During Phase II of the Cross-National Panic Study, descriptions of the patient's last severe panic attack were collected for 1168 patients. Statistical analysis indicated that patients could be divided into two groups, characterised by the presence or absence of prominent respiratory symptoms. The two groups did not differ on demographic variables or coexisting diagnoses, but they did differ on psychopathology on entry to the study and treatment outcome. The group with prominent respiratory symptoms suffered more spontaneous panic attacks and responded to imipramine, whereas the group without prominent respiratory symptoms suffered more situational panic attacks and responded more to alprazolam. It is important to distinguish spontaneous and situational panic attacks, to aid choice of treatment.
It has been shown previously Orme et al., 1972) that of the drugs studied dichloralphenazone, phenazone, quinalbarbitone, and amylobarbitone will increase the rate of warfarin metabolism while chlordiazepoxide, diazepam,nitrazepam, and methaqualone will not. This property was used as a marker in this study so that the time-course and extent of changes in plasma GGT activity could be compared with some changes in values known to reflect hepatic microsomal enzyme activity. It was found that the timing of the changes in plasma warfarin concentration was closely similar to that of changes in GGT activity. Both changes were observable by seven days, in most cases a plateau was reached after 10-15 days, and a return towards baseline values began immediately drug administration was stopped. It has been suggested previously that changes in serum GGT are found only after three months' treatment with inducing agents (Rosalki et al., 1971) but this was not confirmed in the present investigation.Some evidence of a relation between drug dose and the increase in enzyme activity was also apparent. In those instances where a rise in GGT activity occurred, in over half the cases the increase took the GGT activity above the upper limit of normal. Thus the possibility of drug-induced changes in plasma GGT must influence the interpretation of raised GGT activities in suspected liver disease, especially when such raised levels occur unaccompanied by abnormalities in other tests of liver function (Whitfield et al., 1972).Administration of three benzodiazepines, diazepam, nitrazepam, and chlordiazepoxide or methaqualone produced no change in steady state plasma warfarin concentration in four patients, but two of these patients showed a significant rise in plasma GGT activity. If these changes in plasma GGT activity reflect changes in the liver enzymes then these drugs may have caused an increase in liver GGT without an increase in the activity of enzymes concerned with drug oxidation. Alternatively, other factors, such as the effects of alcohol consumption, may have influenced GGT activity (Rosalki and Rau, 1972).In view of these discrepancies between changes in rates of drug oxidation and plasma GGT activity, it appears that increases in the plasma GGT activity cannot always be used as an index of changes in the activity of liver microsomal enzymes concerned with drug oxidation since it might lead to both false-positive and false-negative results.It remains to be proved that the increase in plasma GGT concentration produced by inducing agents is accompanied by an increase in hepatic GGT in man. Other possibilities are that other tissues such as the kidney or gut are the source of the increased plasma GGT or that the rate of catabolism of circulating GGT is altered or that these drugs produce hepatic damage of the type which is accompanied by an increase in plasma GGT activity in hepatobiliary disease. However, RosaLki et al. (1972) have reported that a wide range of serum enzymes other than GGT remained normal in patients in whom a ...
The issue of false or recovered memories should not be allowed to confuse the recognition and treatment of sexually abused children. We concluded that when memories are 'recovered' after long periods of amnesia, particularly when extraordinary means were used to secure the recovery of memory, there is a high probability that the memories are false, i.e. of incidents that had not occurred. Some guidelines which should enable practitioners to avoid the pitfalls of memory recovery are offered.
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