This long-term extension of an 8-week randomized, naturalistic study in patients with panic disorder with or without agoraphobia compared the efficacy and safety of clonazepam (n = 47) and paroxetine (n = 37) over a 3-year total treatment duration. Target doses for all patients were 2 mg/d clonazepam and 40 mg/d paroxetine (both taken at bedtime). This study reports data from the long-term period (34 months), following the initial 8-week treatment phase. Thus, total treatment duration was 36 months. Patients with a good primary outcome during acute treatment continued monotherapy with clonazepam or paroxetine, but patients with partial primary treatment success were switched to the combination therapy. At initiation of the long-term study, the mean doses of clonazepam and paroxetine were 1.9 (SD, 0.30) and 38.4 (SD, 3.74) mg/d, respectively. These doses were maintained until month 36 (clonazepam 1.9 [SD, 0.29] mg/d and paroxetine 38.2 [SD, 3.87] mg/d). Long-term treatment with clonazepam led to a small but significantly better Clinical Global Impression (CGI)-Improvement rating than treatment with paroxetine (mean difference: CGI-Severity scale -3.48 vs -3.24, respectively, P = 0.02; CGI-Improvement scale 1.06 vs 1.11, respectively, P = 0.04). Both treatments similarly reduced the number of panic attacks and severity of anxiety. Patients treated with clonazepam had significantly fewer adverse events than those treated with paroxetine (28.9% vs 70.6%, P < 0.001). The efficacy of clonazepam and paroxetine for the treatment of panic disorder was maintained over the long-term course. There was a significant advantage with clonazepam over paroxetine with respect to the frequency and nature of adverse events.

Este estudo recebeu apoio do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), processo nº 554411/2005-9. ResumoIntrodução: É crescente a produção científica brasileira na adaptação de instrumentos internacionais para avaliar ansiedade. A tradução e adaptação transcultural de escalas é um primeiro passo na obtenção de instrumentos válidos que permitam a comparação de diferentes populações. O objetivo do presente estudo foi traduzir e avaliar a equivalência semântica do Cardiac Anxiety Questionnaire, realizando um estudo piloto na população brasileira de diferentes níveis de escolaridade. Método: O processo de adaptação transcultural envolveu duas traduções e retrotraduções realizadas por avaliadores independentes, avaliação das versões e elaboração de uma versão síntese. Também examinamos os comentários dos participantes sobre a versão preliminar do questionário, os quais foram usados no desenvolvimento da versão final. Resultados: Para cada item do instrumento, apresentam-se os resultados das quatro etapas. Os participantes com maior grau de escolaridade não apresentaram dificuldades na compreensão do instrumento, tendo apenas apresentado sugestões controversas acerca do item 5. Entretanto, os participantes apenas com escolaridade em nível fundamental relataram dificuldades com os itens 2, 4, 6, 7, 10, 11 e 14. Algumas alterações semânticas foram realizadas com o intuito de facilitar a compreensão do instrumento. Conclusão: A utilização de duas versões de tradução e retrotradução, discussão sobre a versão síntese e a interlocução com a população-alvo proporcionaram maior segurança ao processo de equivalência semântica da versão final brasileira. Descritores: Estudos de validação, astenia neurocirculatória e coronariopatia. AbstractIntroduction: There has been a growing interest in the cross-cultural application of psychological questionnaires to assess anxiety. The translation and cross-cultural adaptation of the original instrument is the first step in validating an instrument in a new population that will permit comparisons between different populations. The goals of this study were to translate the Cardiac Anxiety Questionnaire, assess its semantic equivalence, and perform a preliminary test with participants from the Brazilian population that were drawn from different educational backgrounds. Method: The cross-cultural adaptation process consisted of two translations and back translations performed by two independent evaluators; a critical evaluation of the two versions, and the development of a synthesized version. We also examined comments provided by participants on the preliminary version of the questionnaire and used them for the development of the final version. Results: We report the results of the four stages for each item of the instrument. Participants with tertiary education had no difficulties comprehending the translated items of the questionnaire, only pointing item 5 as ambiguous. Participants from the lower educational level reported comprehension problems regarding items...

RESUMO -As relações entre habilidades sociais percebidas pelo cônjuge e satisfação conjugal foram investigadas. Cinquenta casais (n=100), com idades entre 29 a 69 anos e tempo de união entre sete e 38 anos, responderam à Escala de Satisfação Conjugal, ao Inventário de Habilidades Sociais Conjugais e ao Questionário de Empatia Conjugal. A análise de regressão múltipla apontou forte relação entre a empatia do cônjuge e a satisfação conjugal, seguida pela expressão de sentimentos e defesa dos próprios direitos. O número de filhos se correlacionou inversamente com a satisfação e as mulheres foram percebidas como mais empáticas. As habilidades sociais, especialmente a empatia, parecem ser facilitadores da satisfação conjugal. Recomenda-se o desenvolvimento dessas habilidades no tratamento de casais em crise.Palavras-chave: satisfação conjugal; casamento; habilidades sociais; empatia. The Relations between Marital Satisfaction and Social Skills Perceived in the SpouseABSTRACT -This study investigated the association between the social skills perceived by the spouse and marital satisfaction. Fifty couples (n=100), aged from 29 to 69 and with relationship lasting from seven to 38 years, were asked to fill in the Marital Satisfaction Scale, the Marital Social Skills Inventory and the Marital Empathy Questionnaire. Multiple regression analysis revealed that spouse's empathy was strongly correlated with marital satisfaction, followed by the expression of feelings and defense of own rights. The number of offspring was inversely correlated with satisfaction, and women were perceived by their partners as more empathic. The presence of social skills, particularly empathy, seems to be facilitators of marital satisfaction. Interventions directed to the development of social skills may be useful in the treatment of distressed couples.

Psychological factors such as stress and depression have already been established as primary and secondary cardiovascular risk factors. More recently, the role of anxiety in increasing cardiac risk has also been studied. The underlying mechanisms of increased cardiac risk in panic disorder patients seem to reflect the direct and indirect effects of autonomic dysfunction, as well as behavioral risk factors associated with an unhealthy lifestyle. Implications of the comorbidity between panic and cardiovascular disease include higher morbidity, functional deficits, increased cardiovascular risk, and poor adherence to cardiac rehabilitation or exercise programs. This article probes the most recent evidence on the association between coronary artery disease, anxiety and panic disorder, and discusses the potential role of incorporating regular physical exercise and cognitive behavioral therapy in the treatment of this condition.