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Personality and symptom sensitivity predictors of alprazolam withdrawal in panic disorder

Published online by Cambridge University Press:  09 April 2003

P. ROY-BYRNE ,
J. RUSSO ,
M. POLLACK ,
R. STEWART ,
A. BYSTRISKY ,
J. BELL ,
J. ROSENBAUM ,
M. H. CORRIGAN ,
J. STOLK  and
A. J. RUSH
...Show all authors
P. ROY-BYRNE
Affiliation:
From the Departments of Psychiatry University of Washington, Seattle; Harvard Massachusetts General Hospital, Boston; University of Texas Southwestern Medical Center, Dallas; Medical University of South Carolina, Charleston; UCLA Neuropsychiatric Institute, LA; University of Colorado, Denver; Quintiles Inc.; and Pharmacia Inc., USA
J. RUSSO
Affiliation:
From the Departments of Psychiatry University of Washington, Seattle; Harvard Massachusetts General Hospital, Boston; University of Texas Southwestern Medical Center, Dallas; Medical University of South Carolina, Charleston; UCLA Neuropsychiatric Institute, LA; University of Colorado, Denver; Quintiles Inc.; and Pharmacia Inc., USA
M. POLLACK
Affiliation:
From the Departments of Psychiatry University of Washington, Seattle; Harvard Massachusetts General Hospital, Boston; University of Texas Southwestern Medical Center, Dallas; Medical University of South Carolina, Charleston; UCLA Neuropsychiatric Institute, LA; University of Colorado, Denver; Quintiles Inc.; and Pharmacia Inc., USA
R. STEWART
Affiliation:
From the Departments of Psychiatry University of Washington, Seattle; Harvard Massachusetts General Hospital, Boston; University of Texas Southwestern Medical Center, Dallas; Medical University of South Carolina, Charleston; UCLA Neuropsychiatric Institute, LA; University of Colorado, Denver; Quintiles Inc.; and Pharmacia Inc., USA
A. BYSTRISKY
Affiliation:
From the Departments of Psychiatry University of Washington, Seattle; Harvard Massachusetts General Hospital, Boston; University of Texas Southwestern Medical Center, Dallas; Medical University of South Carolina, Charleston; UCLA Neuropsychiatric Institute, LA; University of Colorado, Denver; Quintiles Inc.; and Pharmacia Inc., USA
J. BELL
Affiliation:
From the Departments of Psychiatry University of Washington, Seattle; Harvard Massachusetts General Hospital, Boston; University of Texas Southwestern Medical Center, Dallas; Medical University of South Carolina, Charleston; UCLA Neuropsychiatric Institute, LA; University of Colorado, Denver; Quintiles Inc.; and Pharmacia Inc., USA
J. ROSENBAUM
Affiliation:
From the Departments of Psychiatry University of Washington, Seattle; Harvard Massachusetts General Hospital, Boston; University of Texas Southwestern Medical Center, Dallas; Medical University of South Carolina, Charleston; UCLA Neuropsychiatric Institute, LA; University of Colorado, Denver; Quintiles Inc.; and Pharmacia Inc., USA
M. H. CORRIGAN
Affiliation:
From the Departments of Psychiatry University of Washington, Seattle; Harvard Massachusetts General Hospital, Boston; University of Texas Southwestern Medical Center, Dallas; Medical University of South Carolina, Charleston; UCLA Neuropsychiatric Institute, LA; University of Colorado, Denver; Quintiles Inc.; and Pharmacia Inc., USA
J. STOLK
Affiliation:
From the Departments of Psychiatry University of Washington, Seattle; Harvard Massachusetts General Hospital, Boston; University of Texas Southwestern Medical Center, Dallas; Medical University of South Carolina, Charleston; UCLA Neuropsychiatric Institute, LA; University of Colorado, Denver; Quintiles Inc.; and Pharmacia Inc., USA
A. J. RUSH
Affiliation:
From the Departments of Psychiatry University of Washington, Seattle; Harvard Massachusetts General Hospital, Boston; University of Texas Southwestern Medical Center, Dallas; Medical University of South Carolina, Charleston; UCLA Neuropsychiatric Institute, LA; University of Colorado, Denver; Quintiles Inc.; and Pharmacia Inc., USA
J. BALLENGER
Affiliation:
From the Departments of Psychiatry University of Washington, Seattle; Harvard Massachusetts General Hospital, Boston; University of Texas Southwestern Medical Center, Dallas; Medical University of South Carolina, Charleston; UCLA Neuropsychiatric Institute, LA; University of Colorado, Denver; Quintiles Inc.; and Pharmacia Inc., USA
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Abstract

Background. Discontinuation of benzodiazepine (BZ) treatment results in a well-characterized withdrawal syndrome in 40–50% of anxious patients. While numerous studies have established the role of BZ dose, treatment duration, half-life, potency, rate of withdrawal and severity of underlying anxiety disorder in predicting severity of withdrawal symptoms, fewer studies have examined the role of psychological and personality factors.

Method. In 123 panic disorder patients undergoing gradual tapered discontinuation of alprazolam in conjunction with pre-treatment with carbamazepine or placebo, the relationship between measures of ‘symptom sensitivity’ and ‘harm avoidance’, and severity of withdrawal symptoms measured as peak severity of symptoms, time before taper needed to be slowed due to symptoms, and ability to complete taper, was examined.

Results. After controlling for the less substantial effects of dose, treatment duration, pre-taper anxiety and panic attack frequency, measures of symptom sensitivity and harm avoidance accounted for an additional 3–6% of withdrawal variance.

Conclusions. These results show an effect of symptom sensitivity and harm avoidance on BZ withdrawal symptoms, comparable to prior findings linking dependent personality characteristics to withdrawal severity. Failure to show the expected effect on ability to complete taper may be due to either the more symptomatic nature of the patients in this study.

Type
Research Article
Information
Psychological Medicine , Volume 33 , Issue 3 , April 2003 , pp. 511 - 518
Copyright
© 2003 Cambridge University Press

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