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1997 Volume 37 Issue 3 Pages
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Article type: Index
1997 Volume 37 Issue 3 Pages
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Article type: Appendix
1997 Volume 37 Issue 3 Pages
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Article type: Appendix
1997 Volume 37 Issue 3 Pages
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[in Japanese]
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1997 Volume 37 Issue 3 Pages
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[in Japanese]
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1997 Volume 37 Issue 3 Pages
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Article type: Appendix
1997 Volume 37 Issue 3 Pages
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Article type: Article
1997 Volume 37 Issue 3 Pages
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Yoshifumi Koshino, Toshihiko Hamada
Article type: Article
1997 Volume 37 Issue 3 Pages
215-222
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The cardiac symptoms such as palpitation and chest pain are common in patients with panic disorder (PD). The PD patients with chest pain often underwent coronary arteriography because of fear of possible serious cardiac disease. However, the prevalence of PD is very high among the patients who have chest pain and normal coronary arteriograms. The mitral valve prolapse (MVP) syndrome has symptoms indistinguishable from panic attacks. The studies with two-dimensional echocardiography and blind evaluation of MVP found significantly higher prevalences of mild MVP in PD patients than in the control groups. Our study confirmed this finding as well. We compared the heart rate and the R-R interval varianace (CV= standard deviation of R-R intervals/mean R-R intervals X 100) of 32 PD patients with those of 32 age and sex matched healthy controls. The heart rate in the lying position tended to be higher in PD patients than in the healthy controls. And in the standing position, it was significantly higher in PD patiens than in the controls. In the lying position, CV of R-R was smaller in PD patients than in healthy controls. These findings suggested that PD patients had sympathetic arousal and vagal withdrawal. Then the heart rate and CV of R-R interval of 15 PD patients with MVP were compared with those of 15 PD patiens without MVP. The age and sex of the both groups were matched. The PD patients with MVP had smaller CV than PD patients without MVP. It was suggested that the cardiac vagal withdrawal was more prominent in PD patients with MVP.
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1997 Volume 37 Issue 3 Pages
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Takeshi Inoue, Tsukasa Koyama
Article type: Article
1997 Volume 37 Issue 3 Pages
223-229
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Recent clinical evidence has shown that selective serotonin reuptake inhibitors (SSRls) are effective in the treatment of various anxiety disorders, such as panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder and social phobia in addition to depressive disorders. However, several animal models of anxiety, such as conflict test, have failed to show the anxiolytic effects of SSRI. Conditioned fear stress (CFS : re-exposure to an environment paired previously with inescapable electric footshock) induces defecation, urination, increased blood pressure and freezing behavior, an index of anxiety. The authors have shown the anxiolytic effects of benzodiazepines, SSRls, serotonin_<lA> (5-HT_<IA>) agonist and 5-HT precursor on CFS-induced freezing behavior. These results are consistent with clinical effects of these drugs in the treatment of anxiety disorders, and suggest that facilitation of 5-HT neurotransmission decreases anxiety because SSRIs and 5-HT precursor are assumed to increase the output from the 5-HT synapse. We also reported that CFS increased the serotonergic activity in the medial prefrontal cortex (mPFC). Furthermore, more intense CFS, following repeated conditioning, increased it not only in the mPFC, but also in the nucleus accumbens and amygdala. The bilateral mPFC Iesions did not reduce conditioned freezing. This lesion study and other previous reports suggest that 5-HT activation in the mPFC during CFS does not cause emotional reaction to CFS, but may, rather, reflect coping with stress. These findings suggest the close relationship between anxietv and serotonin in the brain.
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1997 Volume 37 Issue 3 Pages
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masatoshi Tanaka
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1997 Volume 37 Issue 3 Pages
231-239
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We examined the role of rat brain noradrenaline (NA) system in the provocation of anxiety by measuring levels of 3-methoxy-4-hydroxyphenylethyleneglycol sulfate (MHPG-S0_<4>) , the major metabolite of noradrenaline (NA) , and NA Ievels in the perfusates obtained by intracerebral microdialysis. Diazepam, an anxiolytic drug of benzodiazepines (BDZs) , significantly reduced both increases in NA release caused by immobilization stress in the hypothalamus, amygdala and locus coeruleus (LC)region and emotional responses exposed to stress. These changes were reversed by flumazenil, an antagonist of BDZs, which suggested that the actions of diazepam were mediated via BDZ receptors. Stresses, wherein the emotional factor was predominantly involved, caused increases in NA release in these brain regions and these increases were also attenuated by diazepam in a flumazenil reversible manner. Yohimbine, which caused significant increases in NA release in these regions, enhanced anxiety-related behavior in the animals and β-carboline 3-carboxylate ethyl ester, an anxiogenic drug, caused increases in NA release in these regions. From these findings, it is suggested that increases in NA release in the hypothalamus, amygdala and LC are, in part, involved in the provocation of anxiety and/or fear.
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Tomifusa Kuboki
Article type: Article
1997 Volume 37 Issue 3 Pages
241-246
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There has long been interest in and debate about the relationship between affective disorders and anxiety disorders, and this is especially true of panic disorder. A number of reviewers have examined the prevalence of depressive comorbidity, and their conclusions are highly supportive of the observation that panic disorder and depressive disorders co-occur at very high rates. Reviews find these rates to range from 22〜91%. Most reviewers have found that when the disorders of depression and panic co-occur, they are more severe than when either syndrome occurs alone. And, in individuals with both depressive disorder and panic disorder, social disability and attempt of suicide or suicide behavior are increased when compared to individuals with either disorder alone. In our out-patients, 30 patients with comorbid depressive disorder and panic disorder are studied. All patients show high scores(over 40 points) in SDS and are diagnosed as having depressive disorder and panic disorder by 2 doctors. After drug therapy for 8 weeks at least, the condition of 26 patients has made a change for the better.
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Article type: Appendix
1997 Volume 37 Issue 3 Pages
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Hideaki Ninomiya
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1997 Volume 37 Issue 3 Pages
247-252
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It is well known that there is a large overlap between anxiety and depression, and co-occurence of one or more mental disorders is defined as comorbidity. In the primary care setting, frequent are patients who do not meet formal diagnostic criteria of mental disorders, and present anxiety and/or depression of limited number and/or intensity. Of the patients those with both anxiety and depression are tend to show severe social impairment and their outcome is not improved in spite of early recognition and treatment. Some researchers have extracted depression with severe anxious symptoms from typical depression and claim that the prognosis and their response to pharmacotherapy are diffcrent from those of typical depression. International classification of disease and related health problems (10 th version) present a new diagnostic category, mixed anxiety-depression disorder, in which both anxiety and depression are present but none of both fulfill a formal diagnostic category. The idea of "Comorbidity" comes from insufficient diagnostic marker in psychiatry, however, it may provide a cue for better psychiatric treatment.
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Article type: Appendix
1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
253-254
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
254-255
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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1997 Volume 37 Issue 3 Pages
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Article type: Cover
1997 Volume 37 Issue 3 Pages
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