dothiepin-hydrochloride and Panic-Disorder

Repeated assessments of psychopathology, together with personality status, were made over two years on 181 psychiatric out-patients with generalised anxiety disorder (59), panic disorder (66), or dysthymic disorder (56) diagnosed using an interview schedule for DSM-III. Patients were randomly allocated to drug treatment, cognitive and behaviour therapy, or a self-help treatment programme. Although there were no overall differences in compliance rate and efficacy between the three modes of treatment, the psychological treatment methods, particularly self-help, were more effective in patients without personality disorder, and those with personality disorder responded better to drug treatment, primarily antidepressants. The findings suggest that assessment of personality status could be a valuable aid to selection of treatment in neurotic disorders and that self-help approaches are particularly valuable once personality disorder has been excluded.

Topics: Adult; Anxiety Disorders; Cognitive Behavioral Therapy; Depressive Disorder; Diazepam; Dothiepin; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neurotic Disorders; Panic Disorder; Personality Assessment; Self-Help Groups

The validity of the general neurotic syndrome, a combination of anxiety, depression and dependent personality disorder, was examined in a 2-year study of outpatients with dysthymic, panic and generalized anxiety disorder diagnosed using a structured interview schedule. The general neurotic syndrome, found in a third of the patients, was associated with greater mental disorder and a significantly worse outcome than patients without the syndrome. It did not, however, predict response to treatment. Further analysis revealed that the general neurotic syndrome was a better predictor of short- and long-term outcome than any other variable apart from initial psychopathology score. It is argued that the syndrome may represent a personality diathesis that makes the individual more vulnerable to both anxiety and depressive symptoms.

Topics: Adjustment Disorders; Anxiety Disorders; Cognitive Behavioral Therapy; Depressive Disorder; Diazepam; Dothiepin; England; Follow-Up Studies; Humans; Life Change Events; Neurotic Disorders; Panic Disorder; Personality Disorders; Psychiatric Status Rating Scales; Self Care