A comparison of low-dose risperidone to paroxetine in the treatment of panic attacks: a randomized, single-blind study

<p>Abstract</p> <p>Background</p> <p>Because a large proportion of patients with panic attacks receiving approved pharmacotherapy do not respond or respond poorly to medication, it is important to identify additional therapeutic strategies for the management of panic symptoms. This article describes a randomized, rater-blind study comparing low-dose risperidone to standard-of-care paroxetine for the treatment of panic attacks.</p> <p>Methods</p> <p>Fifty six subjects with a history of panic attacks were randomized to receive either risperidone or paroxetine. The subjects were then followed for eight weeks. Outcome measures included the Panic Disorder Severity Scale (PDSS), the Hamilton Anxiety Scale (Ham-A), the Hamilton Depression Rating Scale (Ham-D), the Sheehan Panic Anxiety Scale-Patient (SPAS-P), and the Clinical Global Impression scale (CGI).</p> <p>Results</p> <p>All subjects demonstrated a reduction in both the frequency and severity of panic attacks regardless of treatment received. Statistically significant improvements in rating scale scores for both groups were identified for the PDSS, the Ham-A, the Ham-D, and the CGI. There was no difference between treatment groups in the improvement in scores on the measures PDSS, Ham-A, Ham-D, and CGI. Post hoc tests suggest that subjects receiving risperidone may have a quicker clinical response than subjects receiving paroxetine.</p> <p>Conclusion</p> <p>We can identify no difference in the efficacy of paroxetine and low-dose risperidone in the treatment of panic attacks. Low-dose risperidone appears to be tolerated equally well as paroxetine. Low-dose risperidone may be an effective treatment for anxiety disorders in which panic attacks are a significant component.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov Identifier: NCT100457106</p

Relationship Dynamics as Inconsistent Mediators of Traumatic Stress and Condomless Sex Among Jail-detained Women

Thesis (Ph.D.)--University of Washington, 2015Incarcerated women, especially women in jail, are at high risk for HIV and other sexually transmitted diseases. Research is needed to establish the key predictors of risk behavior, so that these can be targeted in interventions. Traumatic stress, substance use and intimate relationship dynamics likely influence infection and transmission risk among incarcerated women; however, these effects are not well understood. The author tested a model, based in Social Action Theory, of the effects of traumatic stress on condomless sex through the mediators of relational anxiety, relationship power, relationship closeness, and substance use. Jail-detained women who reported having a main sex partner in the three months prior to their arrest were interviewed (N = 205). The original model, accounting for 28% of the variance in condomless sex, had acceptable fit and found evidence for the effects of all factors except substance use. A better fitting model that re-specified effects of relationship power leading to substance use and substance use leading to relationship closeness was also supported, with all paths significant. Finally, a simplified model excluding substance use was tested and demonstrated almost identical fit and beta values. Results suggest that traumatic stress among jail-detained women impacts condom use within main partnerships through divergent effects on closeness and power in the relationship. This may obscure the importance of traumatic stress on condomless sex when these pathways are omitted in statistical analyses. The results have compelling implications, but they require replication, especially given the limitations of cross-sectional data and retrospective reporting. Ultimately, interventions aimed at alleviating traumatic stress among women involved in the criminal justice system should consider evaluating relationship dynamics and sexual health practices

Two-Way Text Messaging for Health Behavior Change Among Human Immunodeficiency Virus–Positive Individuals

Background: Text-messaging systems have been used to promote a range of health behaviors, including medication adherence among human immunodeficiency virus–positive individuals. However, little is currently known about the specific characteristics of messaging systems that promote user engagement. Objective: Using data from a randomized controlled trial involving a pager-based text messaging system, this study sought to examine the overall usability of the system, user evaluation of the system, demographic and psychosocial correlates of usability, and its performance as an adherence assessment tool. Materials and Methods: The messaging system consisted of an alphanumeric pager capable of sending and receiving individualized text messages and the software necessary to program and track communication. The system was evaluated using behavioral outcomes (pager message response rate), self-report survey responses, focus group discussions, and data from electronic medication monitoring pill bottles. Results: Although the majority of participants reported that the system was effective in reminding them to take medication doses, the overall response rate to system messages was relatively low (42.8%) and dropped significantly over the course of the 3-month intervention period. In addition, user engagement did not differ significantly by most demographic and psychosocial variables. Conclusions: The pager-based text messaging system was received well by participants and appears to be applicable to a broad population; however, the system did not actively engage all participants over the course of the trial. Future research should determine whether systems customized to personal preference in notification style, frequency, and user device can increase use and provide further assistance to achieve optimal medication adherence