Benzodiazepine use in Sao Paulo, Brazil

OBJECTIVES: To report the prevalence and factors associated with the use of benzodiazepines in the general population and those with a mental health condition in the metropolitan area of Sa˜o Paulo, Brazil. METHODS: 5,037 individuals from the Sao Paulo Megacity Mental Health Survey data were interviewed using the Composite International Diagnostic Interview, designed to generate DSM-IV diagnoses. Additionally, participants were asked if they had taken any medication in the previous 12 months for the treatment of any mental health condition. RESULTS: The prevalence of benzodiazepine use ranged from 3.6% in the general population to 7.8% among subjects with a mental health condition. Benzodiazepine use was more prevalent in subjects that had been diagnosed with a mood disorder as opposed to an anxiety disorder (14.7% vs. 8.1%, respectively). Subjects that had been diagnosed with a panic disorder (33.7%) or bipolar I/II (23.3%) reported the highest use. Individuals aged X50 years (11.1%), those with two or more disorders (11.2%), those with moderate or severe disorders (10%), and those that used psychiatric services (29.8%) also reported higher use. CONCLUSION: These findings give an overview of the use of benzodiazepines in the general population, which will be useful in the public health domain. Benzodiazepine use was higher in those with a mental health condition, with people that had a mood disorder being the most vulnerable. Furthermore, females and the elderly had high benzodiazepine use, so careful management in these groups is required

Primary headaches in patients with generalized anxiety disorder

Although anxiety disorders and headaches are comorbid conditions, there have been no studies evaluating the prevalence of primary headaches in patients with generalized anxiety disorder (GAD). The aim of this study was to analyze the lifetime prevalence of primary headaches in individuals with and without GAD. A total of 60 individuals were evaluated: 30 GAD patients and 30 controls without mental disorders. Psychiatric assessments and primary headache diagnoses were made using structured interviews. Among the GAD patients, the most common diagnosis was migraine, which was significantly more prevalent among the GAD patients than among the controls, as were episodic migraine, chronic daily headache and aura. Tension-type headache was equally common in both groups. Primary headaches in general were significantly more common and more severe in GAD patients than in controls. In anxiety disorder patients, particularly those with GAD, accurate diagnosis of primary headache can improve patient management and clinical outcomes

Panic disorder and exercise avoidance

Objectives: 1) To identify whether patients with panic disorder in general and those with the respiratory subtype in particular actively avoid exercise; 2) to investigate physiological differences in cardiopulmonary function parameters in patients with panic disorder in general, patients with the respiratory subtype of panic disorder, and healthy controls upon exercise challenge. Methods: Patients with panic disorder were classified as having either the respiratory or the non-respiratory subtype. Both groups were compared to controls in terms of exercise avoidance patterns and performance on cardiopulmonary exercise testing. Results: Patients with panic disorder exhibited higher exercise avoidance scores and worse performance on cardiopulmonary exercise testing as compared with controls. No differences were found between patients with the respiratory and non-respiratory subtypes. Conclusions: Exercise avoidance is present in panic disorder and is associated with poorer performance on cardiopulmonary exercise testing. These findings are not limited to patients with the respiratory subtype of the disorder