Adult patients with panic disorder are characterized by high levels of harm avoidance and anxiety sensitivity. Both, might be the product of the illness or might represent risk factors for development of panic disorder in adulthood. To examine this hypothesis we examined these factors in a high-risk sample of children of patients with panic disorder compared to peer of non affected parents.

Fifty-six children were assessed by the J-TCI, the CASI and semistructured clinical interviews for the assessment of anxiety disorders.

The results showed no significant differences between children at risk for panic disorder and peer of non affected parents for Cloninger's temperamental dimensions and anxiety sensitivity while anxiety disorder, in particular separation anxiety disorder, were more frequent among children of patients with panic disorder.

Our data suggest that specific temperamental profiles and high anxiety sensitivity are not significantly associated with familial vulnerability to PD, thus suggesting that they may not be significant childhood risk factors for PD, and confirm the association between childhood separation anxiety disorder and panic disorder.

To demonstrate through 2 classic case examples that panic disorders can be predictably overcome through ‘Breakthrough Intimacy’ - closeness between committed couples far greater than their previous maximum level.

Lifetrack therapy works with couples (the patient and his/her partner in life) bringing them far closer than ever before, guided by their own daily self-rating on 41 parameters that allow accurate graphic tracking via Internet of subtle changes in their personalities during each therapy session. Working in three-way teamwork, the therapist actively helps the couple to achieve closeness far greater than their previous maximum level, overcoming waves of symptom spikes (such as panic attacks) until they disappear by exhaustion, as the couples undergo personality transformation.

Of the 1,170 patients treated (all of them showing varying degree of anxiety) over the last 20 years, 48% of patients reached a level of adjustment beyond their previous maximum level. 31% reached a level more than twice, 24% reached more than three times, 20% reached more than four times, 16% reached more than five times, and 7.6% reached more than ten times their previous maximum level of adjustment far beyond symptom elimination, according to their own daily subjective self-rating.

Panic disorders may be better understood and treated as the consequence of one's personality which can be transformed through ‘Breakthrough Intimacy.’ The results of this study prove that traditional ‘disease’ concept of panic disorders must be overcome to substantially improve our profession's therapeutic productivity with panic and anxiety disorders.

Panic Disorder with or without or without agoraphobia (PD/A) is common and can be treated effectively with SSRI medication or cognitive behaviour therapy (CBT). However, a great challenge is generally the lack of skilled CBT therapists. Therefore, there has been a move toward evaluating different forms of self-help approaches requiring less therapist contact than in traditional CBT. A novel treatment modality in this field, showing efficacy in several randomised trials, but until yet not evauated within regular care, is Internet-based treatment.

The aim of these two studies was to evaluate the effectiveness of Internet-based CBT for PD within regular care with patients referred for treatment.

We have conducted two trials. The first trial was a small open study including 20 patients and the second is a larger randomised trial comparing Internet-CBT with group CBT. The Internet-CBT consisted of 10 weekly modules accompanied by e-mail support. In the randomised trial, the group CBT included the same self-help material administered during 10 group sessions.

The results of these trials indicate that Internet-based CBT is both an effective and potentially cost-effective alternative for patients with PD, in both trials showing a clinically significant effect on PD-symptoms measured by the clinician rated Panic Disorder Severity Scale. Moreover, preliminary data from the randomised trial show no significant differences in effect between Internet- or group-delivered CBT.

Our work suggests the possibility of markedly increasing the access to evidence-based psychological treatment within regular psychiatric care by using the internet as treatment medium.

To explore the gender differences in Axis I and Axis II disorders comorbidity in patients with panic disorder and agoraphobia (PDA).

The sample consisted of 157 consecutive patients (71.3% females) with principal diagnosis of PDA. The assessment included administration of SCID-I and SCID-II. Women and men were then compared with regards to the type and frequency of the comorbid Axis I and Axis II disorders.

Axis I disorders. Men (2.02±1.82) and women (2.05±1.27) did not differ significantly the mean number of comorbid Axis I diagnoses per patient but women had a significantly higher rate of at least one comorbid Axis I diagnosis (87.5% vs. 73.3%) and a significantly higher rate of at least one comorbid anxiety disorder (79.5% vs. 53.3%). Women had a significantly higher frequency of specific phobia (58.9% vs 33.3%) and major depressive disorder (51.8% vs. 35.6%) than men. Men had a significantly higher rate of hypochondriasis (26.7% vs. 7.1%) and past alcohol abuse/dependence (33.3% vs. 0.9%). Axis II disorders. Men and women did not differ on the mean number of personality disorder (PD) diagnoses (1.02 vs. 0.96) and the distribution of at least one PD diagnosis (51.1% vs. 53.6%). Women had significantly higher rate of dependent PD (27.7% vs. 11.1%) and men had higher rate of narcissistic PD (15.6% vs. 6.3%).

Ten patients suffernig from panic disorder according to DSMIV criteria, who were poor responders to standard therapy/ SSRI or SNRI AD/ were examined.The most common symptoms were fear of going crazy, losing control, dying, fainting with vegetative symptoms as palpitation, trembling, sweating, vertigo.Olanzapine, quetiapine or risperidon were added.

Objective global assessment measured by HAMA, CGI and Quality of Life Scale made before, two and four months after beginning of trial.Mild to significant improvement were recorded in seven patients related to reduced severity and number of attacks.Quetiapin then olanzapin showed best results.

Recommended treatment approaches include cognitive-behavioural as well as pharmacotherapy. Disorder have significant implications on global functioning, quality of life, suicidal risk.Limitation of our study is small number of participants, but there is a sense to try addition atypical antipsychotic in refractory cases.

The aim of our study was detection of brain electrical activity changes in panic disorder (PD) patients by means of the electromagnetic tomography. Several observations suggest the panic disorder should be characterized by right frontal hyperactivation (Wiedemann et al., 1999).

Electroencephalograms of 33 panic disorder patients (9 men and 24 women) were compared with the same number of age and gender matched control subjects. EEG was recorded in the resting state with a 19-channel amplifier. 3-dimensional distribution of the current density was revealed by a method of quantitative electroencephalography - Low Resolution Brain Electromagentic Tomography (LORETA, Pascual-Marqui et al. 1994)

There was increase in the beta1 and beta2 frequency band over the frontal cortex including the insula and orbitofrontal cortex (p<0.01) with right side maximum in panic disorder patients. Also bilateral decrease in the alpha band over the occipital cortex including precuneus and posterior cingulate (p<0.02) was found.

The findings of our study confirmed hypothesis of frontal brain asymmetry with higher level of right hemisphere activation in panic disorder patients. These data are the first evidence of applying LORETA method to panic disorder studying.

This study was supported by the project MZ0PCP2005

Panic disorder (PD) is a common and debilitating anxiety disorder. Recent neuroanatomical theories of PD propose an extensive involvement of limbic system in pathophysiology of this condition. In fact, several structural and functional neuroimaging studies have shown changes in limbic structures, such as hippocampus in PD patients. Despite this, no prior studies have examined hippocampal neurochemistry in this disorder. The current study used proton magnetic resonance spectroscopy imaging (1H-MRSI) to examine possible neurochemical abnormalities in hippocampus in PD patients.

Twenty-five patients meeting the DSM-IV criteria for PD and eighteen psychiatrically healthy controls were investigated. The subjects were paired based on gender, age, years of education, handedness, and socioeconomic level. N-acetylaspartate (NAA, a putative marker of neuronal viability) and choline (Cho, involved in the synthesis and degradation of cell membranes) levels were quantified relative to creatine (Cr, which is thought to be relatively stable among individuals and in most brain areas) in both right and left hippocampus.

Compared with controls, panic patients demonstrated significantly lower NAA/Cr in the left hippocampus. No other difference was detected.

This result is consistent with the previous findings of hippocampal alterations in PD and provides the first neurochemical suggesting of involvement of this structure in the disorder.

To get the necessary information we used of a questionnaire contain 21 question. To get the demographic and sleeping pattern information, two kindsof questions have been considered.12 questions were about demographic characteristics, 13questions were about sleep disorders and pattern of personnel in different shifts.The samples were 764 nurses personnel.

The research results showed that there is a meaningful difference between the rate of sleep disorders of those who have fixed alternative shifts(one month in the morning, one month in the afternoon, one month at night)with those who have inverse alternative shifts (night and morning).

We suggest to hospital directors to review their scheduales and consider the following points as much as possible.

1. - use the fast alternative system (2 morning shifts,2 afternoon shifts, 2 night shifts and 2 days off).

2. - night work hours shoud be reduced from 12 hours to 8 hours to reduce the stress and sideeffects of work.

3. - the shifts should be clockwise(morning-afternoon-night) and not anticlockwise (morning-night-afternoon).

The incidence of IDDM is increasing in the world.In regard to increasing prevalence of IDDM and probable introduction between IDDM and sleep quality, it was designed this study to evaluate the sleep quality in adolescents.

This case-control study was done IN Isfahan Behavioral Sciences Research Center and Endocrine Research Center . The 120 cases were selected from adolescents (11-18 year old) with IDDM referral to Isfahan Endocrine Research Center. Control group were 120 and matched with cases. The criteria for diagnosing diabetes were Classification and Diagnose Committee Criteria. PSQI was used to evaluate the quality of sleep. Data was and analyzed it with t-test, Pierson coefficient and ANOVA.

The mean age in cases and controls was 14.5±2.2 and 14.3±2.3. 46.7% of cases had family history of diabetes, whereas, it was 5.8% in controls. The mean of FBS in cases was 159±68 mg/dl. The mean of HbA1c was 8.8±1.99. 75.8% of diabetic adolescents were PSQI score over 5 (cases=7.3±2.3 & controls=5.7±2.6. p<0.001). Some sleep disturbances: sleep onset latency, poor sleep efficiency and daytime dysfunction are significantly more in diabetic adolescents than controls. There is not any relation between PSQI and BMI. But there was a direct relation between PSQI and HbA1c by regression analysis.

There is poor sleep in adolescents with IDDM. IDDM causes sleep disturbances probably by some different ways. So, it is very important to consider the quality of sleep in IDDM and manage probable sleep problem.

The guinea pig is a naturally-occurring animal model of insomnia. Therefore, it was of interest to determine, in this species, the effects on sleep and waking states of different hypnotic substances.

Accordingly, in the chronically-implanted adult and aged guinea pigs, we examined changes in NREM sleep, REM sleep, and wakefulness following the administration of eszopiclone and zolpidem.

Compared with naturally occurring sleep and wakefulness, the effects of eszopiclone were characterized by the induction of NREM sleep that occurred with a short latency, as well as long duration episodes of NREM sleep that were accompanied by an increase in delta power. The administration of zolpidem, compared with the responses produced by eszopiclone, resulted in shorter duration episodes of NREM sleep that arose at a longer latency; there was no change in delta power in conjunction with the administration of zolpidem. In addition, compared with zolpidem, lower doses of eszopiclone were required to induce the preceding effects.

We conclude that eszopiclone may have an advantage compared to zolpidem in producing homeostatic sleep on the basis of its ability to induce consolidated, long-duration episodes of NREM sleep. Since delta power has been suggested to reflect enhanced sleep-related memory and learning processes, we hypothesize that the increase in delta power that was induced by eszopiclone, which was not present following the administration of zolpidem, may facilitate memory and learning mechanisms during NREM sleep.

Support for this study provided by Sepracor Inc., Marlborough, MA.

Hypoxia that occurs in conjunction with sleep-related breathing disorders, such as Obstructive Sleep Apnea, as well as processes associated with cerebral ischemia, have deleterious effects on the morphology and functioning of the hippocampus. In previous studies, we determined that a decrease in oxygenation produces neuroexcitotoxicity that eventuates in apoptosis, i.e., programmed cell death, that can be reduced by the activation of GABAergic processes.

In the present experiment, which was conducted in adult guinea pigs, in vivo, we examined the effects of the administration of eszopiclone, which is a hypnotic that activates various GABAA subunit receptors, on apoptosis in various CNS sites.

Recurrent periods of apnea, which were induced for a period of 3-5 hours, produced significant apoptosis in various brain regions. Compared with control data, there was a highly statistically significant decrease in the number of apoptotic cells in the forebrain (hippocampus, amygdala, and prefrontal, cingulate, and insular cortices) and in the brainstem (e.g., dorsal raphe) in animals that were administered eszopiclone prior to the induction of recurrent apnea.

We conclude that eszopiclone is capable of providing neuroprotection for the degradative, apoptotic consequences of a decrease in oxygenation of cerebral tissue that arises as a consequence of disease and disorders that involve hypoxia or ischemia. We therefore suggest, in addition to its hypnotic effects, that eszopiclone produces neuroprotection for hypoxia-induced neurodegeneration in the forebrain as well as in the brainstem.

Support for this study provided by Sepracor Inc., Marlborough, MA.

We showed previously that 31% of Swiss population (N=1002)suffers from insomnia(DSM-IV criteria) (Delini-Stula et al. 2007). We report here the results of the analysis of the causes, day-time consequences and treatments.

An 80 items questionnaire was addressed (telephone interview)to a random sample of subjects of both sexes. The recorded responses were either transformed into numerical and categorical values or expressed in percentages of observations. The results were descriptively analyzed.

The main causes of insomnia were classified into 6 categories: personal-, professional and financial problems, diseases, alcoholism and environmental factors. The most frequent were personal (32%) and professional (34%) problems. Only 1% of subjects reported financial worries as cause of insomnia. The most prominent day-time consequences were: fatigue (72%, p<0.003) reduced vitality (46%, p<0.002), irritability (54%, p<0.001) depressed mood (44%, p<002)and impaired cognition (44-51 %, p<0.001). 70% of insomnia subjects reported never to use any treatment. Only 40% of severe insomniacs used prescribed drugs. Also, of the whole population only 44% believed in the efficacy of the hypnotics, but 56% though that herbal products are effective.

In view of marked day-time consequences and obviously under-treatment, insomnia (defined by DSM-IV criteria) in Switzerland is a problem that needs more attention.

Chronic insomnia (ChI) is a common condition in Primary Care (PC). Regardless that it's often related to psychiatric morbidity it appears to be a strong predictor of future depression and a disabling disorder by itself. The aim of this study was to measure and compare clinical and psychiatric characteristics of both patients with primary ChI and secondary ChI.

A random sample of 225 subjects older than 18 years old, from 3 PC Centres of the area of Madrid (Spain) was interviewed using the Oviedo Sleep Questionnaire, a semi-structured interview for sleep disorders. The subjects completed the Patient Health Questionnaire. Data about medical conditions, drug treatments, days of work lost (last year) and use of health care services (last 3 months), were also collected. Psychiatric and clinical characteristics between groups (primary vs secondary ChI) were compared.

78 patients fulfilled criteria for ChI and 53 (67.9 %) of them were suffering from any psychiatric disorder (including subtreshold conditions). Patients with primary ChI compared to secondary insomnia patients had no significant differences in age, gender, use of health care resources and days of work lost. However, patients with secondary ChI compared to primary ChI had more somatic and depressive symptoms (U-Mann-Witney test; p=0.002 and p<0.001, respectively).

There is an important group of patients among PC attendees suffering primary ChI. Patients suffering primary ChI are comparable to patients with psychiatric disorders and insomnia in terms of days of work lost and use of health care resources.

Parents consulting the Psychology Department of the General Children's Hospital of Penteli about their children's concentrating difficulties often complain that they also present sleep problems, such as nightmares, somnambulism, difficulties to fall asleep etc. The aim of the present study is to examine the co-morbidity between ADHD and sleep disorders, as long as previous studies at our Department

The sample consisted of 173 children, who consulted the Department about the above problems, aged 6 to 14 (68,2% boys, 31,8% girls). Children were categorized into two groups: a) children diagnosed with ADHD b) children not diagnosed with ADHD. Parents were invited to completed the ADHD-IV scale, as well as the Aschenbach CBCL test. Children were submitted to BECK's Youth Inventory. In order to compare the two groups we used the t test.

Considering parents and children's reports, it was found that co-morbidity between ADHD and sleeping difficulties does exist to a significant level. More precisely, children with hyperactivity, compulsiveness and concentrating difficulties also seemed to experience low quality of sleep. Co-morbidity between ADHD and sleep disorders was not found to be affected by sex, whereas age seemed to be an important factor.

A considerable percentage of children with ADHD was also found to present significant sleep disorders. It is also important to note that children presenting not the whole syndrome but some symptoms of ADHD, also tend to have sleep difficulties.

Major Depressive Disorder (MDD) and generalized anxiety disorder (GAD) can coexist and patients may have insomnia marked by difficulty falling and/or staying asleep and potentially reduced quality of life (QoL). Eszopiclone has been shown to improve sleep in patients with insomnia comorbid with MDD or GAD. This analysis examined the effects of eszopiclone co-therapy on the HAM-D17 in these two patient populations.

Patients with insomnia comorbid with MDD and baseline HAM-D17>14 (excluding insomnia items; n=545) received morning fluoxetine and were randomized to nightly eszopiclone 3mg or placebo for 8 weeks. Patients with insomnia comorbid with GAD and screening MADRS≤20 (n=593) received daily escitalopram oxalate and were randomized to nightly eszopiclone 3mg or placebo for 8 weeks. Clinician-administered HAM-D17 was evaluated at baseline and Weeks 4 and 8 in both studies.

Baseline HAM-D17 median scores were 22 and 15 in the MDD and GAD populations, respectively. Change from baseline HAM-D17 scores were significantly improved (p<0.02) with eszopiclone co-therapy at Weeks 4 (−10.0±7.6) and 8 (−13.6±7.7) relative to fluoxetine monotherapy (−8.4±6.8 and –11.5±7.1) in the MDD population. Similarly, change from baseline HAM-D17 scores in the GAD population were significantly improved (p<0.002) with eszopiclone co-therapy at Weeks 4 and 8 (−5.8±4.9 and –6.7±5.4) relative to escitalopram monotherapy (−4.3±5.1 and –5.4±5.6).

Treatment of insomnia with eszopiclone was associated with significant improvements in HAM-D17 scores relative to fluoxetine or escitalopram monotherapy in patients with insomnia comorbid with MDD or GAD, even after removal of insomnia items from the scale.