These results suggest that regular aerobic exercise alone, in comparison with placebo, is associated with significant clinical improvement in patients suffering from panic disorder, but that it is less effective than treatment with clomipramine.
Abstract. The efficacy of the heparin-induced extracorporeal LDL-precipitation (HELP)-apheresis procedure has been studied in an open prospective multicentre trial. After 2 years of regular weekly HELP-treatment the data from 39 of 51 patients could be evaluated according to the study criteria. Twelve of the initially recruited study patients were omitted from the evaluation either because of premature termination of the treatment or because they did not fulfil the exact guidelines of the study protocol. A mean of 2.83 1 plasma was regularly treated on average every 7.85 days. The mean pre-/post-apheresis LDLcholesterol levels decreased from 286/121 mgdl-' at the first HELP treatment to 203/77mgdl-l after 1 year and to 205/77mgdl-' after 2 years of regular apheresis; the corresponding values for fibrinogen were 314/144, 246/98 and 250/105 mgdl-', respectively. In contrast, the mean pre-/post-apheresis HDLcholesterol levels rose from 41/38 through 511 44mgdl-' after 1 year to 52/43mgdl-' after 2 years of treatment. The overall result was a normalization of the atherogenic index (LDL-/HDL-cholesterol ratio) from 6.9/3.2 to 4*0/1.9. The angiographies from 33 patients obtained before and after 2 years of regular treatment could be evaluated blindly using the cardiovascular angiography analysis system. The mean degree of stenosis of all segments decreased from (26.7%) segments, whereas 29/187 (15.5%) segments showed progression. In 108/187 (57.8%) segments the lesions were stable (< 8% deviation) over 2 years. We conclude that regular treatment with HELP-LDLapheresis is able to stabilize progressive atherosclerotic disease and to induce almost twice as much regression as progression of atherosclerotic lesions.
Cognitive-behavioral therapy has proven an effective adjunct to standard treatment of rheumatoid arthritis outpatients. These effects were shown in an unselected sample with increasing disease activity and with comparable changes in medication during treatment. We recommend cognitive-behavioral treatment as an desirable adjunct to standard medical treatment of rheumatoid arthritis.
Exercise habits and indices of aerobic fitness as measured by spiroergometric testing were examined in 38 patients with panic disorder and/or agoraphobia and 24 untrained healthy controls. Maximal oxygen consumption, maximal power output and the power output at a lactate concentration of 4 mmol/l were significantly reduced in the patient group when compared to untrained controls. Other parameters like physical work capacity at a heart rate of 150/min, maximal lactate concentration, vital capacity, subjective exertion at maximal work load, and maximal heart rate did not differ between patients and controls. Patient interviews revealed that aerobic exercise is avoided by the vast majority of patients. Reduced aerobic fitness might contribute to the pathophysiology of panic disorder and/or agoraphobia.
Several clinical studies suggest antidepressive and anxiolytic effects of regular aerobic exercise. To study the effects of exercise on central serotonergic receptor sensitivity, we performed neuroendocrine challenges using oral doses of meta-chlorophenylpiperazine (m-CPP, 0.4 mg/ kg), ipsapirone (0.3 mg/kg) and placebo in 12 marathon runners and 12 healthy controls not practicing regular exercise. After administration of the nonselective serotonergic agonist m-CPP, which exerts a number of wellreproducible effects mainly by means of its action on 5-HT Meta-chlorophenylpiperazine (m-CPP); Ipsapirone Several studies of healthy volunteers have shown a positive effect of endurance training on anxiety, depressive symptoms, self-esteem, concentration, sexual satisfaction, and stress tolerance (de Coverley Veale 1987;Farmer et al. 1988;Hughes 1984;Lennox et al. 1990;MacMahon 1990;Sothman et al. 1992). There is also some evidence that exercise is effective against mild-to-moderate depression and against anxiety disorders (Doyne et al. 1987;Greist et al. 1979;Martinsen et al. 1985;McCann and Holmes 1984;Pappas et al. 1990;Sexton et al. 1989). Research in sports medicine has focused on physiological and immunological consequences of exercise, and little is known about changes in central neurotransmitter function associated with acute or regular endurance training.Several lines of evidence suggest that motor activity affects central serotonin metabolism. In the cerebrospinal fluid of depressed patients, the concentration of the serotonin metabolite 5-HIAA was significantly higher after 4 hours of motor activity than in the same patients after bed rest (Post et al. 1973). Aerobic exercise causes a rise of free fatty acids Fischer et al. From the Department of Psychiatry, University of Göttingen, Göt-tingen, Germany (AB, DM, BB, GH, UB, ER), the Department of Neurology (AG), University of Würzburg, Würzburg, Germany; the Department of Clinical Pharmacology (CHG), Department of Sports Medicine (UH-V), University of Göttingen, Göttingen, Germany; Institute of Sports and Preventive Medicine (TM), University of Saarbrücken, Saarbrücken, Germany.Address correspondence to: Dr. A. Broocks, The Department of Psychiatry, University of Göttingen, von-Siebold-Strasse 5, D-37075 Göttingen, Germany.Received 28 October 1997; revised 12 March 1998; accepted 13 April 1998. N EUROPSYCHOPHARMACOLOGY 1999 -VOL . 20 , NO . 2 Decreased Serotonergic Responsiveness in Marathon Runners 151 1991), which displace free tryptophan (TRP) from its plasma-protein-binding sites (Blomstrand et al. 1988;Chaouloff et al. 1986). This leads to an increase of free TRP in relation to other large neutral amino acids (LNAA) (Chaouloff et al. 1989). Because the TRP influx into the brain correlates with the TRP/LNAA plasma ratio (Fernstrom and Wurtman 1971;Wurtman and Fernstrom 1976), exercise leads to a higher precursor availability in the brain, which, in turn, stimulates 5-HT synthesis (Broocks et al. 1989;Chaouloff 1997). Data from animal studies show th...
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