family history to yield 64 at high risk for panic disorder, 22 at high risk for affective disorder and 22 at high risk for neither disorder. Another two groups of never-ill subjects will be identified through ill probands attending an outpatient facility; 33 will have a proband with primary depression complicated by panic attacks and 22 will have a proband with panic disorder complicated by secondary depression. All high-risk subjects will undergo structured diagnostic interviews and a CO2 inhalation test. In addition, for each highrisk subject, the ill family member who defines the pedigree will be interviewed directly. According to predictions, panic attacks will occur only among subjects with a family history of autonomous panic disorder. Moreover, a relationship will emerge between hypersensitivity to CO2 inhalation and a history of morbid childhood separation anxiety. Raters will maintain annual contact with subjects using brief telephone interviews. If the study's predictions are sustained, subsequent efforts will be directed toward lengthening the follow-up period and toward an eventual, ten-year diagnostic reassessment. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TREATMENT FOR COMORBID ASTHMA AND PANIC DISORDER Principal Investigator & Institution: Lehrer, Paul M.; Professor; Psychiatry; Univ of Med/Dent Nj-R W Johnson Med Sch Robert Wood Johnson Medical Sch Piscataway, Nj 08854 Timing: Fiscal Year 2001; Project Start 15-AUG-2000; Project End 30-JUN-2003 Summary: A manualized treatment approach will be developed for people with comorbid panic disorder (PD) and asthma. PD is much more common among asthmatics than in the general population, and there is evidence that asthma and PD may mutually exacerbate each other. This occurs through mechanisms that are physiological (autonomic hyperreactivity, hyperventilation, effects of medications), cognitive (fear of respiratory-linked body sensations, faulty discrimination between asthma and panic symptoms), and behavioral (inappropriate behavioral and pharmacological interventions). This project will integrate well-validated manualized treatment approaches for panic ("panic control therapy") and asthma ("asthma education"), and add components of particular importance to the comorbid group (e.g., discriminating between panic and asthma symptoms and between adaptive asthmaspecific panic and maladaptive generalized panic, reconciling superficially contradictory recommendations given in asthma and panic therapies). During the first year a manual will be expanded and tested on 10 comorbid subjects. During the next two years, it will be refined and pilot tested on 40 comorbid subjects, using a waiting list control and a 6month follow-up. The principal outcome measures will be indices of high/low PD endstate functioning and improvement in asthma severity. A number of exploratory measures also will be analyzed. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TREATMENT OF PANIC DISORDER LONG TERM STRATEGIES Principal Investigator & Institution: Shear, M. Katherine.; Professor; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2001; Project Start 01-FEB-1999; Project End 31-JAN-2004 Summary: This is one of four identical revised applications for a multi-center study of long-term treatment strategies for panic disorder (PD). The study builds upon the findings of our original multi-center study comparing imipramine, placebo, cognitive behavior therapy (CBT), and their combination in the treatment of PD patients with no more than mild agoraphobia. That study found response rates were as high with CBT or imipramine alone as with their combination. Given the added cost of combined treatments, it therefore seems reasonable to begin with monotherapy. Further, following general principles of medical practice, it would be reasonable to initiate treatment with the less invasive behavioral intervention. It is then important to learn what should be done following initial treatment. The proposed grant addresses this subject. In the proposed study, all subjects initially receive CBT alone. Subjects are then randomized in one of two postacute studies, depending on response status. These studies address two questions: (1) among patients who respond to an initial course of CBT, is maintenance therapy required to maintain response?; and (2) among those who fail to respond substantially to an initial course of CBT, will the addition of pharmacotherapy improve response? A total of 336 subjects will be enrolled from 4 sites over a 3 year period. Responders will be randomized to a maintenance study comparing no maintenance with 9 months of continued CBT. Non-responders will be randomized to a study comparing paroxetine with continued CBT. In addition to the main questions, possible predictors of response and relapse will be examined as well as possible mediators of

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response. Central to this revised proposal is the continuation of a well- functioning and productive collaboration among the sites conducting the current study. These sites already have in place the trained and certified assessment and treatment personnel and rigorous monitoring procedures that are essential for the conduct of a study such as the one we propose. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT OF PANIC DISORDER--LONG TERM STRATEGIES Principal Investigator & Institution: Barlow, David H.; Director; Psychology; Boston University Charles River Campus 881 Commonwealth Avenue Boston, Ma 02215 Timing: Fiscal Year 2001; Project Start 01-FEB-1999; Project End 31-JAN-2004 Summary: This is one of four identical applications for a multi-center study of long-term treatment strategies for panic disorder (PD). The study builds upon the findings of our original multi-center study comparing imipramine, placebo, cognitive behavior therapy (CBT), and their combination in the treatment of PD patients with no more than mild agoraphobia. That study found response rates were as high with CBT or imipramine alone as with their combination. Given the added cost of combined treatments, it therefore seems reasonable to begin with monotherapy. Further, following general principles of medical practice, it would be reasonable to initiate treatment with the less invasive behavioral intervention. It is then important to learn what should be done following initial treatment. The proposed grant addresses this subject. In the proposed study, all subjects initially receive CBT alone. Subjects are then randomized in one of two postacute studies, depending on response status. These studies address two questions: (1) among patients who respond to an initial course of CBT, is maintenance therapy required to maintain response?; and (2) among those who fail to respond substantially to an initial course of CBT, will the addition of pharmacotherapy improve response? A total of 336 subjects will be enrolled from 4 sites over a 3 year period. Responders will be randomized to a maintenance study comparing no maintenance with 9 months of continued CBT. Non-responders will be randomized to a study comparing paroxetine with continued CBT. In addition to the main questions, possible predictors of response and relapse will be examined as well as possible mediators of response. Central to this proposal is the continuation of a well-functioning and productive collaboration among the sites conducting the current study. These sites already have in place the trained and certified assessment and treatment personnel and rigorous monitoring procedures that are essential for the conduct of a study such as the one we propose. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: TREATMENT OF PANIC DISORDER--LONG TERM STRATEGIES Principal Investigator & Institution: Gorman, Jack M.; Professor; Long Island Jewish Medical Center 270-05 76Th Ave New Hyde Park, Ny 11040 Timing: Fiscal Year 2001; Project Start 01-FEB-1999; Project End 31-JAN-2004 Summary: Three broad goals underlie this continuation application for a multicenter collaborative study of the treatment of panic disorder; 1) completion of the originally proposed study, comparing cognitive behavioral panic control treatment (PCT), imipramine or placebo administered double blind (MED) and the combination (COM), 2) comparison of treatment durability over 6 or 24 month maintenance with further 24 month follow-up, and 3) cross-over treatment of MED and PCT nonresponders to the opposite treatment. It is clearly important to complete enrollment of the remaining 37%

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of 480 patients needed to answer key questions related tot he relative efficacy of PCT, MED and COM. Study enrollment began somewhat later than we predicted because of rigorous attention to state-of-the -art assessment and quality control procedures. Careful thought about essential assessment domains appears to have been well worth the effort. Not only are the procedures we developed working well, but they have been used already by other investigators in the field and have influenced recent consensus on assessment of panic disorder. We devoted great care to training and certifying therapists and to developing extensive quality assurance procedures, essential to a cross site study. PCT adherence ratings are among the most detailed and rigorous in the field, while our procedures for MED training, certification and adherence monitoring reflect a level of quality control rarely undertaken in psychopharmacology trials. Study of long term maintenance and follow-up is a natural and important extension of the efficacy study. With efficacy of short term treatment for panic disorder well established, there is growing recognition of the need to address durability of treatment, especially medication. Naturalistic follow-up of patients who participated in efficacy trials document continued intermittent symptoms and ongoing functional impairment even with continued naturalistic treatment, and a high rate of relapse following medication discontinuation. However, there ar no prospective studies of long term outcome using rigorous, blinded assessment procedures and quality controlled maintenance treatment. There is a need to determine course and outcome during and after optimal long term maintenance treatment. Although this is an obvious question, few studies to date have investigated sequential treatment strategies. Such approaches could provide considerable useful information. Our original study will provide definitive information for clinicians regarding the best choices for acute treatment of panic disorder. We now recognize that the cohort of subjects we have assembled also provide a unique opportunity to conduct the first large scale study of treatment durability and the first systematic study of effectiveness of cross-over treatment for nonresponders. Thus, we are proposing to add these aims. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT REFRACTORY PANIC DISORDER Principal Investigator & Institution: Simon, Naomi M.; Massachusetts General Hospital 55 Fruit St Boston, Ma 02114 Timing: Fiscal Year 2001; Project Start 15-FEB-2000; Project End 31-JAN-2005 Summary: This is an application for a Mentored Patient-Oriented Research Career Development Award with a focus on developing expertise in the study of treatment refractory panic disorder. The candidate proposes to build upon her expertise studying novel therapeutics for panic disorder, and obtain training to assess "next-step" psychopharmacologic and cognitive-behavioral therapy approaches for patients who remain symptomatic despite initial intervention. Panic disorder with or without agoraphobia is a common anxiety disorder, and when broader measures assessing remission including panic attacks, anticipatory anxiety, agoraphobic avoidance, and functional and quality of life measures are used, it is clear that many patients remain symptomatic and significantly impaired despite initial treatment. However, there is minimal data to guide clinicians in their approach to these patients, and the proposed study is designed as an initial step in addressing this issue in a systematic manner. Research Plan: The primary study is a three phase, twenty-four week clinical trial in which patients who remain symptomatic at the end of one phase enter the next. Phase I is a six-week open sertraline treatment trial to prospectively determine treatment refractoriness. Phase II is a six-week double-blind three arm randomized trial of

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sertraline at continued dose, sertraline at elevated dose, and sertraline plus clonazepam. Phase III is a twelve-week randomized single-blind trial of the addition of cognitivebehavioral therapy versus "medication optimization" with sertraline and clonazepam. Environment: The proposed study will be based at the Massachusetts General Hospital and will complement a program of training and supervised research under the mentorship of Dr. Mark Pollack, with consultation from experts. Career Development Plan: Training will emphasize skills necessary for designing and carrying out studies to evaluate treatment interventions for patients with panic disorder who remain symptomatic despite initial intervention, and will include work at the Harvard School of Public Health on research methodology and statistics, and supervision with consultants regarding training in outcome assessment, cognitive-behavioral therapy training, and strategies to study the transmission of findings regarding panic treatment to primary care and community settings that will lay the foundation for future independent investigation by the candidate in this area. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VENTILATORY PHYSIOLOGY IN CHILDREN AT RISK FOR ANXIETY Principal Investigator & Institution: Klein, Rachel G.; Professor; Psychiatry; New York University School of Medicine 550 1St Ave New York, Ny 10016 Timing: Fiscal Year 2001; Project Start 28-SEP-1999; Project End 31-MAY-2003 Summary: The proposed investigation addresses the biology of risk for anxiety disorders. It derives from important parallel scientific concerns regarding the association between adult and child anxiety disorders, coupled with concerns regarding the mechanisms which underlie this association. The study specifically evolves from findings that link childhood separation anxiety disorder (SAD) and adult panic disorder (PD). These findings include: family studies noting elevated rates of SAD in offspring of adults with PD; longitudinal studies linking childhood SAD to adult PD; and biological studies finding CO2-hypersensitivity in children with SAD. CO2-hypersensitivity is also found in both adults with PD and non-ill adult relatives of patients with PD. Taken together, these findings point to the existence of a latent vulnerability to PD reflected in the respiratory system. We propose to examine respiratory function in children at high risk for panic disorder. Major hypotheses are that at risk children, compared to controls, exhibit more variable respiration and hypersensitivity to CO2 exposure as manifested by greater symptomatic and physiologic responses to the inhalation of 5 percent of CO2. We hypothesize that such abnormalities will occur among offspring even in the absence of an anxiety disorder. Aims are addressed through the study of ventilatory measures in offspring, ages nine-to-17, of adults with PD, as compared to offspring of adults with a) social phobia but not panic disorder, b) major depression but neither panic disorder nor social phobia, and c) no mental disorder. A total of nearly 350 children and their parents have been systematically assessed in an ongoing diagnostic study of children at highrisk for anxiety. In the proposed work, diagnosis will be updated with separate interviewers for each family member. Children will undergo a CO2 inhalation procedure in their home with a validated apparatus. Outcome measures consist of: i) pre-experimental respiratory variability, as well as ii) the symptomatic, and iii) physiological response to CO2. A series of studies conducted by the investigative team finds that these factors distinguish adults with PD and children with SAD from relevant contrast groups. Respiratory variables will be rated blind to parental and child diagnosis. The inclusion of offspring from pathological comparison groups, together with offspring of normals, provides a rigorous test of hypothesized diagnostic

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specificity in the relationship between respiratory factors and anxiety in both children and adults. The proposed study follows naturally from the investigative team's prior work and capitalizes on the availability of a well-characterized sample. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VIRTUAL REALITY IN BALANCE DISORDERS Principal Investigator & Institution: Whitney, Susan L.; Physical Therapy; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2007 Summary: (provided by applicant): The overall goal of this patient-oriented research career development award is to prepare the candidate to perform quantitative research as an independent investigator in the field of vestibular rehabilitation. The candidate has background as a clinical physical therapist and academician. She has prepared herself over the last few years to transition from a clinician to a clinician scientist. The candidate intends to use this award to receive focused coursework and research training related to persons at risk for falling and those with vestibular dysfunction. The candidate intends to augment her education in physical therapy and motor learning/control with coursework in three core areas: 1) the psychology of persons with anxiety/panic disorders, 2) research design, especially the use of randomized clinical trials, and 3) augment her knowledge of virtual reality, the special senses (including vestibular physiology and anatomy), and optic flow. Dr. Joseph Furman, Dr. Rolf Jacob, and Dr. Mark Redfern will mentor the candidate's research development. With their guidance, the candidate will receive intensive training in postural control, vestibular anatomy and physiology, panic/anxiety, and research methods related to persons with vestibular disorders. The primary objectives of this research are to increase the understanding of how virtual reality affects postural control in persons with vestibular disorders, to compare virtual reality therapy to conventional physical therapy, and to determine if virtual reality scenes used in a virtual reality cave can be effectively adapted for use with head mounted devices for application in rehabilitation. The proposed research will examine postural sway, anxiety self-report, and gain/clinical balance measures following exposure to virtual reality (VR) scenes. The data derived from the above three goals will help direct a randomized clinical trial that will assist in determining if virtual reality is an effective method of intervention with persons with vestibular dysfunction. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, 3 4

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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and type “panic disorder” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for panic disorder in the PubMed Central database: •

Further genetic evidence for a panic disorder syndrome mapping to chromosome 13q. by Hamilton SP, Fyer AJ, Durner M, Heiman GA, Baisre de Leon A, Hodge SE, Knowles JA, Weissman MM.; 2003 Mar 4; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=151378

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Pentagastrin-induced release of free fatty acids in healthy volunteers and patients with panic disorder: effect of pretreatment with ethinyl estradiol. by Morrow JD, McManus K, Tait GR, Bellavance F, Chrapko W, Lara N, Le Melledo JM.; 2003 Mar; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=161733

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with panic disorder, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “panic disorder” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for panic disorder (hyperlinks lead to article summaries): •

A breath-holding challenge in panic disorder patients, their healthy first-degree relatives, and normal controls. Author(s): Nardi AE, Nascimento I, Valenca AM, Lopes FL, Zin WA, Mezzasalma MA, Versiani M. Source: Respiratory Physiology & Neurobiology. 2002 October 23; 133(1-2): 43-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12385730&dopt=Abstract

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A comparison of metacognitions in patients with hallucinations, delusions, panic disorder, and non-patient controls. Author(s): Morrison AP, Wells A. Source: Behaviour Research and Therapy. 2003 February; 41(2): 251-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12547384&dopt=Abstract

6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A controlled study of behavioral inhibition in children of parents with panic disorder and depression. Author(s): Rosenbaum JF, Biederman J, Hirshfeld-Becker DR, Kagan J, Snidman N, Friedman D, Nineberg A, Gallery DJ, Faraone SV. Source: The American Journal of Psychiatry. 2000 December; 157(12): 2002-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11097967&dopt=Abstract

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A modern learning theory perspective on the etiology of panic disorder. Author(s): Bouton ME, Mineka S, Barlow DH. Source: Psychological Review. 2001 January; 108(1): 4-32. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11212632&dopt=Abstract

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A randomized, double-blind, placebo-controlled study of the effects of adjunctive paroxetine in panic disorder patients unsuccessfully treated with cognitivebehavioral therapy alone. Author(s): Kampman M, Keijsers GP, Hoogduin CA, Hendriks GJ. Source: The Journal of Clinical Psychiatry. 2002 September; 63(9): 772-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12363116&dopt=Abstract

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Acute L-5-hydroxytryptophan administration inhibits carbon dioxide-induced panic in panic disorder patients. Author(s): Schruers K, van Diest R, Overbeek T, Griez E. Source: Psychiatry Research. 2002 December 30; 113(3): 237-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12559480&dopt=Abstract

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Agoraphobia without a history of panic disorder may be part of the panic disorder syndrome. Author(s): Andrews G, Slade T. Source: The Journal of Nervous and Mental Disease. 2002 September; 190(9): 624-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12357097&dopt=Abstract

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Amygdalar atrophy in panic disorder patients detected by volumetric magnetic resonance imaging. Author(s): Massana G, Serra-Grabulosa JM, Salgado-Pineda P, Gasto C, Junque C, Massana J, Mercader JM, Gomez B, Tobena A, Salamero M. Source: Neuroimage. 2003 May; 19(1): 80-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12781728&dopt=Abstract

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Antioxidant enzyme and malondialdehyde levels in patients with panic disorder. Author(s): Kuloglu M, Atmaca M, Tezcan E, Ustundag B, Bulut S. Source: Neuropsychobiology. 2002; 46(4): 186-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12566935&dopt=Abstract

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Anxiety sensitivity and 35% CO2 reactivity in patients with panic disorder. Author(s): Perna G, Romano P, Caldirola D, Cucchi M, Bellodi L. Source: Journal of Psychosomatic Research. 2003 June; 54(6): 573-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12781312&dopt=Abstract

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Anxiety sensitivity and panic disorder. Author(s): McNally RJ. Source: Biological Psychiatry. 2002 November 15; 52(10): 938-46. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12437935&dopt=Abstract

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Anxiety sensitivity in first-degree relatives of patients with panic disorder. Author(s): van Beek N, Griez E. Source: Behaviour Research and Therapy. 2003 August; 41(8): 949-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12880648&dopt=Abstract

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Anxiety with panic disorder linked to chromosome 9q in Iceland. Author(s): Thorgeirsson TE, Oskarsson H, Desnica N, Kostic JP, Stefansson JG, Kolbeinsson H, Lindal E, Gagunashvili N, Frigge ML, Kong A, Stefansson K, Gulcher JR. Source: American Journal of Human Genetics. 2003 May; 72(5): 1221-30. Epub 2003 April 04. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12679899&dopt=Abstract

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Are benzodiazepines still the medication of choice for patients with panic disorder with or without agoraphobia? Author(s): Bruce SE, Vasile RG, Goisman RM, Salzman C, Spencer M, Machan JT, Keller MB. Source: The American Journal of Psychiatry. 2003 August; 160(8): 1432-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12900305&dopt=Abstract

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Association between panic disorder, major depressive disorder and celiac disease: a possible role of thyroid autoimmunity. Author(s): Carta MG, Hardoy MC, Boi MF, Mariotti S, Carpiniello B, Usai P. Source: Journal of Psychosomatic Research. 2002 September; 53(3): 789-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12217453&dopt=Abstract

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Association between the CCK-A receptor gene and panic disorder. Author(s): Ise K, Akiyoshi J, Horinouchi Y, Tsutsumi T, Isogawa K, Nagayama H. Source: American Journal of Medical Genetics. 2003 April 1; 118B(1): 29-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12627462&dopt=Abstract

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Association of a MAOA gene variant with generalized anxiety disorder, but not with panic disorder or major depression. Author(s): Tadic A, Rujescu D, Szegedi A, Giegling I, Singer P, Moller HJ, Dahmen N. Source: American Journal of Medical Genetics. 2003 Feb15; 117B(1): 1-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12555227&dopt=Abstract

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Association of an exonic LDHA polymorphism with altered respiratory response in probands at high risk for panic disorder. Author(s): Philibert RA, Nelson JJ, Sandhu HK, Crowe RR, Coryell WH. Source: American Journal of Medical Genetics. 2003 Feb15; 117B(1): 11-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12555229&dopt=Abstract

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Attachment and panic disorder. Author(s): Pacchierotti C, Bossini L, Castrogiovanni A, Pieraccini F, Soreca I, Castrogiovanni P. Source: Psychopathology. 2002 November-December; 35(6): 347-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590193&dopt=Abstract

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Attribution of improvement to medication and increased risk of relapse of panic disorder with agoraphobia. Author(s): Biondi M, Picardi A. Source: Psychotherapy and Psychosomatics. 2003 March-April; 72(2): 110-1; Author Reply 111. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12601232&dopt=Abstract

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Basilar artery response to hyperventilation in panic disorder. Author(s): Ball S, Shekhar A. Source: The American Journal of Psychiatry. 1997 November; 154(11): 1603-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9356573&dopt=Abstract

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Bayesian analysis of a previously published genome screen for panic disorder reveals new and compelling evidence for linkage to chromosome 7. Author(s): Logue MW, Vieland VJ, Goedken RJ, Crowe RR. Source: American Journal of Medical Genetics. 2003 August 15; 121B(1): 95-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12898582&dopt=Abstract

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Behavioral and neurophysiological evidence for altered processing of anxiety-related words in panic disorder. Author(s): Pauli P, Dengler W, Wiedemann G, Montoya P, Flor H, Birbaumer N, Buchkremer G. Source: Journal of Abnormal Psychology. 1997 May; 106(2): 213-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9131841&dopt=Abstract

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Behavioral, neuroendocrine and biochemical effects of different doses of 5-HTP in panic disorder. Author(s): van Vliet IM, Slaap BR, Westenberg HG, Den Boer JA. Source: European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology. 1996 May; 6(2): 103-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8791035&dopt=Abstract

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Behavioral, neuroendocrine, and cardiovascular response to flumazenil: no evidence for an altered benzodiazepine receptor sensitivity in panic disorder. Author(s): Potokar J, Lawson C, Wilson S, Nutt D. Source: Biological Psychiatry. 1999 December 15; 46(12): 1709-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10624555&dopt=Abstract

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Behavioral, neuroendocrine, and cardiovascular response to flumazenil: no evidence for an altered benzodiazepine receptor sensitivity in panic disorder. Author(s): Strohle A, Kellner M, Holsboer F, Wiedemann K. Source: Biological Psychiatry. 1999 February 1; 45(3): 321-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10023509&dopt=Abstract

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Behavioral, sympathetic and adrenocortical responses to yohimbine in panic disorder patients and normal controls. Author(s): Gurguis GN, Vitton BJ, Uhde TW. Source: Psychiatry Research. 1997 June 16; 71(1): 27-39. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9247979&dopt=Abstract

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Benzodiazepine discontinuation difficulties in panic disorder: conceptual model and outcome for cognitive-behavior therapy. Author(s): Otto MW, Hong JJ, Safren SA. Source: Current Pharmaceutical Design. 2002; 8(1): 75-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11812251&dopt=Abstract

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Benzodiazepine receptor uptake in a patient with panic disorder after citalopram treatment. Author(s): Tiihonen J, Lepola U, Kuikka J. Source: Neuropsychiatry, Neuropsychology, and Behavioral Neurology. 1997 October; 10(4): 260-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9359124&dopt=Abstract

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Benzodiazepines and anxiety sensitivity in panic disorder. Author(s): Fava GA, Grandi S, Belluardo P, Savron G, Raffi AR, Conti S, Saviotti FM. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 1994 November; 18(7): 1163-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7846286&dopt=Abstract

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Benzodiazepines and exposure-based cognitive behavior therapies for panic disorder: conclusions from combined treatment trials. Author(s): Spiegel DA, Bruce TJ. Source: The American Journal of Psychiatry. 1997 June; 154(6): 773-81. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9167504&dopt=Abstract

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Bipolar disorder and panic disorder in families: an analysis of chromosome 18 data. Author(s): MacKinnon DF, Xu J, McMahon FJ, Simpson SG, Stine OC, McInnis MG, DePaulo JR. Source: The American Journal of Psychiatry. 1998 June; 155(6): 829-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9619158&dopt=Abstract

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Blink rate variability in patients with panic disorder: new trial using audiovisual stimulation. Author(s): Kojima M, Shioiri T, Hosoki T, Sakai M, Bando T, Someya T. Source: Psychiatry and Clinical Neurosciences. 2002 October; 56(5): 545-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12193245&dopt=Abstract

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Blocking the cycle of panic disorder. Ways to gain control of the fear of fear. Author(s): Vanin JR, Vanin SK. Source: Postgraduate Medicine. 1999 May 1; 105(5): 141-6; Quiz 205. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10335325&dopt=Abstract

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Brain blood flow in anxiety disorders. OCD, panic disorder with agoraphobia, and post-traumatic stress disorder on 99mTcHMPAO single photon emission tomography (SPET). Author(s): Lucey JV, Costa DC, Adshead G, Deahl M, Busatto G, Gacinovic S, Travis M, Pilowsky L, Ell PJ, Marks IM, Kerwin RW. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1997 October; 171: 346-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9373423&dopt=Abstract

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Brain circuits in panic disorder. Author(s): Coplan JD, Lydiard RB. Source: Biological Psychiatry. 1998 December 15; 44(12): 1264-76. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9861469&dopt=Abstract

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Brain electrical microstates in subjects with panic disorder. Author(s): Galderisi S, Bucci P, Mucci A, Bernardo A, Koenig T, Maj M. Source: Brain Research Bulletin. 2001 March 1; 54(4): 427-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11306196&dopt=Abstract

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Brain regions showing increased activation by threat-related words in panic disorder. Author(s): Maddock RJ, Buonocore MH, Kile SJ, Garrett AS. Source: Neuroreport. 2003 March 3; 14(3): 325-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12634477&dopt=Abstract

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Breathing training for treating panic disorder. Useful intervention or impediment? Author(s): Meuret AE, Wilhelm FH, Ritz T, Roth WT. Source: Behavior Modification. 2003 October; 27(5): 731-54. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14531164&dopt=Abstract

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Brief cognitive therapy for panic disorder: a randomized controlled trial. Author(s): Clark DM, Salkovskis PM, Hackmann A, Wells A, Ludgate J, Gelder M. Source: Journal of Consulting and Clinical Psychology. 1999 August; 67(4): 583-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10450630&dopt=Abstract

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Carbon dioxide in the study of panic disorder: issues of definition, methodology, and outcome. Author(s): Rassovsky Y, Kushner MG. Source: Journal of Anxiety Disorders. 2003; 17(1): 1-32. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12464286&dopt=Abstract

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Carbon dioxide test as an additional clinical measure of treatment response in panic disorder. Author(s): Valenca AM, Nardi AE, Nascimento I, Zin WA, Versiani M. Source: Arquivos De Neuro-Psiquiatria. 2002 June; 60(2-B): 358-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12131931&dopt=Abstract

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Carbon dioxide test in respiratory panic disorder subtype. Author(s): Nardi AE, Valenca AM, Nascimento I, Zin WA, Versiani M. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2002 September; 47(7): 685-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12355684&dopt=Abstract

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Cardiac care 2000. PSVT: heart or panic disorder? Author(s): Vanek M. Source: Emerg Med Serv. 2000 September; 29(9): 63-5. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11143037&dopt=Abstract

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Catechol O-methyltransferase genetic polymorphism in panic disorder. Author(s): Woo JM, Yoon KS, Yu BH. Source: The American Journal of Psychiatry. 2002 October; 159(10): 1785-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12359690&dopt=Abstract

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Catechol o-methyltransferase, serotonin transporter, and tryptophan hydroxylase gene polymorphisms in bipolar disorder patients with and without comorbid panic disorder. Author(s): Rotondo A, Mazzanti C, Dell'Osso L, Rucci P, Sullivan P, Bouanani S, Gonnelli C, Goldman D, Cassano GB. Source: The American Journal of Psychiatry. 2002 January; 159(1): 23-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11772685&dopt=Abstract

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Central and peripheral chemoreflex characteristics: panic disorder patients vs. healthy volunteers. Author(s): Struzik L, Katzman M, Vijay N, Coonerty-Femiano A, Mahamed S, Duffin J. Source: Advances in Experimental Medicine and Biology. 2001; 499: 435-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11729921&dopt=Abstract

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Central and peripheral chemoreflexes in panic disorder. Author(s): Katzman MA, Struzik L, Vijay N, Coonerty-Femiano A, Mahamed S, Duffin J. Source: Psychiatry Research. 2002 December 15; 113(1-2): 181-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12467957&dopt=Abstract

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Childhood history of anxiety disorders among adults with social phobia: rates, correlates, and comparisons with patients with panic disorder. Author(s): Otto MW, Pollack MH, Maki KM, Gould RA, Worthington JJ 3rd, Smoller JW, Rosenbaum JF. Source: Depression and Anxiety. 2001; 14(4): 209-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11754127&dopt=Abstract

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Cholecystokinin and panic disorder: past and future clinical research strategies. Author(s): Bradwejn J, Koszycki D. Source: Scand J Clin Lab Invest Suppl. 2001; 234: 19-27. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11713976&dopt=Abstract

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Chronicity, relapse, and illness--course of panic disorder, social phobia, and generalized anxiety disorder: findings in men and women from 8 years of follow-up. Author(s): Yonkers KA, Bruce SE, Dyck IR, Keller MB. Source: Depression and Anxiety. 2003; 17(3): 173-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12768651&dopt=Abstract

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Clinical and psychosocial outcome of patients affected by panic disorder with or without agoraphobia: results from a naturalistic follow-up study. Author(s): Carpiniello B, Baita A, Carta MG, Sitzia R, Macciardi AM, Murgia S, Altamura AC. Source: European Psychiatry : the Journal of the Association of European Psychiatrists. 2002 November; 17(7): 394-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12547305&dopt=Abstract

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Cognitive therapy versus interoceptive exposure as treatment of panic disorder without agoraphobia. Author(s): Arntz A. Source: Behaviour Research and Therapy. 2002 March; 40(3): 325-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11863242&dopt=Abstract

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Cognitive-behavioral therapy for panic disorder: a review of treatment elements, strategies, and outcomes. Author(s): Rayburn NR, Otto MW. Source: Cns Spectr. 2003 May; 8(5): 356-62. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12766691&dopt=Abstract

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Comorbid bipolar disorder and panic disorder in families with a high prevalence of bipolar disorder. Author(s): MacKinnon DF, Zandi PP, Cooper J, Potash JB, Simpson SG, Gershon E, Nurnberger J, Reich T, DePaulo JR. Source: The American Journal of Psychiatry. 2002 January; 159(1): 30-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11772686&dopt=Abstract

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Comparative phenomenology of ataques de nervios, panic attacks, and panic disorder. Author(s): Lewis-Fernandez R, Guarnaccia PJ, Martinez IE, Salman E, Schmidt A, Liebowitz M. Source: Culture, Medicine and Psychiatry. 2002 June; 26(2): 199-223. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12211325&dopt=Abstract

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Comparison between two models of experimental anxiety in healthy volunteers and panic disorder patients. Author(s): Graeff FG, Silva M, Del Ben CM, Zuardi AW, Hetem LA, Guimaraes FS. Source: Neuroscience and Biobehavioral Reviews. 2001 December; 25(7-8): 753-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11801299&dopt=Abstract

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Correlates of therapeutic response in panic disorder presenting with palpitations: heart rate variability, sleep, and placebo effect. Author(s): Baker B, Khaykin Y, Devins G, Dorian P, Shapiro C, Newman D. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 2003 July; 48(6): 381-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12894612&dopt=Abstract

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Cost-effectiveness and cost offset of a collaborative care intervention for primary care patients with panic disorder. Author(s): Katon WJ, Roy-Byrne P, Russo J, Cowley D. Source: Archives of General Psychiatry. 2002 December; 59(12): 1098-104. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12470125&dopt=Abstract

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Culture and panic disorder: how far have we come? Author(s): Good BJ. Source: Culture, Medicine and Psychiatry. 2002 June; 26(2): 133-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12211321&dopt=Abstract

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Decreased chaos and increased nonlinearity of heart rate time series in patients with panic disorder. Author(s): Rao RK, Yeragani VK. Source: Autonomic Neuroscience : Basic & Clinical. 2001 April 12; 88(1-2): 99-108. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11474552&dopt=Abstract

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Decreased chaos of heart rate time series in children of patients with panic disorder. Author(s): Srinivasan K, Ashok MV, Vaz M, Yeragani VK. Source: Depression and Anxiety. 2002; 15(4): 159-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12112720&dopt=Abstract

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Depression and panic disorder after heart transplantation--treatment with sertraline. Author(s): Hesslinger B, Van de Loo A, Klecha D, Harter M, Schmidt-Schweda S. Source: Pharmacopsychiatry. 2002 January; 35(1): 31-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11819158&dopt=Abstract

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Determinants of pharmacologic treatment failure in panic disorder. Author(s): Cowley DS, Ha EH, Roy-Byrne PP. Source: The Journal of Clinical Psychiatry. 1997 December; 58(12): 555-61; Quiz 562-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9448663&dopt=Abstract

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Diagnosis and management of panic disorder in medical practice. Author(s): Manoharam E, Jebaraj P, Jacob KS. Source: Natl Med J India. 2000 July-August; 13(4): 205-6. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11002690&dopt=Abstract

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Dissociative symptoms in panic disorder. Author(s): Ball S, Robinson A, Shekhar A, Walsh K. Source: The Journal of Nervous and Mental Disease. 1997 December; 185(12): 755-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9442187&dopt=Abstract

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Diurnal variation of cortisol in panic disorder. Author(s): Bandelow B, Wedekind D, Sandvoss V, Broocks A, Hajak G, Pauls J, Peter H, Ruther E. Source: Psychiatry Research. 2000 September 11; 95(3): 245-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10974363&dopt=Abstract

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Divided and selective attention in panic disorder. A comparative study of patients with panic disorder, major depression and healthy controls. Author(s): Lautenbacher S, Spernal J, Krieg JC. Source: European Archives of Psychiatry and Clinical Neuroscience. 2002 October; 252(5): 210-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12451461&dopt=Abstract

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Do panic symptom profiles influence response to a hypoxic challenge in patients with panic disorder? A preliminary report. Author(s): Beck JG, Shipherd JC, Ohtake P. Source: Psychosomatic Medicine. 2000 September-October; 62(5): 678-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11020098&dopt=Abstract

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Do panic symptoms during periods of remission predict relapse of panic disorder? Author(s): Weisberg RB, Machan JT, Dyck IR, Keller MB. Source: The Journal of Nervous and Mental Disease. 2002 March; 190(3): 190-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11923654&dopt=Abstract

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Does 5-HT restrain panic? A tryptophan depletion study in panic disorder patients recovered on paroxetine. Author(s): Bell C, Forshall S, Adrover M, Nash J, Hood S, Argyropoulos S, Rich A, Nutt DJ. Source: Journal of Psychopharmacology (Oxford, England). 2002 March; 16(1): 5-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11949771&dopt=Abstract

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Does nocturnal panic represent a more severe form of panic disorder? Author(s): Craske MG, Lang AJ, Mystkowski JL, Zucker BG, Bystritsky A, Yan-Go F. Source: The Journal of Nervous and Mental Disease. 2002 September; 190(9): 611-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12357095&dopt=Abstract

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Double-blind clonazepam vs placebo in panic disorder treatment. Author(s): Valenca AM, Nardi AE, Nascimento I, Mezzasalma MA, Lopes FL, Zin W. Source: Arquivos De Neuro-Psiquiatria. 2000 December; 58(4): 1025-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11105068&dopt=Abstract

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Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. Author(s): Palatnik A, Frolov K, Fux M, Benjamin J. Source: Journal of Clinical Psychopharmacology. 2001 June; 21(3): 335-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11386498&dopt=Abstract

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Double-blind, fixed-dose, placebo-controlled study of paroxetine in the treatment of panic disorder. Author(s): Ballenger JC, Wheadon DE, Steiner M, Bushnell W, Gergel IP. Source: The American Journal of Psychiatry. 1998 January; 155(1): 36-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9433336&dopt=Abstract

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Drawbacks of GENEHUNTER for larger pedigrees: application to panic disorder. Author(s): Goedken R, Ludington E, Crowe R, Fyer AJ, Hodge SE, Knowles JA, Vieland VJ, Weissman MM. Source: American Journal of Medical Genetics. 2000 December 4; 96(6): 781-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11121181&dopt=Abstract

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Dream recall, nightmare frequency, and nocturnal panic attacks in patients with panic disorder. Author(s): Schredl M, Kronenberg G, Nonnell P, Heuser I. Source: The Journal of Nervous and Mental Disease. 2001 August; 189(8): 559-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11531210&dopt=Abstract

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Duration of imipramine therapy and relapse in panic disorder with agoraphobia. Author(s): Mavissakalian MR, Perel JM. Source: Journal of Clinical Psychopharmacology. 2002 June; 22(3): 294-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12006900&dopt=Abstract

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Dysfunctional breathing and asthma. Panic disorder needs to be considered. Author(s): Davies SJ, Jackson PR, Ramsay LE. Source: Bmj (Clinical Research Ed.). 2001 September 15; 323(7313): 631; Author Reply 631-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11575318&dopt=Abstract

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Dysregulation of the hypothalamic-pituitary-adrenocortical system in panic disorder. Author(s): Schreiber W, Lauer CJ, Krumrey K, Holsboer F, Krieg JC. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 1996 July; 15(1): 7-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8797187&dopt=Abstract

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Early carbon dioxide challenge test may predict clinical response in panic disorder. Author(s): Valenca AM, Nardi AE, Nascimento I, Zin WA, Lopes FL, Mezzasalma MA, Versiani M. Source: Psychiatry Research. 2002 November 15; 112(3): 269-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12450637&dopt=Abstract

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Early coadministration of clonazepam with sertraline for panic disorder. Author(s): Goddard AW, Brouette T, Almai A, Jetty P, Woods SW, Charney D. Source: Archives of General Psychiatry. 2001 July; 58(7): 681-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11448376&dopt=Abstract

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Early improvement predicts endpoint remission status in sertraline and placebo treatments of panic disorder. Author(s): Pollack MH, Rapaport MH, Fayyad R, Otto MW, Nierenberg AA, Clary CM. Source: Journal of Psychiatric Research. 2002 July-August; 36(4): 229-36. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12191627&dopt=Abstract

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Early traumatic life events, parental attitudes, family history, and birth risk factors in patients with panic disorder. Author(s): Bandelow B, Spath C, Tichauer GA, Broocks A, Hajak G, Ruther E. Source: Comprehensive Psychiatry. 2002 July-August; 43(4): 269-78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12107864&dopt=Abstract

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Effect of acute tryptophan depletion on CO2-induced anxiety in patients with panic disorder and normal volunteers. Author(s): Miller HE, Deakin JF, Anderson IM. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2000 February; 176: 182-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10755058&dopt=Abstract

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Effect of treatment of panic disorder in patients with frequent ICD discharges: a pilot study. Author(s): Kuijpers PM, Honig A, Wellens HJ. Source: General Hospital Psychiatry. 2002 May-June; 24(3): 181-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12062144&dopt=Abstract

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Effects of selective serotonin reuptake inhibitors on cholesterol levels in patients with panic disorder. Author(s): Bailey DL, Le Melledo JM. Source: Journal of Clinical Psychopharmacology. 2003 June; 23(3): 317-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12826997&dopt=Abstract

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Efficacy of usual antidepressant dosing regimens of fluoxetine in panic disorder: randomised, placebo-controlled trial. Author(s): Michelson D, Allgulander C, Dantendorfer K, Knezevic A, Maierhofer D, Micev V, Paunovic VR, Timotijevic I, Sarkar N, Skoglund L, Pemberton SC. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2001 December; 179: 514-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11731354&dopt=Abstract

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Electrocardiogram, vectocardiogram and body surface maps in patients with panic disorder. Author(s): Pisvejcova K, Paclt I, Slavicek J, Kittnar O, Dohnalova A, Kitzlerova E. Source: Physiological Research / Academia Scientiarum Bohemoslovaca. 2002; 51(4): 401-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12449439&dopt=Abstract

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Electroencephalography during sleep of patients with nocturnal panic disorder. Author(s): Landry P, Marchand L, Mainguy N, Marchand A, Montplaisir J. Source: The Journal of Nervous and Mental Disease. 2002 August; 190(8): 559-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12193844&dopt=Abstract

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Electrophysiological evidence reveals affective evaluation deficits early in stimulus processing in patients with panic disorder. Author(s): Windmann S, Sakhavat Z, Kutas M. Source: Journal of Abnormal Psychology. 2002 May; 111(2): 357-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12003457&dopt=Abstract

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EMDR for panic disorder with agoraphobia: comparison with waiting list and credible attention-placebo control conditions. Author(s): Goldstein AJ, de Beurs E, Chambless DL, Wilson KA. Source: Journal of Consulting and Clinical Psychology. 2000 December; 68(6): 947-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11142547&dopt=Abstract

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Emotion-focused psychotherapy for patients with panic disorder. Author(s): Shear MK, Houck P, Greeno C, Masters S. Source: The American Journal of Psychiatry. 2001 December; 158(12): 1993-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11729015&dopt=Abstract

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Erectile dysfunction: prevalence and relationship to depression, alcohol abuse and panic disorder. Author(s): Okulate G, Olayinka O, Dogunro AS. Source: General Hospital Psychiatry. 2003 May-June; 25(3): 209-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12748034&dopt=Abstract

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Estrogen receptor 1 gene (ESR1) variants in panic disorder. Author(s): Sand PG, Schlurmann K, Luckhaus C, Gotz M, Stober G, Lesch KP, Riederer P, Franke P, Maier W, Nothen MM, Propping P, Fritze J, Deckert J. Source: American Journal of Medical Genetics. 2002 May 8; 114(4): 426-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11992565&dopt=Abstract

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Evaluating panic-specific factors in the relationship between suicide and panic disorder. Author(s): Schmidt NB, Woolaway-Bickel K, Bates M. Source: Behaviour Research and Therapy. 2001 June; 39(6): 635-49. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11400709&dopt=Abstract

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Evaluation of regional cerebral blood flow changes in panic disorder with Tc99mHMPAO SPECT. Author(s): Eren I, Tukel R, Polat A, Karaman R, Unal S. Source: Psychiatry Research. 2003 June 30; 123(2): 135-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12850252&dopt=Abstract

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Evidence for a susceptibility locus for panic disorder near the catechol-Omethyltransferase gene on chromosome 22. Author(s): Hamilton SP, Slager SL, Heiman GA, Deng Z, Haghighi F, Klein DF, Hodge SE, Weissman MM, Fyer AJ, Knowles JA. Source: Biological Psychiatry. 2002 April 1; 51(7): 591-601. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11950461&dopt=Abstract

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Exacerbation of panic disorder symptoms following Vicodin exposure. Author(s): Sansone RA, Sansone LA. Source: General Hospital Psychiatry. 2002 November-December; 24(6): 448-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12490349&dopt=Abstract

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Explicit and implicit memory biases in depression and panic disorder. Author(s): Banos RM, Medina PM, Pascual J. Source: Behaviour Research and Therapy. 2001 January; 39(1): 61-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11125724&dopt=Abstract

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Factors in the etiology and pathogenesis of panic disorder: revisiting the attachmentseparation paradigm. Author(s): Shear MK. Source: The American Journal of Psychiatry. 1996 July; 153(7 Suppl): 125-36. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8659636&dopt=Abstract

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Factors influencing health perceptions in patients with panic disorder. Author(s): Schmidt NB, Telch MJ, Joiner TE Jr. Source: Comprehensive Psychiatry. 1996 July-August; 37(4): 253-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8826689&dopt=Abstract

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Familial aggregation and phenomenology of 'early'-onset (at or before age 20 years) panic disorder. Author(s): Goldstein RB, Wickramaratne PJ, Horwath E, Weissman MM. Source: Archives of General Psychiatry. 1997 March; 54(3): 271-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9075468&dopt=Abstract

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Familial transmission of panic disorder: effect of major depression comorbidity. Author(s): Mannuzza S, Chapman TF, Klein DF, Fyer AJ. Source: Anxiety. 1994-95; 1(4): 180-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9160571&dopt=Abstract

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Family genetic studies of panic disorder. Author(s): Weissman MM. Source: Journal of Psychiatric Research. 1993; 27 Suppl 1: 69-78. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8145184&dopt=Abstract

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Family history of panic disorder and hypersensitivity to CO2 in patients with panic disorder. Author(s): Perna G, Bertani A, Caldirola D, Bellodi L. Source: The American Journal of Psychiatry. 1996 August; 153(8): 1060-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8678175&dopt=Abstract

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Fibromyalgia is associated with panic disorder and functional dyspepsia with mood disorders. A study of women with random sample population controls. Author(s): Malt EA, Berle JE, Olafsson S, Lund A, Ursin H. Source: Journal of Psychosomatic Research. 2000 November; 49(5): 285-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11164052&dopt=Abstract

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Fluctuation of symptoms and social functioning in panic disorder with or without concomitant depression. A 5-year prospective follow-up. Author(s): Albus M, Scheibe G, Scherer J. Source: Psychopathology. 1995; 28(5): 229-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8559945&dopt=Abstract

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Fluoxetine in panic disorder: pharmacologic and tritiated platelet imipramine and paroxetine binding study. Author(s): Pecknold JC, Luthe L, Iny L, Ramdoyal D. Source: Journal of Psychiatry & Neuroscience : Jpn. 1995 May; 20(3): 193-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7786880&dopt=Abstract

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Fluvoxamine in the treatment of panic disorder: a multi-center, double-blind, placebo-controlled study in outpatients. Author(s): Asnis GM, Hameedi FA, Goddard AW, Potkin SG, Black D, Jameel M, Desagani K, Woods SW. Source: Psychiatry Research. 2001 August 5; 103(1): 1-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11472786&dopt=Abstract

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Fluvoxamine or placebo in the treatment of panic disorder and relationship to blood concentrations of fluvoxamine. Author(s): Sandmann J, Lorch B, Bandelow B, Hartter S, Winter P, Hiemke C, Benkert O. Source: Pharmacopsychiatry. 1998 July; 31(4): 117-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9754844&dopt=Abstract

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Follow-up on the treatment of panic disorder with or without agoraphobia: a quantitative review. Author(s): Bakker A, van Balkom AJ, Spinhoven P, Blaauw BM, van Dyck R. Source: The Journal of Nervous and Mental Disease. 1998 July; 186(7): 414-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9680042&dopt=Abstract

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Forum. What are the current treatments for panic disorder? Author(s): Pollack MH. Source: The Harvard Mental Health Letter / from Harvard Medical School. 2000 May; 16(11): 8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10760973&dopt=Abstract

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Four cases of panic disorder successfully treated with Kampo (Japanese herbal) medicines: Kami-shoyo-san and Hange-koboku-to. Author(s): Mantani N, Hisanaga A, Kogure T, Kita T, Shimada Y, Terasawa K. Source: Psychiatry and Clinical Neurosciences. 2002 December; 56(6): 617-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12485303&dopt=Abstract

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Frequency distribution of serum cholesterol levels in patients with panic disorder: comparison with normal controls. Author(s): Shioiri T, Fujii K, Someya T, Takahashi S. Source: Psychiatry and Clinical Neurosciences. 1998 December; 52(6): 601-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9895208&dopt=Abstract

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Frequency of panic attacks and panic disorder in adolescents. Author(s): Essau CA, Conradt J, Petermann F. Source: Depression and Anxiety. 1999; 9(1): 19-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9989346&dopt=Abstract

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Frontal CSF enlargement in panic disorder: a qualitative CT-scan study. Author(s): Wurthmann C, Bogerts B, Gregor J, Baumann B, Effenberger O, Dohring W. Source: Psychiatry Research. 1997 December 30; 76(2-3): 83-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9522400&dopt=Abstract

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Functional promoter polymorphism of the human serotonin transporter: lack of association with panic disorder. Author(s): Deckert J, Catalano M, Heils A, Di Bella D, Friess F, Politi E, Franke P, Nothen MM, Maier W, Bellodi L, Lesch KP. Source: Psychiatric Genetics. 1997 Spring; 7(1): 45-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9264139&dopt=Abstract

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Functioning and well-being of patients with panic disorder. Author(s): Sherbourne CD, Wells KB, Judd LL. Source: The American Journal of Psychiatry. 1996 February; 153(2): 213-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8561201&dopt=Abstract

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Further genetic evidence for a panic disorder syndrome mapping to chromosome 13q. Author(s): Hamilton SP, Fyer AJ, Durner M, Heiman GA, Baisre de Leon A, Hodge SE, Knowles JA, Weissman MM. Source: Proceedings of the National Academy of Sciences of the United States of America. 2003 March 4; 100(5): 2550-5. Epub 2003 February 25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12604791&dopt=Abstract

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GABA(A) receptor-modulating neuroactive steroid composition in patients with panic disorder before and during paroxetine treatment. Author(s): Strohle A, Romeo E, di Michele F, Pasini A, Yassouridis A, Holsboer F, Rupprecht R. Source: The American Journal of Psychiatry. 2002 January; 159(1): 145-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11772707&dopt=Abstract

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Gauging the effectiveness of extended imipramine treatment for panic disorder with agoraphobia. Author(s): Mavissakalian MR, Perel JM, Talbott-Green M, Sloan C. Source: Biological Psychiatry. 1998 June 1; 43(11): 848-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9611676&dopt=Abstract

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Gender differences in panic disorder symptoms and illicit drug use among young people in Hungary. Author(s): Kecskes I, Rihmer Z, Kiss K, Sarai T, Szabo A, Kiss GH. Source: European Psychiatry : the Journal of the Association of European Psychiatrists. 2002 March; 17(1): 29-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11918990&dopt=Abstract

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Gender differences in panic disorder: findings from the National Comorbidity Survey. Author(s): Sheikh JI, Leskin GA, Klein DF. Source: The American Journal of Psychiatry. 2002 January; 159(1): 55-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11772690&dopt=Abstract

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Gender effects and alcohol use in panic disorder with agoraphobia. Author(s): Cox BJ, Swinson RP, Shulman ID, Kuch K, Reichman JT. Source: Behaviour Research and Therapy. 1993 May; 31(4): 413-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8512541&dopt=Abstract

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Gender-related differences in the onset of panic disorder. Author(s): Barzega G, Maina G, Venturello S, Bogetto F. Source: Acta Psychiatrica Scandinavica. 2001 March; 103(3): 189-95. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11240575&dopt=Abstract

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Gender-related distribution of personality disorders in a sample of patients with panic disorder. Author(s): Barzega G, Maina G, Venturello S, Bogetto F. Source: European Psychiatry : the Journal of the Association of European Psychiatrists. 2001 April; 16(3): 173-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11353596&dopt=Abstract

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Generalized anxiety and panic disorder. Author(s): Rabatin J, Keltz LB. Source: The Western Journal of Medicine. 2002 May; 176(3): 164-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12016238&dopt=Abstract

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Generalized anxiety disorder and panic disorder in the elderly: a review. Author(s): Blazer DG. Source: Harvard Review of Psychiatry. 1997 May-June; 5(1): 18-27. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9385016&dopt=Abstract

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Generalized anxiety disorder versus panic disorder: participation in controlled efficacy trials. Author(s): Mavissakalian MR, Zamar N. Source: Comprehensive Psychiatry. 2000 July-August; 41(4): 253-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10929792&dopt=Abstract

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Genetic studies of panic disorder: a review. Author(s): van den Heuvel OA, van de Wetering BJ, Veltman DJ, Pauls DL. Source: The Journal of Clinical Psychiatry. 2000 October; 61(10): 756-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11078037&dopt=Abstract

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Genomewide survey of panic disorder. Author(s): Crowe RR, Goedken R, Samuelson S, Wilson R, Nelson J, Noyes R Jr. Source: American Journal of Medical Genetics. 2001 January 8; 105(1): 105-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11424978&dopt=Abstract

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Gepirone and the treatment of panic disorder: an open study. Author(s): Pecknold JC, Luthe L, Scott-Fleury MH, Jenkins S. Source: Journal of Clinical Psychopharmacology. 1993 April; 13(2): 145-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8096526&dopt=Abstract

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Global measures of outcome in a controlled comparison of pharmacological and psychological treatment of panic disorder and agoraphobia in primary care. Author(s): Sharp DM, Power KG, Simpson RJ, Swanson V, Anstee JA. Source: The British Journal of General Practice : the Journal of the Royal College of General Practitioners. 1997 March; 47(416): 150-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9167318&dopt=Abstract

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G-protein level quantification in platelets and leukocytes from patients with panic disorder. Author(s): Stein MB, Chen G, Potter WZ, Manji HK. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 1996 August; 15(2): 180-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8840354&dopt=Abstract

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Graves'disease after the onset of panic disorder. Author(s): Matsubayashi S, Tamai H, Matsumoto Y, Tamagawa K, Mukuta T, Morita T, Kubo C. Source: Psychotherapy and Psychosomatics. 1996; 65(5): 277-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8893330&dopt=Abstract

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Group cognitive-behavior therapy for patients failing to respond to pharmacotherapy for panic disorder: a clinical case series. Author(s): Otto MW, Pollack MH, Penava SJ, Zucker BG. Source: Behaviour Research and Therapy. 1999 August; 37(8): 763-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10452176&dopt=Abstract

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Growth hormone response to apomorphine in panic disorder: comparison with major depression and normal controls. Author(s): Pichot W, Hansenne M, Gonzalez Moreno A, Ansseau M. Source: European Archives of Psychiatry and Clinical Neuroscience. 1995; 245(6): 306-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8527467&dopt=Abstract

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Growth hormone response to intravenous clonidine in social phobia: comparison to patients with panic disorder and healthy volunteers. Author(s): Tancer ME, Stein MB, Uhde TW. Source: Biological Psychiatry. 1993 November 1; 34(9): 591-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8292687&dopt=Abstract

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Growth-hormone response to clonidine in panic disorder patients in comparison to patients with major depression and healthy controls. Author(s): Gann H, Riemann D, Stoll S, Berger M, Muller WE. Source: Pharmacopsychiatry. 1995 May; 28(3): 80-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7568369&dopt=Abstract

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Headache types and panic disorder: directionality and specificity. Author(s): Breslau N, Schultz LR, Stewart WF, Lipton R, Welch KM. Source: Neurology. 2001 February 13; 56(3): 350-4. Erratum In: Neurology 2001 April 24; 56(8): 1124. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11171900&dopt=Abstract

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Heart period and QT variability, hostility, and type-A behavior in normal controls and patients with panic disorder. Author(s): Yeragani VK, Kumar HV. Source: Journal of Psychosomatic Research. 2000 December; 49(6): 401-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11182432&dopt=Abstract

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Heart rate and blood pressure in panic disorder, major depression, and comorbid panic disorder with major depression. Author(s): Townsend MH, Bologna NB, Barbee JG. Source: Psychiatry Research. 1998 June 15; 79(2): 187-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9705056&dopt=Abstract

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Heart rate variability as predictor of nonresponse to mirtazapine in panic disorder: a preliminary study. Author(s): Slaap BR, Boshuisen ML, van Roon AM, den Boer JA. Source: International Clinical Psychopharmacology. 2002 March; 17(2): 69-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11892720&dopt=Abstract

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Heartbeat perception in panic disorder: a reanalysis. Author(s): Willem Van der Does AJ, Antony MM, Ehlers A, Barsky AJ. Source: Behaviour Research and Therapy. 2000 January; 38(1): 47-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10645023&dopt=Abstract

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Hematologic alterations and CO(2) hypersensitivity in male panic disorder patients and normal controls: similarities to high-altitude hypoxia and chronic lung disease. Author(s): Ross DC, Preter M, Klein DF. Source: Depression and Anxiety. 2001; 14(2): 153-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11668670&dopt=Abstract

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Hemodynamic response to respiratory challenges in panic disorder. Author(s): Martinez JM, Coplan JD, Browne ST, Goetz R, Welkowitz LA, Papp LA, Klein DF, Gorman JM. Source: Journal of Psychosomatic Research. 1998 January; 44(1): 153-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9483471&dopt=Abstract

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History of childhood abuse in panic disorder, social phobia, and generalized anxiety disorder. Author(s): Safren SA, Gershuny BS, Marzol P, Otto MW, Pollack MH. Source: The Journal of Nervous and Mental Disease. 2002 July; 190(7): 453-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12142846&dopt=Abstract

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History of childhood attention deficit hyperactivity disorder (ADHD) features among adults with panic disorder. Author(s): Fones CS, Pollack MH, Susswein L, Otto M. Source: Journal of Affective Disorders. 2000 May; 58(2): 99-106. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10781699&dopt=Abstract

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How does interoceptive exposure for panic disorder work? An uncontrolled case study. Author(s): Beck JG, Shipherd JC, Zebb BJ. Source: Journal of Anxiety Disorders. 1997 September-October; 11(5): 541-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9407272&dopt=Abstract

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How study of respiratory physiology aided our understanding of abnormal brain function in panic disorder. Author(s): Sinha S, Papp LA, Gorman JM. Source: Journal of Affective Disorders. 2000 December; 61(3): 191-200. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11163421&dopt=Abstract

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Human nuclear transcription factor gene CREM: genomic organization, mutation screening, and association analysis in panic disorder. Author(s): Domschke K, Kuhlenbaumer G, Schirmacher A, Lorenzi C, Armengol L, DiBella D, Gratacos M, Garritsen HS, Nothen MM, Franke P, Sand P, Fritze J, Perez G, Maier W, Sibrowski W, Estivill X, Bellodi L, Ringelstein EB, Arolt V, Martin-Santos R, Catalano M, Stogbauer F, Deckert J. Source: American Journal of Medical Genetics. 2003 Feb15; 117B(1): 70-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12555239&dopt=Abstract

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Hyperventilation challenge test in panic disorder and depression with panic attacks. Author(s): Nardi AE, Valenca AM, Nascimento I, Zin WA. Source: Psychiatry Research. 2001 December 15; 105(1-2): 57-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11740975&dopt=Abstract

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Hyperventilation in panic disorder and social phobia. Author(s): Nardi AE, Valenca AM, Nascimento I, Mezzasalma MA, Zin WA. Source: Psychopathology. 2001 May-June; 34(3): 123-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11316957&dopt=Abstract

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Hyperventilation in panic disorder patients and healthy first-degree relatives. Author(s): Nardi AE, Valenca AM, Nascimento I, Mezzasalma MA, Lopes FL, Zin WA. Source: Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Medicas E Biologicas / Sociedade Brasileira De Biofisica. [et Al.]. 2000 November; 33(11): 1317-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11050662&dopt=Abstract

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Hypocapnia associated with cardiac stress scintigraphy in chest pain patients with panic disorder. Author(s): Maddock RJ, Carter CS, Tavano-Hall L, Amsterdam EA. Source: Psychosomatic Medicine. 1998 January-February; 60(1): 52-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9492240&dopt=Abstract

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Hypochondriacal concerns and somatization in panic disorder. Author(s): Furer P, Walker JR, Chartier MJ, Stein MB. Source: Depression and Anxiety. 1997; 6(2): 78-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9451549&dopt=Abstract

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Hypophosphatemia as atypical panic disorder: a case study. Author(s): Kligler B. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 1999 January-February; 12(1): 65-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10050645&dopt=Abstract

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Hypothalamic-pituitary-adrenal axis activity in panic disorder. 24-hour secretion of corticotropin and cortisol. Author(s): Abelson JL, Curtis GC. Source: Archives of General Psychiatry. 1996 April; 53(4): 323-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8634010&dopt=Abstract

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Hypothalamic-pituitary-adrenal axis activity in panic disorder: effects of alprazolam on 24 h secretion of adrenocorticotropin and cortisol. Author(s): Abelson JL, Curtis GC, Cameron OG. Source: Journal of Psychiatric Research. 1996 March-April; 30(2): 79-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8816303&dopt=Abstract

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Identification of a compound short tandem repeat stretch in the 5'-upstream region of the cholecystokinin gene, and its association with panic disorder but not with schizophrenia. Author(s): Hattori E, Ebihara M, Yamada K, Ohba H, Shibuya H, Yoshikawa T. Source: Molecular Psychiatry. 2001 July; 6(4): 465-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11443535&dopt=Abstract

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Idiopathic environmental intolerance: increased prevalence of panic disorderassociated cholecystokinin B receptor allele 7. Author(s): Binkley K, King N, Poonai N, Seeman P, Ulpian C, Kennedy J. Source: The Journal of Allergy and Clinical Immunology. 2001 May; 107(5): 887-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11344357&dopt=Abstract

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Increased ACTH concentrations associated with cholecystokinin tetrapeptideinduced panic attacks in patients with panic disorder. Author(s): Strohle A, Holsboer F, Rupprecht R. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 2000 March; 22(3): 251-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10693152&dopt=Abstract

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Increased left posterior parietal-temporal cortex activation after D-fenfluramine in women with panic disorder. Author(s): Meyer JH, Swinson R, Kennedy SH, Houle S, Brown GM. Source: Psychiatry Research. 2000 May 15; 98(3): 133-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10821996&dopt=Abstract

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Increased probability of remaining in remission from panic disorder with agoraphobia after drug treatment in patients who received concurrent cognitivebehavioural therapy: a follow-up study. Author(s): Biondi M, Picardi A. Source: Psychotherapy and Psychosomatics. 2003 January-February; 72(1): 34-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12466636&dopt=Abstract

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Increased QT variability in patients with panic disorder and depression. Author(s): Yeragani VK, Pohl R, Jampala VC, Balon R, Ramesh C, Srinivasan K. Source: Psychiatry Research. 2000 April 10; 93(3): 225-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10760381&dopt=Abstract

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Increased response to a putative panicogenic nocebo administration in female patients with panic disorder. Author(s): Strohle A. Source: Journal of Psychiatric Research. 2000 November-December; 34(6): 439-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11165311&dopt=Abstract

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Increased sympathetic response to standing in panic disorder. Author(s): Coupland NJ, Wilson SJ, Potokar JP, Bell C, Nutt DJ. Source: Psychiatry Research. 2003 May 1; 118(1): 69-79. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12759163&dopt=Abstract

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Individual differences predictive of drinking to manage anxiety among non-problem drinkers with panic disorder. Author(s): Kushner MG, Abrams K, Thuras P, Thuras P, Hanson KL. Source: Alcoholism, Clinical and Experimental Research. 2000 April; 24(4): 448-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10798580&dopt=Abstract

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Induced panic attacks shift gamma-aminobutyric acid type A receptor modulatory neuroactive steroid composition in patients with panic disorder: preliminary results. Author(s): Strohle A, Romeo E, di Michele F, Pasini A, Hermann B, Gajewsky G, Holsboer F, Rupprecht R. Source: Archives of General Psychiatry. 2003 February; 60(2): 161-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12578433&dopt=Abstract

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Influence of personality on behavioral response to cholecystokinin-tetrapeptide in patients with panic disorder. Author(s): Koszycki D, Zacharko RM, Bradwejn J. Source: Psychiatry Research. 1996 May 17; 62(2): 131-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8771610&dopt=Abstract

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Instrument to assess depersonalization-derealization in panic disorder. Author(s): Cox BJ, Swinson RP. Source: Depression and Anxiety. 2002; 15(4): 172-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12112722&dopt=Abstract

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Interactive model of therapeutic response in panic disorder: moclobemide, a case in point. Author(s): Uhlenhuth EH, Warner TD, Matuzas W. Source: Journal of Clinical Psychopharmacology. 2002 June; 22(3): 275-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12006898&dopt=Abstract

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Is bipolar disorder specifically associated with panic disorder in youths? Author(s): Birmaher B, Kennah A, Brent D, Ehmann M, Bridge J, Axelson D. Source: The Journal of Clinical Psychiatry. 2002 May; 63(5): 414-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12019666&dopt=Abstract

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Is early separation anxiety a risk factor for adult panic disorder?: a critical review. Author(s): Silove D, Manicavasagar V, Curtis J, Blaszczynski A. Source: Comprehensive Psychiatry. 1996 May-June; 37(3): 167-79. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8732584&dopt=Abstract

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Is panic disorder linked to cognitive avoidance of threatening information? Author(s): McNally RJ, Otto MW, Yap L, Pollack MH, Hornig CD. Source: Journal of Anxiety Disorders. 1999 July-August; 13(4): 335-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10504105&dopt=Abstract

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Is panic disorder with psychosensorial symptoms (depersonalization-derealization) a more severe clinical subtype? Author(s): Marquez M, Segui J, Garcia L, Canet J, Ortiz M. Source: The Journal of Nervous and Mental Disease. 2001 May; 189(5): 332-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11379980&dopt=Abstract

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Is placebo response the same as drug response in panic disorder? Author(s): Rapaport MH, Pollack M, Wolkow R, Mardekian J, Clary C. Source: The American Journal of Psychiatry. 2000 June; 157(6): 1014-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10831487&dopt=Abstract

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Is the autonomic dysfunction the missing link between panic disorder, hypertension and cardiovascular disease? Author(s): Grassi G, Kiowski W. Source: Journal of Hypertension. 2002 December; 20(12): 2347-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12473854&dopt=Abstract

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Is there a specific relationship between asthma and panic disorder? Author(s): Van Peski-Oosterbaan AS, Spinhoven P, Van der Does AJ, Willems LN, Sterk PJ. Source: Behaviour Research and Therapy. 1996 April; 34(4): 333-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8871365&dopt=Abstract

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L-5-hydroxytryptophan induced increase in salivary cortisol in panic disorder patients and healthy volunteers. Author(s): Schruers K, van Diest R, Nicolson N, Griez E. Source: Psychopharmacology. 2002 June; 161(4): 365-9. Epub 2002 April 19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12073163&dopt=Abstract

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Laboratory psychophysiological assessment and imagery exposure in panic disorder patients. Author(s): Bystritsky A, Maidenberg E, Craske MG, Vapnik T, Shapiro D. Source: Depression and Anxiety. 2000; 12(2): 102-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11091934&dopt=Abstract

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Lack of genetic linkage or association between a functional serotonin transporter polymorphism and panic disorder. Author(s): Hamilton SP, Heiman GA, Haghighi F, Mick S, Klein DF, Hodge SE, Weissman MM, Fyer AJ, Knowles JA. Source: Psychiatric Genetics. 1999 March; 9(1): 1-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10335545&dopt=Abstract

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Lactate sensitivity and cardiac cholinergic function in panic disorder. Author(s): Yeragani VK, Srinivasan K, Balon R, Ramesh C, Berchou R. Source: The American Journal of Psychiatry. 1994 August; 151(8): 1226-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8037261&dopt=Abstract

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Life events in childhood, adolescence and adulthood and the relationship to panic disorder. Author(s): Horesh N, Amir M, Kedem P, Goldberger Y, Kotler M. Source: Acta Psychiatrica Scandinavica. 1997 November; 96(5): 373-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9395156&dopt=Abstract

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Lifetime trauma history and panic disorder: findings from the National Comorbidity Survey. Author(s): Leskin GA, Sheikh JI. Source: Journal of Anxiety Disorders. 2002; 16(6): 599-603. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12405520&dopt=Abstract

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Linkage genome scan for loci predisposing to panic disorder or agoraphobia. Author(s): Gelernter J, Bonvicini K, Page G, Woods SW, Goddard AW, Kruger S, Pauls DL, Goodson S. Source: American Journal of Medical Genetics. 2001 August 8; 105(6): 548-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11496373&dopt=Abstract

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Locus of control orientation in panic disorder and the differential effects of treatment. Author(s): Bakker A, Spinhoven P, van der Does AJ, van Balkom AJ, van Dyck R. Source: Psychotherapy and Psychosomatics. 2002 March-April; 71(2): 85-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11844944&dopt=Abstract

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Longitudinal outcome with pharmacotherapy in a naturalistic study of panic disorder. Author(s): Simon NM, Safren SA, Otto MW, Sharma SG, Lanka GD, Pollack MH. Source: Journal of Affective Disorders. 2002 May; 69(1-3): 201-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12103467&dopt=Abstract

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Long-term course and outcome of panic disorder. Author(s): Pollack MH, Otto MW. Source: The Journal of Clinical Psychiatry. 1997; 58 Suppl 2: 57-60. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9078996&dopt=Abstract

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Long-term evaluation of paroxetine, clomipramine and placebo in panic disorder. Collaborative Paroxetine Panic Study Investigators. Author(s): Lecrubier Y, Judge R. Source: Acta Psychiatrica Scandinavica. 1997 February; 95(2): 153-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9065681&dopt=Abstract

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Long-term experience with clonazepam in patients with a primary diagnosis of panic disorder. Author(s): Worthington JJ 3rd, Pollack MH, Otto MW, McLean RY, Moroz G, Rosenbaum JF. Source: Psychopharmacology Bulletin. 1998; 34(2): 199-205. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9641001&dopt=Abstract

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Long-term maintenance and discontinuation of imipramine therapy in panic disorder with agoraphobia. Author(s): Mavissakalian MR, Perel JM. Source: Archives of General Psychiatry. 1999 September; 56(9): 821-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12884888&dopt=Abstract

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Long-term outcome of panic disorder and social phobia. Author(s): Hunt C, Andrews G. Source: Journal of Anxiety Disorders. 1998 July-August; 12(4): 395-406. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9699122&dopt=Abstract

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Long-term outcome of panic disorder with agoraphobia treated by exposure. Author(s): Fava GA, Rafanelli C, Grandi S, Conti S, Ruini C, Mangelli L, Belluardo P. Source: Psychological Medicine. 2001 July; 31(5): 891-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11459386&dopt=Abstract

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Long-term outcome of pharmacological and psychological treatment for panic disorder with agoraphobia: a 2-year naturalistic follow-up. Author(s): de Beurs E, van Balkom AJ, Van Dyck R, Lange A. Source: Acta Psychiatrica Scandinavica. 1999 January; 99(1): 59-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10066008&dopt=Abstract

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Low cholesterol level in patients with panic disorder: the association with major depression. Author(s): Agargun MY, Algun E, Sekeroglu R, Kara H, Tarakcioglu M. Source: Journal of Affective Disorders. 1998 July; 50(1): 29-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9716276&dopt=Abstract

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Low-dose venlafaxine treatment in panic disorder. Author(s): Papp LA, Sinha SS, Martinez JM, Coplan JD, Amchin J, Gorman JM. Source: Psychopharmacology Bulletin. 1998; 34(2): 207-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9641002&dopt=Abstract

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Management of treatment-refractory panic disorder. Author(s): Mathew SJ, Coplan JD, Gorman JM. Source: Psychopharmacology Bulletin. 2001 Spring; 35(2): 97-110. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12397890&dopt=Abstract

•

Mania or anxiety disorders linked to panic disorder. Author(s): Parvin MM, Swartz CM. Source: The American Journal of Psychiatry. 2002 December; 159(12): 2115-6; Author Reply 2116. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12450975&dopt=Abstract

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Marijuana and panic disorder. Author(s): Deas D, Gerding L, Hazy J. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2000 December; 39(12): 1467. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11128322&dopt=Abstract

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Marital relationship and the treatment of panic disorder with agoraphobia: a critical review. Author(s): Marcaurelle R, Belanger C, Marchand A. Source: Clinical Psychology Review. 2003 March; 23(2): 247-76. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12573672&dopt=Abstract

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Maternal panic disorder: infant temperament, neurophysiology, and parenting behaviors. Author(s): Warren SL, Gunnar MR, Kagan J, Anders TF, Simmens SJ, Rones M, Wease S, Aron E, Dahl RE, Sroufe LA. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2003 July; 42(7): 814-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12819441&dopt=Abstract

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Memory performance in panic disorder patients after chronic use of clomipramine. Author(s): de Carvalho SC, Marcourakis T, Artes R, Gorenstein C. Source: Journal of Psychopharmacology (Oxford, England). 2002 September; 16(3): 2206. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12236628&dopt=Abstract

Studies

81

•

Migraine, major depression, panic disorder, and personality traits in women aged 4074 years: a population-based study. Author(s): Clin Evid. 2002 Dec;(8):1003-9 Source: Cephalalgia : an International Journal of Headache. 2002 September; 22(7): 54351. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12603925

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Mirtazapine in the treatment of panic disorder: an open-label trial. Author(s): Sarchiapone M, Amore M, De Risio S, Carli V, Faia V, Poterzio F, Balista C, Camardese G, Ferrari G. Source: International Clinical Psychopharmacology. 2003 January; 18(1): 35-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12490773&dopt=Abstract

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Modulation by muscarinic antagonists of the response to carbon dioxide challenge in panic disorder. Author(s): Battaglia M, Bertella S, Ogliari A, Bellodi L, Smeraldi E. Source: Archives of General Psychiatry. 2001 February; 58(2): 114-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11177112&dopt=Abstract

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Morbidity of comorbid psychiatric diagnoses in the clinical presentation of panic disorder. Author(s): Apfeldorf WJ, Spielman LA, Cloitre M, Heckelman L, Shear MK. Source: Depression and Anxiety. 2000; 12(2): 78-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11091930&dopt=Abstract

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Naturalistic manner of benzodiazepine use and cognitive behavioral therapy outcome in panic disorder with agoraphobia. Author(s): Westra HA, Stewart SH, Conrad BE. Source: Journal of Anxiety Disorders. 2002; 16(3): 233-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12214810&dopt=Abstract

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Nefazodone may increase anxiety in panic disorder. Author(s): Strohle A, Ehrenthal HD. Source: Journal of Clinical Psychopharmacology. 2002 February; 22(1): 95-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11799352&dopt=Abstract

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Neuroactive steroid levels in patients with panic disorder. Author(s): Pearson Murphy BE. Source: The American Journal of Psychiatry. 2003 March; 160(3): 593-4; Author Reply 594. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12611857&dopt=Abstract

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Panic Disorder

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Neurobiological correlates of panic disorder and agoraphobia. Author(s): Al-Haddad MK, Sequeira RP, Nayar U. Source: Journal of Postgraduate Medicine. 2001 January-March; 47(1): 55-61. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11590298&dopt=Abstract

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Neurobiology of panic disorder. Author(s): Bourin M, Baker GB, Bradwejn J. Source: Journal of Psychosomatic Research. 1998 January; 44(1): 163-80. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9483472&dopt=Abstract

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Neurosteroid secretion in panic disorder. Author(s): Brambilla F, Biggio G, Pisu MG, Bellodi L, Perna G, Bogdanovich-Djukic V, Purdy RH, Serra M. Source: Psychiatry Research. 2003 May 30; 118(2): 107-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12798975&dopt=Abstract

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Nightmares and panic disorder associated with carvedilol overdose. Author(s): Maebara C, Ohtani H, Sugahara H, Mine K, Kubo C, Sawada Y. Source: The Annals of Pharmacotherapy. 2002 November; 36(11): 1736-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12398570&dopt=Abstract

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No association or linkage between polymorphisms in the genes encoding cholecystokinin and the cholecystokinin B receptor and panic disorder. Author(s): Hamilton SP, Slager SL, Helleby L, Heiman GA, Klein DF, Hodge SE, Weissman MM, Fyer AJ, Knowles JA. Source: Molecular Psychiatry. 2001 January; 6(1): 59-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11244486&dopt=Abstract

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Nonlinear measures of respiration: respiratory irregularity and increased chaos of respiration in patients with panic disorder. Author(s): Yeragani VK, Radhakrishna RK, Tancer M, Uhde T. Source: Neuropsychobiology. 2002; 46(3): 111-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12422057&dopt=Abstract

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Norepinephrine transporter gene (NET) variants in patients with panic disorder. Author(s): Sand PG, Mori T, Godau C, Stober G, Flachenecker P, Franke P, Nothen MM, Fritze J, Maier W, Lesch KP, Riederer P, Beckmann H, Deckert J. Source: Neuroscience Letters. 2002 November 15; 333(1): 41-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12401556&dopt=Abstract

Studies

83

•

Obsessional personality and outcome of panic disorder. Author(s): Tyrer P, Seivewright N, Ferguson B, Johnson T. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1998 February; 172: 187. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9519078&dopt=Abstract

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Obsessive-compulsive disorder and separation anxiety co-morbidity in early onset panic disorder. Author(s): Goodwin R, Lipsitz JD, Chapman TF, Mannuzza S, Fyer AJ. Source: Psychological Medicine. 2001 October; 31(7): 1307-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11681556&dopt=Abstract

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Oedipal dynamics in panic disorder. Author(s): Busch FN, Milrod BL, Rudden M, Shapiro T, Singer M, Aronson A, Roiphe J. Source: J Am Psychoanal Assoc. 1999; 47(3): 773-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10586400&dopt=Abstract

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On the significance of cholecystokinin receptors in panic disorder. Author(s): van Megen HJ, den Boer JA, Westenberg HG. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 1994 December; 18(8): 1235-46. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7863014&dopt=Abstract

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Once-weekly dosing of fluoxetine in the maintenance of remission in panic disorder. Author(s): Emmanuel NP, Ware MR, Brawman-Mintzer O, Ballenger JC, Lydiard RB. Source: The Journal of Clinical Psychiatry. 1999 May; 60(5): 299-301. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10362436&dopt=Abstract

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Onset and recovery from panic disorder in the Baltimore Epidemiologic Catchment Area follow-up. Author(s): Eaton WW, Anthony JC, Romanoski A, Tien A, Gallo J, Cai G, Neufeld K, Schlaepfer T, Laugharne J, Chen LS. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1998 December; 173: 501-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9926079&dopt=Abstract

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Open trial of psychodynamic psychotherapy for panic disorder: a pilot study. Author(s): Milrod B, Busch F, Leon AC, Shapiro T, Aronson A, Roiphe J, Rudden M, Singer M, Goldman H, Richter D, Shear MK. Source: The American Journal of Psychiatry. 2000 November; 157(11): 1878-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11058492&dopt=Abstract

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Outcome assessment and clinical improvement in panic disorder: evidence from a randomized controlled trial of fluoxetine and placebo. The Fluoxetine Panic Disorder Study Group. Author(s): Michelson D, Lydiard RB, Pollack MH, Tamura RN, Hoog SL, Tepner R, Demitrack MA, Tollefson GD. Source: The American Journal of Psychiatry. 1998 November; 155(11): 1570-7. Erratum In: Am J Psychiatry 1999 January; 156(1): 161. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9812120&dopt=Abstract

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Overprediction of fear in panic disorder with agoraphobia. Author(s): Cox BJ, Swinson RP. Source: Behaviour Research and Therapy. 1994 September; 32(7): 735-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7980359&dopt=Abstract

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Oxcarbazepine for panic disorder occurring after two grand mal seizures: a case report. Author(s): Windhaber J, Maierhofer D, Dantendorfer K. Source: The Journal of Clinical Psychiatry. 1997 September; 58(9): 404-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9378694&dopt=Abstract

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Panic disorder and depression: a psychodynamic exploration of comorbidity. Author(s): Rudden M, Busch FN, Milrod B, Singer M, Aronson A, Roiphe J, Shapiro T. Source: The International Journal of Psycho-Analysis. 2003 August; 84(Pt 4): 997-1015. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=13678503&dopt=Abstract

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Panic disorder and response to sertraline: the effect of previous treatment with benzodiazepines. Author(s): Rapaport MH, Pollack MH, Clary CM, Mardekian J, Wolkow R. Source: Journal of Clinical Psychopharmacology. 2001 February; 21(1): 104-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11199932&dopt=Abstract

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Panic disorder associated with clozapine. Author(s): Bressan RA, Monteiro VB, Dias CC. Source: The American Journal of Psychiatry. 2000 December; 157(12): 2056. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11097983&dopt=Abstract

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Panic disorder in Thailand: a report on the secondary data analysis. Author(s): Udomratn P. Source: J Med Assoc Thai. 2000 October; 83(10): 1158-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11143481&dopt=Abstract

Studies

85

•

Panic disorder. Author(s): Martin AC. Source: Lippincott's Primary Care Practice. 2000 March-April; 4(2): 228-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11143632&dopt=Abstract

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Panic-free status is not associated with improvement on continuous measures in panic disorder. Author(s): van Balkom AJ, Spinhoven P, Bakker A, Rammeloo KC, Graatsma AT, Adriaanse MT, van Dyck R. Source: The Journal of Nervous and Mental Disease. 2000 December; 188(12): 840-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11191586&dopt=Abstract

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Patterns of psychopathology and dysfunction in high-risk children of parents with panic disorder and major depression. Author(s): Biederman J, Faraone SV, Hirshfeld-Becker DR, Friedman D, Robin JA, Rosenbaum JF. Source: The American Journal of Psychiatry. 2001 January; 158(1): 49-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11136633&dopt=Abstract

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Physiological changes during carbon dioxide inhalation in patients with panic disorder, major depression, and premenstrual dysphoric disorder: evidence for a central fear mechanism. Author(s): Gorman JM, Kent J, Martinez J, Browne S, Coplan J, Papp LA. Source: Archives of General Psychiatry. 2001 February; 58(2): 125-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11177114&dopt=Abstract

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Positive association between panic disorder and polymorphism of the serotonin 2A receptor gene. Author(s): Inada Y, Yoneda H, Koh J, Sakai J, Himei A, Kinoshita Y, Akabame K, Hiraoka Y, Sakai T. Source: Psychiatry Research. 2003 May 1; 118(1): 25-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12759158&dopt=Abstract

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Psychological and physiological predictors of response to carbon dioxide challenge in individuals with panic disorder. Author(s): Rassovsky Y, Kushner MG, Schwarze NJ, Wangensteen OD. Source: Journal of Abnormal Psychology. 2000 November; 109(4): 616-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11195985&dopt=Abstract

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QT interval variability in panic disorder patients after isoproterenol infusions. Author(s): Pohl R, K Yeragani V. Source: The International Journal of Neuropsychopharmacology / Official Scientific Journal of the Collegium Internationale Neuropsychopharmacologicum (Cinp). 2001 March; 4(1): 17-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11343625&dopt=Abstract

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Quality of life and cost factors in panic disorder. Author(s): Davidson JR. Source: Bulletin of the Menninger Clinic. 1996 Spring; 60(2 Suppl A): A5-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8857424&dopt=Abstract

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Quality of life and panic-related work disability in subjects with infrequent panic and panic disorder. Author(s): Katerndahl DA, Realini JP. Source: The Journal of Clinical Psychiatry. 1997 April; 58(4): 153-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9164425&dopt=Abstract

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Quality of life and psychiatric morbidity in panic disorder and generalized anxiety disorder. Author(s): Massion AO, Warshaw MG, Keller MB. Source: The American Journal of Psychiatry. 1993 April; 150(4): 600-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8465877&dopt=Abstract

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Quality of life in patients with panic disorder. Author(s): Candilis PJ, McLean RY, Otto MW, Manfro GG, Worthington JJ 3rd, Penava SJ, Marzol PC, Pollack MH. Source: The Journal of Nervous and Mental Disease. 1999 July; 187(7): 429-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10426463&dopt=Abstract

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Quality of life in social anxiety disorder compared with panic disorder and the general population. Author(s): Simon NM, Otto MW, Korbly NB, Peters PM, Nicolaou DC, Pollack MH. Source: Psychiatric Services (Washington, D.C.). 2002 June; 53(6): 714-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12045308&dopt=Abstract

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Quality of well being in panic disorder: the assessment of psychiatric and general disability. Author(s): Rubin HC, Rapaport MH, Levine B, Gladsjo JK, Rabin A, Auerbach M, Judd LL, Kaplan R. Source: Journal of Affective Disorders. 2000 January-March; 57(1-3): 217-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10708834&dopt=Abstract

Studies

87

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Quantitative EEG correlates of panic disorder. Author(s): Knott VJ, Bakish D, Lusk S, Barkely J, Perugini M. Source: Psychiatry Research. 1996 November 25; 68(1): 31-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9027931&dopt=Abstract

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Quantitative electroencephalographic effects of caffeine in panic disorder. Author(s): Newman F, Stein MB, Trettau JR, Coppola R, Uhde TW. Source: Psychiatry Research. 1992 August; 45(2): 105-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1488468&dopt=Abstract

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rCBF differences between panic disorder patients and control subjects during anticipatory anxiety and rest. Author(s): Boshuisen ML, Ter Horst GJ, Paans AM, Reinders AA, den Boer JA. Source: Biological Psychiatry. 2002 July 15; 52(2): 126-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12114004&dopt=Abstract

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Reduced levels of creatine in the right medial temporal lobe region of panic disorder patients detected with (1)H magnetic resonance spectroscopy. Author(s): Massana G, Gasto C, Junque C, Mercader JM, Gomez B, Massana J, Torres X, Salamero M. Source: Neuroimage. 2002 July; 16(3 Pt 1): 836-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12169267&dopt=Abstract

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Relationship between perfectionism, personality disorders and agoraphobia in patients with panic disorder. Author(s): Iketani T, Kiriike N, Stein MB, Nagao K, Nagata T, Minamikawa N, Shidao A, Fukuhara H. Source: Acta Psychiatrica Scandinavica. 2002 September; 106(3): 171-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12197853&dopt=Abstract

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Relationship between separation anxiety disorder, parental panic disorder, and atopic disorders in children: a controlled high-risk study. Author(s): Slattery MJ, Klein DF, Mannuzza S, Moulton JL 3rd, Pine DS, Klein RG. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2002 August; 41(8): 947-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12162630&dopt=Abstract

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Residual symptoms and comorbidity in panic disorder. Author(s): Corominas A, Guerrero T, Vallejo J. Source: European Psychiatry : the Journal of the Association of European Psychiatrists. 2002 November; 17(7): 399-406. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12547306&dopt=Abstract

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Respiratory panic disorder subtype and sensitivity to the carbon dioxide challenge test. Author(s): Valenca AM, Nardi AE, Nascimento I, Zin WA, Versiani M. Source: Brazilian Journal of Medical and Biological Research = Revista Brasileira De Pesquisas Medicas E Biologicas / Sociedade Brasileira De Biofisica. [et Al.]. 2002 July; 35(7): 783-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12131917&dopt=Abstract

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Response of patients with panic disorder and symptoms of hypomania to cognitive behavior therapy for panic. Author(s): Bowen RC, D'Arcy C. Source: Bipolar Disorders. 2003 April; 5(2): 144-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12680905&dopt=Abstract

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Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder. Author(s): Tarlo SM, Poonai N, Binkley K, Antony MM, Swinson RP. Source: Environmental Health Perspectives. 2002 August; 110 Suppl 4: 669-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12194904&dopt=Abstract

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Review of the long-term effectiveness of cognitive behavioral therapy compared to medications in panic disorder. Author(s): Nadiga DN, Hensley PL, Uhlenhuth EH. Source: Depression and Anxiety. 2003; 17(2): 58-64. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12621593&dopt=Abstract

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Role of elastin polymorphisms in panic disorder. Author(s): Philibert RA, Nelson JJ, Bedell B, Goedken R, Sandhu HK, Noyes R Jr, Crowe RR. Source: American Journal of Medical Genetics. 2003 Feb15; 117B(1): 7-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12555228&dopt=Abstract

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Selective attention for hyperventilatory sensations in panic disorder. Author(s): Kroeze S, van Den Hout MA. Source: Journal of Anxiety Disorders. 2000 November-December; 14(6): 563-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11918092&dopt=Abstract

Studies

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Selective serotonin reuptake inhibitors in the treatment of panic disorder and agoraphobia. Author(s): Bakker A, van Balkom AJ, van Dyck R. Source: International Clinical Psychopharmacology. 2000 August; 15 Suppl 2: S25-30. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11110016&dopt=Abstract

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Serotonergic modulation of the balance system in panic disorder: an open study. Author(s): Perna G, Alpini D, Caldirola D, Raponi G, Cesarani A, Bellodi L. Source: Depression and Anxiety. 2003; 17(2): 101-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12621600&dopt=Abstract

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Sertraline treatment of panic disorder: response in patients at risk for poor outcome. Author(s): Pollack MH, Rapaport MH, Clary CM, Mardekian J, Wolkow R. Source: The Journal of Clinical Psychiatry. 2000 December; 61(12): 922-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11206597&dopt=Abstract

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Sertraline versus imipramine treatment of comorbid panic disorder and major depressive disorder. Author(s): Lepola U, Arato M, Zhu Y, Austin C. Source: The Journal of Clinical Psychiatry. 2003 June; 64(6): 654-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12823079&dopt=Abstract

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Smoking modulates neuroendocrine responses to ipsapirone in patients with panic disorder. Author(s): Broocks A, Bandelow B, Koch K, Bartmann U, Kinkelbur J, Schweiger U, Hohagen F, Hajak G. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 2002 August; 27(2): 270-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12093600&dopt=Abstract

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Specificity of panic response to CO(2) inhalation in panic disorder: a comparison with major depression and premenstrual dysphoric disorder. Author(s): Kent JM, Papp LA, Martinez JM, Browne ST, Coplan JD, Klein DF, Gorman JM. Source: The American Journal of Psychiatry. 2001 January; 158(1): 58-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11136634&dopt=Abstract

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SSRIs vs. TCAs in the treatment of panic disorder: a meta-analysis. Author(s): Bakker A, van Balkom AJ, Spinhoven P. Source: Acta Psychiatrica Scandinavica. 2002 September; 106(3): 163-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12197851&dopt=Abstract

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Sympathetic and cardiac baroreflex function in panic disorder. Author(s): Lambert EA, Thompson J, Schlaich M, Laude D, Elghozi JL, Esler MD, Lambert GW. Source: Journal of Hypertension. 2002 December; 20(12): 2445-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12473870&dopt=Abstract

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Syndrome profiles in alcoholism and panic disorder with or without agoraphobia: an explorative family study. Author(s): Davids E, Muller MJ, Rollmann N, Burkart M, Regier-Klein E, Szegedi A, Benkert O, Maier W. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2002 October; 26(6): 1079-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12452529&dopt=Abstract

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The amygdala, panic disorder, and cardiovascular responses. Author(s): Shekhar A, Sajdyk TJ, Gehlert DR, Rainnie DG. Source: Annals of the New York Academy of Sciences. 2003 April; 985: 308-25. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12724167&dopt=Abstract

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The effect of pharmacotherapist characteristics on treatment outcome in panic disorder. Author(s): Gorman JM, Martinez JM, Goetz R, Huppert JD, Ray S, Barlow DH, Shear MK, Woods SW. Source: Depression and Anxiety. 2003; 17(2): 88-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12621597&dopt=Abstract

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The efficacy of sertraline in panic disorder: combined results from two fixed-dose studies. Author(s): Sheikh JI, Londborg P, Clary CM, Fayyad R. Source: International Clinical Psychopharmacology. 2000 November; 15(6): 335-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11110009&dopt=Abstract

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The impact of smoking on panic disorder: an initial investigation of a pathoplastic relationship. Author(s): Zvolensky MJ, Schmidt NB, McCreary BT. Source: Journal of Anxiety Disorders. 2003; 17(4): 447-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12826091&dopt=Abstract

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The lactic acid response to alkalosis in panic disorder : an integrative review. Author(s): Maddock RJ. Source: The Journal of Neuropsychiatry and Clinical Neurosciences. 2001 Winter; 13(1): 22-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11207326&dopt=Abstract

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The long-term course of panic disorder--an 11 year follow-up. Author(s): Swoboda H, Amering M, Windhaber J, Katschnig H. Source: Journal of Anxiety Disorders. 2003; 17(2): 223-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12614664&dopt=Abstract

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The relationship between agoraphobia symptoms and panic disorder in a non-clinical sample of adolescents. Author(s): Hayward C, Killen JD, Taylor CB. Source: Psychological Medicine. 2003 May; 33(4): 733-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785475&dopt=Abstract

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Therapeutic response to benzodiazepine in panic disorder subtypes. Author(s): Valenca AM, Nardi AE, Mezzasalma MA, Nascimento I, Zin WA, Lopes FL, Versiani M. Source: Sao Paulo Medical Journal = Revista Paulista De Medicina. 2003 March 5; 121(2): 77-80. Epub 2003 July 14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12870055&dopt=Abstract

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Transcriptional activities of cholecystokinin promoter haplotypes and their relevance to panic disorder susceptibility. Author(s): Ebihara M, Ohba H, Hattori E, Yamada K, Yoshikawa T. Source: American Journal of Medical Genetics. 2003 April 1; 118B(1): 32-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12627463&dopt=Abstract

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Treatment of mitral valve prolapse and panic disorder with metoprolol. Author(s): Zwanzger P, Baghai T, Schule C, Rupprecht R. Source: World J Biol Psychiatry. 2000 April; 1(2): 124-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12607209&dopt=Abstract

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Unconscious pregnancy fantasies as an underlying dynamism in panic disorder. Author(s): Milrod B. Source: J Am Psychoanal Assoc. 1998; 46(3): 673-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9795887&dopt=Abstract

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Uncoupling of the noradrenergic-hypothalamic-pituitary-adrenal axis in panic disorder patients. Author(s): Coplan JD, Pine D, Papp L, Martinez J, Cooper T, Rosenblum LA, Gorman JM. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 1995 August; 13(1): 65-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8526972&dopt=Abstract

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Undertreatment of panic disorder in primary care: role of patient and physician characteristics. Author(s): Roy-Byrne P, Russo J, Dugdale DC, Lessler D, Cowley D, Katon W. Source: The Journal of the American Board of Family Practice / American Board of Family Practice. 2002 November-December; 15(6): 443-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12463289&dopt=Abstract

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Unemployment and emergency room visits predict poor treatment outcome in primary care panic disorder. Author(s): Roy-Byrne PP, Russo J, Cowley DS, Katon WJ. Source: The Journal of Clinical Psychiatry. 2003 April; 64(4): 383-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12716237&dopt=Abstract

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Unexplained chest pain: when is it panic disorder? Author(s): Fleet RP, Beitman BD. Source: Clin Cardiol. 1997 March; 20(3): 187-94. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9068902&dopt=Abstract

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Unrecognized paroxysmal supraventricular tachycardia. Potential for misdiagnosis as panic disorder. Author(s): Lessmeier TJ, Gamperling D, Johnson-Liddon V, Fromm BS, Steinman RT, Meissner MD, Lehmann MH. Source: Archives of Internal Medicine. 1997 March 10; 157(5): 537-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9066458&dopt=Abstract

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Urinary excretion of cortisol, norepinephrine, testosterone, and melatonin in panic disorder. Author(s): Bandelow B, Sengos G, Wedekind D, Huether G, Pilz J, Broocks A, Hajak G, Ruther E. Source: Pharmacopsychiatry. 1997 July; 30(4): 113-7. Erratum In: Pharmacopsychiatry 1997 November; 30(6): 278. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9271775&dopt=Abstract

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Use of benzodiazepines in panic disorder. Author(s): Davidson JR. Source: The Journal of Clinical Psychiatry. 1997; 58 Suppl 2: 26-8; Discussion 29-31. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9078991&dopt=Abstract

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Use of low-dose fluoxetine in major depression and panic disorder. Author(s): Louie AK, Lewis TB, Lannon RA. Source: The Journal of Clinical Psychiatry. 1993 November; 54(11): 435-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8270588&dopt=Abstract

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Use of selective serotonin reuptake inhibitors for the treatment of childhood panic disorder: a pilot study. Author(s): Renaud J, Birmaher B, Wassick SC, Bridge J. Source: Journal of Child and Adolescent Psychopharmacology. 1999; 9(2): 73-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10461817&dopt=Abstract

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Vagal attenuation in panic disorder: an assessment of parasympathetic nervous system function and subjective reactivity to respiratory manipulations. Author(s): Asmundson GJ, Stein MB. Source: Psychosomatic Medicine. 1994 May-June; 56(3): 187-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8084962&dopt=Abstract

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Valproate treatment of comorbid panic disorder and affective disorders in two alcoholic patients. Author(s): Brady KT, Sonne S, Lydiard RB. Source: Journal of Clinical Psychopharmacology. 1994 February; 14(1): 81-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8151011&dopt=Abstract

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Valproate treatment of panic disorder and lactate-induced panic attacks. Author(s): Keck PE Jr, Taylor VE, Tugrul KC, McElroy SL, Bennett JA. Source: Biological Psychiatry. 1993 April 1; 33(7): 542-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8513040&dopt=Abstract

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Valproic acid for panic disorder associated with multiple sclerosis. Author(s): Marazziti D, Cassano GB. Source: The American Journal of Psychiatry. 1996 June; 153(6): 842-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8633710&dopt=Abstract

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Venlafaxine for panic disorder: results from a double-blind, placebo-controlled study. Author(s): Pollack MH, Worthington JJ 3rd, Otto MW, Maki KM, Smoller JW, Manfro GG, Rudolph R, Rosenbaum JF. Source: Psychopharmacology Bulletin. 1996; 32(4): 667-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8993089&dopt=Abstract

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Venlafaxine treatment of panic disorder: a case series. Author(s): Geracioti TD Jr. Source: The Journal of Clinical Psychiatry. 1995 September; 56(9): 408-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7665539&dopt=Abstract

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Ventilatory effects of tryptophan depletion in panic disorder: a preliminary report. Author(s): Kent JM, Coplan JD, Martinez J, Karmally W, Papp LA, Gorman JM. Source: Psychiatry Research. 1996 September 27; 64(2): 83-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8912949&dopt=Abstract

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Visuo-spatial attention processes in panic disorder with agoraphobia: a pilot study using a visual target discrimination task. Author(s): Dupont H, Mollard E, Cottraux J. Source: European Psychiatry : the Journal of the Association of European Psychiatrists. 2000 June; 15(4): 254-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10951609&dopt=Abstract

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Voluntary breath holding: not a suitable probe of the suffocation alarm in panic disorder. Author(s): Willem Van der Does AJ. Source: Behaviour Research and Therapy. 1997 August; 35(8): 779-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9256521&dopt=Abstract

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What are effective treatments for panic disorder? Author(s): Weissman AM. Source: The Journal of Family Practice. 2002 September; 51(9): 743. Erratum In: J Fam Pract 2002 October; 51(10): 831. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12366889&dopt=Abstract

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What to do when SSRIs fail: eight strategies for optimizing treatment of panic disorder. Author(s): Zamorski MA, Albucher RC. Source: American Family Physician. 2002 October 15; 66(8): 1477-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12408422&dopt=Abstract

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What treatments do patients with panic disorder and agoraphobia get? Author(s): Bandelow B, Sievert K, Rothemeyer M, Hajak G, Ruther E. Source: European Archives of Psychiatry and Clinical Neuroscience. 1995; 245(3): 165-71. Erratum In: Eur Arch Psychiatry Clin Neurosci 1995; 246(1): 62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7669824&dopt=Abstract

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Why Van der Does, Van Dyck and Spinhoven (1997) did not demonstrate that superior heartbeat perception in panic disorder is partly an artefact. Author(s): Ehlers A. Source: Journal of Affective Disorders. 1998 June; 49(3): 241-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9629955&dopt=Abstract

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CHAPTER 2. NUTRITION AND PANIC DISORDER Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and panic disorder.

Finding Nutrition Studies on Panic Disorder The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “panic disorder” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “panic disorder” (or a synonym): •

A risk-benefit assessment of pharmacological treatments for panic disorder. Author(s): Department of Psychiatry, University of Cincinnati College of Medicine, Ohio, USA. Source: Bennett, J A Moioffer, M Stanton, S P Dwight, M Keck, P E Drug-Saf. 1998 June; 18(6): 419-30 0114-5916

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Acute inositol does not attenuate m-CPP-induced anxiety, mydriasis and endocrine effects in panic disorder. Author(s): Soroka Medical Center, Kupat Holim Sick Fund, Ben Gurion University of the Negev, Beer-sheba, Israel. Source: Benjamin, J Nemetz, H Fux, M Bleichman, I Agam, G J-Psychiatr-Res. 1997 JulAugust; 31(4): 489-95 0022-3956

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Behavioral, neuroendocrine and biochemical effects of different doses of 5-HTP in panic disorder. Author(s): Department of Psychiatry, Academic Hospital Utrecht, The Netherlands. Source: van Vliet, I M Slaap, B R Westenberg, H G Den Boer, J A EurNeuropsychopharmacol. 1996 May; 6(2): 103-10 0924-977X

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Catechol O-methyltransferase genetic polymorphism in panic disorder. Author(s): Department of Neuropsychiatry, Seoul Paik Hospital, Inje University, Seoul, Korea. Source: Woo, J M Yoon, K S Yu, B H Am-J-Psychiatry. 2002 October; 159(10): 1785-7 0002-953X

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Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. Author(s): Ministry of Health Mental Health Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheba, Israel. Source: Palatnik, A Frolov, K Fux, M Benjamin, J J-Clin-Psychopharmacol. 2001 June; 21(3): 335-9 0271-0749

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Effects of tryptophan depletion on carbon dioxide provoked panic in panic disorder patients. Author(s): Department of Psychiatry & Neuropsychology, Maastricht University, P. O. Box 88, 6200 AB, Maastricht, The Netherlands. [email protected] Source: Schruers, K Klaassen, T Pols, H Overbeek, T Deutz, N E Griez, E Psychiatry-Res. 2000 April 10; 93(3): 179-87 0165-1781

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Efficacy of divalproex sodium in patients with panic disorder and mood instability who have not responded to conventional therapy. Author(s): Department of Psychiatry, University of Saskatchewan, Saskatoon. Source: Baetz, M Bowen, R C Can-J-Psychiatry. 1998 February; 43(1): 73-7 0706-7437

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Elevated serum lactate following hyperventilation during glucose infusion in panic disorder. Author(s): Department of Psychiatry, University of California Davis School of Medicine. Source: Maddock, R J Mateo Bermudez, J Biol-Psychiatry. 1990 February 15; 27(4): 411-8 0006-3223

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Endocrine, cardiovascular, and behavioral effects of intravenous protirelin in patients with panic disorder. Author(s): Section on Anxiety and Affective Disorders, National Institute of Mental Health, Bethesda, Md 20892.

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Source: Stein, M B Uhde, T W Arch-Gen-Psychiatry. 1991 February; 48(2): 148-56 0003990X •

Enhanced sensitivity to cholecystokinin tetrapeptide in panic disorder. Clinical and behavioral findings. Author(s): Psychopharmacology Division, St Mary's Hospital Center, Montreal, Quebec, Canada. Source: Bradwejn, J Koszycki, D Shriqui, C Arch-Gen-Psychiatry. 1991 July; 48(7): 603-10 0003-990X

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Evidence for a susceptibility locus for panic disorder near the catechol-Omethyltransferase gene on chromosome 22. Author(s): Department of Psychiatry, College of Physicians and Surgeons at Columbia University, New York, NY, USA. Source: Hamilton, Steven P Slager, Susan L Heiman, Gary A Deng, Zemin Haghighi, Fatemeh Klein, Donald F Hodge, Susan E Weissman, Myrna M Fyer, Abby J Knowles, James A Biol-Psychiatry. 2002 April 1; 51(7): 591-601 0006-3223

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Exogenous factors in panic disorder: clinical and research implications. Author(s): Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle 98195. Source: Roy Byrne, P P Uhde, T W J-Clin-Psychiatry. 1988 February; 49(2): 56-61 01606689

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Four cases of panic disorder successfully treated with Kampo (Japanese herbal) medicines: Kami-shoyo-san and Hange-koboku-to. Author(s): Department of Japanese Oriental (Kampo) Medicine, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Sugitani, Toyama, Japan. [email protected] Source: Mantani, N Hisanaga, A Kogure, T Kita, T Shimada, Y Terasawa, K PsychiatryClin-Neurosci. 2002 December; 56(6): 617-20 1323-1316

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Growth hormone response to apomorphine in panic disorder: comparison with major depression and normal controls. Author(s): Psychiatric Unit, University Hospital of Liege, Belgium. Source: Pichot, W Hansenne, M Gonzalez Moreno, A Ansseau, M Eur-Arch-PsychiatryClin-Neurosci. 1995; 245(6): 306-8 0940-1334

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Induced panic attacks shift gamma-aminobutyric acid type A receptor modulatory neuroactive steroid composition in patients with panic disorder: preliminary results. Author(s): Max Planck Institute of Psychiatry, Munich, Germany. [email protected] Source: Strohle, A Romeo, E di Michele, F Pasini, A Hermann, B Gajewsky, G Holsboer, F Rupprecht, R Arch-Gen-Psychiatry. 2003 February; 60(2): 161-8 0003-990X

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L-5-hydroxytryptophan induced increase in salivary cortisol in panic disorder patients and healthy volunteers. Author(s): Department of Psychiatry, Institute of Brain and Behaviour, Maastricht University, P.O. Box 88, 6200 AB Maastricht The Netherlands, [email protected] Source: Schruers, K van Diest, R Nicolson, N Griez, E Psychopharmacology-(Berl). 2002 June; 161(4): 365-9 0033-3158

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Neurobiology of panic disorder. Author(s): GIS Medicament, Groupe de Recherche Neurobiologie de l'anxiete ER 302, Faculte de Medecine, Nantes, France.

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Source: Bourin, M Baker, G B Bradwejn, J J-Psychosom-Res. 1998 January; 44(1): 163-80 0022-3999 •

Oral contraceptives and panic disorder. Author(s): Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston 29425. Source: Deci, P A Lydiard, R B Santos, A B Arana, G W J-Clin-Psychiatry. 1992 May; 53(5): 163-5 0160-6689

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Panic disorder and social phobia: current treatments and new strategies. Author(s): Department of Psychiatry and Behavioral Services, Duke University Medical Center, Durham, North Carolina 27710, USA. Source: Davidson, J R Connor, K M Sutherland, S M Cleve-Clin-J-Med. 1998; 65 Suppl 1: SI39-44; discussion SI45-7 0891-1150

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Plasma MHPG levels in lactate and isoproterenol anxiety states. Author(s): Lafayette Clinic, Detroit, MI 48207. Source: Pohl, R Ettedgui, E Bridges, M Lycaki, H Jimerson, D Kopin, I Rainey, J M BiolPsychiatry. 1987 September; 22(9): 1127-36 0006-3223

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Platelet alpha-2-receptor binding and adenylate cyclase activity in panic disorder. Author(s): Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06508. Source: Charney, D S Innis, R B Duman, R S Woods, S W Heninger, G R Psychopharmacology-(Berl). 1989; 98(1): 102-7 0033-3158

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Provocative agents in panic disorder. Author(s): GIS Medicament, Department of Pharmacology, Faculty of Medicine, B.P., Nantes, France. Source: Bourin, M Malinge, M Guitton, B Therapie. 1995 Jul-August; 50(4): 301-6 00405957

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rCBF differences between panic disorder patients and control subjects during anticipatory anxiety and rest. Author(s): Department of Psychiatry, Division of Biological Psychiatry, Graduate School of Behavioral and Cognitive Neurosciences, Groningen University Hospital, The Netherlands. Source: Boshuisen, M L Ter Horst, G J Paans, A M Reinders, A A den Boer, J A BiolPsychiatry. 2002 July 15; 52(2): 126-35 0006-3223

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Replication of action of cholecystokinin tetrapeptide in panic disorder: clinical and behavioral findings. Author(s): Division of Psychopharmacology, St. Mary's Hospital Center, Montreal, PQ, Canada. Source: Bradwejn, J Koszycki, D Payeur, R Bourin, M Borthwick, H Am-J-Psychiatry. 1992 July; 149(7): 962-4 0002-953X

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Role of the basolateral amygdala in panic disorder. Author(s): Department of Psychiatry, Indiana University Medical Center, Indianapolis 46202, USA. [email protected] Source: Shekhar, A Sajdyk, T S Keim, S R Yoder, K K Sanders, S K Ann-N-Y-Acad-Sci. 1999 June 29; 877747-50 0077-8923

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Smoking modulates neuroendocrine responses to ipsapirone in patients with panic disorder. Author(s): Department of Psychiatry and Psychotherapy, University of Lubeck, 23538 Lubeck, Germany. [email protected]

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Source: Broocks, A Bandelow, B Koch, K Bartmann, U Kinkelbur, J Schweiger, U Hohagen, F Hajak, G Neuropsychopharmacology. 2002 August; 27(2): 270-8 0893-133X •

Sodium valproate and clonazepam for treatment-resistant panic disorder. Author(s): University Hospital, Monterrey, Mexico. Source: Ontiveros, A Fontaine, R J-Psychiatry-Neurosci. 1992 June; 17(2): 78-80 11804882

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Somatic sensations, anxiety, and control in panic disorder. Author(s): Department of Psychology, University of Illinois, Champaign 61820. Source: Salzer, M S Berenbaum, H J-Behav-Ther-Exp-Psychiatry. 1994 March; 25(1): 7580 0005-7916

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Stimulation response to corticotropin-releasing hormone (CRH) in patients with depression, alcoholism and panic disorder. Author(s): Psychiatrische Universitatsklinik, Universitat Mainz, Germany. Source: Holsboer, F von Bardeleben, U Buller, R Heuser, I Steiger, A Horm-Metab-ResSuppl. 1987; 1680-8 0170-5903

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The ACTH (4-9) analog ORG 2766 in panic disorder: a preliminary study. Source: den Boer, J A Westenberg, H G Mastenbroek, B van Ree, J M PsychopharmacolBull. 1989; 25(2): 204-8 0048-5764

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Valproic acid and panic disorder. Author(s): Royal Victoria Hospital, Montreal, Quebec. Source: Primeau, F Fontaine, R Beauclair, L Can-J-Psychiatry. 1990 April; 35(3): 248-50 0706-7437

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What treatments do patients with panic disorder and agoraphobia get? Author(s): Department of Psychiatry, University of Gottingen, Germany. Source: Bandelow, B Sievert, K Rothemeyer, M Hajak, G Ruther, E Eur-Arch-PsychiatryClin-Neurosci. 1995; 245(3): 165-71 0940-1334

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

The following is a specific Web list relating to panic disorder; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

Minerals Magnesium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,890,00.html

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CHAPTER 3. DISORDER

ALTERNATIVE

MEDICINE

AND

PANIC

Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to panic disorder. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to panic disorder and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “panic disorder” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to panic disorder: •

A 28-year-old woman with panic disorder, 1 year later. Author(s): Burns RB, Hartman EE. Source: Jama : the Journal of the American Medical Association. 2002 July 24-31; 288(4): 494. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12132981&dopt=Abstract

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A 28-year-old woman with panic disorder. Author(s): Gorman JM. Source: Jama : the Journal of the American Medical Association. 2001 July 25; 286(4): 450-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11466124&dopt=Abstract

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A case of panic disorder treated with breathing retraining. Author(s): Rapee RM. Source: Journal of Behavior Therapy and Experimental Psychiatry. 1985 March; 16(1): 63-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3998176&dopt=Abstract

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A clinical study of autogenic training-based behavioral treatment for panic disorder. Author(s): Sakai M. Source: Fukuoka Igaku Zasshi. 1996 March; 87(3): 77-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8727357&dopt=Abstract

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A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder. Author(s): Clark DM, Salkovskis PM, Hackmann A, Middleton H, Anastasiades P, Gelder M. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1994 June; 164(6): 759-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7952982&dopt=Abstract

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A controlled comparison of relaxation and diazepam in panic disorder. Author(s): Taylor CB, Kenigsberg ML, Robinson JM. Source: The Journal of Clinical Psychiatry. 1982 October; 43(10): 423-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6749827&dopt=Abstract

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A preliminary investigation of cognitive and relaxation treatment of panic disorder: effects on intense anxiety vs 'background' anxiety. Author(s): Waddell MT, Barlow DH, O'Brien GT. Source: Behaviour Research and Therapy. 1984; 22(4): 393-402. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6383332&dopt=Abstract

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Agoraphobia and panic disorder: 3.5 years after alprazolam and/or exposure treatment. Author(s): Kilic C, Noshirvani H, Basoglu M, Marks I. Source: Psychotherapy and Psychosomatics. 1997; 66(4): 175-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9259039&dopt=Abstract

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Alprazolam reduces response to loud tones in panic disorder but not in posttraumatic stress disorder. Author(s): Shalev AY, Bloch M, Peri T, Bonne O. Source: Biological Psychiatry. 1998 July 1; 44(1): 64-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9646885&dopt=Abstract

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An integrated approach to the treatment of panic disorder. Author(s): Roberts R. Source: American Journal of Psychotherapy. 1984 July; 38(3): 413-30. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6385736&dopt=Abstract

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Applied relaxation vs cognitive behavior therapy in the treatment of panic disorder. Author(s): Ost LG, Westling BE. Source: Behaviour Research and Therapy. 1995 February; 33(2): 145-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7887873&dopt=Abstract

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Applied relaxation vs progressive relaxation in the treatment of panic disorder. Author(s): Ost LG. Source: Behaviour Research and Therapy. 1988; 26(1): 13-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3277613&dopt=Abstract

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Applied relaxation, exposure in vivo and cognitive methods in the treatment of panic disorder with agoraphobia. Author(s): Ost LG, Westling BE, Hellstrom K. Source: Behaviour Research and Therapy. 1993 May; 31(4): 383-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8099789&dopt=Abstract

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Asystole during trigger point injections in a patient with panic disorder. Author(s): Spevak C. Source: Reg Anesth. 1997 November-December; 22(6): 583. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9425979&dopt=Abstract

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Autonomic instability during relaxation in panic disorder. Author(s): Roth WT, Wilhelm FH, Trabert W. Source: Psychiatry Research. 1998 August 17; 80(2): 155-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9754695&dopt=Abstract

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Behavioral, cognitive, and pharmacological treatments of panic disorder with agoraphobia: critique and synthesis. Author(s): Michelson LK, Marchione K. Source: Journal of Consulting and Clinical Psychology. 1991 February; 59(1): 100-14. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2002125&dopt=Abstract

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Benzodiazepine receptor uptake in a patient with panic disorder after citalopram treatment. Author(s): Tiihonen J, Lepola U, Kuikka J.

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Source: Neuropsychiatry, Neuropsychology, and Behavioral Neurology. 1997 October; 10(4): 260-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9359124&dopt=Abstract •

Biological correlates of panic disorder with agoraphobia: practice perspectives for nurses. Author(s): Laraia MT. Source: Archives of Psychiatric Nursing. 1991 December; 5(6): 373-81. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1759863&dopt=Abstract

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Brainstem evoked potentials in panic disorder. Author(s): Knott VJ, Bakish D, Barkley J. Source: Journal of Psychiatry & Neuroscience : Jpn. 1994 July; 19(4): 301-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7918353&dopt=Abstract

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Breathing training for treating panic disorder. Useful intervention or impediment? Author(s): Meuret AE, Wilhelm FH, Ritz T, Roth WT. Source: Behavior Modification. 2003 October; 27(5): 731-54. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14531164&dopt=Abstract

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Cerebral glucose metabolic differences in patients with panic disorder. Author(s): Nordahl TE, Semple WE, Gross M, Mellman TA, Stein MB, Goyer P, King AC, Uhde TW, Cohen RM. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 1990 August; 3(4): 261-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2400544&dopt=Abstract

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Cognitive behavioral treatment compared with nonprescriptive treatment of panic disorder. Author(s): Shear MK, Pilkonis PA, Cloitre M, Leon AC. Source: Archives of General Psychiatry. 1994 May; 51(5): 395-401. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8179463&dopt=Abstract

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Cognitive-behavioral approaches to panic disorder and social phobia. Author(s): Barlow DH. Source: Bulletin of the Menninger Clinic. 1992 Spring; 56(2 Suppl A): A14-28. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1623337&dopt=Abstract

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Comparison between two models of experimental anxiety in healthy volunteers and panic disorder patients. Author(s): Graeff FG, Silva M, Del Ben CM, Zuardi AW, Hetem LA, Guimaraes FS.


Source: Neuroscience and Biobehavioral Reviews. 2001 December; 25(7-8): 753-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11801299&dopt=Abstract •

Comparison of cognitive therapy and relaxation training for panic disorder. Author(s): Beck JG, Stanley MA, Baldwin LE, Deagle EA 3rd, Averill PM. Source: Journal of Consulting and Clinical Psychology. 1994 August; 62(4): 818-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7962886&dopt=Abstract

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Does preference for type of treatment matter? A study of exposure in vivo with or without hypnosis in the treatment of panic disorder with agoraphobia. Author(s): Van Dyck R, Spinhoven P. Source: Behavior Modification. 1997 April; 21(2): 172-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9086865&dopt=Abstract

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Drug treatment of panic disorder. Reply to comment by Marks and associates. Author(s): Klerman GL. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1992 October; 161: 465-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1309180&dopt=Abstract

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EMDR for panic disorder with agoraphobia: comparison with waiting list and credible attention-placebo control conditions. Author(s): Goldstein AJ, de Beurs E, Chambless DL, Wilson KA. Source: Journal of Consulting and Clinical Psychology. 2000 December; 68(6): 947-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11142547&dopt=Abstract

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Eye movement desensitization and reprocessing treatment for panic disorder: a controlled outcome and partial dismantling study. Author(s): Feske U, Goldstein AJ. Source: Journal of Consulting and Clinical Psychology. 1997 December; 65(6): 1026-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9420364&dopt=Abstract

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Four cases of panic disorder successfully treated with Kampo (Japanese herbal) medicines: Kami-shoyo-san and Hange-koboku-to. Author(s): Mantani N, Hisanaga A, Kogure T, Kita T, Shimada Y, Terasawa K. Source: Psychiatry and Clinical Neurosciences. 2002 December; 56(6): 617-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12485303&dopt=Abstract

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Hyperventilation and panic disorder. Author(s): Cowley DS, Roy-Byrne PP.

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Source: The American Journal of Medicine. 1987 November; 83(5): 929-37. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2890301&dopt=Abstract •

Hyperventilation syndrome or panic disorder--what's in the name? Author(s): Marshall JR. Source: Hosp Pract (Off Ed). 1987 October 15; 22(10): 105-8, 111-2, 117-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3116008&dopt=Abstract

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Immune cell imbalance in major depressive and panic disorders. Author(s): Marazziti D, Ambrogi F, Vanacore R, Mignani V, Savino M, Palego L, Cassano GB, Akiskal HS. Source: Neuropsychobiology. 1992; 26(1-2): 23-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1282223&dopt=Abstract

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Immunity, major depression, and panic disorder comorbidity. Author(s): Andreoli A, Keller SE, Rabaeus M, Zaugg L, Garrone G, Taban C. Source: Biological Psychiatry. 1992 May 1; 31(9): 896-908. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1637930&dopt=Abstract

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Inpatient treatment of complicated agoraphobia and panic disorder. Author(s): Pollard CA, Obermeier HJ, Cox GL. Source: Hosp Community Psychiatry. 1987 September; 38(9): 951-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2890565&dopt=Abstract

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Instructional set does not alter outcome of respiratory challenges in panic disorder. Author(s): Papp LA, Welkowitz LA, Martinez JM, Klein DF, Browne S, Gorman JM. Source: Biological Psychiatry. 1995 December 15; 38(12): 826-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8750042&dopt=Abstract

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Interoceptive exposure versus breathing retraining within cognitive-behavioural therapy for panic disorder with agoraphobia. Author(s): Craske MG, Rowe M, Lewin M, Noriega-Dimitri R. Source: The British Journal of Clinical Psychology / the British Psychological Society. 1997 February; 36 ( Pt 1): 85-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9051281&dopt=Abstract

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Laboratory psychophysiological assessment and imagery exposure in panic disorder patients. Author(s): Bystritsky A, Maidenberg E, Craske MG, Vapnik T, Shapiro D.


Source: Depression and Anxiety. 2000; 12(2): 102-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11091934&dopt=Abstract •

Marijuana (cannabis) use is anecdotally said to precipitate anxiety symptoms in patients with panic disorder. Is there any research evidence to support this? Also, can marijuana use precipitate or expose paranoia in patients with an underlying bipolar disorder? Author(s): Seibyl JP, Krystal JH, Charney DS. Source: Journal of Clinical Psychopharmacology. 1990 February; 10(1): 78. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2307743&dopt=Abstract

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Marijuana and panic disorder. Author(s): Deas D, Gerding L, Hazy J. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2000 December; 39(12): 1467. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11128322&dopt=Abstract

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Mirtazapine in the treatment of panic disorder. Author(s): Carli V, Sarchiapone M, Camardese G, Romano L, DeRisio S. Source: Archives of General Psychiatry. 2002 July; 59(7): 661-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12090820&dopt=Abstract

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Natural killer cell activity in patients with panic disorder. Author(s): McDaniel JS, Risby ED, Stipetic M, Jewart RD, Caudle J. Source: Anxiety. 1994-95; 1(4): 192-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9160573&dopt=Abstract

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Panic disorder with agoraphobia. Author(s): Klein DF. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1993 December; 163: 835-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7905776&dopt=Abstract

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Patterns of change during cognitive behavioral treatment for panic disorder. Author(s): Stanley MA, Beck JG, Averill PM, Baldwin LE, Deagle EA 3rd, Stadler JG. Source: The Journal of Nervous and Mental Disease. 1996 September; 184(9): 567-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8831648&dopt=Abstract

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Personality traits among panic disorder with agoraphobia patients before and after symptom-focused treatment. Author(s): Hoffart A, Hedley LM.

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Source: Journal of Anxiety Disorders. 1997 January-February; 11(1): 77-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9131883&dopt=Abstract •

Plasma anti-serotonin and serotonin anti-idiotypic antibodies are elevated in panic disorder. Author(s): Coplan JD, Tamir H, Calaprice D, DeJesus M, de la Nuez M, Pine D, Papp LA, Klein DF, Gorman JM. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 1999 April; 20(4): 386-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10088140&dopt=Abstract

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Prepulse inhibition deficits in patients with panic disorder. Author(s): Ludewig S, Ludewig K, Geyer MA, Hell D, Vollenweider FX. Source: Depression and Anxiety. 2002; 15(2): 55-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11891993&dopt=Abstract

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Priming panic interpretations in children of patients with panic disorder. Author(s): Schneider S, Unnewehr S, Florin I, Margraf J. Source: Journal of Anxiety Disorders. 2002; 16(6): 605-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12405521&dopt=Abstract

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Psychoimmunoendocrine aspects of panic disorder. Author(s): Brambilla F, Bellodi L, Perna G, Battaglia M, Sciuto G, Diaferia G, Petraglia F, Panerai A, Sacerdote P. Source: Neuropsychobiology. 1992; 26(1-2): 12-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1335559&dopt=Abstract

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Psychological and physiological predictors of response to carbon dioxide challenge in individuals with panic disorder. Author(s): Rassovsky Y, Kushner MG, Schwarze NJ, Wangensteen OD. Source: Journal of Abnormal Psychology. 2000 November; 109(4): 616-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11195985&dopt=Abstract

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Psychological treatments of panic disorder without agoraphobia: cognitive therapy versus applied relaxation. Author(s): Arntz A, van den Hout M. Source: Behaviour Research and Therapy. 1996 February; 34(2): 113-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8741719&dopt=Abstract

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Psychophysiological response patterns in panic disorder. Author(s): Hoehn-Saric R, McLeod DR, Zimmerli WD.


Source: Acta Psychiatrica Scandinavica. 1991 January; 83(1): 4-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2011954&dopt=Abstract •

Psychosocial treatment prescriptions for generalized anxiety disorder, panic disorder, and social phobia, 1991-1996. Author(s): Goisman RM, Warshaw MG, Keller MB. Source: The American Journal of Psychiatry. 1999 November; 156(11): 1819-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10553751&dopt=Abstract

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Pulmonary function in panic disorder: evidence against the dyspnea-fear theory. Author(s): Spinhoven P, Onstein EJ, Sterk PJ. Source: Behaviour Research and Therapy. 1995 May; 33(4): 457-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7755534&dopt=Abstract

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Rate of improvement during cognitive-behavioral group treatment for panic disorder. Author(s): Penava SJ, Otto MW, Maki KM, Pollack MH. Source: Behaviour Research and Therapy. 1998 July-August; 36(7-8): 665-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9682523&dopt=Abstract

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Relaxation-induced EEG alterations in panic disorder patients. Author(s): Knott V, Bakish D, Lusk S, Barkely J. Source: Journal of Anxiety Disorders. 1997 July-August; 11(4): 365-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9276782&dopt=Abstract

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Reports of childhood incest by adults with panic disorder or agoraphobia. Author(s): Gogoleski MA, Thyer BA, Waller RJ. Source: Psychological Reports. 1993 August; 73(1): 289-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8367569&dopt=Abstract

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Respiratory biofeedback-assisted therapy in panic disorder. Author(s): Meuret AE, Wilhelm FH, Roth WT. Source: Behavior Modification. 2001 September; 25(4): 584-605. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11530717&dopt=Abstract

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Respiratory training prior to exposure in vivo in the treatment of panic disorder with agoraphobia: efficacy and predictors of outcome. Author(s): de Beurs E, Lange A, van Dyck R, Koele P. Source: The Australian and New Zealand Journal of Psychiatry. 1995 March; 29(1): 10413. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7625959&dopt=Abstract

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Responses to panic induction procedures in subjects with multiple chemical sensitivity/idiopathic environmental intolerance: understanding the relationship with panic disorder. Author(s): Tarlo SM, Poonai N, Binkley K, Antony MM, Swinson RP. Source: Environmental Health Perspectives. 2002 August; 110 Suppl 4: 669-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12194904&dopt=Abstract

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Safety and side-effects of alprazolam. Controlled study in agoraphobia with panic disorder. Author(s): O'Sullivan GH, Noshirvani H, Basoglu M, Marks IM, Swinson R, Kuch K, Kirby M. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1994 July; 165(2): 79-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7802851&dopt=Abstract

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Skin conductance habituation in panic disorder patients. Author(s): Roth WT, Ehlers A, Taylor CB, Margraf J, Agras WS. Source: Biological Psychiatry. 1990 June 1; 27(11): 1231-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2191728&dopt=Abstract

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Testing the suffocation false alarm theory of panic disorder. Author(s): Klein DF. Source: Anxiety. 1994; 1(1): 1-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9160539&dopt=Abstract

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The dichotomy of alexithymia and panic disorder. Author(s): Stuppy WP, Shipko S. Source: Int J Psychosom. 1994; 41(1-4): 30-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7843863&dopt=Abstract

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The efficacy of breathing retraining and the centrality of hyperventilation in panic disorder: a reinterpretation of experimental findings. Author(s): Ley R. Source: Behaviour Research and Therapy. 1991; 29(3): 301-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1883310&dopt=Abstract

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The long-term treatment of panic disorder. Author(s): Davidson JR. Source: The Journal of Clinical Psychiatry. 1998; 59 Suppl 8: 17-21; Discussion 22-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9707158&dopt=Abstract


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The psychoimmunological association of panic disorder and allergic reaction. Author(s): Schmidt-Traub S, Bamler KJ. Source: The British Journal of Clinical Psychology / the British Psychological Society. 1997 February; 36 ( Pt 1): 51-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9051278&dopt=Abstract

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The role of hyperventilation in panic disorder: a response to Ley (1991) Author(s): de Ruiter C, Garssen B, Rijken H, Kraaimaat F. Source: Behaviour Research and Therapy. 1992 November; 30(6): 643-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1417690&dopt=Abstract

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The role of self-directed in vivo exposure in combination with cognitive therapy, relaxation training, or therapist-assisted exposure in the treatment of panic disorder with agoraphobia. Author(s): Murphy MT, Michelson LK, Marchione K, Marchione N, Testa S. Source: Journal of Anxiety Disorders. 1998 March-April; 12(2): 117-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9560175&dopt=Abstract

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Treatment of panic disorder with agoraphobia: comparison of fluvoxamine, placebo, and psychological panic management combined with exposure and of exposure in vivo alone. Author(s): de Beurs E, van Balkom AJ, Lange A, Koele P, van Dyck R. Source: The American Journal of Psychiatry. 1995 May; 152(5): 683-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7726307&dopt=Abstract

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Two cases of panic disorder treated with autogenic training and in vivo exposure without medication. Author(s): Sakai M, Takeichi M. Source: Psychiatry and Clinical Neurosciences. 1996 December; 50(6): 335-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9014233&dopt=Abstract

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Two-year follow-up after a randomised controlled trial of self- and clinicianaccompanied exposure for phobia/panic disorders. Author(s): Park JM, Mataix-Cols D, Marks IM, Ngamthipwatthana T, Marks M, Araya R, Al-Kubaisy T. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2001 June; 178: 543-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11388971&dopt=Abstract

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Vagal innervation techniques in the treatment of panic disorder. Author(s): Sartory G, Olajide D.

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Source: Behaviour Research and Therapy. 1988; 26(5): 431-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3056393&dopt=Abstract •

What treatments do patients with panic disorder and agoraphobia get? Author(s): Bandelow B, Sievert K, Rothemeyer M, Hajak G, Ruther E. Source: European Archives of Psychiatry and Clinical Neuroscience. 1995; 245(3): 165-71. Erratum In: Eur Arch Psychiatry Clin Neurosci 1995; 246(1): 62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7669824&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to panic disorder; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Anxiety Source: Healthnotes, Inc.; www.healthnotes.com Anxiety Source: Integrative Medicine Communications; www.drkoop.com


Anxiety and Panic Attacks Source: Prima Communications, Inc.www.personalhealthzone.com Post Traumatic Stress Disorder Source: Integrative Medicine Communications; www.drkoop.com •

Alternative Therapy Autoregulation Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html

•

Herbs and Supplements Alprazolam Source: Healthnotes, Inc.; www.healthnotes.com Antidepressants Source: Healthnotes, Inc.; www.healthnotes.com AVA Source: Integrative Medicine Communications; www.drkoop.com GABA (Gamma-Amino Butyric Acid) Source: Healthnotes, Inc.; www.healthnotes.com Hyssop Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Inositol Source: Healthnotes, Inc.; www.healthnotes.com Inositol Source: Prima Communications, Inc.www.personalhealthzone.com Kava Kava Alternative names: Piper methysticum, Ava Source: Integrative Medicine Communications; www.drkoop.com Piper Alternative names: Kava; Piper methysticum Forst.f Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Piper Methysticum Source: Integrative Medicine Communications; www.drkoop.com Yohimbe Alternative names: Pausinystalia yohimbe Source: Healthnotes, Inc.; www.healthnotes.com

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General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON PANIC DISORDER Overview In this chapter, we will give you a bibliography on recent dissertations relating to panic disorder. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “panic disorder” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on panic disorder, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Panic Disorder ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to panic disorder. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

A Comparison of Medical Hypnoanalysis and Cognitive Hypnotherapy for Treatment of Agoraphobia, Panic Disorder and Severe Anxiety (hypnotherapy) by Scott, John Atwood, Jr., Edd from Memphis State University, 1991, 152 pages http://wwwlib.umi.com/dissertations/fullcit/9127656

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A Study of Locus of Control and the Effectiveness of Cognitive-behavioral Group Therapy in the Treatment of Persons with Panic Disorder by Mitchell, Christopher Gerard, Dsw from The Catholic University of America, 1997, 135 pages http://wwwlib.umi.com/dissertations/fullcit/9728797

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Cognitive Treatment of Panic Disorder: a Test of Outcome, Process, and Theory by Sokol, Leslie Ellen, PhD from University of Pennsylvania, 1989, 87 pages http://wwwlib.umi.com/dissertations/fullcit/8922611

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Cognitive-behavioral Treatment for Panic Disorder with Agoraphobia an Evaluation of Cognitive and Exposure Components of Treatment by Rowan, Vivienne C; PhD from The University of Manitoba (Canada), 1989 http://wwwlib.umi.com/dissertations/fullcit/NL54836

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Differences in Cognitive Responses to Fear among Individuals Diagnosed As Panic Disorder, Generalized Anxiety Disorder, Agoraphobia with Panic Attacks, and Simple Phobia by Dattilio, Frank Mark, PhD from Temple University, 1987, 232 pages http://wwwlib.umi.com/dissertations/fullcit/8711320

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Panic Disorder and Chronic Hyperventilation by Lynch, Patrick Bruce; PhD from University of Calgary (Canada), 1989 http://wwwlib.umi.com/dissertations/fullcit/NL54277

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Panic Disorder with Dissociation: a Comparative Study by Schimmel, Tara Faith; Psyd from Carlos Albizu University, 2002, 73 pages http://wwwlib.umi.com/dissertations/fullcit/3070511

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Panic Disorder: a Review of Genetic Studies, Effects of Pregnancy on Clinical Course, and Treatment Options by Harrelson, Laura Leanne; Ms from Sarah Lawrence College, 2002, 34 pages http://wwwlib.umi.com/dissertations/fullcit/1408526

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Perceptions of College Students Diagnosed with Panic Disorder with Agoraphobia: Academic, Psychosocial, and Environmental Views of Their College Experience by Angle, Susan Pugh; PhD from Virginia Polytechnic Institute and State University, 1999, 251 pages http://wwwlib.umi.com/dissertations/fullcit/3000292

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Perceptions of College Students Diagnosed with Panic Disorder with Agoraphobia: Academic, Psychosocial, and Environmental Views of Their College Experience by Angle, Susan Pugh; PhD from Virginia Polytechnic Institute and State University, 1999, 251 pages http://wwwlib.umi.com/dissertations/fullcit/3015755

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Personality Traits and Maternal Care in the Etiology of Panic Disorder with Agoraphobia by Balice, Guy Francis, PhD from University of California, Los Angeles, 1997, 94 pages http://wwwlib.umi.com/dissertations/fullcit/9721287

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Psychotherapeutic Process in Psychodynamic Psychotherapy for Panic Disorder and Co-morbid Depression by Goldman, Heather Ann; PhD from Long Island University, the Brooklyn Center, 2002, 89 pages http://wwwlib.umi.com/dissertations/fullcit/3049628

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The Effectiveness of Existential Art Therapy on Locus of Control, Self-efficacy, and Self-esteem on the Mobility and Cognitions of Individuals Diagnosed with Panic Disorder by Crystal, Jennifer Page; PhD from Wayne State University, 2001, 175 pages http://wwwlib.umi.com/dissertations/fullcit/3037066

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The Effects of Acceptance Versus Suppression of Emotion on Subjective and Psychophysicological Response to Carbon Dioxide Challenge in Patients with Panic Disorder by Levitt, Jill Tracy; PhD from Boston University, 2003, 188 pages http://wwwlib.umi.com/dissertations/fullcit/3068040

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The Impact of Panic Disorder on Asthma by Feldman, Jonathan Mark; PhD from Rutgers the State University of New Jersey - New Brunswick, 2002, 82 pages http://wwwlib.umi.com/dissertations/fullcit/3066703

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The Incidence of Panic Disorder Presentation Related to Perimenopausal Women by Balentine, Pamela Virginia; PhD from Capella University, 2002, 95 pages http://wwwlib.umi.com/dissertations/fullcit/3068399

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. CLINICAL TRIALS AND PANIC DISORDER Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning panic disorder.

Recent Trials on Panic Disorder The following is a list of recent trials dedicated to panic disorder.8 Further information on a trial is available at the Web site indicated. •

Brain Chemical Receptor Effects in Patients with Panic Disorder and Post-Traumatic Stress Disorder Condition(s): Panic Disorder; Posttraumatic Stress Disorder; Major Depressive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this study is to examine how certain brain chemicals work in patients with Panic Disorder (PD) and Post-Traumatic Stress Disorder (PTSD) with and without major depressive disorder (MDD). Study Type: Observational Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00025974

•

Evaluation of Clonazepam and Paroxetine for Panic Disorder with Depression Condition(s): Panic Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH)

8

These are listed at www.ClinicalTrials.gov.

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Purpose - Excerpt: The purpose of this study is to examine the safety and effectiveness of the drug combination paroxetine and clonazepam in treating people with panic disorder (PD) and major depression. Phase(s): Phase IV Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00031317 •

Interactive Computer Treatment for Panic Disorder Condition(s): Panic Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this study is to develop an interactive computer based version of cognitive behavioral therapy (CBT) and compare its effectiveness to book based CBT for the treatment of panic disorder. Phase(s): Phase I Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00063375

•

Panic Disorder Study Condition(s): Panic Disorder Study Status: This study is currently recruiting patients. Sponsor(s): Wyeth-Ayerst Research Purpose - Excerpt: The primary objective of this study is to determine the efficacy, safety, and tolerability of a flexible dose of venlafaxine extended-release (ER) capsules administered for 10 weeks in the treatment of adult outpatients with panic disorder (PD) in a placebo-controlled phase III study. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00038896

•

Therapy for Depression with Co-occurring Panic or Anxiety Symptoms Condition(s): Depression; Mood Disorder; Anxiety Disorder; Panic Disorder; Major Depressive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this study is to develop and test a new therapy designed to treat depressed patients with co-occurring symptoms of panic or anxiety. Phase(s): Phase I; Phase II Study Type: Interventional

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Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00051207 •

Treatment of Panic Disorder: Long Term Strategies Condition(s): Panic Disorder; Agoraphobia Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: Cognitive behavior therapy (CBT) with or without medication has been used in the treatment of panic disorder (PD). The purpose of this study is 1) to determine whether nine months of maintenance cognitive-behavior therapy (CBT) significantly improves the likelihood of sustained improvement; and 2) to determine the acute acceptability and efficacy of medication therapy or continued CBT alone among patients who fail to respond sufficiently to an initial course of CBT alone. It has been found that patients with PD respond as well to CBT or medication alone as they do to a combination of the two. Since the combined treatments are expensive and CBT is associated with less risk of medical toxicity compared to medications, CBT alone will be used first. All patients will first receive CBT alone. If the patient responds to this therapy, the patient will be assigned randomly (like tossing a coin) to 1 of 2 groups. One group will continue to receive CBT (maintenance therapy) for 9 months. The other group of responders will not receive any further therapy. If a patient does not respond to CBT alone, he/she will be assigned randomly to 1 of 2 different groups. One group will receive paroxetine; the other will continue to receive CBT for a longer period. The response to treatment will be evaluated to see which regimen works best to treat PD. The study will last approximately 3 years. An individual may be eligible for this study if he/she has panic disorder with no more than mild agoraphobia (fear of being in public places) and is at least 18 years old. Phase(s): Phase III Study Type: Interventional Contact(s): Katherine Shear, PhD 1-412-624-1340 [email protected]; Susan Ray, PhD [email protected] or [email protected] Web Site: http://clinicaltrials.gov/ct/show/NCT00000368

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Vestibular Dysfunction In Adult Patients With Panic Disorder With or Without Agoraphobia Condition(s): Anxiety Disorder; Panic Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Research Resources (NCRR); University of Pittsburgh Purpose - Excerpt: Objectives: I. Determine whether the prevalence of abnormalities on clinical vestibular (balance) tests is higher in panic disorder with agoraphobia than in uncomplicated panic disorder and nonpanic anxiety disorder. II. Determine whether the prevalence of abnormalities on audiological tests of cochlear or brainstem function is elevated in panic disorder without agoraphobia or nonpanic anxiety disorder. III. Determine whether symptom patterns can be identified that are indicative of vestibular abnormalities in panic disorder. IV. Determine whether vestibular dysfunction can be induced by psychosomatic mechanisms. Study Type: Interventional Contact(s): see Web site below

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Web Site: http://clinicaltrials.gov/ct/show/NCT00004367 •

Panic Disorder Study Condition(s): Panic Disorder Study Status: This study is not yet open for patient recruitment. Sponsor(s): Wyeth-Ayerst Research Purpose - Excerpt: The primary objective is to determine the efficacy, safety, and tolerability of venlafaxine extended release (ER) capsules in the treatment of outpatients with panic disorder (PD) in comparison to those of placebo. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00044772

•

Phase II Double-Blind, Placebo-Controlled Study of the Reinforcing Effects of Alprazolam in Patients with Anxiety Condition(s): Anxiety Disorder; Panic Disorder Study Status: This study is completed. Sponsor(s): National Institute on Drug Abuse (NIDA); University of Texas Purpose - Excerpt: Objectives: I. Determine whether the benzodiazepine alprazolam reinforces self-medication behavior in anxious patients with varying histories of using other drugs. II. Establish outpatient methods for the study of self-medication and drug reinforcement in patients vulnerable to prescription drug abuse or dependence. III. Evaluate the influence of alcohol and other non-prescription drug use as determinants of vulnerability in these patients. IV. Identify personality, attitudinal, or other variables that might predict different patterns of self-medication. V. Assess the effects of cognitive-behavioral therapy on alprazolam self-medication. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004373

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Pilot Study of Vestibular Rehabilitation Training for Panic Disorder With Vestibular Dysfunction Condition(s): Vestibular Diseases; Agoraphobia; Panic Disorder Study Status: This study is completed. Sponsor(s): National Center for Research Resources (NCRR); University of Pittsburgh Purpose - Excerpt: Objectives: I. Evaluate whether vestibular rehabilitation training is of value in reducing anxiety symptoms in patients with panic disorder with or without agoraphobia who have vestibular dysfunction as identified by clinical vestibular tests. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004366

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•

Randomized Study of Cognitive-Behavioral Therapy vs Imipramine and Their Combination for Panic Disorder Condition(s): Panic Disorder Study Status: This study is completed. Sponsor(s): National Institute of Mental Health (NIMH); Long Island Jewish Medical Center Purpose - Excerpt: Objectives: I. Determine which treatment is most effective for patients with panic disorder: cognitive-behavioral therapy (CBT) plus imipramine (IMI), CBT plus placebo, CBT alone, IMI alone, or placebo alone. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00004834

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “panic disorder” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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•

For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 6. PATENTS ON PANIC DISORDER Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “panic disorder” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on panic disorder, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Panic Disorder By performing a patent search focusing on panic disorder, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 9Adapted from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on panic disorder: •

1,4-benzodiazepines with 6-membered heterocyclic rings to treat panic and anxiety disorder Inventor(s): Bock; Mark G. (Hatfield, PA), Evans; Ben E. (Lansdale, PA), Freidinger; Roger M. (Lansdale, PA) Assignee(s): Merck & Co., Inc. (Rahway, NJ) Patent Number: 5,177,071 Date filed: June 17, 1991 Abstract: Pharmaceutical compositions containing 6-membered heterocyclic rings are disclosed which are useful in the treatment of panic disorder or anxiety disorder. Excerpt(s): This application is related to Merck U.S. patent application Ser. No. 378,444, filed Jul. 10, 1986. Cholecystokinins (CCK) and gastrin are structurally-related neuropeptides which exist in gastrointestinal tissue and in the central nervous system (see, V. Mutt, Gastrointestinal Hormones, G. B. J. Glass, Ed., Raven Press, N.Y., p. 169 and G. Nisson, ibid, p. 127). The isolation of the 33-amino acid polypeptide, cholecystokinin (CCK-33), from porcine intestine, Mutt, V. et al., "Structure of Porcine Cholecystokininpancreozymin. 1. Cleavage with Thrombin and Trypsin", European J. Biochem. 6, 156, (1968), was followed by the discovery that it occurs in numerous molecular forms at various sites throughout the peripheral and central nervous systems, Larsson, L. et al., "Localization and Molecular Heterogeneity of Cholecystokinin in the Central and Peripheral Nervous System", Brain Res., 165, 201 (1979). In the mammalian brain the predominant fragments are the carboxy terminal octapeptide, H--Asp-Tyr(SO.sub.3 H)--Met--Gly--Trp--Met--Asp--Phe--NH.sub.2 (CCK-8s, CCK.sub.26-33) and tetrapeptide, CCK-4 (CCK.sub.30-33). Web site: http://www.delphion.com/details?pn=US05177071__

•

Blood levels of CCK peptides relative to panic disorder treatment Inventor(s): Sheehan; David V. (Lutz, FL), Talbot; Janet D. (Lutz, FL), Thomas; Thomas N. (Palm Harbor, FL) Assignee(s): University of South Florida (Tampa, FL) Patent Number: 5,558,987 Date filed: November 18, 1994 Abstract: A method of treating a patient having a panic disorder, the patient having an elevated CCK peptide plasma level, by lowering the plasma CCK peptide level of the patient. A further method provides a diagnosis of panic disorder in a patient by detecting if that patient's plasma contains elevated CCK peptide levels. A further method determines the efficacy of the drug for the treatment of panic disorder by detecting the ability of the drug to lower elevated CCK peptide levels in a model for panic disorder. Additionally, a method of dosing a patient having elevated CCK peptide levels with an antipanic disorder drug is characterized by administering the drug to a patient and monitoring the lowering of the elevated plasma CCK peptide levels of the patient.

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Excerpt(s): The present invention relates to the relationship between cholecystokinin (CCK) and panic disorder. More specifically, the present invention provides 1) a method of treating a patient having a panic disorder, 2) a method of diagnosing panic disorder in a patient, 3) a method of determining the efficacy of a drug for the treatment of panic disorder, and 4) a method of predicting the vulnerability of a patient to panic disorder. The present invention relates to the relationship between panic disorder and cholecystokinin (CCK). Panic disorder affects 3.6% of the general population(1) and 1014% of patients in cardiology practices (2,3). It is a chronic relapsing illness(4,5) characterized by paroxysmal anxiety attacks that strike suddenly and for no apparent reason. Seventy-five percent of its victims are women(6). It has a unimodal age of onset (mean 23 years) rarely starting before age 12 or after age 45(7) and is 12 times more frequent in the 25-44 age group than in the 65+ age group(6). Panic disorder is more common in monozygotic than in dizygotic twins(8). Its inheritance pattern is consistent with single locus genetics (9,10,11) and preliminary evidence implicates the long arm of chromosome 16(12). It is associated with an increased risk of mitral valve prolapse(13), hypertension(14), alcohol abuse and dependence(15), and has an excess mortality from suicide and among men from cardiovascular death(16). The lack of understanding of the biochemical basis of panic disorder is hampering the development of drugs effective in the treatment of this disorder. Web site: http://www.delphion.com/details?pn=US05558987__ •

Compositions containing sertraline and a 5-HT.sub.1D receptor agonist or antagonist Inventor(s): Chenard; Bertrand L. (New York, NY), Howard; Harry R. (New York, NY), Macor; John E. (New York, NY), Schulz; David W. (New York, NY), Sprouse; Jeffrey S. (New York, NY) Assignee(s): Pfizer Inc. (New York, NY) Patent Number: 5,597,826 Date filed: September 14, 1994 Abstract: The present invention relates to novel compositions containing the serotonin selective re-uptake inhibitor (SSRI), preferably (1S-cis)-4-(3,4-dichlorophenyl)-1,2,3,4tetrahydro-N-methyl-1-naphthalenam ine, and an agonist or antagonist of the serotonin 1 (5-HT.sub.1) receptor and to the use of such compositions for treating or preventing a condition selected from mood disorders, including depression, seasonal affective disorders and dysthmia, anxiety disorders including generalized anxiety disorder and panic disorder; agoraphobia, avoidant personality disorder; social phobia; obsessive compulsive disorder; post-traumatic stress disorder; memory disorders including dementia, amnestic disorders and age-associated memory impairment; disorders of eating behavior, including anorexia nervosa and bulimia nervosa; obesity; cluster headache; migraine; pain; Alzheimer's disease; chronic paroxysmal hemicrania; headache associated with vascular disorders; Parkinson's disease, including dementia in Parkinson's disease, neuroleptic-induced parkinsonism and tardive dyskinesias; endocrine disorders such as hyperprolactinaemia; vasospasm (particularly in the cerebral vasculature); hypertension; disorders in the gastrointestinal tract where changes in motility and secretion are involved; sexual dysfunction, including premature ejaculation; and chemical dependencies. Excerpt(s): The present invention relates to novel compositions containing the serotonin selective re-uptake inhibitor (SSRI) (1S-cis)-4-(3,4- dichlorophenyl)-1,2,3,4-tetrahydro-Nmethyl-1-naphthalenemine (hereinafter sertraline) and an agonist or antagonist of the

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serotonin 1 (5-HT.sub.1) receptor and to the use of such compositions for treating or preventing a condition selected from mood disorders, including depression, seasonal effective disorders and dysthmia, anxiety disorders including generalized anxiety disorder and panic disorder; agoraphobia, avoidant personality disorder; social phobia; obsessive compulsive disorder; post-traumatic stress disorder; memory disorders including dementia, amnestic disorders and age-associated memory impairment; disorders of eating behavior, including anorexia nervosa and bulimia nervosa; obesity; cluster headache; migraine; pain; Alzheimer's disease; chronic paroxysmal hemicrania; headache associated with vascular disorders; Parkinson's disease, including dementia in Parkinson's disease, neuroleptic-induced parkinsonism and tardive dyskinesias; endocrine disorders such as hyperprolactinaemia; vasospasm (particularly in the cerebral vasculature); hypertension; disorders in the gastrointestinal tract where changes in motility and secretion are involved; sexual dysfunction, including premature ejaculation; and chemical dependencies. U.S. Pat. No. 4,536,518 issued Aug. 20, 1985 refers to sertraline and derivatives thereof and states that these compounds are useful as antidepressant agents. U.S. Pat. No. 4,940,731 issued Jul. 10, 1990 refers to a method of treating premature ejaculation using sertraline. Web site: http://www.delphion.com/details?pn=US05597826__ •

Gepirone for alleviation of panic disorders Inventor(s): Kurtz; Neil (Weston, CT), Newton; Roger E. (Evansville, IN), Temple, Jr.; Davis L. (Wallingford, CT) Assignee(s): Bristol-Myers Company (New York, NY) Patent Number: 4,782,060 Date filed: July 29, 1987 Abstract: Gepirone and its pharmaceutically acceptable salts are useful in alleviation of panic disorders which can take the form of clinical syndromes comprising, for example, panic attacks, agoraphobia and phobic anxiety. Excerpt(s): This invention is concerned with a drug bio-affecting body-treating process which employs the pyrimidine compound 4,4-dimethyl-1-[4-[4-(2-pyrimidinyl)-1piperazinyl]butyl]-2,6-piperidinedi one or a pharmaceutically acceptable acid addition salt thereof. The synthesis of the compound and the disclosure of its anxiolytic properties are described in the following patents and publications. 1. D. L. Temple, Jr., U.S. Pat. No. 4,423,049, issued Dec. 27, 1983. Web site: http://www.delphion.com/details?pn=US04782060__

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Method for alleviation of panic disorders Inventor(s): Kurtz; Neil M. (Westport, CT), Newton; Roger E. (Evansville, IN), Temple, Jr.; Davis L. (Wallingford, CT) Assignee(s): Bristol-Myers Company (New York, NY) Patent Number: 4,634,703 Date filed: October 25, 1985

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Abstract: Buspirone and its pharmaceutically acceptable salts are useful in alleviation of panic disorders which can take the form of clinical syndromes comprising, for example, panic attacks, agoraphobia and phobic anxiety. Excerpt(s): This invention is concerned with a drug bioaffecting body-treating process which employs the pyrimidine compound 8-[4-[4-(2-pyrimidinyl)-1-piperazinyl]butyl]8-azaspiro[4.5]decane-7,9-dio ne or a pharmaceutically acceptable acid addition salt thereof. The synthesis of the compound and the disclosure of its psychotropic properties are described in the following patents and publications. 1. Y. H. Wu, et al., J. Med. Chem., 15, 477 (1972). Web site: http://www.delphion.com/details?pn=US04634703__ •

Method for the treatment of panic disorder Inventor(s): Schweizer; Edward E. (Wilmington, DE) Assignee(s): Trustees of the University of Pennsylvania (Philadelphia, PA) Patent Number: 5,166,202 Date filed: December 13, 1991 Abstract: Midazolam and its pharmaceutically acceptable salts are useful in the treatment of panic disorder, panic attacks and the prevention of panic attacks. Excerpt(s): This invention relates to a method for treatment of panic disorder. More particularly, a method of treating panic disorder with intranasal midazolam is provided. Panic disorder is an illness which is estimated to afflict 1.5-2% of the adult population. The hallmark of panic disorder is the sudden, crescendo panic attack which may be as fleeting as a few minutes in duration, or may persist for over an hour before subsiding. The majority of patients suffering from panic disorder report an average attack frequency (four 4-symptom attacks) of less than one per day, which is true even for many moderate-to-severely ill patients such as those treated in the large CrossNational Collaborative Panic Study (Ballenger, J. C. et al., "Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. I. Efficacy in short-term treatment," Arch Gen Psychiatry, 45:413-422 (1988)). Current treatment strategies for panic disorder focus on attempts to control and prevent these intermittent, but severe and often disabling panic attacks, and thereby to reduce the associated inter-episode anticipatory anxiety, phobic avoidance, and somatic preoccupations. To accomplish this effectively with drug therapy requires daily doses of high potency benzodiazepines such as alprazolam, or daily doses of antidepressants such as imipramine. Web site: http://www.delphion.com/details?pn=US05166202__

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Method for treating panic disorder Inventor(s): Sikter; Andras (Budapest, HU) Assignee(s): S+V Engineering Kft. (Budapest, HU) Patent Number: 5,348,749 Date filed: November 5, 1992 Abstract: A method for treating panic disorder, which comprises administering to a human suffering from panic disorder 0.03 to 1.5 mmoles of zinc and 2 to 100 mmoles of

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magnesium and 2 to 60 mmoles of phosphorus and 3 to 90 mmoles of potassium as a daily dose in a composition consisting essentially of zinc, magnesium, phosphorus and potassium, in a weight ratio of 1-15:25-200:50-200:100-500, respectively. Excerpt(s): This application is a continuation-in-part of co-pending international application No. PCT/HU91/00018 filed May 10, 1991, which designates the United States. The invention relates to a method for treating panic disorder in humans, by administration of a novel pharmaceutical composition comprising zinc, magnesium, phosphorus and potassium in a determined ratio. It is known that mineral substances and trace elements are of vital importance in the human (generally in living) organism(s). A great number of publications deal with the effect of the given elements (such as zinc, potassium, magnesium and phosphorus) applied separately. Web site: http://www.delphion.com/details?pn=US05348749__ •

Method for treating patients suffering from anxiety neurosis and anxietylike neurosis, and alcoholism Inventor(s): Bruinvels; Jacques (DE Bilt, NL), Pepplinkhuizen; Lolke (Rotterdam, NL) Assignee(s): Erasmus Universiteit Rotterdam (Rotterdam, NL) Patent Number: 4,156,013 Date filed: June 9, 1978 Abstract: Patients suffering from anxiety neurosis and anxietylike neurosis often accompanied by alcoholism are treated by administration of medicine containing a.beta.-(p-halogen phenyl)-.GAMMA.-aminobutyric acid as active compound. As a result these patients were totally freed from the above mentioned complaints. Excerpt(s): The invention relates to a process for the preparation of a medicine having anti-anxiety neurosis and anti-anxietylike neurosis activity and to a medicine having such activity. From clinical trials it appeared that patients having anxiety neurosis, as defined by Woodruff, R. A., Goodwin, D. W. and Guze, S. B. and Wheeler, E. O., White, P. D., Reed, E. W. and Cohen, M. E., did not show any amelioration upon administration of known anxiolytics. The symptoms of anxiety neurosis, as defined by Woodruff and Wheeler, are in decreasing significancy: palpitation, tires easily, breathlessness, nervousness, chest pain, sighing, dizziness, faintness, apprehensiveness, headache, paresthesias, weakness, trembling, breath unsatisfactory, insomnia, unhappiness, shakiness, fatigued all the time, sweating, fear of death, smothering, syncope, urinary frequency, vomiting and diarrhea and anorexia. Web site: http://www.delphion.com/details?pn=US04156013__

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Method of treating psychiatric disorders by electrical stimulation within the orbitofrontal cerebral cortex Inventor(s): Kopell; Brian H. (New York City, NY), Rezai; Ali R. (New York City, NY) Assignee(s): ElectroCore Techniques, LLC (Summit, NJ) Patent Number: 6,418,344 Date filed: February 24, 2000

Patents 131

Abstract: A method for treating psychiatric diseases such as Anxiety disorder (including General Anxiety Disorder, Obsessive Compulsive Disease, and Panic Disorder), Affective Disorder(including Major Depression and Bipolar Disorder) by neuromodulation (either chemical or electrical) of the frontal cerebral cortex, and in particular regions within the orbitofrontal cerebral cortex. The method includes the steps of determining a common group of patients, each suffering from a common specific diagnosis for a psychiatric disorder; determining which common regions of the patients' orbitofrontal cerebral cortex are involved in the pathogenesis of the abnormal electrical and chemical activity associated with the psychiatric disease; surgically implanting an electrode and/or catheter and electrical signal generating device and/or drug-delivery pump such that the electrode and/or catheter is positioned within the region of the frontal cerebral cortex known as the orbitofrontal cortex; and selectively adjusting the level of electrical and/or chemical stimulation in accordance with the specific effect of the stimulation of the patient. In particular, the region of the frontal cerebral cortex most frequently associated with psychiatric disorders is the orbitofrontal cortex. Excerpt(s): This invention relates generally to the treatment of psychiatric disorders by modulating the activity within appropriate regions of the cerebral prefrontal cortex, and more particularly to a method of modifying pathological electrical and chemical activity of the brain by electrical stimulation and/or direct placement of neuromodulating chemicals within the corresponding areas of the orbitofrontal cerebral cortex (OFC). The treatment of psychiatric disorders by neurosurgical techniques has an extensive history. In the early 1930's Fulton and Jacobsen first recongnized that an experimentally induced neurotic behavior in chimpanzees could be abolished by frontal lobectomy. Within a few years, Freeman and Watts developed the first psychosurgical procedure for humans known as the frontal lobotomy. As the inherent physiology of the frontal lobe became more evident, the original freehand procedure of Freeman and Watts became less and less extensive. By the late 1940's, the method of stereotaxis, in which the patient's brain is modeled in 3-dimensional space for exquisite targeting accuracy, merged with lesioning techniques resulting in an even more efficacious and safe psychosurgical procedure. Further developments of stereotactic equipment have combined with novel advancements in functional and anatomic imaging to encompass the state of the art in the neurosurgical treatment of psychiatric disorders today. However, the fundamental limitation of these lesioning techniques is that they are inherently irreverible and static in nature. There is no proverbial "off" switch to alleviate side effects and no way to adjust the desirable effects in response to a patient's developing symptom profile. Within the field of neurosurgery, the use of electrical stimulation for treating neurological disease, including such disorders as compulsive eating, chronic pain, movement disorders, has been widely discussed in the literature. It has been recognized that electrical stimulation holds significant advantages over alternative methods of treatment, for example lesioning, inasmuch as lesioning can only destroy neuronal activity. In many instances, the preferred effect is to stimulate or reversibly block neural signals. Electrical stimulation permits such stimulation of the target neural structures, and equally importantly, it does not require the destruction of the nervous tissue (it is a reversible process, which can literally be shut off or removed at will). Web site: http://www.delphion.com/details?pn=US06418344__

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Reboxetine for treatment obsessive compulsive disorders and panic disorder Inventor(s): Dubini; Adriana (Milan, IT), McCall; John Michael (Kalamazoo, MI), Taylor; Duncan Paul (Kalamazoo, MI), Von Voigtlander; Philip F. (Plainwell, MI), Wong; Erik Ho Fong (Portage, MI) Assignee(s): Pharmacia and Upjohn Company (Kalamazoo, MI) Patent Number: 6,391,876 Date filed: October 19, 2000 Abstract: This invention relates to the use of reboxetine in the treatment of Obsessive Compulsive Disorders and Panic Disorders. Excerpt(s): This invention describes new treatments for several nervous system disorders, including: Obsessive Compulsive Disorders, and panic Disorder. The treatment involves the administration of the drug reboxetine. The introduction of tricyclic antidepressants in the early 1960s has provided a major advance in the treatment of neuropsychiatric disorders. Reactive and endogenous depressions, diagnoses formerly carrying grave prognostic implications, have become, with the introduction of the tricyclic, manageable disorders with a much smaller toll on the patient and the society as a whole. The early tricyclic compounds were reuptake inhibitors of all the catecholamines released in the synaptic cleft, thus resulting in prolongation and enhancement of the dopamine (DA), noradrenaline (NA) and serotonin (5-hydroxytryptamine=5-HT) action. Lack of selectivity also causes undesired side effects particularly on the acetylcholine (especially the muscarinic component), and histamine mediated neurotransmission. Web site: http://www.delphion.com/details?pn=US06391876__

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Remedy for anxiety neurosis Inventor(s): Miura; Toshiro (Yamaguchi-ken, JP) Assignee(s): Chugai Seiyaku Kabushiki Kaisha (Tokyo, JP) Patent Number: 5,905,086 Date filed: February 13, 1998 Abstract: N-(2-Hydroxyethyl)nicotinamide nitrate or its salt prevents or ameliorates anxiety neurosis or panic disorder, or the following anxiety. This compound or its salt has few side effects and exhibits immediate action. Excerpt(s): This invention relates to remedies for anxiety neurosis, in particular, drugs efficacious in treating panic disorder characterized by containing N-(2hydroxyethyl)nicotinamide nitrate or its salt as the active ingredient. Anxiety neurosis means neurosis in a broad sense with anxiety being the predominant symptom. According to DSM-III edited by U.S. Society of Psychiatry in 1980, anxiety neurosis is classified into panic disorder and global anxiety neurosis. It has been a practice to treat anxiety neurosis including panic disorder with the use of tricyclic antidepressive drugs or benzodiazepine anxiolytic drugs. However, it is pointed out that these drugs suffer from some problems. Namely, the tricyclic antidepressive drugs exert their effects slowly and give rise to cholinolytic side effects. On the other hand, the benzodiazepine anxiolytic drugs induce side effects of hypersedation, break-off phenomenon, etc. and, moreover, produce addiction. That is to say, there has been known no satisfactory remedy for anxiety neurosis.

Patents 133

Web site: http://www.delphion.com/details?pn=US05905086__ •

Treatment of panic disorders with estazolam Inventor(s): Coleman; James H. (Cumberland, RI) Assignee(s): The Upjohn Company (Kalamazoo, MI) Patent Number: 4,481,208 Date filed: June 6, 1983 Abstract: Therapeutic process for treating panic disorders in humans comprising, the systemic administration of a 6-phenyl-8-chloro-4H-s-triazolo[4,3-a][1,4]benzodiazepine including the N-oxides and pharmacologically acceptable acid addition salts thereof in combination with a pharmaceutical carrier. Excerpt(s): Panic attacks, a spontaneous attack, thought to be a biochemical disorder of genetic origin, begins in the majority of subjects at ages 15 to 30 years. The attacks occur with no apparent reason to the subject and are accompanied by symptoms of hyperventilation, heart-pounding, pain in head, numbness or tingling of the limbs, hot and cold flashes, lump in throat, and the like. The attacks continue to occur and can lead the subject to become house bound. Various treatments have been prescribed, including hypnosis and behavior therapies and chemotherapy, particularly the administration of imipramine hydrochloride or phenelzine sulfate. The latter although somewhat effective have undesirable side-effects, chlordiazepoxide and diazepam have been tried but found not effective to block the panic attack. Estazolam has been indicated for the management of anxiety disorders. Web site: http://www.delphion.com/details?pn=US04481208__

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Use of 5-HT.sub.3 receptor antagonists in treating panic disorders or obsessive compulsive disorders Inventor(s): Azcona; Alberto E. (Basel, CH), Taylor; Pamela (Basel, CH) Assignee(s): Sandoz Ltd. (Basel, CH) Patent Number: 5,530,008 Date filed: January 24, 1994 Abstract: 5-HT.sub.3 Receptor antagonists are useful in treating panic disorders or obsessive compulsive disorders. Excerpt(s): The present invention relates to a new use, in particular a new pharmaceutical use, for the compound group comprising 5HT.sub.3 receptor antagonists, said compound group being referred to hereinafter collectively as COMPOUNDS OF THE INVENTION. 5-HT.sub.3 receptor antagonists are a well known class of compounds. Spatial models for 5-HT.sub.3 receptors and 5-HT.sub.3 antagonists have been proposed recently by M. F. Hibert and S. Peroutka. They are typically compounds which act on 5-HT.sub.3 receptors on the e.g. isolated rabbit heart or vagus nerve by antagonizing the action of 5-HT thereon. They may have a pA.sub.2 greater than 6 or preferably more than 8 or 9.5-HT.sub.3 antagonists may be selective for 5-HT.sub.3 receptors as compared to other serotonin receptors or dopamine receptors. vi) a compound specifically or generically disclosed in DE 3,740,352 A, WO 8803801 A, EP 266,899 A, GB 2,192,885 A, GB 2,208,862 A, EP 219,929 A, EP 219,193 A, EP 212,398 A,

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EP 210,840 A, EP 191,562 A, EP 248,843 A, WO 89/09217, the contents of which are incorporated herein by reference. Web site: http://www.delphion.com/details?pn=US05530008__

Patent Applications on Panic Disorder As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to panic disorder: •

Antidepressant azaheterocyclylmethyl derivatives of 1,4,5-trioxa-phenanthrene Inventor(s): Stack, Gary P.; (Ambler, PA), Tran, Megan; (Hoboken, NJ) Correspondence: Wyeth; Patent Law Group; Five Giralda Farms; Madison; NJ; 07940; US Patent Application Number: 20020193401 Date filed: April 25, 2002 Abstract: Compounds of the formula 1useful for the treatment of diseases such as depression (including but not limited to major depressive disorder, childhood depression and dysthymia), anxiety, panic disorder, post-traumatic stress disorder, premenstrual dysphoric disorder attention deficit disorder (with and without hyperactivity), obsessive compulsive disorder (including trichotillomania), social anxiety disorder, generalized anxiety disorder, obesity, eating disorders such as anorexia nervosa, bulimia nervosa, vasomotor flushing, cocaine and alcohol addiction, sexual dysfunction and related illnesses. Excerpt(s): This application claims priority from co-pending provisional application serial No. 60/287,448, filed Apr. 30, 2001, the entire disclosure of which is hereby incorporated by reference. Major depression is a serious health problem affecting more than 5% of the population, with a life-time prevalence of 15-20%. Selective serotonin reuptake inhibitors have produced significant success in treating depression and related illnesses and have become among the most prescribed drugs. They nonetheless have a slow onset of action, often taking several weeks to produce their full therapeutic effect. Furthermore, they are effective in fewer than two-thirds of patients. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Aryloxy piperidinyl derivatives for the treatment of depression Inventor(s): Mewshaw, Richard E.; (King of Prussia, PA), Zhou, Dahui; (East Brunswick, NJ), Zhou, Ping; (Plainsboro, NJ) Correspondence: Joseph M. Mazzarese; American Home Products Corporation; Patent Law Department; Five Giralda Farms; Madison; NJ; 07940; US Patent Application Number: 20020091141 Date filed: November 15, 2001

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This has been a common practice outside the United States prior to December 2000.

Patents 135

Abstract: This invention provides compounds useful in treating serotonin-related central nervous system disorders, including anxiety, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, sleep disorders, sexual dysfunction, alcohol and drug addiction, Alzheimer's disease, Parkinson's disease, obesity and migraine, the compounds having the general formula: 1wherein: R.sub.1 and R.sub.2 may each be H or an alkyl or alkoxy group; or R.sub.1 and R.sub.2 may be concatenated to form a bicyclic ring system with the phenyl ring to which they are bound; X is selected from hydrogen, halogen, cyano, C.sub.1--C.sub.6 alkoxy; Z is (CH.sub.2)n or carbonyl; n is 0, 1 or 2; the dashed line indicates an optional double bond; or a pharmaceutically acceptable salt thereof. Excerpt(s): This application claims priority from copending provisional application(s) serial No. 60/252,140 filed on Nov. 16, 2000, the entire disclosure of which is hereby incorporated by reference. This invention relates to new aryloxy indole derivatives as pharmaceuticals which are useful for the treatment in mammals of diseases affected by disorders of the serotonin-affected neurological systems, such as depression, anxiety, panic disorder, obsessive-compulsive disorder, sleep disorders, sexual dysfunction, alcohol and drug, addiction, Alzheimer's disease, Parkinson's disease, obesity and migraine, as well as methods of enhancing cognition. Pharmaceuticals which enhance serotonergic neurotransmission are of useful benefit for the treatment of many psychiatric disorders, including depression and anxiety. The first generation of nonselective serotonin-affecting drugs operated through a variety of physiological functions which endowed them with several side effect liabilities. The more currently prescribed drugs, the selective serotonin (5-HT) reuptake inhibitors (SSRIs), act predominately by inhibiting 5-HT, which is released at the synapses, from being actively removed from the synaptic cleft via a presynaptic serotonin transport carrier. Since SSRIs require several weeks before they exert their full therapeutic effect, this 5-HT blockade mechanism per se cannot account for their therapeutic activity. It is speculated that this two week induction which occurs before a full antidepressant effect is observed, is due to the involvement of the 5-HT.sub.1A autoreceptors which suppress the firing activity of 5-HT neuron, causing a dampening of the therapeutic effect. Studies suggest that after several weeks of SSRI administration, a desensitization of the 5-HT autoreceptors occurs allowing a full antidepressant effect in most patients. Recent studies by Artigas et al. (Trends Neurosci., 1996, 19, 378-383) suggest a combination of 5-HT.sub.1A activity and inhibition of 5-HT uptake within a single molecular entity can achieve a more robust and fast-acting antidepressant effect. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

BION1 is a novel ion channel Inventor(s): Bray-Ward, Patricia; (Madison, CT), Kaczmarek, Leonard; (Guilford, CT), Nimmakayalu, Manjunath; (New Haven, CT), Tang, Michael; (New Haven, CT) Correspondence: Banner & Witcoff; 1001 G Street N W; Suite 1100; Washington; DC; 20001; US Patent Application Number: 20030078403 Date filed: June 25, 2002 Abstract: Polymorphisms are identified in a human gene which encodes a voltage-gated ion channel. The gene maps to the same portion of human chromosome 13q22 to which genes for schizophrenia susceptibility, Bipolar Disorder, and Panic Disorder Syndrome have been mapped. The polymorphisms are used to follow inheritance of the

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susceptibilities within families. They are also used to identify affected probands. A complete mRNA sequence and genomic structure provide insights into function and relationship to other ion channels. Excerpt(s): This application claims priority from Provisional Application Serial No. 60/300,101 filed Jun. 25, 2001, the contents of which are hereby incorporated by reference. This invention is related to ion channels expressed in brain tissue. In particular it is related to ion channels which are associated with susceptibility to psychiatric disorders. It has long been known that the flow of ions in and out of cells in the nervous system is crucial for their activity, and that specific ion channels are largely responsible for this movement. Ion channels are generally gated (with the exception of the K.sup.+ leak channels), either by ligand binding or by voltage. Ligand binding ion channels convert extracellular chemical signals into electrical signals, while voltage gated ion channels, particularly Na.sup.+ channels, play a key role in action potential propagation. The voltage gated Ca.sup.++ channel provides the only known means of converting electrical signals into chemical signals. We describe here the isolation and characterization of BION1 (Brain Ion 1), a novel voltage gated channel protein of unknown ion specificity. Various lines of evidence are presented that link the gene encoding this protein with a schizophrenia susceptibility locus on chromosome 13q32. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Cyclopenta[b][1,4]diazepino[6,7,1-hi]indoles and derivatives Inventor(s): Nelson, James A.; (Washington Crossing, PA), Rosenzweig-Lipson, Sharon J.; (East Brunswick, NJ), Sabalski, Joan E.; (Yardville, NJ), Sabb, Annmarie L.; (Pennington, NJ), Vogel, Robert L.; (Stratford, NJ), Welmaker, Gregory S.; (Jackson, NJ) Correspondence: Steven R. Eck; American Home Products Corporation; Patent Law Department - 2B; Five Giralda Farms; Madison; NJ; 07940; US Patent Application Number: 20020107242 Date filed: November 2, 2001 Abstract: This invention provides compounds of the formulae: 1wherein:R.sub.1 is hydrogen, --C(O)CH.sub.3 or alkyl of 1-6 carbon atoms;R.sub.2 and R.sub.3 are each, independently, hydrogen, alkyl of 1-6 carbon atoms, cycloalkyl, alkoxy of 1-6 carbon atoms, --CH.sub.2OH, fluoroalkyl, alkyl sulfonamide of 1-6 carbon atoms, alkyl amide of 1-6 carbon atoms, amino, alkylamino of 1-6 carbon atoms, dialkylamino of 1-6 carbon atoms per alkyl moiety, fluoroalkoxy of 1-6 carbon atoms, acyl of 2-7 carbon atoms, aryl, or aroyl;R.sub.4 and R.sub.5 are each, independently, hydrogen, alkyl of 1-6 carbon atoms, alkoxy of 1-6 carbon atoms, halogen, fluoroalkyl, --CN, alkyl sulfonamide of 1-6 carbon atoms, alkyl amide of 1-6 carbon atoms, amino, alkylamino of 1-6 carbon atoms, dialkylamino of 1-6 carbon atoms per alkyl moiety, fluoroalkoxy of 1-6 carbon atoms, acyl of 2-7 carbon atoms, or aroyl;R.sub.6 and R.sub.7 are each independently hydrogen, C.sub.1-C.sub.6 alkyl or cycloalkyl;or a pharmaceutically acceptable salt thereof, as well as pharmaceutical compositions containing these compounds and methods for their use, including treatment of obsessive-compulsive disorder, panic disorder, depression, anxiety, generalized anxiety disorder, schizophrenia, migraine, sleep disorders, eating disorders, obesity, epilepsy, and spinal cord injury. Excerpt(s): This application claims priority from copending provisional application Serial No. 60/245,593, filed Nov. 3, 2000, the entire disclosure of which is hereby incorporated by reference. The present invention relates to

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cyclopenta[b][1,4]diazepino[6,7,1-- hi]indoles and derivatives thereof, which are serotonin 5-hydroxytryptamine 2.sub.c (5HT.sub.2c) receptor agonists useful for the treatment of central nervous system disorders including, but not limited to, obsessivecompulsive disorder, depression, anxiety, generalized anxiety disorder, schizophrenia, panic disorder, migraine, sleep disorders, such as sleep apnea, eating disorders, such as hyperphagia, obesity, epilepsy, and spinal cord injury. Obesity is a medical disorder characterized by an excess of body fat or adipose tissue. Comorbidities associated with obesity are Type II diabetes, cardiovascular disease, hypertension, hyperlipidemia, stroke, osteoarthritis, sleep apnea, gall bladder disease, gout, some cancers, some infertility, and early mortality. As the percentage of obese individuals continues to rise both in the U.S. and abroad, obesity is expected to be a major health risk in the 21.sup.st Century. The serotonin 5-hydroxytryptamine (5-HT) receptor is a G-protein coupled receptor which is expressed in neurons in many regions of the human central nervous system. [Wilkinson, L. O. and Dourish, C. T. in Serotonin Receptor Subtypes: Basic and Clinical Aspects (ed. Peroutka, S. J. ) 147-210 (Wiley-Liss, N.Y., 1991).] The 5HT.sub.2c receptor (formerly called the 5HT.sub.1C receptor) is a prominent subtype of the serotonin receptor found in the central nervous system of both rats and humans. It is expressed widely in both cortical and subcortical regions. [Julius, D. MacDermott, A. B., Axel, R. Jessell, T. M. Science 241:558-564 (1988).] Studies in several animal species and in humans have shown that the non-selective 5HT.sub.2C receptor agonist, metachlorophenylpiperazine (MCPP) decreases food intake. [Cowen, P. J., Clifford, E. M., Williams, C., Walsh, A. E. S., Fairburn, C. G. Nature 376: 557 (1995).] Tecott, et al have demonstrated that transgenic mice lacking the 5HT.sub.2C receptor eat more and are heavier than Wild Type mice. [Tecott, L. H., Sun, L. M., Akana, S. F., Strack, A. M., Lowenstein, D. H., Dallman, M. F., Jullus, D. Nature 374: 542-546 (1995).] Compounds of this invention are 5HT.sub.2C receptor subtype selective agonists which are selective over other monoamine receptors, causes a reduction in food intake and result in a reduction in weight gain. Other therapeutic indications for 5HT.sub.2C agonists are obsessive compulsive disorder, depression, panic disorder, schizophrenia, sleep disorders, eating disorders, and epilepsy. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Novel heteroaryl derivatives, their preparation and use Inventor(s): Andersen, Kim; (Virum, DK), Krog-Jensen, Christian; (Copenhagen, DK), Mikkelsen, Gitte; (Ballerup, DK), Mikkelsen, Ivan; (Koge, DK), Moltzen, Ejner Knud; (Gentofte, DK), Rottlander, Mario; (Valby, DK), Ruhland, Thomas; (Valby, DK) Correspondence: Darby & Darby P.C.; 805 Third Avenue; New York; NY; 10022; US Patent Application Number: 20030050306 Date filed: June 25, 2002 Abstract: A heteroaryl derivative having the formula (I) 1any of its enantiomers or any mixture thereof, wherein X is --O--, --S--, or CR.sup.4R.sup.5--; and Y is -CR.sup.6R.sup.7; --CR.sup.6R.sup.7--CR.s- up.8R.sup.9--, or --CR.sup.6--CR.sup.7; or X and Y together form a group --CR.sup.4.dbd.R.sup.5--, or --CR.sup.4.dbd.CR.sup.5-CR.sup.6R.sup.7--; Z is --O--, or --S--; W is N, C, or CH; n is 2, 3, 4, 5, 6, 7, 8, 9 or 10; m is 2 or 3; A is O or S wherein the doted lines mean an optional bond. The compounds of the invention are considered useful for the treatment of affective disorders such as general anxiety disorder, panic disorder, obsessive compulsive disorder, depression, social phobia and eating disorders, and neurological disorders such as psychosis.

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Excerpt(s): This application is a Continuation of International Application No. PCT/DK00/00741, filed Dec. 29, 2000. The disclosure of the prior application is hereby incorporated by reference. The present invention relates to novel heteroaryl derivatives potently binding to the 5-HT.sub.1A receptor, pharmaceutical compositions containing these compounds and the use thereof for the treatment of certain psychiatric and neurological disorders. The compounds of the invention are also potent dopamine D.sub.4 receptor ligands and are considered to be particularly useful for the treatment of depression and psychosis. Furthermore, many compounds of the invention have potent serotonin reuptake inhibition activity and/or effect at dopamine D.sub.3 receptors. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Pharmaceutical composition and method of modulating cholinergic function in a mammal Inventor(s): Coe, Jotham W.; (Niantic, CT), Sands, Steven B.; (Stonington, CT) Correspondence: Pfizer Inc; 150 East 42nd Street; 5th Floor - Stop 49; New York; NY; 10017-5612; US Patent Application Number: 20030008892 Date filed: March 25, 2002 Abstract: A pharmaceutical composition and method of modulating cholinergic function in a mammal comprising administration of a NRPA compound or a pharmaceutically acceptable salt thereof; and an anti-emetic/anti-nausea agent or a pharmaceutically acceptable salt thereof; and a pharmaceutically acceptable carrier. The NRPA compound and the anti-emetic/anti-nausea agent are present in amounts that render the composition effective modulating cholinergic function or in the treatment of a diorder or condition selected from inflammatory bowel disease (including but not limited to ulcerative colitis, pyoderma gangrenosum and Crohn's disease), irritable bowel syndrome, spastic dystonia, chronic pain, acute pain, celiac sprue, pouchitis, vasoconstriction, anxiety, panic disorder, depression, bipolar disorder, autism, sleep disorders, jet lag, amyotrophic lateral sclerosis (ALS), cognitive dysfunction, hypertension, bulimia, anorexia, obesity, cardiac arrythmias, gastric acid hypersecretion, ulcers, pheochromocytoma, progressive supranuclear palsy, chemical dependencies and addictions (e.g., dependencies on, or addictions to nicotine (and/or tobacco products), alcohol, benzodiazepines, barbiturates, opioids or cocaine), headache, migraine, stroke, traumatic brain injury (TBI), obsessive-compulsive disorder (OCD), psychosis, Huntington's chorea, tardive dyskinesia, hyperkinesia, dyslexia, schizophrenia, multiinfarct dementia, age-related cognitive decline, epilepsy, including petit mal absence epilepsy, senile dementia of the Alzheimer's type (AD), Parkinson's disease (PD), attention deficit hyperactivity disorder (ADHD) and Tourette's Syndrome. The method of using these compositions is also disclosed. Excerpt(s): The present invention relates to pharmaceutical compositions for modulating cholinergic function in a mammal comprising a nicotinic receptor partial agonist compound in combination with an anti-emetic/anti-nausea agent and a pharmaceutically acceptable carrier. The nicotinic receptor partial agonists (NRPAs) included herein are aryl fused azapolycyclic compounds. NRPAs are not limited to those described here. The term NRPA refers to all chemical compounds which bind at neuronal nicotinic acetylcholine specific receptor sites in mammalian tissue and elicit a partial agonist response. A partial agonist response is defined here to mean a partial, or incomplete functional effect in a given functional assay. Additionally, a partial agonist

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will also exhibit some degree of antagonist activity by its ability to block the action of a full agonist (Feldman, R. S., Meyer, J. S. & Quenzer, L. F. Principles of Neuropsychopharmacology, 1997; Sinauer Assoc. Inc.). The present invention may be used to treat mammals (e.g. humans) for inflammatory bowel disease (including but not limited to ulcerative colitis, pyoderma gangrenosum and Crohn's disease), irritable bowel syndrome, spastic dystonia, chronic pain, acute pain, celiac sprue, pouchitis, vasoconstriction, anxiety, panic disorder, depression, bipolar disorder, autism, sleep disorders, jet lag, amyotrophic lateral sclerosis (ALS), cognitive dysfunction, hypertension, bulimia, anorexia, obesity, cardiac arrythmias, gastric acid hypersecretion, ulcers, pheochromocytoma, progressive supranuclear palsy, chemical dependencies and addictions (e.g., dependencies on, or addictions to nicotine (and/or tobacco products), alcohol, benzodiazepines, barbiturates, opioids or cocaine), headache, migraine, stroke, traumatic brain injury (TBI), obsessive-compulsive disorder (OCD), psychosis, Huntington's chorea, tardive dyskinesia, hyperkinesia, dyslexia, schizophrenia, multiinfarct dementia, age-related cognitive decline, epilepsy, including petit mal absence epilepsy, senile dementia of the Alzheimer's type (AD), Parkinson's disease (PD), attention deficit hyperactivity disorder (ADHD) and Tourette's Syndrome with a decrease in the incidence and severity of unwanted side effects such as nausea and/or stomach upset. The present invention also relates to the combination use of NRPAs and anti-emetic/anti-nausea agents resulting in modulation of cholinergic function without nausea. The combination will provide an improved treatment paradigm than NRPAs alone. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Pharmaceutical composition for neurotrophic action Inventor(s): Ishihara, Yuji; (Ibaraki, JP), Kato, Koki; (Hyogo, JP), Miyamoto, Masaomi; (Hyogo, JP) Correspondence: Takeda Pharmaceuticals North America, Inc; Intellectual Property Department; 475 Half Day Road; Suite 500; Lincolnshire; IL; 60069; US Patent Application Number: 20030130262 Date filed: December 27, 2002 Abstract: The present invention provides a composition for neurotrophic action which comprises a compound of the formula: 1whereinAr is an optionally condensed phenyl group which may be substituted;n is an integer of 1 to 10;R is a hydrogen atom or a hydrocarbon group which may be substituted; andY is an amino group which may be substituted or a nitrogen-containing saturated heterocyclic group which may be substituted; or a salt thereof,which compounds are useful for preventing and/or treating (1) neurodegenerative diseases (e.g. senile dementia, Alzheimer's disease, Down's syndrome, Parkinson's disease, Creutzfelt-Jakob disease, amyotrophic lateral sclerosis, diabetic neuropathy, etc.), (2) neuropathy in cerebrovascular diseases (e.g. impairment of cerebral blood flow based on cerebral infarction, cerebral hemorrhage, cerebral sclerosis, etc.), brain trauma, spiral cord injury, cerebritis sequela and cerebral palsy, (4) mental diseases (e.g. depression, panic disorder, schizophrenia, etc.), etc. Excerpt(s): The present invention relates to a pharmaceutical composition for neurotrophic action having an excellent property. Proteins such as nerve growth factor (NGF), ciliary neurotrophic factor, insulin growth factor-I and brain-derived neurotrophic factor (BDNF) are known as neurotrophic factors (NTF). They are related to homeostasis of neurons in vivo and have (1) action of survival and retention of

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neurons, (2) action of synaptic proplasia, (3) action of protecting against cell death and (4) long term potentiation in the hippocampus. It is known that NGF, BDNF, etc. increase choline acetyltransferase (ChAT) activity and that compounds increasing ChAT activity have protective action on nerve cells and neurotrophic action [The Journal of Neuroscience, Vol. 16, No. 21, pages 6665-6675, (1996) and Neuroscience, Vol. 55, No. 3, pages 629-641, (1993)]. Therefore, through the above actions, medicines having neurotrophic like action are useful for preventing and/or treating (1) neurodegenerative diseases (e.g. senile dementia, Alzheimer's disease, Down's syndrome, Parkinson's disease, Creutzfelt-Jakob disease, amyotrophic lateral sclerosis, diabetic neuropathy, etc.), (2) neuropathy in cerebrovascular diseases (e.g. impairment of cerebral blood flow based on cerebral infarction, cerebral hemorrhage, cerebral sclerosis, etc.), brain trauma, spiral cord injury, cerebritis sequela and cerebral palsy, (3) dysmnesia (e.g. senile dementia, amnesia, etc.), (4) mental diseases (e.g. depression, panic disorder, schizophrenia, etc.), etc. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Phosphodiesterase type 5 (PDE5) inhibitors for the treatment of selective serotonin reuptake inhibitor (SSR) induced sexual dysfunction Inventor(s): Harrison, Wilma; (Harrison, NY), Siegel, Richard L.; (New York, NY) Correspondence: Gregg C. Benson; Pfizer INC.; Patent Department, MS 4159; Eastern Point Road; Groton; CT; 06340; US Patent Application Number: 20030055070 Date filed: February 19, 2002 Abstract: This invention is directed to the use phosphodiesterase type 5 (PDE5) inhibitors in the treatment of selective serotonin reuptake inhibitor (SSRI) induced sexual dysfunction. Specifically, this invention is directed to a method for treating an animal to cure; prevent or ameliorate SSRI induced sexual dysfunction which comprises administering to the animal an effective amount of the inhibitor. The animal may be a male or a female human. The invention also includes the use of such inhibitors in the manufacture of a medicament to prevent; cure or ameliorate SSRI induced sexual dysfunction. Moreover, the invention includes a kit comprising a SSRI, such as sertraline, fluoxetine, paroxetine, and a PDE5 inhibitor, such as sildenafil citrate, for the treatment or prevention of serotonergic associated disorders such as depression, obsessive compulsive disorder or panic disorder, while reducing or preventing sexual dysfunction. Excerpt(s): This application is a continuation of application No. 09/602,790 filed on Jun. 23, 2000, which claims priority from provisional application U.S. serial No. 60/141,980, filed Jul. 1, 1999. This invention relates to the use of phosphodiesterase type 5 (PDE5 ) inhibitors for the treatment of selective serotonin reuptake inhibitor (SSRI) induced sexual dysfunction. In one embodiment the PDE5 inhibitors of this invention are pyrazolopyrimidone compounds, such as pyrazolo[4,3-d]pyrimidin-7-ones, or more specifically sildenafil citrate, VIAGRA.RTM., 1-[[3-(6,7-dihydro-1-methyl-7-oxo-3propyl-1H-pyrazolo[4,3-d]pyrimidin-5-yl)-4-ethoxyphenyl]sulfonyl]-4methylpiperazine citrate. In the general male population, erectile impotence or erectile dysfunction (ED) may be defined as an inability to obtain or sustain an erection adequate for intercourse. Its prevalence is claimed to be between 2 and 7% of the human male population, increasing with age, up to 50 years, and between 18 and 75% between 55 and 80 years of age. In the U.S.A. alone, for example, it has been estimated that there

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are up to 10 million impotent males, with the majority suffering from problems of organic rather than of psychogenic origin. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Piperidine, tetrahydropyridine and piperazine derivatives, their preparation and use Inventor(s): Bjornholm, Berith; (Vaerlose, DK), Krog-Jensen, Christian; (Kobenhavn O, DK), Moltzen, Ejner Knud; (Gentofte, DK) Correspondence: Darby & Darby P.C.; 805 Third Avenue; New York; NY; 10022; US Patent Application Number: 20020035113 Date filed: July 9, 2001 Abstract: A piperidine, tetrahydropyridine or piperazine derivative having formula (I), 1any of its enantiomers or any mixture thereof, or an acid addition salt thereof, wherein B is C.sub.1-10-alkylene, C.sub.1-10-alkenylene or C.sub.1-10-alkynylene; X is --O--, --S--, or CR.sup.4R.sup.5--; and Y is --CR.sup.6R.sup.7, --CR.sup.6R.sup.7--CR.sup.8R.sup.9, or CR.sup.6.dbd.CR.sup.7--; or X and Y together form a group --CR.sup.4.dbd.CR.sup.5, or --CR.sup.4--CR.sup.5--CR.sup.6R.sup.7--; Z is --O--, or --S--; W is N, C, or CH, and the dotted line is an optional bond; A is a bicyclic ring selected from (Ia) or (Ib) wherein E.sup.1, E.sup.2 and E.sup.3 are selected from O, S, N, NR.sup.11, C, CR.sup.12 and CHR.sup.13, and the dotted line indicates an optional bond, provided that E.sup.2 and E.sup.1 and/or E.sup.3 may not simultaneously be O, or S. The compounds of the invention are considered useful for the treatment of affective disorders, such as depression, psychosis, anxiety disorders including general anxiety disorder, panic disorder, obsessive compulsive disorder, and eating disorders. Excerpt(s): The present invention relates to novel piperidine, tetrahydropyridine and piperazine derivatives which are potent serotonin reuptake inhibitors, pharmaceutical compositions containing these compounds and the use thereof for the treatment of disorders or diseases responsive to the inhibition of serotonin re-uptake. The compounds of the invention also possess antagonistic activity at 5-HT.sub.1A receptors and are considered to be particularly useful for the treatment of depression. Selective serotonin (or 5-HT) reuptake inhibitors (SSRIs) such as fluoxetine, paroxetine, sertraline, fluvoxamine and citalopram represent a major step forward in the treatment of depression because they have fewer and less severe side effects compared to first generation antidepressant (tricyclics and non-selective MAO inhibitors). The side effects associated with first generation antidepressants are such that they cause some patients to withdraw from treatment. SSRIs and all other antidepressants currently available suffer from a serious drawback in that several weeks of treatment are necessary to produce the therapeutic effect. The late onset of action is a significant problem, particularly in the treatment of patients with severe depression and suicide potential. Further, one in three patients are not responsive to SSRIs. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Polymorphic DNAs and their use for diagnosis of susceptibility to panic disorder Inventor(s): Hattori, Eiji; (Saitama, JP), Yoshikawa, Takeo; (Saitama, JP) Correspondence: Morrison & Foerster Llp; 3811 Valley Centre Drive; Suite 500; San Diego; CA; 92130-2332; US Patent Application Number: 20020160390 Date filed: December 7, 2001 Abstract: The present invention relates to a method for diagnosing panic disorder, said method being based on the determination of the class of polymorphism of the short tandem repeat (STR) complex in the upstream region of human cholecystokinin gene. The polymorphic DNA comprises a DNA sequence, having a general formula (1):5'(GGAA).sub.n1X(GGAG).sub.n2(GGAA).sub.n3(GGGA).sub.n4GAG(AGAC).sub.n 5Y(G- GAA).sub.n63' (1)wherein X denotes a DNA sequence of SEQ ID NO: 1, Y denotes a DNA sequence of SEQ ID NO:2 and each of n1, n2, n3, n4, n5 and n6 denotes independently 0 or a positive integral number, whereby said DNA ranging from 363 to 399 base pairs in length. The invention also relates to an assay kit used for implementing said method. Excerpt(s): This application claims priority to Japanese Patent Application No. 2000375090, filed on Dec. 8, 2000. The present invention relates to novel polymorphisms, and more specifically, to polymorphisms of the short tandem repeat type in the 5'-upstream region of human cholecystokinin gene, and their use, i.e. a method and a kit for diagnosis of susceptibility to panic disorder. Panic disorder is a common and genetically complex mental illness, characterized by recurrent and unexpected panic attacks. It exhibits a lifetime prevalence rate of between 1.2/100 to 2.4/100 in the general population (Weissman, M. M. et al., Arch. Gen. Psychiatry, 1997; 54, 305-309). Family studies have consistently shown a higher prevalence ranging from between 7.7% to 20.5% in the first-degree relatives of probands. Twin studies have shown concordance rates of 25% for MZ twins and 10% for DZ twins (Skre, I. et al., Acta Psychiatr Scand. 1993; 88, 85-92). These epidemiological studies suggest involvement of genetic factors in the development of this disease. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Remedial agent for anxiety neurosis or depression and piperazine derivative Inventor(s): Chaki, Shigeyuki; (Saitama-shi, JP), Ishii, Takaaki; (Saitama-shi, JP), Nakazato, Atsuro; (Satte-shi, JP), Ogawa, Shin-ichi; (Okegawa-shi, JP), Okubo, Taketoshi; (Asaka-shi, JP) Correspondence: Lorussso & Loud; 3137 Mount Vernon Avenue; Alexandria; VA; 22305; US Patent Application Number: 20030186992 Date filed: December 18, 2002 Abstract: There are provided a therapeutic preparation for anxiety neurosis or depression which comprises a MC.sub.4 receptor antagonist as an effective ingredient; and a piperazine derivative represented by Formula [1]: 1[wherein Ar.sup.1 is a phenyl group, a substituted phenyl group, a naphthyl group or a substituted naphthyl group; Ar.sup.2 is a naphthyl group, a substituted naphthyl group, a quinolyl group, a group represented by the formula: 2(wherein R.sup.4 is a hydrogen atom or a halogen atom;

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and X--Y is CH--NH, CH--O, CH--S or N--O) or a group represented by the formula: 3(wherein R.sup.5 is a hydrogen atom, a hydroxyl group or a C.sub.1-10 alkoxy group); R.sup.1 is a hydrogen atom, a C.sub.1-10 alkyl group, a C.sub.3-8 cycloalkyl group, a C.sub.3-10 alkenyl group, a phenyl group, a 1-cyanoethyl group, a pyrimidin-2-yl group or an amidyl group; R.sup.2 and R.sup.3 are the same or different, and are each a hydrogen atom or a C.sub.1-10 alkyl group; A-B is N--CH.sub.2, CH--CH.sub.2, C(OH)-CH.sub.2 or C.dbd.CH; T.sup.1 is a single bond, --N(R.sup.6)-- (wherein R.sup.6 is a hydrogen atom or a C.sub.1-10 alkyl group), --O--, --CH.dbd.CH-- or --C(.dbd.O)--; n is an integer of from 1 to 10 and when T.sup.1 is a single bond, --CH.dbd.CH-- or -C(.dbd.O)--, n is an integer of from 2 to 10 when T.sup.1 is --N(R.sup.6)-- or --O--], or a pharmaceutically acceptable salt thereof. Excerpt(s): The present invention relates to a therapeutic preparation for anxiety neurosis or depression which comprises a MC.sub.4 receptor antagonist as an effective ingredient, and relates to novel piperazine derivatives having a MC.sub.4 receptor antagonistic action. It is suggested by the recent progress of pathophysiology that stress is deeply pertinent to development mechanism of anxiety neurosis and depression. As an intracerebral reaction caused by stress, there has been known a functional abnormality of neuroendocrine system of which representative is the functional abnormality of hypothalamus-pituitary-adrenal system. From such a background, the neuropeptides which locate in pituitary and affect neuroendocrine attract attention as a development reason of depression/anxiety. Among such neuropeptides are corticotropin releasing factors (CRF) and proopiomelanocortin (POMC). CRF is known to play the central role of stress reaction such as susceptibility of hypothalamuspituitary-adrenal system, and suggested to have relation to anxiety/depression. Melanocortins [adrenocorticotropic hormone (ACTH), melanocyte stimulating hormone (MSH)] produced from POMC are main neuropeptides in hypothalamus, but there is no report of the substances acting to melanocortin receptors relating to stress reaction and depression/anxiety neurosis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Therapeutic heterocyclic compounds Inventor(s): Chapdelaine, Marc; (Wilmington, DE), Davenport, Timothy; (Wilmington, DE), Haeberlein, Markus; (Sodertalje, SE), Horchler, Carey; (Wilmington, DE), McCauley, John P.; (Wilmington, DE), Pierson, Edward; (Wilmington, DE), Sohn, Daniel; (Sodertalje, SE) Correspondence: Astra Zeneca Pharmaceuticals LP; Global Intellectual Property; 1800 Concord Pike; Wilmington; DE; 19850-5437; US Patent Application Number: 20030013708 Date filed: January 16, 2002 Abstract: Provided herein is a compound having the formula (I): 1Wherein said compounds are useful for the treatment of psychiatric disorders including but not limited to depression, generalized anxiety, eating disorders, dementia, panic disorder, and sleep disorders. The compounds may also be useful in the treatment of gastrointestinal disorders, cardiovascular regulation, motor disorders, endocrine disorders, vasospasm and sexual dysfunction. The compounds are 5HT.sub.1B and 5HT.sub.1D antagonists.

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Excerpt(s): This application claims priority to foreign patent Application Number 0103650-8, filed in Sweden on Nov. 2, 2001 which is pending and it also claims priority to U.S. Provisional Patent Application No. 60/262,107 filed on Jan. 16, 2001. This patent application is co-pending with PCT Application No. ______ filed on even date herewith in European Patent Office in Sweden. This invention relates to novel 8-amino derivatives, methods for their preparation, pharmaceutical compositions containing them and their use in therapy. Serotonin (5-HT) has been implicated in many psychiatric disorders including but not limited to depression, generalized anxiety, eating disorders, dementia, panic disorder, and sleep disorders. Furthermore serotonin has been implicated in gastrointestinal disorders, cardiovascular regulation, motor disorders, endocrine disorders, vasospasm and sexual dysfunction. Serotonin receptors have been subdivided into at least 14 subtypes, see Barnes and Sharp, Neuropharmacology, 1999, 38, 1083-1152, incorporated herein by reference. These various subtypes are responsible for serotonin's action in many pathophysicogical conditions. The 5-HT.sub.1 family of receptors has high affinity for serotonin and consists of five related receptors. This family includes the 5-HT.sub.1B and 5-HT.sub.1D receptor subtypes. Compounds that interact with the 5-HT.sub.1 family are known to have therapeutic potential in the above mentioned disorders and diseases. In particular, compounds that are 5HT.sub.1B and 5HT.sub.1D antagonist have been known to be antidepressant and anxiolytic agents. Compounds that are 5HT.sub.1B and 5HT.sub.1D agonists have been used in the treatment of migraine. R.sup.11 is --H, alkyl, AOH, --SO.sub.2A, --SO.sub.2NH.sub.2, -SO.sub.2NHA, --SO.sub.2NA.sub.2, --SO.sub.2NHAR.sup.9, --C(.dbd.O)R.sup.9, alkylR.sup.9, C(.dbd.O)A, C(.dbd.O)NH.sub.2, C(.dbd.O)NHA, C(.dbd.O)NA.sub.2 or -C(.dbd.O)OA; or a pharmaceutically acceptable salt of said compound. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with panic disorder, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “panic disorder” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on panic disorder. You can also use this procedure to view pending patent applications concerning panic disorder. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 7. BOOKS ON PANIC DISORDER Overview This chapter provides bibliographic book references relating to panic disorder. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on panic disorder include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “panic disorder” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on panic disorder: •

Principles and Practice of Relapse Prevention Summary: This book provides an up-to-date and comprehensive analysis of current research on relapse prevention. This edited collection presents, with one overall perspective, the diverse applications of relapse prevention. It addresses the conceptual and methodological issues of relapse prevention and offers directions for future research. The book covers relapse prevention strategies for alcohol problems, smoking, obesity, anorexia nervosa, and bulimia. Clinical problems such as depression, schizophrenia, panic disorder and panic disorder with agoraphobia, obsessivecompulsive disorders, and sexual deviance are discussed as well. The book also describes relapse prevention techniques for complaints such as chronic pain, martial problems, social competence, and stuttering.

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Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “panic disorder” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “panic disorder” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “panic disorder” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

An End to Panic: Breakthrough Techniques for Overcoming Panic Disorder by Elke Zuercher-White (1998); ISBN: 1572241136; http://www.amazon.com/exec/obidos/ASIN/1572241136/icongroupinterna

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Anxiety Disorders Comorbid with Depression: Panic Disorder and Agoraphobia by Spilios Argyropolous, et al; ISBN: 1841840491; http://www.amazon.com/exec/obidos/ASIN/1841840491/icongroupinterna

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Anxiety, Phobias & Panic Disorders - a clinical guideline [DOWNLOAD: PDF] by Apollo Managed Care Consultants (Author); ISBN: B00007CIEU; http://www.amazon.com/exec/obidos/ASIN/B00007CIEU/icongroupinterna

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Autobiography of an Agoraphobic: One Man's Struggle With Panic Disorder by Michael R. Patrick (2003); ISBN: 1410786307; http://www.amazon.com/exec/obidos/ASIN/1410786307/icongroupinterna

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Clinical Aspects of Panic Disorder by James C. Ballenger (Editor); ISBN: 0471566942; http://www.amazon.com/exec/obidos/ASIN/0471566942/icongroupinterna

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Cognitive Therapy of Anxiety and Panic Disorder: First Interview Techniques (Cassette) by Aaron Beck; ISBN: 9990058547; http://www.amazon.com/exec/obidos/ASIN/9990058547/icongroupinterna

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Cognitive Therapy of Anxiety and Panic Disorders: First Interview by Aaron T. Beck (Author); ISBN: 0898628741; http://www.amazon.com/exec/obidos/ASIN/0898628741/icongroupinterna

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Do you have sudden bursts of fear for no reason? : a real illness : panic disorder (SuDoc HE 20.8102:IL 6/PANIC) by U.S. Dept of Health and Human Services; ISBN: B000112WSQ; http://www.amazon.com/exec/obidos/ASIN/B000112WSQ/icongroupinterna

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Getting treatment for panic disorder : information for patients, families, and friends (SuDoc HE 20.8102:T 71/2/995) by U.S. Dept of Health and Human Services; ISBN: B00010PIQ0; http://www.amazon.com/exec/obidos/ASIN/B00010PIQ0/icongroupinterna

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I Made It Through the Rain: A Story About Overcoming Panic Disorder by Robert E. Sterling (2002); ISBN: 0595214053; http://www.amazon.com/exec/obidos/ASIN/0595214053/icongroupinterna

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Let's Talk Facts About Panic Disorder by The American Psychiatric Association Division of Public Affairs; ISBN: 0890423571; http://www.amazon.com/exec/obidos/ASIN/0890423571/icongroupinterna

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Living with Panic Disorder by John MFT Tsilimparis (Author) (2003); ISBN: 141370297X; http://www.amazon.com/exec/obidos/ASIN/141370297X/icongroupinterna

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Mental Health Disorders Sourcebook: Basic Information About Schizophrenia, Depression, Bipolar Disorder, Panic Disorder, Obsessive-Compulsive Disorder, Phobias and Other Anxiety disorder (Health Reference Series, Vol 9) by Karen Bellenir (Editor) (1997); ISBN: 0780800400; http://www.amazon.com/exec/obidos/ASIN/0780800400/icongroupinterna

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Neurobiology of panic disorder; ISBN: 084514507X; http://www.amazon.com/exec/obidos/ASIN/084514507X/icongroupinterna

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Neurobiology of Panic Disorder (Frontiers of Clinical Neuroscience, Vol 8) by James C. Ballenger (Editor); ISBN: 0471562106; http://www.amazon.com/exec/obidos/ASIN/0471562106/icongroupinterna

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No Need to Fear: Overcoming Panic Disorder by Koz, St. Christopher, et al; ISBN: 1930693877; http://www.amazon.com/exec/obidos/ASIN/1930693877/icongroupinterna

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Overcoming Panic Disorder by Lorna Weinstock, Eleanor Gilman; ISBN: 0809231026; http://www.amazon.com/exec/obidos/ASIN/0809231026/icongroupinterna

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Overcoming Panic Disorder and Agoraphobia: Client Manual by Elke Zuercher-White (1999); ISBN: 1572241470; http://www.amazon.com/exec/obidos/ASIN/1572241470/icongroupinterna

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Panic Disorder by Nancy M. Campbell (2001); ISBN: 0736810307; http://www.amazon.com/exec/obidos/ASIN/0736810307/icongroupinterna

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Panic Disorder & Its Treatment by J. F. Rosenbaum (Editor), Mark H. Pollack (Editor); ISBN: 0824702166; http://www.amazon.com/exec/obidos/ASIN/0824702166/icongroupinterna

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Panic disorder (SuDoc HE 20.8102:P 19/2) by Mary Lynn Hendrix; ISBN: B000109E6K; http://www.amazon.com/exec/obidos/ASIN/B000109E6K/icongroupinterna

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Panic Disorder and Agoraphobia: A Comprehensive Guide for the Practitioner by John R. Walker (Editor), et al; ISBN: 0534112862; http://www.amazon.com/exec/obidos/ASIN/0534112862/icongroupinterna

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Panic Disorder and Agoraphobia: A Guide by John H. Greist, James W. Jefferson (2001); ISBN: 1890802263; http://www.amazon.com/exec/obidos/ASIN/1890802263/icongroupinterna

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Panic Disorder and Anxiety in Adolescence by Sara Golden Mattis, et al; ISBN: 1854333526; http://www.amazon.com/exec/obidos/ASIN/1854333526/icongroupinterna

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Panic Disorder in the Medical Setting by Wayne J. Katon; ISBN: 0880483725; http://www.amazon.com/exec/obidos/ASIN/0880483725/icongroupinterna

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Panic Disorder: A Critical Analysis by Richard J. McNally; ISBN: 0898622638; http://www.amazon.com/exec/obidos/ASIN/0898622638/icongroupinterna

•

Panic Disorder: Assessment and Treatment Through a Wide-Angle Lens by Frank M. Dattilio, Jesus A. Salas-Auvert (2000); ISBN: 1891944355; http://www.amazon.com/exec/obidos/ASIN/1891944355/icongroupinterna

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•

Panic Disorder: Clinical Diagnosis, Management and Mechanisms by David J. Nutt (Editor), et al; ISBN: 1853175188; http://www.amazon.com/exec/obidos/ASIN/1853175188/icongroupinterna

•

Panic Disorder: Clinical, Biological, and Treatment Aspects (The Einstein Psychiatry, No 12) by Gregory N. Asnis, et al; ISBN: 0471089990; http://www.amazon.com/exec/obidos/ASIN/0471089990/icongroupinterna

•

Panic Disorder: Making the Diagnosis [ABRIDGED] by David H. Barlow, Peter Di Nardo; ISBN: 0898629632; http://www.amazon.com/exec/obidos/ASIN/0898629632/icongroupinterna

•

Panic Disorder: The Facts (The Facts) by Stanley Rachman, et al (2004); ISBN: 0198528817; http://www.amazon.com/exec/obidos/ASIN/0198528817/icongroupinterna

•

Panic Disorder: The Great Pretender by Michael, D.O. Zal, et al; ISBN: 0738205761; http://www.amazon.com/exec/obidos/ASIN/0738205761/icongroupinterna

•

Panic Disorder: The Medical Point of View by William D. Kernodle; ISBN: 0963153323; http://www.amazon.com/exec/obidos/ASIN/0963153323/icongroupinterna

•

Panic Disorder: Theory, Research, and Therapy (Wiley Series in Clinical Psychology) by Roger Baker (Editor); ISBN: 0471923192; http://www.amazon.com/exec/obidos/ASIN/0471923192/icongroupinterna

•

Panic Disorders: Making the Diagnosis by David H. Barlow; ISBN: 9990060436; http://www.amazon.com/exec/obidos/ASIN/9990060436/icongroupinterna

•

Practice Guideline for the Treatment of Patients With Panic Disorder by Psychiatric Press Incorporated (Editor), et al (1998); ISBN: 0890423113; http://www.amazon.com/exec/obidos/ASIN/0890423113/icongroupinterna

•

Psychodynamic Approaches to the Adolescent With Panic Disorder by Barbara Milrod, et al (2004); ISBN: 1575242303; http://www.amazon.com/exec/obidos/ASIN/1575242303/icongroupinterna

•

Sexual Aversion And Sexual Phobias And Panic Disorders by Helen Singer Kaplan, Donald F., M.D. Klein (Contributor); ISBN: 0876304501; http://www.amazon.com/exec/obidos/ASIN/0876304501/icongroupinterna

•

Surviving Panic Disorder: What You Need to Know by Stuart Shipko M. D. (2003); ISBN: 1410787346; http://www.amazon.com/exec/obidos/ASIN/1410787346/icongroupinterna

•

The Assessment and Treatment of Panic Disorder and Agoraphobia by Edwin De Beurs (1993); ISBN: 9051702027; http://www.amazon.com/exec/obidos/ASIN/9051702027/icongroupinterna

•

The Earl Campbell Story: A Football Great's Battle With Panic Disorder by Earl Campbell (Editor), et al (1999); ISBN: 1550223917; http://www.amazon.com/exec/obidos/ASIN/1550223917/icongroupinterna

•

Treating Panic Disorder and Agoraphobia: A Step-By-Step Clinical Guide by Elke Zuercher-White (1997); ISBN: 1572240849; http://www.amazon.com/exec/obidos/ASIN/1572240849/icongroupinterna

•

Treatment of panic disorder with and without agoraphobia : January 1985 through July 1991 : 1448 citations (SuDoc HE 20.3615/2:91-8) by Karen Patrias; ISBN:

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0160306922; http://www.amazon.com/exec/obidos/ASIN/0160306922/icongroupinterna •

Treatment of Panic Disorder: A Consensus Development Conference by Barry E., Ph.D. Wolfe, Jack D., Ph.D. Maser (Editor); ISBN: 0880486856; http://www.amazon.com/exec/obidos/ASIN/0880486856/icongroupinterna

•

Understanding and Treating Panic Disorder: Cognitive-Behavioural Approaches by Steven Taylor (Author); ISBN: 0471490679; http://www.amazon.com/exec/obidos/ASIN/0471490679/icongroupinterna

•

Understanding panic disorder (SuDoc HE 20.8102:P 19/3) by Mary Lynn Hendrix; ISBN: B00010LN5A; http://www.amazon.com/exec/obidos/ASIN/B00010LN5A/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “panic disorder” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:11 •

Overcoming panic disorder and agoraphobia: a cognitive restructuring and exposurebased protocol for the treatment of panic and agoraphobia Author: Zuercher-White, Elke,; Year: 1994; Oakland, CA: New Harbinger Publications, c1999; ISBN: 1572241462 http://www.amazon.com/exec/obidos/ASIN/1572241462/icongroupinterna

•

Panic disorder Author: Rachman, Stanley.; Year: 1993; Oxford; New York: Oxford University Press, 1996; ISBN: 0192627384 http://www.amazon.com/exec/obidos/ASIN/0192627384/icongroupinterna

•

Stress-related disorders sourcebook: basic consumer health information about stress and stress-related disorders: including stress origins and signals, environmental stress at work and home, mental and emotional stress associated with depression, post-traumantic stress disorder, panic disorder, suicide, and the physical effects of stress and the cardiovascular, immune, and nervous systems: along with stress management techniques, a glossary, and a listing of additional resources Author: Shannon, Joyce Brennfleck.; Year: 1997; Detroit, MI: Omnigraphics, 2002; ISBN: 0780805607 http://www.amazon.com/exec/obidos/ASIN/0780805607/icongroupinterna

•

Understanding and treating panic disorder: cognitive-behavioural approaches Author: Taylor, Steven,; Year: 1998; Chichester; New York: John Wiley, c2000; ISBN: 0471987042 http://www.amazon.com/exec/obidos/ASIN/0471987042/icongroupinterna

11

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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Chapters on Panic Disorder In order to find chapters that specifically relate to panic disorder, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and panic disorder using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “panic disorder” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on panic disorder: •

Improving Your Emotional Awareness Source: in Bolen, B.B. Breaking the Bonds of Irritable Bowel Syndrome: A Psychological Approach to Regaining Control of Your Life. Oakland, CA: New Harbinger Publications, Inc. 2000. p.95-111. Contact: Available from New Harbinger Publications, Inc. 5674 Shattuck Avenue, Oakland, California 94609. (800) 748-6273 or (510) 652-0215. Fax: (510) 652-5472. E-mail: [email protected]. Website: http://www.newharbinger.com/contactus.htm. PRICE: $14.95 and handling. ISBN: 1572241888. Summary: Irritable bowel syndrome (IBS) consists of recurrent episodes of abdominal pain related to altered bowel habit, which may consist of predominantly constipation or diarrhea, or an alternation between the two. This chapter on improving one's emotional awareness is from a book in which the author encourages an open discussion of the symptoms and feelings that accompany irritable bowel syndrome (IBS). Charts and worksheets help readers track the relationship between unpleasant symptoms and external triggers such as foods, stressful events, emotional states, and certain thoughts. Coping skills, such as relaxation exercises and assertiveness techniques, teach readers how to manage their stress more effectively and help them break free of the restrictions placed upon them by the disruptiveness of this digestive disorder. This chapter covers stress-related illnesses, the fight-or-flight response, risk factors, depression, generalized anxiety disorder, panic disorder, healthy versus unhealthy emotions, common IBS emotions, and strategies for self-soothing. Throughout the chapter, the author emphasizes the importance of educating oneself and taking an active role in one's own disease management.

•

Vestibular Rehabilitation Source: in Valente, M.; Hosford-Dunn, H.; Roeser, R.J., eds. Audiology: Treatment. New York, NY: Thieme. 2000. p. 639-667. Contact: Available from Thieme. 333 Seventh Avenue, New York, NY 10001. (800) 7823488. Fax (212) 947-0108. E-mail: [email protected]. PRICE: $69.00 plus shipping and handling. ISBN: 0865778590. Summary: Vestibular disorders, responsible for complaints of dizziness and vertigo, are a common complaint in the adult and geriatric population. This chapter on vestibular rehabilitation is from a textbook that provides a comprehensive overview of the numerous treatment options available to help patients relieve the clinical symptoms seen in an audiology practice. After a review of the definitions of the relevant terms, the author discusses past approaches to the patient with dizziness; the physiological basis

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for recovery, in static symptoms and dynamic symptoms; controversies in vestibular rehabilitation, including critical periods of compensation, rehabilitation versus repositioning, vestibular rehabilitation versus medication, and generic versus customized exercise; adaptive strategies, including cervical ocular reflex input, modification of saccades, modification of smooth pursuit, and substitution of sensory inputs and decreased head movements; planning, goal writing, and documentation; treatment strategies, including that for unilateral vestibular loss, bilateral vestibular loss, the limits of vestibular rehabilitation, vestibular therapy and central lesions, and fall prevention; benign paroxsymal positional vertigo (BPPV), including pathophysiology, treatment options, and variant forms of BPPV; vestibular disorders and panic disorder; and billing codes. The chapter includes an outline of the topic covered, a list of references, a summary outline of the related preferred practice guidelines, and various 'pearls and pitfalls' offering practical advice to the reader. 3 figures. 4 tables. 115 references.

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CHAPTER 8. MULTIMEDIA ON PANIC DISORDER Overview In this chapter, we show you how to keep current on multimedia sources of information on panic disorder. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Bibliography: Multimedia on Panic Disorder The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in panic disorder (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on panic disorder: •

Anxiety and panic disorders [videorecording] Source: James Barbee; Year: 1998; Format: Videorecording; [Irvine, Calif.]: CME, c1998

•

Cognitive therapy for panic disorders [videorecording] Source: American Psychological Association; Year: 1997; Format: Videorecording; Washington, D.C.: The Association, c1997

•

Current developments in panic disorders [videorecording] Source: [presented by] the Medical University of South Carolina, College of Pharmacy and Health Communications Network; Year: 1991; Format: Videorecording; Charleston, S.C.: The University, c1991

•

Panic [videorecording]: panic disorders in primary care Source: sponsored by Duke University School of Medicine; CME Information Services, Inc., CMEVideo; Year: 1997; Format: Videorecording; Mt. Laurel, NJ: CMEVideo, 1997

•

Panic disorder [videorecording]: a clinical view Source: Video Atlantic Teleproductions; Year: 1993; Format: Videorecording; Norfolk, VA: A.L. Granoff, c1993

•

Panic disorder [videorecording]: diagnosis and management Source: [presented by] the Medical University of South Carolina, College of Medicine and the Health

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Communications Network; Year: 1992; Format: Videorecording; Charleston, S.C.: Medical University of South Carolina, c1992 •

Panic disorder [videorecording]: the great imitator Source: Jack M. Gorman; Year: 1994; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1994

•

Panic disorder and agoraphobia [videorecording] Source: a production of CinemaHouse Films Inc; Year: 2002; Format: Videorecording; Irvine, CA: Distributed by Concept Media, c2002

•

Panic disorder and agoraphobia [videorecording] Source: Films for the Humanities & Sciences; produced by ICOTOP, Inc; Year: 2002; Format: Videorecording; Princeton, N.J.: Films for the Humanities & Sciences, c2002

•

Panic disorder, the nameless fear [videorecording] Source: with David L. Fogelson; Year: 1986; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, 1986

•

Psychiatric challenges for the primary care physician [videorecording]: panic disorder Source: Jerrold F. Rosenbaum; Year: 1996; Format: Videorecording; Secaucus, N.J.: Network for Continuing Medical Education, c1996

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CHAPTER 9. DISORDER

PERIODICALS AND NEWS ON PANIC

Overview In this chapter, we suggest a number of news sources and present various periodicals that cover panic disorder.

News Services and Press Releases One of the simplest ways of tracking press releases on panic disorder is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “panic disorder” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to panic disorder. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “panic disorder” (or synonyms). The following was recently listed in this archive for panic disorder: •

Forest seeks to market new SSRI for panic disorder Source: Reuters Industry Breifing Date: May 01, 2003

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•

Lilly's Prozac cleared for panic disorder, long-term bulimia treatment Source: Reuters Industry Breifing Date: August 15, 2002

•

Glaxo's Paxil CR wins FDA nod for panic disorder Source: Reuters Industry Breifing Date: February 12, 2002

•

Early diagnosis and treatment of panic disorder in ER is feasible Source: Reuters Industry Breifing Date: February 05, 2002

•

Once-weekly drug helps panic disorder Source: Reuters Health eLine Date: June 09, 1999

•

Sertraline effective in treating panic disorder Source: Reuters Health eLine Date: September 25, 1998

•

Was Darwin Prey To Panic Disorder? Source: Reuters Health eLine Date: January 09, 1997

•

Chest Pain May Be Panic Disorder Source: Reuters Health eLine Date: October 21, 1996 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “panic disorder” (or synonyms) into the search box, and click on “Search News.” As this service is technology

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oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “panic disorder” (or synonyms). If you know the name of a company that is relevant to panic disorder, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “panic disorder” (or synonyms).

Academic Periodicals covering Panic Disorder Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to panic disorder. In addition to these sources, you can search for articles covering panic disorder that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 10. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for panic disorder. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with panic disorder. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to panic disorder: Antidepressants, Monoamine Oxidase (Mao) Inhibitor •

Systemic - U.S. Brands: Marplan; Nardil; Parnate http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202054.html

Antidepressants, Tricyclic •

Systemic - U.S. Brands: Anafranil; Asendin; Aventyl; Elavil; Endep; Norfranil; Norpramin; Pamelor; Sinequan; Surmontil; Tipramine; Tofranil; Tofranil-PM; Vivactil http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202055.html

Benzodiazepines •

Systemic - U.S. Brands: Alprazolam Intensol; Ativan; Dalmane; Diastat; Diazepam Intensol; Dizac; Doral; Halcion; Klonopin; Librium; Lorazepam Intensol; Paxipam; ProSom; Restoril; Serax; Tranxene T-Tab; Tranxene-SD; Tranxene-SD Half Strength; Valium; Xanax http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202084.html

Caffeine •

Systemic - U.S. Brands: Cafcit; Caffedrine Caplets; Dexitac Stay Alert Stimulant; Enerjets; Keep Alert; Maximum Strength SnapBack Stimulant Powders; NoDoz Maximum Strength Caplets; Pep-Back; Quick Pep; Ultra Pep-Back; Vivarin http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202105.html

Paroxetine •

Systemic - U.S. Brands: Paxil http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202717.html

Sertraline •

Systemic - U.S. Brands: Zoloft http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202651.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

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PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

12

These publications are typically written by one or more of the various NIH Institutes.

166 Panic Disorder

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.13 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:14 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

13 Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 14 See http://www.nlm.nih.gov/databases/databases.html.

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html The Combined Health Information Database

A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to one of the following: Brochure/Pamphlet, Fact Sheet, or Information Package, and “panic disorder” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years.” Select your preferred language and the format option “Fact Sheet.” Type “panic disorder” (or synonyms) into the “For these words:” box. The following is a sample result: •

Clinical Management of the HIV - Infected Adult: A Manual for Mid - Level Clinicians Contact: University of Illinois at Chicago, Midwest AIDS Education and Training Center, 808 S Wood St M/C 779, Chicago, IL, 60612-7303, (312) 996-1373. Summary: This manual contains the protocol for the management of the HIV-infected patient. It begins with health maintenance protocols, which allow the clinician to provide a standardized database for the assessment and treatment of HIV-related problems, including acute intervention and ongoing supportive care. The HIV-specific laboratory protocols provide a guideline for monitoring patients with HIV infection which identifies other co-infections and assists in tracking disease progression. The HIVspecific assessment tool is used to help clinicians and caretakers measure the patient's ability to carry out activities of daily living. Complaint-specific protocols cover the ears, nose and sinuses, mouth and throat, fever, headache, shortness of breath, and seizures. The disease-specific protocols include cervical disease, histoplasmosis, HIV-related cardiomyopathy, oral candidiasis, kaposi's sarcoma, and many other specific diseases. Neuropsychiatric protocols offer guidelines for the treatment of major depression, generalized anxiety disorders, panic disorder, suicide, and AIDS dementia complex. The manual concludes with a comprehensive drug protocol--this includes antiretroviral therapy and common HIV medications.

The NLM Gateway15 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “panic disorder” (or synonyms) into the search box and click “Search.” The results will 15 16

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH).

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be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 5129 130 886 8 10 6163

HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.19 Simply search by “panic disorder” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/. 17

Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html.

18

The HSTAT URL is http://hstat.nlm.nih.gov/.

19

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 20 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 21 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

The Genome Project and Panic Disorder In the following section, we will discuss databases and references which relate to the Genome Project and panic disorder. Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).23 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. To search the database, go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html. Type “panic disorder” (or synonyms) into the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. In particular, the option “Database Links” will search across technical databases that offer an abundance of information. The following is an example of the results you can obtain from the OMIM for panic disorder: •

Panic Disorder Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?167870

•

Panic Disorder 1 Web site: http://www.ncbi.nlm.nih.gov/htbin-post/Omim/dispmim?607853 Genes and Disease (NCBI - Map)

The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by system of the body. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may 23

Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.

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wish to revisit it from time to time. The following systems and associated disorders are addressed: •

Cancer: Uncontrolled cell division. Examples: Breast and ovarian cancer, Burkitt lymphoma, chronic myeloid leukemia, colon cancer, lung cancer, malignant melanoma, multiple endocrine neoplasia, neurofibromatosis, p53 tumor suppressor, pancreatic cancer, prostate cancer, Ras oncogene, RB: retinoblastoma, von Hippel-Lindau syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Cancer.html

•

Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html

•

Metabolism: Food and energy. Examples: Adreno-leukodystrophy, atherosclerosis, Best disease, Gaucher disease, glucose galactose malabsorption, gyrate atrophy, juvenile-onset diabetes, obesity, paroxysmal nocturnal hemoglobinuria, phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html

•

Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html

•

Nervous System: Mind and body. Examples: Alzheimer disease, amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, fragile X syndrome, Friedreich’s ataxia, Huntington disease, Niemann-Pick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html

•

Signals: Cellular messages. Examples: Ataxia telangiectasia, Cockayne syndrome, glaucoma, male-patterned baldness, SRY: sex determination, tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html

•

Transporters: Pumps and channels. Examples: Cystic fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html Entrez

Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases:

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3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

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Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books

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Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome

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NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/

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Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide

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OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM

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PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset

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ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

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Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein

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PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

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Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure

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Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy

To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB=genome, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” Enter “panic disorder” (or synonyms) into the search box and click “Go.” Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database24 This online resource has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html, you can search across syndromes using an alphabetical index. Search by keywords at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. 24 Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html.

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The Genome Database25 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “panic disorder” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms).

25

Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html - mission.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on panic disorder can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to panic disorder. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to panic disorder. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “panic disorder”:

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Guides on panic disorder Panic Disorder http://www.nlm.nih.gov/medlineplus/panicdisorder.html

•

Other guides Mental Health http://www.nlm.nih.gov/medlineplus/mentalhealth.html Obsessive-Compulsive Disorder http://www.nlm.nih.gov/medlineplus/obsessivecompulsivedisorder.html Post-Traumatic Stress Disorder http://www.nlm.nih.gov/medlineplus/posttraumaticstressdisorder.html

Within the health topic page dedicated to panic disorder, the following was listed: •

General/Overviews Answers to Your Questions About Panic Disorder Source: American Psychological Association http://www.apa.org/pubinfo/panic.html Closer Look at Panic Disorder Source: American Psychiatric Association http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZXHSH3DM C&sub_cat=47 Panic Attack Source: Anxiety Disorders Association of America http://www.adaa.org/AnxietyDisorderInfor/PanicDisAgor.cfm

•

Treatment Anxiety Disorders Information: Guide to Treatment Source: Anxiety Disorders Association of America http://www.adaa.org/AnxietyDisorderInfor/GuidetoTre.cfm Getting Treatment for Panic Disorder Source: National Institute of Mental Health http://www.nimh.nih.gov/anxiety/getpd.cfm Medications Source: National Institute of Mental Health http://www.nimh.nih.gov/publicat/medicate.cfm Psychosocial Treatments Source: National Alliance for the Mentally Ill http://www.nami.org/Content/ContentGroups/Helpline1/Psychosocial_Treatme nts.htm

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Children Bedtime Panic Attacks: 'My Child Gets Hysterical Before Bedtime' Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=AN00430 Panic Disorder in Children and Adolescents Source: American Academy of Child and Adolescent Psychiatry http://www.aacap.org/publications/factsfam/panic.htm

•

Organizations Anxiety Disorders Association of America http://www.adaa.org/ National Institute of Mental Health http://www.nimh.nih.gov/ National Mental Health Association http://www.nmha.org/

•

Research Anxiety Disorders Research at the National Institute of Mental Health Source: National Institute of Mental Health http://www.nimh.nih.gov/publicat/anxresfact.cfm Panic Disorder and Depression in Parents Linked to Mental Disorders in Children Source: American Psychiatric Association http://www.medem.com/search/article_display.cfm?path=n:&mstr=/ZZZXJC3KJ HC.html&soc=APA&srch_typ=NAV_SERCH

•

Statistics Numbers Count: Mental Disorders in America Source: National Institute of Mental Health http://www.nimh.nih.gov/publicat/numbers.cfm

•

Teenagers All About Anxiety Source: Nemours Foundation http://kidshealth.org/teen/your_mind/mental_health/anxiety.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.

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The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on panic disorder. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

IBS Anxiety Profile Source: Milwaukee, WI: International Foundation for Functional Gastrointestinal Disorders. 1996. 2 p. Contact: Available from International Foundation for Functional Gastrointestinal Disorders (IFFGD). P.O. Box 170864, Milwaukee, WI 53217. (888) 964-2001 or (414) 9641799. Fax (414) 964-7176. E-mail: [email protected]. Website: www.iffgd.org. PRICE: $0.50. Summary: This fact sheet describes the impact of anxiety on people with irritable bowel syndrome (IBS). The author notes that chronic anxiety can disrupt performance and trigger a broad range of psychophysiological complaints, including IBS. Apart from depression, four types of anxiety disorders are commonly found among people with IBS (an individual may have more than one): panic disorder, phobias, obsessive-compulsive disorder, and generalized anxiety disorder (GAD). Among these disorders, GAD is the most common diagnosis for patients with IBS. The author notes the specific symptoms in the categories of motor tension, autonomic hyperactivity, and vigilance and scanning; from these symptoms, six are required for a diagnosis. Also, self-defeating patterns of thought are often found to be associated with GAD and the other anxiety disorders. These patterns of thought usually have five associated features which are especially common in people with IBS: intrusive, anticipatory, catastrophic, perfectionistic, and hidden thoughts. The fact sheet concludes with a brief discussion of treatments for IBSrelated anxiety, notably cognitive-behavioral therapy (CBT). (AA-M). The National Guideline Clearinghouse™

The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search this site located at http://www.guideline.gov/ by using the keyword “panic disorder” (or synonyms). The following was recently posted: •

Major depression, panic disorder and generalized anxiety disorder in adults in primary care Source: Institute for Clinical Systems Improvement - Private Nonprofit Organization; 1996 January (revised 2002 May); 55 pages http://www.guideline.gov/summary/summary.aspx?doc_id=3350&nbr=2576&a mp;string=panic+AND+disorder

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Practice guideline for the treatment of patients with panic disorder. Source: American Psychiatric Association - Medical Specialty Society; 1998 May; 86 pages http://www.guideline.gov/summary/summary.aspx?doc_id=1429&nbr=669&am p;string=panic+AND+disorder Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Facts About Panic Disorder Summary: This 4-page fact sheet covers the prevalence, causes, and treatments for panic disorder. Source: National Institute of Mental Health, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6628

•

Fighting Phobias, The Things That Go Bump in the Mind Summary: This article discusses the most common types of phobias -- panic disorder, agoraphobia, social phobias (fear of animals, the dentist) -- and ways to overcome them. Source: U.S. Food and Drug Administration http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3567

•

Mental Health Publications & Education Programs Summary: Conference proceedings, consumer publications, and public education program materials on anxiety, attention deficit hyperactivity disorder, depression, panic disorder, learning disabilities, bipolar Source: National Institute of Mental Health, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=358

•

Panic Disorder: A Real Illness Source: National Institute of Mental Health, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6565

•

Understanding Panic Disorder Source: National Institute of Mental Health, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=3205

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When Fear Holds Sway: Panic Disorder Summary: This 2-page fact sheet describes panic disorder, research about the disorder, and treatment of the disorder. Source: National Institute of Mental Health, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6633 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to panic disorder. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •


•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to panic disorder. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with panic disorder. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about panic disorder. For more information, see

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the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “panic disorder” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “panic disorder”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “panic disorder” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “panic disorder” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.26

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

26

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)27: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

27

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

185

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

186 Panic Disorder

•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

188 Panic Disorder

•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

189

ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on panic disorder: •

Basic Guidelines for Panic Disorder Panic disorder Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000924.htm Panic disorder with agoraphobia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000923.htm

•

Signs & Symptoms for Panic Disorder Agitation Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003212.htm Anxiety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Blushing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003241.htm

190 Panic Disorder

Chest pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003079.htm Depression Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003213.htm Dizziness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003093.htm Facial paralysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003028.htm Faintness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003092.htm Flushing Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003241.htm Heartburn Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003114.htm Nausea Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm Numbness Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm Palpitations Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003081.htm Paralysis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003190.htm Shortness of breath Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003075.htm Skin, clammy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003216.htm Sleep disturbances Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003210.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Sweating Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003218.htm Tingling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003206.htm

Online Glossaries 191

Trembling Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003192.htm •

Diagnostics and Tests for Panic Disorder Cocaine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003578.htm

•

Nutrition for Panic Disorder Caffeine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002445.htm

•

Background Topics for Panic Disorder Alcohol use Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001944.htm Cardiovascular Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002310.htm Central nervous system Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002311.htm Choking Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000047.htm Endocrine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002351.htm Exercise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001941.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm Respiratory Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002290.htm Stimulants Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002308.htm Substance abuse Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001945.htm

192 Panic Disorder

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

193

PANIC DISORDER DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 3-dimensional: 3-D. A graphic display of depth, width, and height. Three-dimensional radiation therapy uses computers to create a 3-dimensional picture of the tumor. This allows doctors to give the highest possible dose of radiation to the tumor, while sparing the normal tissue as much as possible. [NIH] Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acidity: The quality of being acid or sour; containing acid (hydrogen ions). [EU] Activities of Daily Living: The performance of the basic activities of self care, such as dressing, ambulation, eating, etc., in rehabilitation. [NIH] Acyl: Chemical signal used by bacteria to communicate. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adenocarcinoma: A malignant epithelial tumor with a glandular organization. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adenylate Cyclase: An enzyme of the lyase class that catalyzes the formation of cyclic AMP and pyrophosphate from ATP. EC 4.6.1.1. [NIH] Adipose Tissue: Connective tissue composed of fat cells lodged in the meshes of areolar tissue. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH]

194 Panic Disorder

Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adolescent Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders in individuals 13-18 years. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Afferent: Concerned with the transmission of neural impulse toward the central part of the nervous system. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Agoraphobia: Obsessive, persistent, intense fear of open places. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH] Akathisia: 1. A condition of motor restlessness in which there is a feeling of muscular quivering, an urge to move about constantly, and an inability to sit still, a common extrapyramidal side effect of neuroleptic drugs. 2. An inability to sit down because of intense anxiety at the thought of doing so. [EU] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and

Dictionary 195

renal disease. [EU] Alertness: A state of readiness to detect and respond to certain specified small changes occurring at random intervals in the environment. [NIH] Alexia: The inability to recognize or comprehend written or printed words. [NIH] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alkalosis: A pathological condition that removes acid or adds base to the body fluids. [NIH] Alleles: Mutually exclusive forms of the same gene, occupying the same locus on homologous chromosomes, and governing the same biochemical and developmental process. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Alprenolol: 1-((1-Methylethyl)amino)-3-(2-(2-propenyl)phenoxy)-2-propanol. Adrenergic beta-blocker used as an antihypertensive, anti-anginal, and anti-arrhythmic agent. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino acid: Any organic compound containing an amino (-NH2 and a carboxyl (- COOH) group. The 20 a-amino acids listed in the accompanying table are the amino acids from which proteins are synthesized by formation of peptide bonds during ribosomal translation of messenger RNA; all except glycine, which is not optically active, have the L configuration. Other amino acids occurring in proteins, such as hydroxyproline in collagen, are formed by posttranslational enzymatic modification of amino acids residues in polypeptide chains. There are also several important amino acids, such as the neurotransmitter y-aminobutyric acid, that have no relation to proteins. Abbreviated AA. [EU] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amnesia: Lack or loss of memory; inability to remember past experiences. [EU] Amnestic: Nominal aphasia; a difficulty in finding the right name for an object. [NIH] Amphetamines: Analogs or derivatives of amphetamine. Many are sympathomimetics and central nervous system stimulators causing excitation, vasopression, bronchodilation, and to

196 Panic Disorder

varying degrees, anorexia, analepsis, nasal decongestion, and some smooth muscle relaxation. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH]

Amyloid: A general term for a variety of different proteins that accumulate as extracellular fibrils of 7-10 nm and have common structural features, including a beta-pleated sheet conformation and the ability to bind such dyes as Congo red and thioflavine (Kandel, Schwartz, and Jessel, Principles of Neural Science, 3rd ed). [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anions: Negatively charged atoms, radicals or groups of atoms which travel to the anode or positive pole during electrolysis. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anorexia Nervosa: The chief symptoms are inability to eat, weight loss, and amenorrhea. [NIH]

Antagonism: Interference with, or inhibition of, the growth of a living organism by another

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living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Anterior Cerebral Artery: Artery formed by the bifurcation of the internal carotid artery. Branches of the anterior cerebral artery supply the caudate nucleus, internal capsule, putamen, septal nuclei, gyrus cinguli, and surfaces of the frontal lobe and parietal lobe. [NIH] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticoagulant: A drug that helps prevent blood clots from forming. Also called a blood thinner. [NIH] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: A drug used to treat depression. [NIH] Antidote: A remedy for counteracting a poison. [EU] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antiseptic: A substance that inhibits the growth and development of microorganisms without necessarily killing them. [EU]

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Antiviral: Destroying viruses or suppressing their replication. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiety Disorders: Disorders in which anxiety (persistent feelings of apprehension, tension, or uneasiness) is the predominant disturbance. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Apathy: Lack of feeling or emotion; indifference. [EU] Aphasia: A cognitive disorder marked by an impaired ability to comprehend or express language in its written or spoken form. This condition is caused by diseases which affect the language areas of the dominant hemisphere. Clinical features are used to classify the various subtypes of this condition. General categories include receptive, expressive, and mixed forms of aphasia. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Apomorphine: A derivative of morphine that is a dopamine D2 agonist. It is a powerful emetic and has been used for that effect in acute poisoning. It has also been used in the diagnosis and treatment of parkinsonism, but its adverse effects limit its use. [NIH] Aqueous: Having to do with water. [NIH] Arrhythmia: Any variation from the normal rhythm or rate of the heart beat. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Arteriosclerosis: Thickening and loss of elasticity of arterial walls. Atherosclerosis is the most common form of arteriosclerosis and involves lipid deposition and thickening of the intimal cell layers within arteries. Additional forms of arteriosclerosis involve calcification of the media of muscular arteries (Monkeberg medial calcific sclerosis) and thickening of the walls of small arteries or arterioles due to cell proliferation or hyaline deposition (arteriolosclerosis). [NIH] Arteriovenous: Both arterial and venous; pertaining to or affecting an artery and a vein. [EU] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Articular: Of or pertaining to a joint. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Astringent: Causing contraction, usually locally after topical application. [EU] Astrocytes: The largest and most numerous neuroglial cells in the brain and spinal cord. Astrocytes (from "star" cells) are irregularly shaped with many long processes, including those with "end feet" which form the glial (limiting) membrane and directly and indirectly contribute to the blood brain barrier. They regulate the extracellular ionic and chemical environment, and "reactive astrocytes" (along with microglia) respond to injury. Astrocytes have high- affinity transmitter uptake systems, voltage-dependent and transmitter-gated ion channels, and can release transmitter, but their role in signaling (as in many other functions) is not well understood. [NIH] Ataxia: Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharnyx, larnyx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury

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to the red nucleus; and other conditions. [NIH] Atopic: Pertaining to an atopen or to atopy; allergic. [EU] Atrial: Pertaining to an atrium. [EU] Atrioventricular: Pertaining to an atrium of the heart and to a ventricle. [EU] Atrioventricular Node: A small nodular mass of specialized muscle fibers located in the interatrial septum near the opening of the coronary sinus. It gives rise to the atrioventricular bundle of the conduction system of the heart. [NIH] Atrium: A chamber; used in anatomical nomenclature to designate a chamber affording entrance to another structure or organ. Usually used alone to designate an atrium of the heart. [EU] Atrophy: Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. [NIH] Attenuation: Reduction of transmitted sound energy or its electrical equivalent. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Audiology: The study of hearing and hearing impairment. [NIH] Auditory: Pertaining to the sense of hearing. [EU] Autogenic: A type of succession when the developing vegetation itself is the cause for the succession. [NIH] Autogenic Training: Technique based on muscle relaxation during self-hypnotic exercises. It is used in conjunction with psychotherapy. [NIH] Autoimmune disease: A condition in which the body recognizes its own tissues as foreign and directs an immune response against them. [NIH] Autoimmunity: Process whereby the immune system reacts against the body's own tissues. Autoimmunity may produce or be caused by autoimmune diseases. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Autoreceptors: Transmitter receptors on or near presynaptic terminals (or varicosities) which are sensitive to the transmitter(s) released by the terminal itself. Receptors for the hormones released by hormone-releasing cells are also included. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Barbiturates: A class of chemicals derived from barbituric acid or thiobarbituric acid. Many of these are medically important as sedatives and hypnotics (sedatives, barbiturate), as

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anesthetics, or as anticonvulsants. [NIH] Baroreflex: A negative feedback system which buffers short-term changes in blood pressure. Increased pressure stretches blood vessels which activates pressoreceptors (baroreceptors) in the vessel walls. The net response of the central nervous system is a reduction of central sympathetic outflow. This reduces blood pressure both by decreasing peripheral vascular resistance and by lowering cardiac output. Because the baroreceptors are tonically active, the baroreflex can compensate rapidly for both increases and decreases in blood pressure. [NIH]

Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Basophils: Granular leukocytes characterized by a relatively pale-staining, lobate nucleus and cytoplasm containing coarse dark-staining granules of variable size and stainable by basic dyes. [NIH] Behavior Therapy: The application of modern theories of learning and conditioning in the treatment of behavior disorders. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any Hisomer. [NIH] Beta blocker: A drug used to slow the heart rate and reduce pressure inside blood vessels. It also can regulate heart rhythm. [NIH] Bibliotherapy: A form of supportive psychotherapy in which the patient is given carefully selected material to read. [NIH] Bicuculline: Isoquinoline alkaloid from Dicentra cucullaria and other plants that is a competitive antagonist at GABA-A receptors and thus causes convulsions. [NIH] Bilateral: Affecting both the right and left side of body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH]

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Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bipolar Disorder: A major affective disorder marked by severe mood swings (manic or major depressive episodes) and a tendency to remission and recurrence. [NIH] Bladder: The organ that stores urine. [NIH] Blastocyst: The mammalian embryo in the post-morula stage in which a fluid-filled cavity, enclosed primarily by trophoblast, contains an inner cell mass which becomes the embryonic disc. [NIH] Blood Coagulation: The process of the interaction of blood coagulation factors that results in an insoluble fibrin clot. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Body Image: Individuals' personal concept of their bodies as objects in and bound by space, independently and apart from all other objects. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Brain Stem: The part of the brain that connects the cerebral hemispheres with the spinal cord. It consists of the mesencephalon, pons, and medulla oblongata. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Breeding: The science or art of changing the constitution of a population of plants or animals through sexual reproduction. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchodilator: A drug that relaxes the smooth muscles in the constricted airway. [NIH] Buffers: A chemical system that functions to control the levels of specific ions in solution. When the level of hydrogen ion in solution is controlled the system is called a pH buffer. [NIH]

Bulimia: Episodic binge eating. The episodes may be associated with the fear of not being able to stop eating, depressed mood, or self-deprecating thoughts (binge-eating disorder) and may frequently be terminated by self-induced vomiting (bulimia nervosa). [NIH] Caffeine: A methylxanthine naturally occurring in some beverages and also used as a pharmacological agent. Caffeine's most notable pharmacological effect is as a central

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nervous system stimulant, increasing alertness and producing agitation. It also relaxes smooth muscle, stimulates cardiac muscle, stimulates diuresis, and appears to be useful in the treatment of some types of headache. Several cellular actions of caffeine have been observed, but it is not entirely clear how each contributes to its pharmacological profile. Among the most important are inhibition of cyclic nucleotide phosphodiesterases, antagonism of adenosine receptors, and modulation of intracellular calcium handling. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Calculi: An abnormal concretion occurring mostly in the urinary and biliary tracts, usually composed of mineral salts. Also called stones. [NIH] Calmodulin: A heat-stable, low-molecular-weight activator protein found mainly in the brain and heart. The binding of calcium ions to this protein allows this protein to bind to cyclic nucleotide phosphodiesterases and to adenyl cyclase with subsequent activation. Thereby this protein modulates cyclic AMP and cyclic GMP levels. [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Candidosis: An infection caused by an opportunistic yeasts that tends to proliferate and become pathologic when the environment is favorable and the host resistance is weakened. [NIH]

Cannabis: The hemp plant Cannabis sativa. Products prepared from the dried flowering tops of the plant include marijuana, hashish, bhang, and ganja. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Carboxy: Cannabinoid. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinogens: Substances that increase the risk of neoplasms in humans or animals. Both genotoxic chemicals, which affect DNA directly, and nongenotoxic chemicals, which induce neoplasms by other mechanism, are included. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiac Output: The volume of blood passing through the heart per unit of time. It is usually expressed as liters (volume) per minute so as not to be confused with stroke volume (volume per beat). [NIH] Cardiology: The study of the heart, its physiology, and its functions. [NIH]

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Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Carotid Body: A small cluster of chemoreceptive and supporting cells located near the bifurcation of the internal carotid artery. The carotid body, which is richly supplied with fenestrated capillaries, senses the pH, carbon dioxide, and oxygen concentrations in the blood and plays a crucial role in their homeostatic control. [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catechol: A chemical originally isolated from a type of mimosa tree. Catechol is used as an astringent, an antiseptic, and in photography, electroplating, and making other chemicals. It can also be man-made. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Catheter: A flexible tube used to deliver fluids into or withdraw fluids from the body. [NIH] Cations: Postively charged atoms, radicals or groups of atoms which travel to the cathode or negative pole during electrolysis. [NIH] Caudal: Denoting a position more toward the cauda, or tail, than some specified point of reference; same as inferior, in human anatomy. [EU] Celiac Disease: A disease characterized by intestinal malabsorption and precipitated by gluten-containing foods. The intestinal mucosa shows loss of villous structure. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Division: The fission of a cell. [NIH] Cell membrane: Cell membrane = plasma membrane. The structure enveloping a cell, enclosing the cytoplasm, and forming a selective permeability barrier; it consists of lipids, proteins, and some carbohydrates, the lipids thought to form a bilayer in which integral proteins are embedded to varying degrees. [EU] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and

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meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebral Cortex: The thin layer of gray matter on the surface of the cerebral hemisphere that develops from the telencephalon and folds into gyri. It reaches its highest development in man and is responsible for intellectual faculties and higher mental functions. [NIH] Cerebral Hemorrhage: Bleeding into a cerebral hemisphere of the brain, including lobar, subcortical white matter, and basal ganglia hemorrhages. Commonly associated conditions include hypertension; intracranial arteriosclerosis; intracranial aneurysm; craniocerebral trauma; intracranial arteriovenous malformations; cerebral amyloid angiopathy; and cerebral infarction. [NIH] Cerebral Infarction: The formation of an area of necrosis in the cerebrum caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., infarction, anterior cerebral artery), and etiology (e.g., embolic infarction). [NIH]

Cerebral Palsy: Refers to a motor disability caused by a brain dysfunction. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Chaos: Complex behavior that seems random but actually has some hidden order. [NIH] Chemoreceptor: A receptor adapted for excitation by chemical substances, e.g., olfactory and gustatory receptors, or a sense organ, as the carotid body or the aortic (supracardial) bodies, which is sensitive to chemical changes in the blood stream, especially reduced oxygen content, and reflexly increases both respiration and blood pressure. [EU] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Child Behavior: Any observable response or action of a child from 24 months through 12 years of age. For neonates or children younger than 24 months, infant behavior is available. [NIH]

Chin: The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for

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the passage of blood vessels and a nerve. [NIH] Chlordiazepoxide: An anxiolytic benzodiazepine derivative with anticonvulsant, sedative, and amnesic properties. It has also been used in the symptomatic treatment of alcohol withdrawl. [NIH] Cholecystokinin: A 33-amino acid peptide secreted by the upper intestinal mucosa and also found in the central nervous system. It causes gallbladder contraction, release of pancreatic exocrine (or digestive) enzymes, and affects other gastrointestinal functions. Cholecystokinin may be the mediator of satiety. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chorea: Involuntary, forcible, rapid, jerky movements that may be subtle or become confluent, markedly altering normal patterns of movement. Hypotonia and pendular reflexes are often associated. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as choreatic disorders. Chorea is also a frequent manifestation of basal ganglia diseases. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic renal: Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. [NIH] Ciliary: Inflammation or infection of the glands of the margins of the eyelids. [NIH] Ciliary Neurotrophic Factor: A neurotrophic factor that promotes the survival of various neuronal cell types and may play an important role in the injury response in the nervous system. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Citalopram: A selective neuronal serotonin reuptake inhibitor and a clinically effective antidepressant with tolerable side effects. The drug is also effective in reducing ethanol uptake in alcoholics and is used in depressed patients who also suffer from tardive dyskinesia (TD) in preference to tricyclic antidepressants, which aggravate this condition. [NIH]

Clathrin: The main structural coat protein of coated vesicles which play a key role in the intracellular transport between membranous organelles. Clathrin also interacts with cytoskeletal proteins. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening,

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prevention, diagnosis, or treatment of a disease. [NIH] Clonazepam: An anticonvulsant used for several types of seizures, including myotonic or atonic seizures, photosensitive epilepsy, and absence seizures, although tolerance may develop. It is seldom effective in generalized tonic-clonic or partial seizures. The mechanism of action appears to involve the enhancement of gaba receptor responses. [NIH] Clonic: Pertaining to or of the nature of clonus. [EU] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Clozapine: A tricylic dibenzodiazepine, classified as an atypical antipsychotic agent. It binds several types of central nervous system receptors, and displays a unique pharmacological profile. Clozapine is a serotonin antagonist, with strong binding to 5-HT 2A/2C receptor subtype. It also displays strong affinity to several dopaminergic receptors, but shows only weak antagonism at the dopamine D2 receptor, a receptor commonly thought to modulate neuroleptic activity. Agranulocytosis is a major adverse effect associated with administration of this agent. [NIH] Coated Vesicles: Vesicles formed when cell-membrane coated pits invaginate and pinch off. The outer surface of these vesicles are covered with a lattice-like network of coat proteins, such as clathrin, coat protein complex proteins, or caveolins. [NIH] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Cochlea: The part of the internal ear that is concerned with hearing. It forms the anterior part of the labyrinth, is conical, and is placed almost horizontally anterior to the vestibule. [NIH]

Cochlear: Of or pertaining to the cochlea. [EU] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cognitive behavior therapy: A system of psychotherapy based on the premise that distorted or dysfunctional thinking, which influences a person's mood or behavior, is common to all psychosocial problems. The focus of therapy is to identify the distorted thinking and to replace it with more rational, adaptive thoughts and beliefs. [NIH] Cognitive restructuring: A method of identifying and replacing fear-promoting, irrational beliefs with more realistic and functional ones. [NIH] Cognitive Therapy: A direct form of psychotherapy based on the interpretation of situations (cognitive structure of experiences) that determine how an individual feels and behaves. It is based on the premise that cognition, the process of acquiring knowledge and forming beliefs, is a primary determinant of mood and behavior. The therapy uses behavioral and verbal techniques to identify and correct negative thinking that is at the root of the aberrant behavior. [NIH]

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Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Collapse: 1. A state of extreme prostration and depression, with failure of circulation. 2. Abnormal falling in of the walls of any part of organ. [EU] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such

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as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Compulsions: In psychology, an irresistible urge, sometimes amounting to obsession to perform a particular act which usually is carried out against the performer's will or better judgment. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computer Simulation: Computer-based representation of physical systems and phenomena such as chemical processes. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Concomitant: Accompanying; accessory; joined with another. [EU] Concretion: Minute, hard, yellow masses found in the palpebral conjunctivae of elderly people or following chronic conjunctivitis, composed of the products of cellular degeneration retained in the depressions and tubular recesses in the conjunctiva. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Constrict: Tighten; narrow. [NIH] Constriction: The act of constricting. [NIH] Constriction, Pathologic: The condition of an anatomical structure's being constricted beyond normal dimensions. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Conventional therapy: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional treatment. [NIH]

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Conventional treatment: A currently accepted and widely used treatment for a certain type of disease, based on the results of past research. Also called conventional therapy. [NIH] Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Coordination: Muscular or motor regulation or the harmonious cooperation of muscles or groups of muscles, in a complex action or series of actions. [NIH] Cor: The muscular organ that maintains the circulation of the blood. c. adiposum a heart that has undergone fatty degeneration or that has an accumulation of fat around it; called also fat or fatty, heart. c. arteriosum the left side of the heart, so called because it contains oxygenated (arterial) blood. c. biloculare a congenital anomaly characterized by failure of formation of the atrial and ventricular septums, the heart having only two chambers, a single atrium and a single ventricle, and a common atrioventricular valve. c. bovinum (L. 'ox heart') a greatly enlarged heart due to a hypertrophied left ventricle; called also c. taurinum and bucardia. c. dextrum (L. 'right heart') the right atrium and ventricle. c. hirsutum, c. villosum. c. mobile (obs.) an abnormally movable heart. c. pendulum a heart so movable that it seems to be hanging by the great blood vessels. c. pseudotriloculare biatriatum a congenital cardiac anomaly in which the heart functions as a three-chambered heart because of tricuspid atresia, the right ventricle being extremely small or rudimentary and the right atrium greatly dilated. Blood passes from the right to the left atrium and thence disease due to pulmonary hypertension secondary to disease of the lung, or its blood vessels, with hypertrophy of the right ventricle. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Corticotropin-Releasing Hormone: A neuropeptide released by the hypothalamus that stimulates the release of corticotropin by the anterior pituitary gland. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cotinine: 1-Methyl-5-(3-pyridyl)-2-pyrrolidinone antidepressant. Synonym: Scotine. [NIH]

fumarate.

Stimulant

proposed

as

Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH]

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Creatine: An amino acid that occurs in vertebrate tissues and in urine. In muscle tissue, creatine generally occurs as phosphocreatine. Creatine is excreted as creatinine in the urine. [NIH]

Creatinine: A compound that is excreted from the body in urine. Creatinine levels are measured to monitor kidney function. [NIH] Criterion: A standard by which something may be judged. [EU] Crossing-over: The exchange of corresponding segments between chromatids of homologous chromosomes during meiosia, forming a chiasma. [NIH] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Curare: Plant extracts from several species, including Strychnos toxifera, S. castelnaei, S. crevauxii, and Chondodendron tomentosum, that produce paralysis of skeletal muscle and are used adjunctively with general anesthesia. These extracts are toxic and must be used with the administration of artificial respiration. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is

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multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dentate Gyrus: Gray matter situated above the gyrus hippocampi. It is composed of three layers. The molecular layer is continuous with the hippocampus in the hippocampal fissure. The granular layer consists of closely arranged spherical or oval neurons, called granule cells, whose axons pass through the polymorphic layer ending on the dendrites of pyramidal cells in the hippocampus. [NIH] Depersonalization: Alteration in the perception of the self so that the usual sense of one's own reality is lost, manifested in a sense of unreality or self-estrangement, in changes of body image, or in a feeling that one does not control his own actions and speech; seen in depersonalization disorder, schizophrenic disorders, and schizotypal personality disorder. Some do not draw a distinction between depersonalization and derealization, using depersonalization to include both. [EU] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Derealization: Is characterized by the loss of the sense of reality concerning one's surroundings. [NIH] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Detoxification: Treatment designed to free an addict from his drug habit. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diencephalon: The paired caudal parts of the prosencephalon from which the thalamus, hypothalamus, epithalamus, and subthalamus are derived. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Dimethyl: A volatile metabolite of the amino acid methionine. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Disease Progression: The worsening of a disease over time. This concept is most often used

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for chronic and incurable diseases where the stage of the disease is an important determinant of therapy and prognosis. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Dorsal: 1. Pertaining to the back or to any dorsum. 2. Denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Drinking Behavior: Behaviors associated with the ingesting of water and other liquids; includes rhythmic patterns of drinking (time intervals - onset and duration), frequency and satiety. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Dyslexia: Partial alexia in which letters but not words may be read, or in which words may be read but not understood. [NIH] Dyspepsia: Impaired digestion, especially after eating. [NIH] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH]

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Dyspnea: Difficult or labored breathing. [NIH] Dystonia: Disordered tonicity of muscle. [EU] Dystrophy: Any disorder arising from defective or faulty nutrition, especially the muscular dystrophies. [EU] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Ejaculation: The release of semen through the penis during orgasm. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrode: Component of the pacing system which is at the distal end of the lead. It is the interface with living cardiac tissue across which the stimulus is transmitted. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrophysiological: Pertaining to electrophysiology, that is a branch of physiology that is concerned with the electric phenomena associated with living bodies and involved in their functional activity. [EU] Electroplating: Coating with a metal or alloy by electrolysis. [NIH] Elementary Particles: Individual components of atoms, usually subatomic; subnuclear particles are usually detected only when the atomic nucleus decays and then only transiently, as most of them are unstable, often yielding pure energy without substance, i.e., radiation. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emetic: An agent that causes vomiting. [EU] Empiric: Empirical; depending upon experience or observation alone, without using scientific method or theory. [EU] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Encephalitis: Inflammation of the brain due to infection, autoimmune processes, toxins, and other conditions. Viral infections (see encephalitis, viral) are a relatively frequent cause of this condition. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endocardium: The innermost layer of the heart, comprised of endothelial cells. [NIH] Endocrine System: The system of glands that release their secretions (hormones) directly into the circulatory system. In addition to the endocrine glands, included are the chromaffin

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system and the neurosecretory systems. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Endorphins: One of the three major groups of endogenous opioid peptides. They are large peptides derived from the pro-opiomelanocortin precursor. The known members of this group are alpha-, beta-, and gamma-endorphin. The term endorphin is also sometimes used to refer to all opioid peptides, but the narrower sense is used here; opioid peptides is used for the broader group. [NIH] Endoscopic: A technique where a lateral-view endoscope is passed orally to the duodenum for visualization of the ampulla of Vater. [NIH] Endosomes: Cytoplasmic vesicles formed when coated vesicles shed their clathrin coat. Endosomes internalize macromolecules bound by receptors on the cell surface. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released upon lysis of the cells. [NIH] End-stage renal: Total chronic kidney failure. When the kidneys fail, the body retains fluid and harmful wastes build up. A person with ESRD needs treatment to replace the work of the failed kidneys. [NIH] Enkephalins: One of the three major families of endogenous opioid peptides. The enkephalins are pentapeptides that are widespread in the central and peripheral nervous systems and in the adrenal medulla. [NIH] Entorhinal Cortex: Cortex where the signals are combined with those from other sensory systems. [NIH] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Eosinophils: Granular leukocytes with a nucleus that usually has two lobes connected by a slender thread of chromatin, and cytoplasm containing coarse, round granules that are uniform in size and stainable by eosin. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithalamus: The dorsal posterior subdivision of the diencephalon. The epithalamus is generally considered to include the habenular nuclei (habenula) and associated fiber bundles, the pineal body, and the epithelial roof of the third ventricle. The anterior and posterior paraventricular nuclei of the thalamus are included with the thalamic nuclei although they develop from the same pronuclear mass as the epithalamic nuclei and are sometimes considered part of the epithalamus. [NIH]

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Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with blood. [EU] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Essential Tremor: A rhythmic, involuntary, purposeless, oscillating movement resulting from the alternate contraction and relaxation of opposing groups of muscles. [NIH] Estazolam: A benzodiazepine with anticonvulsant, hypnotic, and muscle relaxant properties. It has been shown in some cases to be more potent than diazepam or nitrazepam. [NIH]

Estrogen: One of the two female sex hormones. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ethinyl Estradiol: A semisynthetic estrogen with high oral estrogenic potency. It is often used as the estrogenic component in oral contraceptives. [NIH] Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evacuation: An emptying, as of the bowels. [EU] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Evoked Potentials: The electric response evoked in the central nervous system by stimulation of sensory receptors or some point on the sensory pathway leading from the receptor to the cortex. The evoked stimulus can be auditory, somatosensory, or visual, although other modalities have been reported. Event-related potentials is sometimes used synonymously with evoked potentials but is often associated with the execution of a motor, cognitive, or psychophysiological task, as well as with the response to a stimulus. [NIH] Excitability: Property of a cardiac cell whereby, when the cell is depolarized to a critical level (called threshold), the membrane becomes permeable and a regenerative inward current causes an action potential. [NIH] Excitation: An act of irritation or stimulation or of responding to a stimulus; the addition of energy, as the excitation of a molecule by absorption of photons. [EU] Exocrine: Secreting outwardly, via a duct. [EU] Exocytosis: Cellular release of material within membrane-limited vesicles by fusion of the vesicles with the cell membrane. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expiration: The act of breathing out, or expelling air from the lungs. [EU] External radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external-beam radiation. [NIH] Extracellular: Outside a cell or cells. [EU]

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Extrapyramidal: Outside of the pyramidal tracts. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fathers: Male parents, human or animal. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Febrile: Pertaining to or characterized by fever. [EU] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fenfluramine: A centrally active drug that apparently both blocks serotonin uptake and provokes transport-mediated serotonin release. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Flumazenil: A potent benzodiazepine receptor antagonist. Since it reverses the sedative and other actions of benzodiazepines, it has been suggested as an antidote to benzodiazepine overdoses. [NIH] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Flushing: A transient reddening of the face that may be due to fever, certain drugs, exertion, stress, or a disease process. [NIH] Fluvoxamine: A selective serotonin reuptake inhibitor. It is effective in the treatment of depression, obsessive-compulsive disorders, anxiety, panic disorders, and alcohol amnestic disorders. [NIH] Fold: A plication or doubling of various parts of the body. [NIH] Foramen: A natural hole of perforation, especially one in a bone. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Frontal Lobe: The anterior part of the cerebral hemisphere. [NIH]

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Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] GABA: The most common inhibitory neurotransmitter in the central nervous system. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gap Junctions: Connections between cells which allow passage of small molecules and electric current. Gap junctions were first described anatomically as regions of close apposition between cells with a narrow (1-2 nm) gap between cell membranes. The variety in the properties of gap junctions is reflected in the number of connexins, the family of proteins which form the junctions. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gene Expression: The phenotypic manifestation of a gene or genes by the processes of gene action. [NIH] Genetic Counseling: Advising families of the risks involved pertaining to birth defects, in order that they may make an informed decision on current or future pregnancies. [NIH] Genetic Engineering: Directed modification of the gene complement of a living organism by such techniques as altering the DNA, substituting genetic material by means of a virus, transplanting whole nuclei, transplanting cell hybrids, etc. [NIH] Genetic Markers: A phenotypically recognizable genetic trait which can be used to identify a genetic locus, a linkage group, or a recombination event. [NIH] Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Geriatric Psychiatry: A subspecialty of psychiatry concerned with the mental health of the aged. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH]

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Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glutamic Acid: A non-essential amino acid naturally occurring in the L-form. Glutamic acid (glutamate) is the most common excitatory neurotransmitter in the central nervous system. [NIH]

Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Glycine: A non-essential amino acid. It is found primarily in gelatin and silk fibroin and used therapeutically as a nutrient. It is also a fast inhibitory neurotransmitter. [NIH] Glycoproteins: Conjugated protein-carbohydrate compounds including mucins, mucoid, and amyloid glycoproteins. [NIH] Gonadal: Pertaining to a gonad. [EU] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Gp120: 120-kD HIV envelope glycoprotein which is involved in the binding of the virus to its membrane receptor, the CD4 molecule, found on the surface of certain cells in the body. [NIH]

Graft: Healthy skin, bone, or other tissue taken from one part of the body and used to replace diseased or injured tissue removed from another part of the body. [NIH] Graft Rejection: An immune response with both cellular and humoral components, directed against an allogeneic transplant, whose tissue antigens are not compatible with those of the recipient. [NIH] Granule: A small pill made from sucrose. [EU] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Gyrus Cinguli: One of the convolutions on the medial surface of the cerebral hemisphere. It surrounds the rostral part of the brain and interhemispheric commissure and forms part of the limbic system. [NIH] Habituation: Decline in response of an organism to environmental or other stimuli with repeated or maintained exposure. [NIH] Haplotypes: The genetic constitution of individuals with respect to one member of a pair of allelic genes, or sets of genes that are closely linked and tend to be inherited together such as those of the major histocompatibility complex. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Head Movements: Voluntary or involuntary motion of head that may be relative to or independent of body; includes animals and humans. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary

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disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Behavior: Behaviors expressed by individuals to protect, maintain or promote their health status. For example, proper diet, and appropriate exercise are activities perceived to influence health status. Life style is closely associated with health behavior and factors influencing life style are socioeconomic, educational, and cultural. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart Transplantation: The transference of a heart from one human or animal to another. [NIH]

Heartbeat: One complete contraction of the heart. [NIH] Hemicrania: An ache or a pain in one side of the head, as in migraine. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoglobinuria: The presence of free hemoglobin in the urine. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance.

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[NIH]

Hippocampus: A curved elevation of gray matter extending the entire length of the floor of the temporal horn of the lateral ventricle (Dorland, 28th ed). The hippocampus, subiculum, and dentate gyrus constitute the hippocampal formation. Sometimes authors include the entorhinal cortex in the hippocampal formation. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Host: Any animal that receives a transplanted graft. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogenation: Specific method of reduction in which hydrogen is added to a substance by the direct use of gaseous hydrogen. [NIH] Hydroxylation: Hydroxylate, to introduce hydroxyl into (a compound or radical) usually by replacement of hydrogen. [EU] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hyperkinesia: Abnormally increased motor function or activity; hyperactivity. [EU] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hyperphagia: Ingestion of a greater than optimal quantity of food. [NIH] Hypersecretion: Excessive secretion. [EU] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Hyperuricemia: A buildup of uric acid (a byproduct of metabolism) in the blood; a side effect of some anticancer drugs. [NIH] Hyperventilation: A pulmonary ventilation rate faster than is metabolically necessary for the exchange of gases. It is the result of an increased frequency of breathing, an increased tidal volume, or a combination of both. It causes an excess intake of oxygen and the blowing

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off of carbon dioxide. [NIH] Hypnotherapy: Sleeping-cure. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypokinesia: Slow or diminished movement of body musculature. It may be associated with basal ganglia diseases; mental disorders; prolonged inactivity due to illness; experimental protocols used to evaluate the physiologic effects of immobility; and other conditions. [NIH] Hypomania: An abnormality of mood resembling mania (persistent elevated or expansive mood, hyperactivity, inflated self-esteem, etc.) but of lesser intensity. [EU] Hypotension: Abnormally low blood pressure. [NIH] Hypothalamic: Of or involving the hypothalamus. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypoxia: Reduction of oxygen supply to tissue below physiological levels despite adequate perfusion of the tissue by blood. [EU] Hypoxic: Having too little oxygen. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Illusion: A false interpretation of a genuine percept. [NIH] Imipramine: The prototypical tricyclic antidepressant. It has been used in major depression, dysthymia, bipolar depression, attention-deficit disorders, agoraphobia, and panic disorders. It has less sedative effect than some other members of this therapeutic group. [NIH]

Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunodeficiency: The decreased ability of the body to fight infection and disease. [NIH] Immunology: The study of the body's immune system. [NIH] Immunosuppressive: Describes the ability to lower immune system responses. [NIH] Immunosuppressive therapy: Therapy used to decrease the body's immune response, such as drugs given to prevent transplant rejection. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Immunotoxin: An antibody linked to a toxic substance. Some immmunotoxins can bind to cancer cells and kill them. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of

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psychological, physiological, or anatomical structure or function. [NIH] Implantation: The insertion or grafting into the body of biological, living, inert, or radioactive material. [EU] Impotence: The inability to perform sexual intercourse. [NIH] Impotent: Unable to have an erection adequate for sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Incest: Sexual intercourse between persons so closely related that they are forbidden by law to marry. [NIH] Incision: A cut made in the body during surgery. [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infant Behavior: Any observable response or action of a neonate or infant up through the age of 23 months. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Inflammatory bowel disease: A general term that refers to the inflammation of the colon and rectum. Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. [NIH]

Infusion: A method of putting fluids, including drugs, into the bloodstream. Also called intravenous infusion. [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Inner ear: The labyrinth, comprising the vestibule, cochlea, and semicircular canals. [NIH]

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Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inositol: An isomer of glucose that has traditionally been considered to be a B vitamin although it has an uncertain status as a vitamin and a deficiency syndrome has not been identified in man. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1379) Inositol phospholipids are important in signal transduction. [NIH] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Insulator: Material covering the metal conductor of the lead. It is usually polyurethane or silicone. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interneurons: Most generally any neurons which are not motor or sensory. Interneurons may also refer to neurons whose axons remain within a particular brain region as contrasted with projection neurons which have axons projecting to other brain regions. [NIH] Intestinal: Having to do with the intestines. [NIH] Intestinal Mucosa: The surface lining of the intestines where the cells absorb nutrients. [NIH] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intracranial Aneurysm: A saclike dilatation of the walls of a blood vessel, usually an artery. [NIH]

Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intrinsic Factor: A glycoprotein secreted by the cells of the gastric glands that is required for the absorption of vitamin B 12. Deficiency of intrinsic factor results in pernicious anemia. [NIH]

Invasive: 1. Having the quality of invasiveness. 2. Involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU]

Involuntary: Reaction occurring without intention or volition. [NIH] Ion Channels: Gated, ion-selective glycoproteins that traverse membranes. The stimulus for channel gating can be a membrane potential, drug, transmitter, cytoplasmic messenger, or a mechanical deformation. Ion channels which are integral parts of ionotropic neurotransmitter receptors are not included. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH]

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Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Ischemia: Deficiency of blood in a part, due to functional constriction or actual obstruction of a blood vessel. [EU] Isoproterenol: Isopropyl analog of epinephrine; beta-sympathomimetic that acts on the heart, bronchi, skeletal muscle, alimentary tract, etc. It is used mainly as bronchodilator and heart stimulant. [NIH] Jealousy: An irrational reaction compounded of grief, loss of self-esteem, enmity against the rival and self criticism. [NIH] Jet lag: Symptoms produced in human beings by fast travel through large meridian difference. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kaposi: A tumor characterized by development, essentially in men, of violet red patches and nodules on the skin. This disease also affects deeper organs. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Labyrinth: The internal ear; the essential part of the organ of hearing. It consists of an osseous and a membranous portion. [NIH] Lactation: The period of the secretion of milk. [EU] Lag: The time elapsing between application of a stimulus and the resulting reaction. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Leukemia: Cancer of blood-forming tissue. [NIH] Leukocytes: White blood cells. These include granular leukocytes (basophils, eosinophils, and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU]

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Ligands: A RNA simulation method developed by the MIT. [NIH] Limbic: Pertaining to a limbus, or margin; forming a border around. [EU] Limbic System: A set of forebrain structures common to all mammals that is defined functionally and anatomically. It is implicated in the higher integration of visceral, olfactory, and somatic information as well as homeostatic responses including fundamental survival behaviors (feeding, mating, emotion). For most authors, it includes the amygdala, epithalamus, gyrus cinguli, hippocampal formation (see hippocampus), hypothalamus, parahippocampal gyrus, septal nuclei, anterior nuclear group of thalamus, and portions of the basal ganglia. (Parent, Carpenter's Human Neuroanatomy, 9th ed, p744; NeuroNames, http://rprcsgi.rprc.washington.edu/neuronames/index.html (September 2, 1998)). [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipophilic: Having an affinity for fat; pertaining to or characterized by lipophilia. [EU] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Lobe: A portion of an organ such as the liver, lung, breast, or brain. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Long-Term Potentiation: A persistent increase in synaptic efficacy, usually induced by appropriate activation of the same synapses. The phenomenological properties of long-term potentiation suggest that it may be a cellular mechanism of learning and memory. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy

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based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Magnetic Resonance Spectroscopy: Spectroscopic method of measuring the magnetic moment of elementary particles such as atomic nuclei, protons or electrons. It is employed in clinical applications such as NMR Tomography (magnetic resonance imaging). [NIH] Maintenance therapy: Treatment that is given to help a primary (original) treatment keep working. Maintenance therapy is often given to help keep cancer in remission. [NIH] Major Histocompatibility Complex: The genetic region which contains the loci of genes which determine the structure of the serologically defined (SD) and lymphocyte-defined (LD) transplantation antigens, genes which control the structure of the immune responseassociated (Ia) antigens, the immune response (Ir) genes which control the ability of an animal to respond immunologically to antigenic stimuli, and genes which determine the structure and/or level of the first four components of complement. [NIH] Malabsorption: Impaired intestinal absorption of nutrients. [EU] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malnutrition: A condition caused by not eating enough food or not eating a balanced diet. [NIH]

Malondialdehyde: The dialdehyde of malonic acid. [NIH] Mania: Excitement of psychotic proportions manifested by mental and physical hyperactivity, disorganization of behaviour, and elevation of mood. [EU] Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Man-made: Ionizing radiation emitted by artificial or concentrated natural, radioactive material or resulting from the operation of high voltage apparatus, such as X-ray apparatus or particle accelerators, of nuclear reactors, or from nuclear explosions. [NIH] Meatus: A canal running from the internal auditory foramen through the petrous portion of the temporal bone. It gives passage to the facial and auditory nerves together with the auditory branch of the basilar artery and the internal auditory veins. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medicament: A medicinal substance or agent. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH]

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Melanocytes: Epidermal dendritic pigment cells which control long-term morphological color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Memory Disorders: Disturbances in registering an impression, in the retention of an acquired impression, or in the recall of an impression. Memory impairments are associated with dementia; craniocerebraltrauma; encephalitis; alcoholism (see also alcohol amnestic disorder); schizophrenia; and other conditions. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Health Services: Organized services to provide mental health care. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Mesolimbic: Inner brain region governing emotion and drives. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolic disorder: A condition in which normal metabolic processes are disrupted, usually because of a missing enzyme. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Methionine: A sulfur containing essential amino acid that is important in many body functions. It is a chelating agent for heavy metals. [NIH] Methyltransferase: A drug-metabolizing enzyme. [NIH] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular

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animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microglia: The third type of glial cell, along with astrocytes and oligodendrocytes (which together form the macroglia). Microglia vary in appearance depending on developmental stage, functional state, and anatomical location; subtype terms include ramified, perivascular, ameboid, resting, and activated. Microglia clearly are capable of phagocytosis and play an important role in a wide spectrum of neuropathologies. They have also been suggested to act in several other roles including in secretion (e.g., of cytokines and neural growth factors), in immunological processing (e.g., antigen presentation), and in central nervous system development and remodeling. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Midazolam: A short-acting compound, water-soluble at pH less than 4 and lipid-soluble at physiological pH. It is a hypnotic-sedative drug with anxiolytic and amnestic properties. It is used for sedation in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. Because of its short duration and cardiorespiratory stability, it is particularly useful in poor-risk, elderly, and cardiac patients. [NIH]

Mitral Valve: The valve between the left atrium and left ventricle of the heart. [NIH] Mitral Valve Prolapse: Abnormal protrusion of one or both of the leaflets of the mitral valve into the left atrium during systole. This may be accompanied by mitral regurgitation, systolic murmur, nonejection click, or cardiac arrhythmia. [NIH] Moclobemide: A reversible inhibitor of monoamine oxidase type A (RIMA) that has antidepressive properties. [NIH] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Monoamine Oxidase: An enzyme that catalyzes the oxidative deamination of naturally occurring monoamines. It is a flavin-containing enzyme that is localized in mitochondrial membranes, whether in nerve terminals, the liver, or other organs. Monoamine oxidase is important in regulating the metabolic degradation of catecholamines and serotonin in neural or target tissues. Hepatic monoamine oxidase has a crucial defensive role in inactivating circulating monoamines or those, such as tyramine, that originate in the gut and are absorbed into the portal circulation. (From Goodman and Gilman's, The Pharmacological

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Basis of Therapeutics, 8th ed, p415) EC 1.4.3.4. [NIH] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Mood Disorders: Those disorders that have a disturbance in mood as their predominant feature. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Motor nerve: An efferent nerve conveying an impulse that excites muscular contraction. [NIH]

Movement Disorders: Syndromes which feature dyskinesias as a cardinal manifestation of the disease process. Included in this category are degenerative, hereditary, post-infectious, medication-induced, post-inflammatory, and post-traumatic conditions. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Multiple sclerosis: A disorder of the central nervous system marked by weakness, numbness, a loss of muscle coordination, and problems with vision, speech, and bladder control. Multiple sclerosis is thought to be an autoimmune disease in which the body's immune system destroys myelin. Myelin is a substance that contains both protein and fat (lipid) and serves as a nerve insulator and helps in the transmission of nerve signals. [NIH] Muscarinic Antagonists: Drugs that bind to but do not activate muscarinic cholinergic receptors (receptors, muscarinic), thereby blocking the actions of endogenous acetycholine or exogenous agonists. Muscarinic antagonists have widespread effects including actions on the iris and ciliary muscle of the eye, the heart and blood vessels, secretions of the respiratory tract, GI system, and salivary glands, GI motility, urinary bladder tone, and the central nervous system. Antagonists that discriminate among the various muscarinic receptor subtypes and might allow better control of peripheral and central actions are under development. [NIH] Muscle Fibers: Large single cells, either cylindrical or prismatic in shape, that form the basic unit of muscle tissue. They consist of a soft contractile substance enclosed in a tubular sheath. [NIH] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle Relaxation: That phase of a muscle twitch during which a muscle returns to a resting position. [NIH] Muscle tension: A force in a material tending to produce extension; the state of being

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stretched. [NIH] Muscular Atrophy: Derangement in size and number of muscle fibers occurring with aging, reduction in blood supply, or following immobilization, prolonged weightlessness, malnutrition, and particularly in denervation. [NIH] Muscular Dystrophies: A general term for a group of inherited disorders which are characterized by progressive degeneration of skeletal muscles. [NIH] Mydriasis: Dilation of pupils to greater than 6 mm combined with failure of the pupils to constrict when stimulated with light. This condition may occur due to injury of the pupillary fibers in the oculomotor nerve, in acute angle-closure glaucoma, and in Adie syndrome. [NIH]

Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myelin: The fatty substance that covers and protects nerves. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Myotonic Dystrophy: A condition presenting muscle weakness and wasting which may be progressive. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neocortex: The largest portion of the cerebral cortex. It is composed of neurons arranged in six layers. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neonatal period: The first 4 weeks after birth. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nephropathy: Disease of the kidneys. [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nerve Growth Factor: Nerve growth factor is the first of a series of neurotrophic factors that were found to influence the growth and differentiation of sympathetic and sensory neurons. It is comprised of alpha, beta, and gamma subunits. The beta subunit is responsible for its growth stimulating activity. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH]

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Nervousness: Excessive excitability and irritability, with mental and physical unrest. [EU] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neural Pathways: Neural tracts connecting one part of the nervous system with another. [NIH]

Neuroanatomy: Study of the anatomy of the nervous system as a specialty or discipline. [NIH]

Neurodegenerative Diseases: Hereditary and sporadic conditions which are characterized by progressive nervous system dysfunction. These disorders are often associated with atrophy of the affected central or peripheral nervous system structures. [NIH] Neuroendocrine: Having to do with the interactions between the nervous system and the endocrine system. Describes certain cells that release hormones into the blood in response to stimulation of the nervous system. [NIH] Neuroendocrinology: The study of the anatomical and functional relationships between the nervous system and the endocrine system. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropeptide: A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurosis: Functional derangement due to disorders of the nervous system which does not affect the psychic personality of the patient. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Neurotic: 1. Pertaining to or characterized by neurosis. 2. A person affected with a neurosis. [EU]

Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Neutrophils: Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and

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stainable by neutral dyes. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitrazepam: A benzodiazepine derivative used as an anticonvulsant and hypnotic. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Normal Distribution: Continuous frequency distribution of infinite range. Its properties are as follows: 1) continuous, symmetrical distribution with both tails extending to infinity; 2) arithmetic mean, mode, and median identical; and 3) shape completely determined by the mean and standard deviation. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Obsessive-Compulsive Disorder: An anxiety disorder characterized by recurrent, persistent obsessions or compulsions. Obsessions are the intrusive ideas, thoughts, or images that are experienced as senseless or repugnant. Compulsions are repetitive and seemingly purposeful behavior which the individual generally recognizes as senseless and from which the individual does not derive pleasure although it may provide a release from tension. [NIH] Ocular: 1. Of, pertaining to, or affecting the eye. 2. Eyepiece. [EU] Oculomotor: Cranial nerve III. It originate from the lower ventral surface of the midbrain and is classified as a motor nerve. [NIH] Oculomotor Nerve: The 3d cranial nerve. The oculomotor nerve sends motor fibers to the levator muscles of the eyelid and to the superior rectus, inferior rectus, and inferior oblique muscles of the eye. It also sends parasympathetic efferents (via the ciliary ganglion) to the muscles controlling pupillary constriction and accommodation. The motor fibers originate in the oculomotor nuclei of the midbrain. [NIH]

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Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] Opacity: Degree of density (area most dense taken for reading). [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Opium: The air-dried exudate from the unripe seed capsule of the opium poppy, Papaver somniferum, or its variant, P. album. It contains a number of alkaloids, but only a few morphine, codeine, and papaverine - have clinical significance. Opium has been used as an analgesic, antitussive, antidiarrheal, and antispasmodic. [NIH] Optic Chiasm: The X-shaped structure formed by the meeting of the two optic nerves. At the optic chiasm the fibers from the medial part of each retina cross to project to the other side of the brain while the lateral retinal fibers continue on the same side. As a result each half of the brain receives information about the contralateral visual field from both eyes. [NIH]

Orgasm: The crisis of sexual excitement in either humans or animals. [NIH] Orthostatic: Pertaining to or caused by standing erect. [EU] Osteoarthritis: A progressive, degenerative joint disease, the most common form of arthritis, especially in older persons. The disease is thought to result not from the aging process but from biochemical changes and biomechanical stresses affecting articular cartilage. In the foreign literature it is often called osteoarthrosis deformans. [NIH] Osteopetrosis: Excessive formation of dense trabecular bone leading to pathological fractures, osteitis, splenomegaly with infarct, anemia, and extramedullary hemopoiesis. [NIH]

Otolith: A complex calcareous concretion in the inner ear which controls man's sense of balance and reactions to acceleration. [NIH] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Overdose: An accidental or deliberate dose of a medication or street drug that is in excess of what is normally used. [NIH] Oxides: Binary compounds of oxygen containing the anion O(2-). The anion combines with metals to form alkaline oxides and non-metals to form acidic oxides. [NIH] Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Palpitation: A subjective sensation of an unduly rapid or irregular heart beat. [EU] Palsy: Disease of the peripheral nervous system occurring usually after many years of increased lead absorption. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar

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gland that secretes digestive enzymes. [NIH] Pancreatic: Having to do with the pancreas. [NIH] Pancreatic cancer: Cancer of the pancreas, a salivary gland of the abdomen. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Panic Disorder: A type of anxiety disorder characterized by unexpected panic attacks that last minutes or, rarely, hours. Panic attacks begin with intense apprehension, fear or terror and, often, a feeling of impending doom. Symptoms experienced during a panic attack include dyspnea or sensations of being smothered; dizziness, loss of balance or faintness; choking sensations; palpitations or accelerated heart rate; shakiness; sweating; nausea or other form of abdominal distress; depersonalization or derealization; paresthesias; hot flashes or chills; chest discomfort or pain; fear of dying and fear of not being in control of oneself or going crazy. Agoraphobia may also develop. Similar to other anxiety disorders, it may be inherited as an autosomal dominant trait. [NIH] Paralysis: Loss of ability to move all or part of the body. [NIH] Paranoia: A psychotic disorder marked by persistent delusions of persecution or delusional jealousy and behaviour like that of the paranoid personality, such as suspiciousness, mistrust, and combativeness. It differs from paranoid schizophrenia, in which hallucinations or formal thought disorder are present, in that the delusions are logically consistent and that there are no other psychotic features. The designation in DSM III-R is delusional (paranoid) disorders, with five types : persecutory, jealous, erotomanic, somatic, and grandiose. [EU] Parasympathetic Nervous System: The craniosacral division of the autonomic nervous system. The cell bodies of the parasympathetic preganglionic fibers are in brain stem nuclei and in the sacral spinal cord. They synapse in cranial autonomic ganglia or in terminal ganglia near target organs. The parasympathetic nervous system generally acts to conserve resources and restore homeostasis, often with effects reciprocal to the sympathetic nervous system. [NIH] Paresthesias: Abnormal touch sensations, such as burning or prickling, that occur without an outside stimulus. [NIH] Parietal: 1. Of or pertaining to the walls of a cavity. 2. Pertaining to or located near the parietal bone, as the parietal lobe. [EU] Parietal Lobe: Upper central part of the cerebral hemisphere. [NIH] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] Paroxetine: A serotonin uptake inhibitor that is effective in the treatment of depression. [NIH]

Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathophysiology: Altered functions in an individual or an organ due to disease. [NIH] Patient Education: The teaching or training of patients concerning their own health needs.

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[NIH]

Patient Participation: Patient involvement in the decision-making process in matters pertaining to health. [NIH] Patient Satisfaction: The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial. [NIH] Pedigree: A record of one's ancestors, offspring, siblings, and their offspring that may be used to determine the pattern of certain genes or disease inheritance within a family. [NIH] Pelvic: Pertaining to the pelvis. [EU] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Pentagastrin: A synthetic polypeptide that has effects like gastrin when given parenterally. It stimulates the secretion of gastric acid, pepsin, and intrinsic factor, and has been used as a diagnostic aid. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Peptide T: N-(N-(N(2)-(N-(N-(N-(N-D-Alanyl L-seryl)-L-threonyl)-L-threonyl) L-threonyl)L-asparaginyl)-L-tyrosyl) L-threonine. Octapeptide sharing sequence homology with HIV envelope protein gp120. It is potentially useful as antiviral agent in AIDS therapy. The core pentapeptide sequence, TTNYT, consisting of amino acids 4-8 in peptide T, is the HIV envelope sequence required for attachment to the CD4 receptor. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Perfusion: Bathing an organ or tissue with a fluid. In regional perfusion, a specific area of the body (usually an arm or a leg) receives high doses of anticancer drugs through a blood vessel. Such a procedure is performed to treat cancer that has not spread. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Personality Disorders: A major deviation from normal patterns of behavior. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top

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of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenyl: Ingredient used in cold and flu remedies. [NIH] Phobia: A persistent, irrational, intense fear of a specific object, activity, or situation (the phobic stimulus), fear that is recognized as being excessive or unreasonable by the individual himself. When a phobia is a significant source of distress or interferes with social functioning, it is considered a mental disorder; phobic disorder (or neurosis). In DSM III phobic disorders are subclassified as agoraphobia, social phobias, and simple phobias. Used as a word termination denoting irrational fear of or aversion to the subject indicated by the stem to which it is affixed. [EU] Phobic Disorders: Anxiety disorders in which the essential feature is persistent and irrational fear of a specific object, activity, or situation that the individual feels compelled to avoid. The individual recognizes the fear as excessive or unreasonable. [NIH] Phosphodiesterase: Effector enzyme that regulates the levels of a second messenger, the cyclic GMP. [NIH] Phospholipids: Lipids containing one or more phosphate groups, particularly those derived from either glycerol (phosphoglycerides; glycerophospholipids) or sphingosine (sphingolipids). They are polar lipids that are of great importance for the structure and function of cell membranes and are the most abundant of membrane lipids, although not stored in large amounts in the system. [NIH] Phosphorus: A non-metallic element that is found in the blood, muscles, nevers, bones, and teeth, and is a component of adenosine triphosphate (ATP; the primary energy source for the body's cells.) [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Phototherapy: Treatment of disease by exposure to light, especially by variously concentrated light rays or specific wavelengths. [NIH] Physical Therapy: The restoration of function and the prevention of disability following disease or injury with the use of light, heat, cold, water, electricity, ultrasound, and exercise. [NIH]

Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Pituitary Gland: A small, unpaired gland situated in the sella turcica tissue. It is connected to the hypothalamus by a short stalk. [NIH] Pituitary-Adrenal System: The interactions between the anterior pituitary and adrenal glands, in which corticotropin (ACTH) stimulates the adrenal cortex and adrenal cortical hormones suppress the production of corticotropin by the anterior pituitary. [NIH] Placebo Effect: An effect usually, but not necessarily, beneficial that is attributable to an expectation that the regimen will have an effect, i.e., the effect is due to the power of suggestion. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized

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by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Plasticity: In an individual or a population, the capacity for adaptation: a) through gene changes (genetic plasticity) or b) through internal physiological modifications in response to changes of environment (physiological plasticity). [NIH] Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polycystic: An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. [NIH] Polymorphic: Occurring in several or many forms; appearing in different forms at different stages of development. [EU] Polymorphism: The occurrence together of two or more distinct forms in the same population. [NIH] Population Control: Includes mechanisms or programs which control the numbers of individuals in a population of humans or animals. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postnatal: Occurring after birth, with reference to the newborn. [EU] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Post-traumatic: Occurring as a result of or after injury. [EU] Post-traumatic stress disorder: A psychological disorder that develops in some individuals after a major traumatic experience such as war, rape, domestic violence, or accident. [NIH] Postural: Pertaining to posture or position. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Potentiate: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis,

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therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Prefrontal Cortex: The rostral part of the frontal lobe, bounded by the inferior precentral fissure in humans, which receives projection fibers from the mediodorsal nucleus of the thalamus. The prefrontal cortex receives afferent fibers from numerous structures of the diencephalon, mesencephalon, and limbic system as well as cortical afferents of visual, auditory, and somatic origin. [NIH] Premenstrual: Occurring before menstruation. [EU] Prescription drug abuse: Using two or more drugs interchangeably in an attempt to counteract the adverse effects of one with the other or to potentiate the effects of one with the other, so that an interdependent habit requiring both is formed. [NIH] Pressoreceptors: Receptors in the vascular system, particularly the aorta and carotid sinus, which are sensitive to stretch of the vessel walls. [NIH] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Presynaptic Terminals: The distal terminations of axons which are specialized for the release of neurotransmitters. Also included are varicosities along the course of axons which have similar specializations and also release transmitters. Presynaptic terminals in both the central and peripheral nervous systems are included. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Problem Solving: A learning situation involving more than one alternative from which a selection is made in order to attain a specific goal. [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Prognostic factor: A situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease, or the chance of the disease recurring (coming back). [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH]

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Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a molecular weight of about 23,000. It is essential in the induction of lactation in mammals at parturition and is synergistic with estrogen. The hormone also brings about the release of progesterone from lutein cells, which renders the uterine mucosa suited for the embedding of the ovum should fertilization occur. [NIH] Promoter: A chemical substance that increases the activity of a carcinogenic process. [NIH] Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Proprioception: The mechanism involved in the self-regulation of posture and movement through stimuli originating in the receptors imbedded in the joints, tendons, muscles, and labyrinth. [NIH] Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protein Binding: The process in which substances, either endogenous or exogenous, bind to proteins, peptides, enzymes, protein precursors, or allied compounds. Specific proteinbinding measures are often used as assays in diagnostic assessments. [NIH] Protein C: A vitamin-K dependent zymogen present in the blood, which, upon activation by thrombin and thrombomodulin exerts anticoagulant properties by inactivating factors Va and VIIIa at the rate-limiting steps of thrombin formation. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protirelin: A tripeptide hormone that originates in the hypothalamus and stimulates the secretion of thyrotropin from the pituitary gland. In humans, it also acts as a prolactinreleasing factor. It is also a neurotransmitter in the central nervous system. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus

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of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Psychopharmacology: The study of the effects of drugs on mental and behavioral activity. [NIH]

Psychophysiology: The study of the physiological basis of human and animal behavior. [NIH]

Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Psychotropic: Exerting an effect upon the mind; capable of modifying mental activity; usually applied to drugs that effect the mental state. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Public Sector: The area of a nation's economy that is tax-supported and under government control. [NIH] Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary hypertension: Abnormally high blood pressure in the arteries of the lungs. [NIH] Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [NIH]

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Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Purulent: Consisting of or containing pus; associated with the formation of or caused by pus. [EU] Pyoderma: Any purulent skin disease (Dorland, 27th ed). [NIH] Pyoderma Gangrenosum: An idiopathic, rapidly evolving, and severely debilitating disease occurring most commonly in association with chronic ulcerative colitis. It is characterized by the presence of boggy, purplish ulcers with undermined borders, appearing mostly on the legs. The majority of cases are in people between 40 and 60 years old. Its etiology is unknown. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Racemic: Optically inactive but resolvable in the way of all racemic compounds. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Random Allocation: A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. [NIH] Randomization: Also called random allocation. Is allocation of individuals to groups, e.g., for experimental and control regimens, by chance. Within the limits of chance variation, random allocation should make the control and experimental groups similar at the start of an investigation and ensure that personal judgment and prejudices of the investigator do not influence allocation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Rape: Unlawful sexual intercourse without consent of the victim. [NIH] Reality Testing: The individual's objective evaluation of the external world and the ability

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to differentiate adequately between it and the internal world; considered to be a primary ego function. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Muscarinic: One of the two major classes of cholinergic receptors. Muscarinic receptors were originally defined by their preference for muscarine over nicotine. There are several subtypes (usually M1, M2, M3.) that are characterized by their cellular actions, pharmacology, and molecular biology. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recombination: The formation of new combinations of genes as a result of segregation in crosses between genetically different parents; also the rearrangement of linked genes due to crossing-over. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Red Nucleus: A pinkish-yellow portion of the midbrain situated in the rostral mesencephalic tegmentum. It receives a large projection from the contralateral half of the cerebellum via the superior cerebellar peduncle and a projection from the ipsilateral motor cortex. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reflex: An involuntary movement or exercise of function in a part, excited in response to a stimulus applied to the periphery and transmitted to the brain or spinal cord. [NIH] Refractory: Not readily yielding to treatment. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Regurgitation: A backward flowing, as the casting up of undigested food, or the backward flowing of blood into the heart, or between the chambers of the heart when a valve is incompetent. [EU] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relative risk: The ratio of the incidence rate of a disease among individuals exposed to a specific risk factor to the incidence rate among unexposed individuals; synonymous with risk ratio. Alternatively, the ratio of the cumulative incidence rate in the exposed to the cumulative incidence rate in the unexposed (cumulative incidence ratio). The term relative risk has also been used synonymously with odds ratio. This is because the odds ratio and relative risk approach each other if the disease is rare ( 5 percent of population) and the number of subjects is large. [NIH] Relaxant: 1. Lessening or reducing tension. 2. An agent that lessens tension. [EU] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial

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remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Research Support: Financial support of research activities. [NIH] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Respiratory System: The tubular and cavernous organs and structures, by means of which pulmonary ventilation and gas exchange between ambient air and the blood are brought about. [NIH] Response rate: The percentage of patients whose cancer shrinks or disappears after treatment. [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retinoblastoma: An eye cancer that most often occurs in children younger than 5 years. It occurs in hereditary and nonhereditary (sporadic) forms. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Saccades: An abrupt voluntary shift in ocular fixation from one point to another, as occurs in reading. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Saponins: Sapogenin glycosides. A type of glycoside widely distributed in plants. Each consists of a sapogenin as the aglycon moiety, and a sugar. The sapogenin may be a steroid or a triterpene and the sugar may be glucose, galactose, a pentose, or a methylpentose. Sapogenins are poisonous towards the lower forms of life and are powerful hemolytics when injected into the blood stream able to dissolve red blood cells at even extreme dilutions. [NIH] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate

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affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Sclerosis: A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Seasonal Affective Disorder: A syndrome characterized by depressions that recur annually at the same time each year, usually during the winter months. Other symptoms include anxiety, irritability, decreased energy, increased appetite (carbohydrate cravings), increased duration of sleep, and weight gain. SAD (seasonal affective disorder) can be treated by daily exposure to bright artificial lights (phototherapy), during the season of recurrence. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Sedatives, Barbiturate: Those derivatives of barbituric or thiobarbituric acid that are used as hypnotics or sedatives. The structural class of all such derivatives, regardless of use, is barbiturates. [NIH] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Self Care: Performance of activities or tasks traditionally performed by professional health care providers. The concept includes care of oneself or one's family and friends. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Semicircular canal: Three long canals of the bony labyrinth of the ear, forming loops and opening into the vestibule by five openings. [NIH] Semisynthetic: Produced by chemical manipulation of naturally occurring substances. [EU] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Septal: An abscess occurring at the root of the tooth on the proximal surface. [NIH] Septal Nuclei: Neural nuclei situated in the septal region. They have afferent and cholinergic efferent connections with a variety of forebrain and brainstem areas including the hippocampus, the lateral hypothalamus, the tegmentum, and the amygdala. Included are the dorsal, lateral, medial, and triangular septal nuclei, septofimbrial nucleus, nucleus of diagonal band, nucleus of anterior commissure, and the nucleus of stria terminalis. [NIH] Sequela: Any lesion or affection following or caused by an attack of disease. [EU] Sequence Homology: The degree of similarity between sequences. Studies of amino acid and nucleotide sequences provide useful information about the genetic relatedness of certain species. [NIH] Sequencing: The determination of the order of nucleotides in a DNA or RNA chain. [NIH]

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Sequential treatment: One treatment after the other. [NIH] Sequester: A portion of dead bone which has become detached from the healthy bone tissue, as occurs in necrosis. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH]

Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Sex Determination: The biological characteristics which distinguish human beings as female or male. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sleep apnea: A serious, potentially life-threatening breathing disorder characterized by repeated cessation of breathing due to either collapse of the upper airway during sleep or absence of respiratory effort. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the

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large intestine. [NIH] Smoking Cessation: Discontinuation of the habit of smoking, the inhaling and exhaling of tobacco smoke. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Behavior: Any behavior caused by or affecting another individual, usually of the same species. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Sodium Lactate: The sodium salt of racemic or inactive lactic acid. It is a hygroscopic agent used intravenously as a systemic and urinary alkalizer. [NIH] Soma: The body as distinct from the mind; all the body tissue except the germ cells; all the axial body. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectroscopic: The recognition of elements through their emission spectra. [NIH] Sperm: The fecundating fluid of the male. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Nerves: The 31 paired peripheral nerves formed by the union of the dorsal and

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ventral spinal roots from each spinal cord segment. The spinal nerve plexuses and the spinal roots are also included. [NIH] Splenomegaly: Enlargement of the spleen. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Sprue: A non febrile tropical disease of uncertain origin. [NIH] Stabilization: The creation of a stable state. [EU] Steel: A tough, malleable, iron-based alloy containing up to, but no more than, two percent carbon and often other metals. It is used in medicine and dentistry in implants and instrumentation. [NIH] Stereotactic: Radiotherapy that treats brain tumors by using a special frame affixed directly to the patient's cranium. By aiming the X-ray source with respect to the rigid frame, technicians can position the beam extremely precisely during each treatment. [NIH] Stereotaxis: Use of a computer and scanning devices to create three-dimensional pictures. This method can be used to direct a biopsy, external radiation, or the insertion of radiation implants. [NIH] Sterility: 1. The inability to produce offspring, i.e., the inability to conceive (female s.) or to induce conception (male s.). 2. The state of being aseptic, or free from microorganisms. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stress management: A set of techniques used to help an individual cope more effectively with difficult situations in order to feel better emotionally, improve behavioral skills, and often to enhance feelings of control. Stress management may include relaxation exercises, assertiveness training, cognitive restructuring, time management, and social support. It can be delivered either on a one-to-one basis or in a group format. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU]

248 Panic Disorder

Subfornical Organ: A structure, situated close to the intraventricular foramen, which induces drinking behavior after stimulation with angiotensin II. [NIH] Subiculum: A region of the hippocampus that projects to other areas of the brain. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Sudden cardiac death: Cardiac arrest caused by an irregular heartbeat. [NIH] Supportive care: Treatment given to prevent, control, or relieve complications and side effects and to improve the comfort and quality of life of people who have cancer. [NIH] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Supraventricular: Situated or occurring above the ventricles, especially in an atrium or atrioventricular node. [EU] Survival Analysis: A class of statistical procedures for estimating the survival function (function of time, starting with a population 100% well at a given time and providing the percentage of the population still well at later times). The survival analysis is then used for making inferences about the effects of treatments, prognostic factors, exposures, and other covariates on the function. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Symptomatic treatment: Therapy that eases symptoms without addressing the cause of disease. [NIH] Symptomatology: 1. That branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. The combined symptoms of a disease. [EU] Synapse: The region where the processes of two neurons come into close contiguity, and the nervous impulse passes from one to the other; the fibers of the two are intermeshed, but, according to the general view, there is no direct contiguity. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of

Dictionary 249

homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synaptic Vesicles: Membrane-bound compartments which contain transmitter molecules. Synaptic vesicles are concentrated at presynaptic terminals. They actively sequester transmitter molecules from the cytoplasm. In at least some synapses, transmitter release occurs by fusion of these vesicles with the presynaptic membrane, followed by exocytosis of their contents. [NIH] Syncope: A temporary suspension of consciousness due to generalized cerebral schemia, a faint or swoon. [EU] Systemic: Affecting the entire body. [NIH] Systole: Period of contraction of the heart, especially of the ventricles. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tachycardia: Excessive rapidity in the action of the heart, usually with a heart rate above 100 beats per minute. [NIH] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] Telangiectasia: The permanent enlargement of blood vessels, causing redness in the skin or mucous membranes. [NIH] Telencephalon: Paired anteriolateral evaginations of the prosencephalon plus the lamina terminalis. The cerebral hemispheres are derived from it. Many authors consider cerebrum a synonymous term to telencephalon, though a minority include diencephalon as part of the cerebrum (Anthoney, 1994). [NIH] Temperament: Predisposition to react to one's environment in a certain way; usually refers to mood changes. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Temporal Lobe: Lower lateral part of the cerebral hemisphere. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Thalamic Diseases: Disorders of the centrally located thalamus, which integrates a wide range of cortical and subcortical information. Manifestations include sensory loss, movement disorders; ataxia, pain syndromes, visual disorders, a variety of neuropsychological conditions, and coma. Relatively common etiologies include cerebrovascular disorders; craniocerebral trauma; brain neoplasms; brain hypoxia; intracranial hemorrhages; and infectious processes. [NIH] Thalamus: Paired bodies containing mostly gray substance and forming part of the lateral wall of the third ventricle of the brain. The thalamus represents the major portion of the diencephalon and is commonly divided into cellular aggregates known as nuclear groups.

250 Panic Disorder

[NIH]

Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Third Ventricle: A narrow cleft inferior to the corpus callosum, within the diencephalon, between the paired thalami. Its floor is formed by the hypothalamus, its anterior wall by the lamina terminalis, and its roof by ependyma. It communicates with the fourth ventricle by the cerebral aqueduct, and with the lateral ventricles by the interventricular foramina. [NIH] Thorax: A part of the trunk between the neck and the abdomen; the chest. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombin: An enzyme formed from prothrombin that converts fibrinogen to fibrin. (Dorland, 27th ed) EC 3.4.21.5. [NIH] Thrombocytes: Blood cells that help prevent bleeding by causing blood clots to form. Also called platelets. [NIH] Thrombomodulin: A cell surface glycoprotein of endothelial cells that binds thrombin and serves as a cofactor in the activation of protein C and its regulation of blood coagulation. [NIH]

Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thrush: A disease due to infection with species of fungi of the genus Candida. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyrotropin: A peptide hormone secreted by the anterior pituitary. It promotes the growth of the thyroid gland and stimulates the synthesis of thyroid hormones and the release of thyroxine by the thyroid gland. [NIH] Tidal Volume: The volume of air inspired or expired during each normal, quiet respiratory cycle. Common abbreviations are TV or V with subscript T. [NIH] Time Management: Planning and control of time to improve efficiency and effectiveness. [NIH]

Tin: A trace element that is required in bone formation. It has the atomic symbol Sn, atomic number 50, and atomic weight 118.71. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tone: 1. The normal degree of vigour and tension; in muscle, the resistance to passive elongation or stretch; tonus. 2. A particular quality of sound or of voice. 3. To make permanent, or to change, the colour of silver stain by chemical treatment, usually with a heavy metal. [EU] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of

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restoring normal tone to tissue. [EU] Tonicity: The normal state of muscular tension. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transcutaneous: Transdermal. [EU] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Translating: Conversion from one language to another language. [NIH] Translation: The process whereby the genetic information present in the linear sequence of ribonucleotides in mRNA is converted into a corresponding sequence of amino acids in a protein. It occurs on the ribosome and is unidirectional. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Treatment Failure: A measure of the quality of health care by assessment of unsuccessful results of management and procedures used in combating disease, in individual cases or series. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Trichotillomania: Compulsion to pull out one's hair. [NIH] Tricuspid Atresia: Absence of the orifice between the right atrium and ventricle, with the

252 Panic Disorder

presence of an atrial defect through which all the systemic venous return reaches the left heart. As a result, there is left ventricular hypertrophy because the right ventricle is absent or not functional. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tryptophan Hydroxylase: An enzyme that catalyzes the hydroxylation of tryptophan to 5hydroxytryptophan in the presence of NADPH and molecular oxygen. It is important in the biosynthesis of serotonin. EC 1.14.16.4 [NIH] Tuberous Sclerosis: A rare congenital disease in which the essential pathology is the appearance of multiple tumors in the cerebrum and in other organs, such as the heart or kidneys. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcerative colitis: Chronic inflammation of the colon that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Uric: A kidney stone that may result from a diet high in animal protein. When the body breaks down this protein, uric acid levels rise and can form stones. [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccination: Administration of vaccines to stimulate the host's immune response. This includes any preparation intended for active immunological prophylaxis. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vagus Nerve: The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents (from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax and abdomen), and efferents to striated muscle (of the larynx and pharynx). [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vascular Resistance: An expression of the resistance offered by the systemic arterioles, and to a lesser extent by the capillaries, to the flow of blood. [NIH] Vasoconstriction: Narrowing of the blood vessels without anatomic change, for which

Dictionary 253

constriction, pathologic is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vasomotor: 1. Affecting the calibre of a vessel, especially of a blood vessel. 2. Any element or agent that effects the calibre of a blood vessel. [EU] VE: The total volume of gas either inspired or expired in one minute. [NIH] Vector: Plasmid or other self-replicating DNA molecule that transfers DNA between cells in nature or in recombinant DNA technology. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venlafaxine: An antidepressant drug that is being evaluated for the treatment of hot flashes in women who have breast cancer. [NIH] Venous: Of or pertaining to the veins. [EU] Venous blood: Blood that has given up its oxygen to the tissues and carries carbon dioxide back for gas exchange. [NIH] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Ventricular: Pertaining to a ventricle. [EU] Vertebrae: A bony unit of the segmented spinal column. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Vestibule: A small, oval, bony chamber of the labyrinth. The vestibule contains the utricle and saccule, organs which are part of the balancing apparatus of the ear. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Villous: Of a surface, covered with villi. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viral vector: A type of virus used in cancer therapy. The virus is changed in the laboratory and cannot cause disease. Viral vectors produce tumor antigens (proteins found on a tumor cell) and can stimulate an antitumor immune response in the body. Viral vectors may also be used to carry genes that can change cancer cells back to normal cells. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH]

254 Panic Disorder

Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Visceral Afferents: The sensory fibers innervating the viscera. [NIH] Vitamin A: A substance used in cancer prevention; it belongs to the family of drugs called retinoids. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] Voltage-gated: It is opened by the altered charge distribution across the cell membrane. [NIH]

War: Hostile conflict between organized groups of people. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH] Yohimbine: A plant alkaloid with alpha-2-adrenergic blocking activity. Yohimbine has been used as a mydriatic and in the treatment of impotence. It is also alleged to be an aphrodisiac. [NIH]

Zygote: The fertilized ovum. [NIH] Zymogen: Inactive form of an enzyme which can then be converted to the active form, usually by excision of a polypeptide, e. g. trypsinogen is the zymogen of trypsin. [NIH]

255

INDEX A Abdomen, 193, 201, 223, 225, 234, 247, 250, 252 Abdominal, 150, 193, 233, 234, 252 Abdominal Pain, 150, 193, 252 Aberrant, 36, 193, 206 Acetylcholine, 132, 138, 193, 205, 231 Acidity, 193, 235 Activities of Daily Living, 168, 193 Acyl, 136, 193 Adaptability, 193, 203 Adaptation, 13, 193, 237 Adenocarcinoma, 17, 193 Adenosine, 193, 202, 236 Adenylate Cyclase, 98, 193 Adipose Tissue, 137, 193 Adjustment, 193 Adolescence, 13, 78, 147, 194 Adolescent Psychiatry, 4, 80, 87, 107, 177, 194 Adrenal Cortex, 194, 209, 236, 238 Adrenal Glands, 194, 236 Adrenal Medulla, 194, 203, 214, 232 Adrenergic, 194, 195, 197, 212, 214, 227, 248, 254 Adverse Effect, 194, 198, 206, 238, 245 Afferent, 194, 238, 244 Affinity, 39, 144, 194, 198, 206, 225, 246 Age of Onset, 127, 194 Agonist, 36, 39, 40, 127, 137, 138, 194, 198, 212, 230, 232 Agoraphobia, 20, 25, 26, 30, 33, 39, 46, 47, 48, 52, 53, 54, 56, 59, 62, 64, 67, 69, 70, 75, 78, 79, 80, 81, 82, 84, 87, 89, 90, 91, 94, 99, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 115, 116, 121, 122, 127, 128, 129, 145, 146, 147, 148, 149, 154, 179, 189, 194, 221, 234, 236 Airway, 194, 201, 245 Akathisia, 194, 197 Albumin, 194, 227 Alertness, 195, 202 Alexia, 195, 212 Algorithms, 24, 195, 201 Alimentary, 195, 224 Alkaline, 195, 202, 233 Alkaloid, 195, 200, 206, 229, 232, 254 Alkalosis, 10, 90, 195

Alleles, 29, 195 Allergen, 195, 211 Alprenolol, 195, 227 Alternative medicine, 156, 195 Alveoli, 195, 253 Amenorrhea, 195, 196 Amine, 195, 220 Amino acid, 126, 195, 197, 205, 210, 211, 218, 220, 227, 231, 235, 239, 244, 245, 248, 250, 251, 252 Amino Acid Sequence, 195, 197 Amnesia, 140, 195 Amnestic, 127, 128, 195, 216, 227, 228 Amphetamines, 195, 206 Amygdala, 7, 8, 9, 16, 38, 40, 42, 90, 98, 196, 200, 225, 244, 249 Amyloid, 196, 204, 218 Anaesthesia, 196, 222 Anal, 19, 196, 216 Analog, 99, 196, 224 Anaphylatoxins, 196, 207 Anatomical, 7, 196, 199, 204, 208, 222, 228, 231, 244 Anemia, 171, 196, 223, 233 Anesthesia, 3, 194, 196, 210, 228 Anesthetics, 36, 196, 200, 214 Angina, 196, 227 Angina Pectoris, 196, 227 Animal model, 15, 196 Anions, 194, 196, 223 Anorexia, 127, 128, 130, 134, 138, 139, 145, 196 Anorexia Nervosa, 127, 128, 134, 145, 196 Antagonism, 196, 202, 206 Anterior Cerebral Artery, 197, 204 Antibodies, 108, 197, 218, 237 Antibody, 194, 197, 207, 218, 220, 221, 222, 226, 241, 246 Anticoagulant, 197, 239 Anticonvulsant, 40, 197, 205, 206, 215, 232 Antidepressant, 28, 64, 128, 134, 135, 141, 144, 197, 205, 209, 216, 221, 253 Antidote, 197, 216 Antiemetic, 197 Antigen, 194, 197, 207, 220, 222, 226, 228 Antigen-Antibody Complex, 197, 207 Antipsychotic, 28, 197, 206, 231 Antiseptic, 197, 203

256 Panic Disorder

Antiviral, 198, 235 Anus, 196, 198, 201, 207 Anxiolytic, 40, 128, 132, 144, 198, 205, 228 Apathy, 198, 231 Aphasia, 195, 198 Apnea, 137, 198 Apomorphine, 71, 97, 198 Aqueous, 198, 200, 210 Arrhythmia, 37, 198, 228 Arterial, 198, 204, 209, 220, 239, 249 Arteries, 198, 201, 209, 227, 240 Arteriosclerosis, 198, 204 Arteriovenous, 198, 204 Artery, 54, 197, 198, 203, 209, 223, 226, 241 Articular, 198, 233 Assay, 138, 142, 198 Astringent, 198, 203 Astrocytes, 198, 228 Ataxia, 171, 198, 249 Atopic, 87, 199 Atrial, 199, 209, 252 Atrioventricular, 199, 209, 248 Atrioventricular Node, 199, 248 Atrium, 199, 209, 228, 248, 251, 253 Atrophy, 52, 171, 199, 231 Attenuation, 93, 199 Atypical, 74, 199, 206 Audiology, 150, 199 Auditory, 41, 199, 215, 226, 238, 252 Autogenic, 102, 111, 199 Autogenic Training, 102, 111, 199 Autoimmune disease, 199, 229 Autoimmunity, 53, 199 Autonomic, 15, 35, 44, 46, 60, 77, 103, 178, 193, 197, 199, 232, 234, 235, 248 Autonomic Nervous System, 199, 234, 235, 248 Autoreceptors, 135, 199 Axons, 199, 211, 223, 238 B Bacteria, 193, 197, 199, 216, 228, 252 Bacterial Physiology, 193, 199 Barbiturates, 138, 139, 199, 244 Baroreflex, 90, 200 Basal Ganglia, 197, 198, 200, 204, 205, 221, 225 Basal Ganglia Diseases, 198, 200, 205, 221 Base, 102, 142, 195, 200, 210, 211, 224, 249 Basophils, 200, 224 Behavior Therapy, 55, 71, 102, 121, 200 Benign, 151, 200, 218, 230 Benzene, 200

Benzodiazepines, 40, 53, 55, 56, 84, 92, 126, 129, 138, 139, 160, 200, 216 Beta blocker, 17, 200 Bibliotherapy, 25, 200 Bicuculline, 8, 200 Bilateral, 151, 200 Bile, 200, 217, 225, 247 Biochemical, 17, 55, 96, 127, 133, 195, 200, 233, 245 Biopsy, 200, 247 Biotechnology, 50, 51, 149, 156, 167, 170, 171, 172, 201 Bipolar Disorder, 16, 17, 18, 28, 41, 58, 59, 76, 88, 107, 131, 135, 138, 139, 147, 201 Bladder, 137, 201, 208, 229, 239, 252 Blastocyst, 201, 208 Blood Coagulation, 201, 202, 250 Blood Platelets, 201, 245 Blood pressure, 8, 35, 72, 200, 201, 203, 204, 220, 221, 228, 240, 246 Blood vessel, 200, 201, 203, 204, 205, 209, 223, 224, 229, 235, 246, 247, 249, 250, 252, 253 Body Fluids, 195, 201, 212, 246 Body Image, 201, 211 Bowel, 138, 139, 150, 178, 196, 201, 211, 222, 223, 247, 252 Bowel Movement, 201, 211, 247 Brain Stem, 201, 234 Branch, 187, 201, 213, 226, 234, 240, 246, 248, 250 Breeding, 15, 201 Bronchi, 201, 214, 224, 251 Bronchial, 201, 220 Bronchodilator, 201, 224 Buffers, 200, 201 Bulimia, 127, 128, 134, 138, 139, 145, 156, 201 C Caffeine, 87, 160, 191, 201 Calcium, 38, 43, 202, 207, 245 Calculi, 202, 218 Calmodulin, 38, 202 Candidiasis, 168, 202 Candidosis, 202 Cannabis, 107, 202 Capsules, 120, 122, 202 Carbohydrate, 202, 218, 244 Carboxy, 126, 202 Carcinogenic, 200, 202, 239, 247 Carcinogens, 202, 233 Cardiac Output, 200, 202

Index 257

Cardiology, 127, 202 Cardiomyopathy, 168, 203 Cardiorespiratory, 203, 228 Cardiovascular, 55, 77, 90, 96, 127, 137, 143, 144, 149, 191, 203, 245 Cardiovascular disease, 77, 137, 203 Carotid Body, 203, 204 Case report, 84, 203, 205 Case series, 71, 93, 203, 205 Catechol, 57, 58, 65, 96, 97, 203 Catecholamine, 21, 203, 212, 235 Catheter, 131, 203 Cations, 203, 223 Caudal, 203, 211, 221, 237 Celiac Disease, 53, 203 Cell Death, 140, 203 Cell Division, 171, 199, 203, 226, 237, 239, 244 Cell membrane, 203, 215, 217, 236, 254 Cell Respiration, 203, 243 Central Nervous System Infections, 203, 218 Cerebellar, 198, 204, 242, 251 Cerebral Cortex, 130, 131, 198, 204, 215, 216, 230 Cerebral Hemorrhage, 139, 140, 204 Cerebral Infarction, 139, 140, 204 Cerebral Palsy, 139, 140, 204, 246 Cerebrovascular, 139, 140, 200, 203, 204, 249 Cerebrum, 204, 249, 252 Cervical, 151, 168, 204 Cervix, 204 Chaos, 60, 82, 204 Chemoreceptor, 37, 197, 204 Chemotactic Factors, 204, 207 Chemotherapy, 133, 204 Chest Pain, 74, 92, 130, 156, 204 Child Behavior, 26, 204 Chin, 204, 227 Chlordiazepoxide, 133, 205 Cholecystokinin, 29, 58, 74, 75, 76, 82, 83, 91, 97, 98, 126, 127, 142, 205 Cholesterol, 64, 68, 79, 200, 205, 209, 247 Choline, 140, 205 Cholinergic, 78, 138, 197, 205, 229, 232, 242, 244 Chorea, 138, 139, 197, 205 Chromosome, 18, 51, 53, 54, 56, 65, 68, 97, 127, 135, 136, 205, 225, 244 Chronic renal, 205, 237 Ciliary, 139, 205, 229, 232

Ciliary Neurotrophic Factor, 139, 205 CIS, 127, 205 Citalopram, 39, 55, 103, 141, 205 Clathrin, 205, 206, 214 Clinical study, 102, 205, 208 Clinical trial, 4, 25, 39, 45, 48, 50, 119, 123, 130, 167, 205, 208, 212, 229, 239, 241 Clonazepam, 49, 62, 63, 79, 99, 119, 120, 206 Clonic, 206 Cloning, 41, 201, 206 Clozapine, 84, 206 Coated Vesicles, 205, 206, 214 Coca, 206 Cocaine, 29, 134, 138, 139, 191, 206 Cochlea, 206, 222 Cochlear, 121, 206 Cofactor, 206, 239, 250 Cognition, 9, 40, 135, 206, 231 Cognitive behavior therapy, 6, 46, 47, 88, 103, 121, 206 Cognitive restructuring, 149, 206, 247 Cognitive Therapy, 57, 102, 105, 108, 111, 146, 206 Colitis, 207 Collagen, 195, 207 Collapse, 207, 245 Colon, 171, 207, 222, 224, 252 Comorbidity, 8, 11, 12, 20, 34, 66, 69, 78, 84, 87, 106, 207 Complement, 14, 17, 26, 49, 196, 207, 217, 226 Complementary and alternative medicine, 101, 114, 207 Complementary medicine, 101, 207 Complete remission, 208, 243 Compliance, 25, 208 Compulsions, 208, 232 Computational Biology, 167, 170, 208 Computer Simulation, 34, 208 Conception, 28, 208, 247 Concomitant, 67, 208 Concretion, 202, 208, 233 Congestion, 197, 208 Connective Tissue, 207, 208, 216, 217, 225, 243 Consciousness, 208, 210, 211, 212, 240, 249 Constipation, 150, 197, 208 Constrict, 208, 230 Constriction, 208, 224, 232, 253 Constriction, Pathologic, 208, 253 Consultation, 14, 26, 41, 49, 208

258 Panic Disorder

Contraindications, ii, 208 Control group, 25, 208, 241 Controlled clinical trial, 26, 208 Controlled study, 36, 52, 62, 67, 93, 110, 208 Conventional therapy, 96, 208, 209 Conventional treatment, 208, 209 Convulsions, 40, 197, 200, 209 Coordination, 209, 229 Cor, 38, 45, 74, 99, 143, 209, 236 Coronary, 196, 199, 203, 209, 227 Coronary heart disease, 203, 209 Coronary Thrombosis, 209, 227 Cortex, 43, 75, 131, 209, 214, 215, 238, 242 Cortical, 9, 137, 209, 236, 238, 244, 249 Corticotropin-Releasing Hormone, 99, 209 Cortisol, 21, 31, 35, 61, 74, 77, 92, 97, 194, 209 Cotinine, 30, 209 Cranial, 209, 218, 232, 234, 235, 252 Craniocerebral Trauma, 200, 204, 209, 218, 249 Creatine, 87, 210 Creatinine, 210 Criterion, 24, 210 Crossing-over, 210, 242 Cues, 8, 44, 210 Curare, 210, 229 Curative, 210, 232, 250 Cutaneous, 202, 210 Cyclic, 193, 202, 210, 236 Cytokine, 17, 210 Cytoplasm, 200, 203, 210, 214, 225, 229, 231, 249 D Data Collection, 35, 210 Decarboxylation, 210, 220 Degenerative, 210, 229, 233 Delirium, 197, 210 Delivery of Health Care, 210, 219 Delusions, 51, 210, 234, 240 Dementia, 127, 128, 138, 139, 140, 143, 144, 168, 197, 210, 227 Dendrites, 211, 231 Density, 29, 211, 233 Dentate Gyrus, 211, 220 Depersonalization, 76, 77, 211, 234, 243 Depressive Disorder, 21, 32, 45, 53, 89, 119, 120, 134, 211, 225 Derealization, 76, 77, 211, 234 Desensitization, 105, 135, 211 Detoxification, 11, 211

Deuterium, 211, 220 Diagnostic procedure, 125, 157, 211 Diarrhea, 130, 150, 211 Diastolic, 211, 220 Diencephalon, 211, 214, 221, 238, 249, 250 Digestion, 195, 200, 201, 211, 212, 223, 225, 247 Digestive system, 124, 211 Dilatation, 211, 223, 238 Dimethyl, 128, 211 Direct, iii, 15, 22, 23, 35, 44, 50, 131, 159, 206, 211, 212, 220, 242, 247, 248 Discrimination, 46, 94, 211 Disease Progression, 168, 211 Dissociation, 116, 194, 212 Distal, 212, 213, 238, 240 Diuresis, 202, 212 Dizziness, 130, 150, 190, 212, 234, 253 Dopamine, 29, 132, 133, 138, 197, 198, 206, 212, 228, 231 Dorsal, 212, 214, 237, 244, 246 Double-blind, 39, 48, 52, 62, 67, 93, 96, 212 Drinking Behavior, 7, 212, 248 Drive, ii, vi, 8, 29, 38, 45, 95, 212 Drug Interactions, 160, 161, 212 Duct, 212, 215, 243 Duodenum, 200, 212, 214, 247 Dyskinesia, 138, 139, 197, 205, 212 Dyslexia, 138, 139, 212 Dyspepsia, 67, 212 Dysphoric, 85, 89, 134, 211, 212 Dysplasia, 171, 212 Dyspnea, 36, 109, 213, 234 Dystonia, 138, 139, 197, 213 Dystrophy, 171, 213 E Eating Disorders, 134, 136, 137, 141, 143, 144, 213 Effector, 193, 207, 213, 236 Ejaculation, 127, 128, 213, 244 Elastin, 88, 207, 213 Elective, 88, 89, 213 Electrode, 131, 213 Electrolyte, 210, 213, 237, 246 Electrophysiological, 7, 64, 213 Electroplating, 203, 213 Elementary Particles, 213, 226, 239 Embryo, 201, 213, 222 Emetic, 138, 198, 213 Empiric, 28, 213 Empirical, 11, 32, 43, 213 Encephalitis, 213, 227

Index 259

Endocarditis, 3, 202, 213 Endocardium, 213 Endocrine System, 213, 231 Endogenous, 36, 44, 132, 212, 214, 229, 239 Endorphins, 214, 231 Endoscopic, 214, 228 Endosomes, 36, 214 Endotoxins, 207, 214 End-stage renal, 205, 214, 237 Enkephalins, 214, 231 Entorhinal Cortex, 214, 220 Environmental Exposure, 214, 233 Environmental Health, 88, 110, 166, 168, 214 Enzymatic, 195, 202, 207, 214, 220 Enzyme, 52, 193, 213, 214, 227, 228, 235, 236, 239, 245, 250, 252, 254 Eosinophils, 214, 224 Epidemiological, 16, 22, 27, 142, 214 Epinephrine, 194, 212, 214, 224, 231, 232, 252 Epithalamus, 211, 214, 225 Epithelial, 193, 214, 215 Erectile, 65, 140, 215, 235 Erection, 140, 215, 222 Erythrocytes, 196, 215 Esophagus, 211, 215, 236, 247 Essential Tremor, 171, 215 Estazolam, 133, 215 Estrogen, 65, 215, 239 Ethanol, 205, 215 Ethinyl Estradiol, 51, 215 Eukaryotic Cells, 215, 222 Evacuation, 208, 215 Evoke, 215, 247 Evoked Potentials, 104, 215 Excitability, 215, 231 Excitation, 7, 195, 204, 215, 231 Exocrine, 205, 215, 233 Exocytosis, 215, 249 Exogenous, 97, 214, 215, 229, 239 Expiration, 215, 243 External radiation, 215, 247 Extracellular, 136, 196, 198, 208, 215, 246 Extrapyramidal, 194, 197, 212, 216 F Family Planning, 167, 216 Fat, 137, 193, 209, 216, 225, 229 Fathers, 7, 216 Fatty acids, 51, 194, 216 Febrile, 216, 247 Feces, 208, 216, 247

Fenfluramine, 8, 75, 216 Fibrosis, 171, 216, 244 Fissure, 211, 216, 238 Fixation, 216, 243 Flumazenil, 55, 216 Fluoxetine, 64, 67, 83, 84, 92, 140, 141, 216 Flushing, 134, 190, 216 Fluvoxamine, 10, 62, 67, 96, 111, 141, 216 Fold, 40, 216 Foramen, 204, 216, 226, 248 Forearm, 201, 216 Frontal Lobe, 131, 197, 204, 216, 238 Fungus, 202, 217 G GABA, 9, 69, 200, 206, 217, 245 Gallbladder, 193, 205, 211, 217 Ganglia, 193, 200, 217, 230, 234, 235, 248 Gap Junctions, 217, 249 Gas, 202, 217, 220, 232, 240, 243, 253 Gas exchange, 217, 243, 253 Gastric, 138, 139, 217, 220, 223, 235 Gastrin, 126, 217, 220, 235 Gastrointestinal, 17, 126, 127, 128, 143, 144, 178, 205, 214, 215, 217, 245, 248 Gastrointestinal tract, 127, 128, 215, 217, 245 Gene Expression, 43, 172, 217 Genetic Counseling, 41, 217 Genetic Engineering, 201, 206, 217 Genetic Markers, 34, 217 Genetics, 16, 18, 19, 27, 29, 34, 37, 41, 53, 54, 62, 65, 68, 70, 73, 77, 78, 88, 91, 127, 217 Genotype, 18, 19, 29, 217, 236 Geriatric Psychiatry, 22, 217 Gland, 194, 217, 225, 233, 234, 236, 239, 244, 247, 250 Glucose, 96, 104, 171, 218, 219, 223, 243 Glutamic Acid, 218, 231 Gluten, 203, 218 Glycine, 195, 218, 231 Glycoproteins, 218, 223 Gonadal, 218, 247 Gout, 137, 218 Governing Board, 218, 238 Gp120, 218, 235 Graft, 218, 220, 221 Graft Rejection, 218, 221 Granule, 37, 211, 218 Growth, 17, 21, 38, 71, 97, 139, 171, 194, 196, 197, 203, 218, 226, 228, 230, 233, 237, 250, 252

260 Panic Disorder

Gyrus Cinguli, 197, 218, 225 H Habituation, 110, 218 Haplotypes, 91, 218 Haptens, 194, 218 Head Movements, 151, 218 Headache, 71, 81, 127, 128, 130, 138, 139, 168, 202, 218, 219 Headache Disorders, 219 Health Behavior, 33, 219 Health Care Costs, 23, 219 Health Expenditures, 219 Health Services, 24, 43, 210, 219 Health Status, 219 Heart attack, 203, 219 Heart Transplantation, 60, 219 Heartbeat, 72, 94, 219, 248 Hemicrania, 127, 128, 219 Hemoglobin, 196, 215, 219 Hemoglobinuria, 171, 219 Hemorrhage, 209, 218, 219, 247 Hemostasis, 219, 245 Hereditary, 218, 219, 229, 231, 243 Heredity, 217, 219 Heterogeneity, 18, 19, 34, 126, 194, 219 Hippocampus, 16, 140, 211, 220, 225, 244, 248 Histamine, 132, 196, 197, 220 Histidine, 220 Homeostasis, 139, 220, 234 Homologous, 195, 210, 220, 244, 248, 249 Hormonal, 17, 21, 199, 220 Hormone, 21, 45, 71, 97, 143, 199, 209, 214, 217, 220, 223, 238, 239, 245, 249, 250 Host, 202, 220, 221, 252, 253 Hydrogen, 135, 136, 139, 142, 193, 195, 200, 201, 202, 211, 220, 228, 235, 240 Hydrogenation, 200, 220 Hydroxylation, 220, 252 Hydroxyproline, 195, 207, 220 Hyperkinesia, 138, 139, 220 Hyperlipidemia, 137, 220 Hyperphagia, 137, 220 Hypersecretion, 138, 139, 220 Hypersensitivity, 45, 49, 66, 72, 195, 211, 220 Hypertension, 17, 77, 90, 127, 128, 137, 138, 139, 203, 204, 218, 220, 227 Hypertrophy, 17, 209, 220, 252 Hyperuricemia, 218, 220 Hyperventilation, 10, 30, 36, 37, 46, 54, 73, 96, 105, 106, 110, 111, 116, 133, 220

Hypnotherapy, 115, 221 Hypnotic, 40, 199, 215, 221, 228, 232 Hypokinesia, 221, 234 Hypomania, 88, 221 Hypotension, 197, 209, 221 Hypothalamic, 44, 63, 74, 91, 221 Hypothalamus, 143, 199, 209, 211, 221, 225, 236, 239, 244, 250 Hypoxia, 72, 210, 221, 249 Hypoxic, 61, 221 I Id, 100, 112, 177, 178, 179, 180, 186, 188, 221 Idiopathic, 74, 88, 110, 221, 241 Illusion, 221, 253 Imipramine, 46, 47, 62, 67, 69, 79, 89, 102, 123, 129, 133, 221 Immune response, 197, 199, 218, 221, 226, 248, 252, 253 Immune system, 199, 221, 229, 252 Immunization, 221, 238 Immunodeficiency, 171, 221 Immunology, 74, 194, 221 Immunosuppressive, 221 Immunosuppressive therapy, 221 Immunotherapy, 17, 211, 221 Immunotoxin, 17, 221 Impairment, 9, 22, 48, 127, 128, 139, 140, 198, 199, 210, 212, 221, 227, 240 Implantation, 208, 222 Impotence, 140, 215, 222, 254 Impotent, 141, 222 In situ, 9, 222 In Situ Hybridization, 9, 222 In vitro, 40, 222 In vivo, 38, 103, 105, 109, 111, 139, 222 Incest, 109, 222 Incision, 222, 223 Indicative, 8, 121, 146, 222, 234, 252 Induction, 13, 88, 110, 135, 197, 222, 239 Infant Behavior, 204, 222 Infarction, 204, 209, 222, 227 Infection, 168, 202, 204, 205, 210, 213, 221, 222, 225, 231, 247, 250 Infertility, 137, 222 Inflammation, 194, 205, 207, 213, 216, 222, 237, 252 Inflammatory bowel disease, 138, 139, 222 Infusion, 8, 10, 36, 96, 222 Inhalation, 16, 27, 38, 45, 49, 85, 89, 222, 237 Inner ear, 222, 233

Index 261

Innervation, 9, 111, 223 Inositol, 62, 96, 113, 223 Inotropic, 212, 223 Insomnia, 130, 223 Insulator, 223, 229 Insulin, 17, 139, 223 Insulin-dependent diabetes mellitus, 223 Intermittent, 48, 129, 223, 225 Interneurons, 9, 223 Intestinal, 203, 205, 223, 226 Intestinal Mucosa, 203, 205, 223 Intestine, 126, 201, 223, 224 Intoxication, 210, 223, 254 Intracellular, 38, 202, 205, 222, 223, 237, 242, 245 Intracranial Aneurysm, 204, 223 Intravenous, 8, 36, 71, 96, 222, 223 Intrinsic, 9, 194, 223, 235 Intrinsic Factor, 223, 235 Invasive, 46, 47, 223, 225 Involuntary, 200, 205, 215, 218, 223, 230, 242 Ion Channels, 136, 198, 223, 249 Ions, 136, 193, 200, 201, 202, 212, 213, 220, 223, 228 Iris, 224, 229 Ischemia, 196, 199, 224 Isoproterenol, 86, 98, 224 J Jealousy, 224, 234 Jet lag, 138, 139, 224 Joint, 198, 224, 233, 248 K Kaposi, 168, 224 Kb, 166, 224 Kidney Disease, 124, 166, 171, 224 L Labile, 207, 224 Labyrinth, 206, 222, 224, 239, 244, 253 Lactation, 28, 224, 239 Lag, 224 Large Intestine, 211, 223, 224, 242, 246 Larynx, 224, 251, 252 Latent, 16, 49, 224, 238 Leukemia, 171, 224 Leukocytes, 71, 200, 204, 214, 224, 229, 231 Library Services, 186, 224 Ligament, 224, 239 Ligands, 40, 138, 225 Limbic, 40, 196, 218, 225, 238 Limbic System, 40, 196, 218, 225, 238

Linkage, 16, 17, 18, 20, 27, 29, 34, 41, 54, 77, 78, 82, 217, 225 Lipid, 198, 205, 223, 225, 228, 229 Lipophilic, 40, 225 Lithium, 197, 225 Liver, 193, 194, 200, 211, 216, 217, 225, 228 Lobe, 131, 204, 225 Localized, 216, 222, 225, 228, 237 Longitudinal Studies, 49, 225 Long-Term Care, 41, 225 Long-Term Potentiation, 38, 225 Lymph, 204, 225 Lymph node, 204, 225 Lymphatic, 222, 225 Lymphocytes, 197, 221, 224, 225 Lymphoid, 197, 225 Lymphoma, 171, 225 M Magnetic Resonance Imaging, 52, 225, 226 Magnetic Resonance Spectroscopy, 9, 87, 226 Maintenance therapy, 46, 47, 121, 226 Major Histocompatibility Complex, 218, 226 Malabsorption, 171, 203, 226 Malignant, 171, 193, 226, 230, 243 Malnutrition, 194, 199, 226, 230 Malondialdehyde, 52, 226 Mania, 80, 221, 226 Manic, 197, 201, 225, 226, 240 Manic-depressive psychosis, 226, 240 Manifest, 21, 226 Man-made, 203, 226 Meatus, 226, 252 Medial, 9, 87, 198, 218, 226, 233, 244 Mediate, 212, 226 Mediator, 205, 226, 245 Medicament, 97, 98, 140, 226 MEDLINE, 167, 170, 171, 226 Meiosis, 226, 248, 249 Melanocytes, 227 Melanoma, 171, 227 Membrane, 198, 203, 206, 207, 215, 218, 223, 224, 227, 236, 245, 249 Memory, 17, 27, 43, 66, 80, 127, 128, 195, 196, 210, 211, 225, 227 Memory Disorders, 127, 128, 227 Meninges, 203, 204, 209, 227 Menstruation, 195, 227, 238 Mental Disorders, 17, 18, 124, 177, 194, 221, 227, 238, 240 Mental Health Services, iv, 4, 43, 169, 227

262 Panic Disorder

Mental Processes, 212, 227, 240 Mentors, 45, 227 Mesolimbic, 197, 227 Meta-Analysis, 89, 227 Metabolic disorder, 218, 227 Metabolite, 211, 227 Methionine, 211, 227 Methyltransferase, 57, 58, 65, 96, 97, 227 Metoprolol, 91, 227 MI, 98, 132, 133, 149, 192, 227 Microbe, 227, 251 Microbiology, 193, 199, 228 Microglia, 198, 228 Microscopy, 9, 228 Midazolam, 129, 228 Mitral Valve, 3, 91, 127, 228 Mitral Valve Prolapse, 3, 91, 127, 228 Moclobemide, 76, 228 Modeling, 19, 40, 41, 228 Modification, 57, 104, 105, 109, 151, 195, 217, 228, 241 Molecular Structure, 228, 252 Molecule, 197, 200, 207, 212, 213, 215, 218, 228, 242, 245, 253 Monitor, 14, 210, 228, 232 Monoamine, 137, 160, 228 Monoamine Oxidase, 160, 228 Monocytes, 224, 229 Monotherapy, 46, 47, 229 Mood Disorders, 67, 127, 128, 229 Morphine, 198, 229, 233 Motility, 127, 128, 229, 245 Motion Sickness, 229, 230 Motor Activity, 209, 229 Motor nerve, 229, 232 Movement Disorders, 131, 197, 229, 249 Mucins, 218, 229, 243 Mucus, 229, 252 Multicenter study, 20, 229 Multiple sclerosis, 93, 229 Muscarinic Antagonists, 81, 229 Muscle Fibers, 199, 229, 230 Muscle relaxant, 40, 215, 229 Muscle Relaxation, 13, 199, 229 Muscle tension, 229 Muscular Atrophy, 171, 230 Muscular Dystrophies, 213, 230 Mydriasis, 96, 230 Mydriatic, 230, 254 Myelin, 229, 230 Myocardium, 196, 227, 230 Myotonic Dystrophy, 171, 230

N Naloxone, 36, 45, 230 Nausea, 138, 190, 197, 230, 234 NCI, 1, 123, 165, 205, 230 Need, 3, 20, 25, 27, 32, 40, 41, 48, 145, 147, 148, 150, 168, 181, 205, 230, 250 Neocortex, 9, 230 Neonatal, 9, 17, 28, 230 Neonatal period, 9, 230 Neoplasia, 171, 230 Neoplasm, 230, 243 Neoplastic, 225, 230 Nephropathy, 224, 230 Nerve Growth Factor, 139, 230 Nervousness, 130, 231 Neural, 9, 15, 16, 42, 131, 194, 196, 228, 231, 244 Neural Pathways, 15, 231 Neuroanatomy, 9, 225, 231 Neurodegenerative Diseases, 139, 140, 200, 231 Neuroendocrine, 22, 37, 55, 89, 96, 98, 143, 231 Neuroendocrinology, 45, 231 Neuroleptic, 127, 128, 194, 197, 206, 231 Neuromuscular, 193, 231 Neuromuscular Junction, 193, 231 Neuronal, 7, 131, 138, 205, 231 Neurons, 9, 137, 139, 206, 211, 217, 223, 229, 230, 231, 232, 248 Neuropathy, 139, 140, 231 Neuropeptide, 209, 231 Neurophysiology, 80, 231 Neurosis, 130, 132, 142, 143, 231, 236 Neurosurgery, 131, 231 Neurotic, 131, 231 Neurotransmitter, 44, 193, 195, 212, 217, 218, 220, 223, 231, 232, 239, 245, 248, 249 Neutrophils, 224, 231 Niacin, 232, 252 Nicotine, 6, 30, 138, 139, 232, 242 Nitrazepam, 215, 232 Nitrogen, 139, 195, 216, 232, 252 Nonverbal Communication, 232, 240 Norepinephrine, 82, 92, 194, 212, 231, 232 Normal Distribution, 9, 232 Nuclear, 7, 73, 200, 215, 225, 226, 232, 249 Nuclei, 7, 9, 196, 214, 217, 226, 232, 234, 239, 244 Nucleic acid, 222, 232 O Ocular, 33, 151, 232, 243

Index 263

Oculomotor, 230, 232 Oculomotor Nerve, 230, 232 Odds Ratio, 233, 242 Oncogene, 171, 233 Opacity, 211, 233 Opiate, 36, 229, 230, 233 Opium, 229, 233 Optic Chiasm, 221, 233 Orgasm, 213, 233 Orthostatic, 14, 21, 197, 233 Osteoarthritis, 137, 233 Osteopetrosis, 17, 233 Otolith, 33, 233 Outpatient, 11, 17, 44, 45, 122, 233 Overdose, 82, 233 Oxides, 133, 233 Oxygen Consumption, 233, 243 P Palliative, 233, 250 Palpitation, 130, 233 Palsy, 138, 139, 233 Pancreas, 193, 211, 223, 233, 234 Pancreatic, 17, 171, 205, 234 Pancreatic cancer, 17, 171, 234 Paralysis, 190, 210, 234, 246 Paranoia, 29, 107, 234 Parasympathetic Nervous System, 93, 234 Paresthesias, 130, 234 Parietal, 75, 197, 234 Parietal Lobe, 197, 234 Parkinsonism, 127, 128, 197, 198, 234 Paroxetine, 11, 46, 47, 52, 61, 62, 67, 69, 79, 119, 120, 121, 140, 141, 160, 234 Paroxysmal, 41, 92, 127, 128, 171, 196, 219, 234 Partial remission, 234, 243 Pathogenesis, 45, 66, 131, 234 Pathologic, 200, 202, 209, 220, 234 Pathophysiology, 16, 17, 37, 45, 143, 151, 234 Patient Education, 178, 184, 186, 192, 234 Patient Participation, 25, 235 Patient Satisfaction, 44, 235 Pedigree, 20, 45, 235 Pelvic, 235, 239 Penis, 213, 235 Pentagastrin, 22, 51, 235 Pepsin, 235 Peptide, 29, 39, 126, 195, 205, 235, 239, 250 Peptide T, 39, 235 Perception, 72, 94, 211, 235, 243 Perfusion, 221, 235

Peripheral Nervous System, 10, 126, 214, 231, 233, 235, 238, 248 Personality Disorders, 20, 69, 87, 235 PH, 56, 235 Pharmacologic, 60, 67, 196, 235, 251 Pharmacotherapy, 11, 23, 46, 47, 71, 78, 82, 235 Pharynx, 235, 252 Phenotype, 27, 29, 37, 236 Phenyl, 130, 133, 135, 139, 142, 236 Phobic Disorders, 236 Phosphodiesterase, 140, 236 Phospholipids, 216, 223, 236 Phosphorus, 130, 202, 236 Phosphorylation, 39, 236 Phototherapy, 236, 244 Physical Therapy, 50, 236 Physiologic, 49, 194, 221, 227, 236, 242, 251 Physiology, 10, 35, 50, 131, 202, 213, 231, 236 Pilot study, 6, 33, 36, 64, 83, 93, 94, 236 Pituitary Gland, 209, 236, 239 Pituitary-Adrenal System, 143, 236 Placebo Effect, 60, 236 Plants, 195, 200, 201, 202, 205, 206, 218, 232, 236, 243, 251 Plasma, 98, 108, 126, 194, 197, 203, 219, 227, 237, 244 Plasma cells, 197, 237 Plasticity, 43, 237 Platelets, 71, 237, 250 Pneumonia, 208, 237 Poisoning, 198, 210, 223, 230, 237 Polycystic, 171, 237 Polymorphic, 20, 142, 211, 237 Polymorphism, 54, 57, 68, 77, 85, 96, 142, 237 Population Control, 67, 237 Posterior, 75, 196, 198, 212, 214, 224, 233, 237 Postnatal, 15, 237 Postsynaptic, 237, 245, 249 Post-traumatic, 14, 42, 56, 127, 128, 134, 219, 229, 237 Post-traumatic stress disorder, 14, 56, 127, 128, 134, 237 Postural, 50, 237 Potassium, 130, 237 Potentiate, 237, 238 Potentiation, 15, 140, 225, 237, 245 Practicability, 237, 251 Practice Guidelines, 151, 169, 178, 237

264 Panic Disorder

Preclinical, 17, 238 Precursor, 205, 212, 213, 214, 232, 238, 252 Predisposition, 14, 238, 249 Prefrontal Cortex, 16, 43, 131, 238 Premenstrual, 85, 89, 134, 238 Prescription drug abuse, 122, 238 Pressoreceptors, 200, 238 Presynaptic, 135, 199, 231, 238, 249 Presynaptic Terminals, 199, 238, 249 Prevalence, 8, 18, 20, 59, 65, 74, 121, 134, 140, 142, 179, 233, 238 Primary Prevention, 5, 238 Probe, 37, 94, 238 Problem Solving, 6, 238 Progesterone, 238, 239, 247 Prognostic factor, 238, 248 Progression, 196, 238 Progressive, 13, 103, 138, 139, 205, 211, 218, 230, 231, 233, 239 Projection, 223, 232, 238, 239, 242 Prolactin, 239 Promoter, 27, 68, 91, 239 Prophase, 239, 248, 249 Prophylaxis, 3, 239, 252 Proprioception, 33, 239 Prospective Studies, 18, 48, 239 Prostate, 17, 171, 239 Protein Binding, 28, 239 Protein C, 137, 194, 195, 206, 239 Protein S, 149, 171, 172, 201, 239 Proteolytic, 207, 239 Protirelin, 96, 239 Protocol, 30, 149, 168, 239 Protons, 220, 226, 239, 241 Proximal, 26, 212, 238, 240, 244 Psychic, 227, 231, 240, 244 Psychoactive, 240, 254 Psychogenic, 141, 240 Psychomotor, 210, 231, 240 Psychopathology, 5, 6, 9, 14, 19, 26, 31, 33, 35, 54, 67, 73, 85, 240 Psychopharmacology, 48, 55, 61, 62, 64, 70, 72, 76, 77, 79, 80, 81, 83, 84, 89, 90, 93, 97, 98, 107, 240 Psychophysiology, 16, 45, 240 Psychosis, 28, 137, 138, 139, 141, 197, 240 Psychotherapy, 4, 6, 23, 25, 30, 54, 65, 71, 75, 78, 83, 98, 102, 103, 116, 199, 200, 206, 240 Psychotropic, 129, 240 Public Health, 4, 14, 26, 30, 36, 49, 169, 240 Public Policy, 167, 240

Public Sector, 43, 240 Pulmonary, 36, 109, 201, 209, 220, 240, 243, 253 Pulmonary Artery, 201, 240, 253 Pulmonary hypertension, 209, 240 Pulmonary Ventilation, 220, 240, 243 Pulse, 228, 241 Purulent, 241, 252 Pyoderma, 138, 139, 241 Pyoderma Gangrenosum, 138, 139, 241 Q Quality of Life, 12, 13, 22, 23, 37, 48, 241, 248 R Race, 241, 246 Racemic, 241, 246 Radiation, 193, 196, 213, 214, 215, 226, 241, 247, 254 Radiation therapy, 193, 215, 241 Radioactive, 220, 222, 226, 232, 241 Random Allocation, 241 Randomization, 10, 24, 241 Randomized, 4, 8, 12, 23, 24, 26, 36, 39, 43, 46, 47, 48, 50, 52, 57, 84, 123, 213, 241 Randomized clinical trial, 50, 241 Rape, 33, 237, 241 Reality Testing, 240, 241 Receptors, Muscarinic, 229, 242 Receptors, Serotonin, 242, 245 Recombinant, 20, 242, 253 Recombination, 35, 217, 242 Rectum, 198, 201, 207, 211, 217, 222, 224, 239, 242 Recur, 242, 244 Recurrence, 201, 226, 242, 244 Red Nucleus, 199, 242 Refer, 1, 207, 212, 214, 216, 223, 231, 240, 242, 253 Reflex, 33, 151, 242 Refractory, 48, 80, 242 Regimen, 121, 213, 235, 236, 242 Regurgitation, 228, 242 Relapse, 4, 10, 11, 12, 28, 30, 34, 46, 47, 48, 54, 58, 61, 62, 145, 242 Relative risk, 27, 29, 242 Relaxant, 242 Reliability, 18, 242 Remission, 7, 12, 34, 48, 61, 63, 75, 83, 201, 226, 242 Research Design, 15, 25, 26, 45, 50, 243 Research Support, 38, 243

Index 265

Respiration, 38, 41, 49, 82, 198, 202, 204, 210, 228, 243 Respiratory Physiology, 35, 38, 51, 73, 243, 253 Respiratory System, 49, 243 Response rate, 46, 47, 243 Restoration, 236, 243 Retinoblastoma, 171, 243 Rigidity, 234, 237, 243 Risk factor, 16, 26, 35, 36, 63, 76, 150, 242, 243 S Saccades, 151, 243 Saliva, 30, 243 Salivary, 31, 35, 77, 97, 211, 229, 234, 243 Salivary glands, 211, 229, 243 Saponins, 243, 247 Sarcoma, 168, 243 Schizoid, 243, 254 Schizotypal Personality Disorder, 211, 243, 254 Sclerosis, 138, 139, 140, 171, 198, 229, 244 Screening, 24, 30, 39, 73, 205, 244 Seasonal Affective Disorder, 127, 244 Secretion, 21, 74, 82, 127, 128, 220, 223, 224, 228, 229, 235, 239, 244 Secretory, 37, 244, 249 Sedative, 40, 205, 216, 221, 228, 244 Sedatives, Barbiturate, 199, 244 Segregation, 34, 41, 242, 244 Seizures, 84, 168, 206, 210, 234, 244 Self Care, 193, 244 Semen, 213, 239, 244 Semicircular canal, 33, 222, 244 Semisynthetic, 215, 244 Senile, 138, 139, 140, 244 Septal, 197, 225, 244 Septal Nuclei, 197, 225, 244 Sequela, 139, 140, 244 Sequence Homology, 235, 244 Sequencing, 29, 244 Sequential treatment, 48, 245 Sequester, 245, 249 Sertraline, 48, 60, 63, 84, 89, 90, 127, 140, 141, 156, 160, 245 Serum, 28, 68, 96, 194, 196, 207, 245 Sex Characteristics, 194, 245, 249 Sex Determination, 171, 245 Shock, 245, 251 Side effect, 131, 132, 135, 139, 141, 159, 194, 197, 205, 220, 245, 248, 251 Signal Transduction, 223, 245

Signs and Symptoms, 242, 245 Skeletal, 210, 224, 230, 245 Skull, 209, 245, 249 Sleep apnea, 137, 245 Small intestine, 212, 220, 223, 245 Smoking Cessation, 30, 246 Smooth muscle, 196, 201, 202, 220, 229, 246, 248 Social Behavior, 9, 246 Social Environment, 241, 246 Social Support, 246, 247 Sodium, 39, 96, 99, 218, 246 Sodium Lactate, 39, 246 Soma, 246 Somatic, 31, 44, 99, 129, 194, 225, 226, 234, 235, 238, 246, 252 Spastic, 138, 139, 246 Spasticity, 246 Spatial disorientation, 212, 246 Specialist, 16, 23, 181, 246 Species, 7, 137, 210, 214, 226, 241, 244, 246, 248, 250, 251, 253, 254 Specificity, 20, 38, 43, 45, 50, 71, 89, 136, 194, 246 Spectroscopic, 10, 226, 246 Sperm, 205, 246 Spinal cord, 136, 137, 198, 201, 203, 205, 227, 230, 231, 234, 235, 242, 246, 247, 248 Spinal Nerves, 235, 246 Splenomegaly, 233, 247 Sporadic, 231, 243, 247 Sprue, 138, 139, 247 Stabilization, 11, 247 Steel, 8, 247 Stereotactic, 131, 247 Stereotaxis, 131, 247 Sterility, 222, 247 Steroid, 28, 69, 76, 81, 97, 209, 243, 247 Stimulant, 160, 202, 209, 220, 224, 247 Stimulus, 7, 8, 64, 212, 213, 215, 223, 224, 234, 236, 242, 247, 250 Stomach, 139, 193, 211, 215, 217, 220, 230, 235, 236, 245, 247 Stool, 207, 224, 247 Stress management, 149, 247 Stroke, 36, 124, 137, 138, 139, 166, 202, 203, 247 Subacute, 222, 247 Subarachnoid, 218, 247 Subclinical, 222, 244, 247 Subfornical Organ, 39, 248 Subiculum, 220, 248

266 Panic Disorder

Subspecies, 246, 248 Substance P, 227, 244, 248 Sudden cardiac death, 36, 248 Supportive care, 168, 248 Suppression, 41, 116, 248 Supraventricular, 92, 248 Survival Analysis, 41, 248 Sympathetic Nervous System, 199, 231, 234, 248 Sympathomimetic, 212, 214, 224, 232, 248 Symphysis, 204, 239, 248 Symptomatic, 10, 38, 48, 49, 205, 248 Symptomatic treatment, 205, 248 Symptomatology, 7, 24, 248 Synapse, 194, 231, 234, 238, 248, 249, 251 Synapsis, 248 Synaptic, 9, 36, 43, 132, 135, 140, 225, 231, 232, 245, 248, 249 Synaptic Transmission, 232, 249 Synaptic Vesicles, 36, 249 Syncope, 130, 249 Systemic, 133, 160, 201, 202, 210, 214, 222, 241, 246, 249, 252 Systole, 103, 228, 249 Systolic, 220, 228, 249 T Tachycardia, 92, 249 Tardive, 127, 128, 138, 139, 197, 205, 249 Telangiectasia, 171, 249 Telencephalon, 200, 204, 249 Temperament, 5, 26, 35, 80, 249 Temporal, 9, 75, 87, 196, 219, 220, 226, 249 Temporal Lobe, 9, 87, 196, 249 Testosterone, 92, 249 Thalamic, 198, 214, 249 Thalamic Diseases, 198, 249 Thalamus, 211, 214, 225, 238, 249 Therapeutics, 48, 161, 229, 250 Third Ventricle, 214, 221, 249, 250 Thorax, 193, 250, 252 Threonine, 235, 250 Threshold, 39, 45, 215, 220, 250 Thrombin, 126, 239, 250 Thrombocytes, 237, 250 Thrombomodulin, 239, 250 Thrombosis, 239, 247, 250 Thrush, 202, 250 Thyroid, 53, 250, 252 Thyrotropin, 239, 250 Tidal Volume, 36, 41, 220, 250 Time Management, 247, 250 Tin, 133, 250

Tolerance, 193, 206, 250 Tomography, 56, 226, 250 Tone, 229, 246, 250 Tonic, 206, 250 Tonicity, 213, 251 Tooth Preparation, 193, 251 Toxic, iv, 200, 210, 214, 221, 231, 232, 251 Toxicity, 121, 212, 251 Toxicology, 168, 251 Toxins, 197, 213, 214, 222, 251 Trace element, 130, 250, 251 Trachea, 201, 224, 236, 250, 251 Transcutaneous, 37, 251 Transfection, 201, 251 Translating, 25, 251 Translation, 195, 251 Transmitter, 193, 198, 199, 212, 223, 226, 232, 249, 251 Transplantation, 17, 205, 221, 226, 251 Trauma, 22, 41, 44, 78, 139, 140, 210, 251 Treatment Failure, 11, 60, 251 Treatment Outcome, 11, 13, 90, 92, 251 Tremor, 234, 251 Trichotillomania, 134, 251 Tricuspid Atresia, 209, 251 Tricyclic, 132, 160, 205, 221, 252 Trigger zone, 197, 252 Tryptophan, 58, 61, 63, 94, 96, 207, 245, 252 Tryptophan Hydroxylase, 58, 252 Tuberous Sclerosis, 171, 252 Tyrosine, 212, 252 U Ulcerative colitis, 138, 139, 222, 241, 252 Unconscious, 91, 196, 221, 252 Urethra, 235, 239, 252 Uric, 218, 220, 252 Urinary, 21, 92, 130, 202, 229, 246, 252 Urine, 201, 210, 212, 219, 252 Uterus, 204, 227, 238, 252 V Vaccination, 17, 252 Vaccine, 239, 252 Vagina, 202, 204, 227, 252 Vaginitis, 202, 252 Vagus Nerve, 133, 252 Vascular, 17, 127, 128, 200, 219, 222, 238, 252 Vascular Resistance, 200, 252 Vasoconstriction, 138, 139, 214, 252 Vasodilator, 212, 220, 253 Vasomotor, 134, 253

Index 267

VE, 27, 44, 93, 253 Vector, 253 Vein, 198, 223, 232, 253 Venlafaxine, 11, 80, 93, 120, 122, 253 Venous, 198, 204, 239, 252, 253 Venous blood, 204, 253 Ventilation, 36, 253 Ventricle, 196, 199, 209, 220, 228, 240, 241, 249, 250, 251, 253 Ventricular, 209, 252, 253 Vertebrae, 246, 253 Vertigo, 150, 253 Vestibular, 32, 50, 121, 122, 150, 253 Vestibule, 206, 222, 244, 253 Veterinary Medicine, 167, 253 Villous, 203, 253 Viral, 43, 213, 253 Viral vector, 43, 253 Virulence, 251, 253 Virus, 17, 204, 217, 218, 253

Visceral, 199, 225, 252, 254 Visceral Afferents, 199, 252, 254 Vitamin A, 223, 254 Vitro, 254 Vivo, 254 Voltage-gated, 135, 254 W War, 237, 254 Weight Gain, 137, 244, 254 Windpipe, 236, 250, 254 Withdrawal, 7, 30, 210, 254 X Xenograft, 196, 254 X-ray, 226, 232, 241, 247, 254 Y Yeasts, 202, 217, 236, 254 Yohimbine, 8, 55, 254 Z Zygote, 208, 254 Zymogen, 239, 254

268 Panic Disorder

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