title: Cognitive style, alprazolam plasma levels, and treatment response in panic disorder.
abstract: This study investigated an anxiety-prone cognitive style (measured by the Anxious Thoughts and Tendencies Questionnaire, AT&T) as a predictor of the acute response to increasing alprazolam plasma levels in panic disorder. Panic disorder patients (n=26) were treated with escalating doses of alprazolam for 4 weeks, then a fixed dose of 1 mg four times a day for 4 weeks. At 0, 1, 2, 3, 4, 6, and 8 weeks, trough alprazolam plasma levels; clinical, self-report, and performance measures; and vital signs were assessed. Panic attack data were from daily diaries. The repeated response measures were analyzed in relation to alprazolam plasma levels using SAS GENMOD, with patients classified as high or low on the baseline AT&T. Panic attacks, anticipatory anxiety, fear, avoidance, overall agoraphobia, the Hamilton Anxiety Rating Scale, and clinicians' global ratings improved with increasing alprazolam plasma levels. Hopkins Symptom Checklist-90 Anger-Hostility; Profile of Mood States Vigor, Confusion, and Friendliness; and speed and accuracy of performance worsened. Patients with high AT&T scores were worse throughout the study on situational panics, fear, avoidance, overall agoraphobia, the Hamilton Anxiety Rating Scale, the Hamilton Rating Scale for Depression, and Clinical Global Improvement; most Hopkins Symptom Checklist-90 clusters; Profile of Mood States Anxiety, Depression, and Confusion; and Continuous Performance Task omissions. We conclude that in panic disorder: (1) alprazolam has a broad spectrum of clinical activity related to plasma levels in individual patients; (2) sedation, disinhibition, and performance deficits may persist for at least a month after dose escalation ends; (3) marked anxiety-prone cognitions predict more symptoms throughout treatment, but do not modify the response to alprazolam and therefore should not influence the choice of alprazolam as treatment.
authors.affiliation: Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico 87131-0001, USA. uhli@unm.edu <uhli@unm.edu>
authors.forename: E H
authors.initials: EH
authors.lastname: Uhlenhuth
authors.forename: Vladan
authors.initials: V
authors.lastname: Starcevic
authors.forename: Clifford
authors.initials: C
authors.lastname: Qualls
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Antal
authors.forename: William
authors.initials: W
authors.lastname: Matuzas
authors.forename: Javaid I
authors.initials: JI
authors.lastname: Javaid
authors.forename: Jamie
authors.initials: J
authors.lastname: Barnhill
mesh_terms: D000293:Adolescent; D000328:Adult; D000525:Alprazolam / Q000097:blood* / Q000627:therapeutic use*; D014151:Anti-Anxiety Agents / Q000097:blood* / Q000627:therapeutic use*; D001007:Anxiety / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D003071:Cognition; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D000525:Alprazolam