Publications (35)158.29 Total impact
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Article: Normal physiological emotions but differences in expression of conscious feelings in children with high-functioning autism.
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ABSTRACT: To provide insight into what aspects of the emotional circuit might be affected in high-functioning autism, we measured indices of physiological emotions and of the expression of conscious feelings in 10 children with high-functioning autism or Asperger syndrome and 10 comparison participants. Pleasant, unpleasant, and neutral pictures were presented while skin conductance responses were measured. Self-report ratings of pleasantness and interestingness were taken between pictures. Skin conductance responses did not differ between the groups. Self report ratings were different, with the children with autism giving more similar answers to the two questions than the comparison children. Impairments in socio-emotional expression in autism may be related to deficits in perception and/or expression of conscious feelings; physiological emotions may be relatively preserved.Journal of Autism and Developmental Disorders 05/2006; 36(3):395-400. · 3.34 Impact Factor -
Article: Intact Galvanic Skin Responses and Impaired Self‐Reports in Response to Emotional Pictures in High‐Functioning Autism
Annals of the New York Academy of Sciences 01/2006; 985(1):501 - 504. · 3.15 Impact Factor -
Article: Cerebral blood flow in obsessive-compulsive patients with major depression: effect of treatment with sertraline or desipramine on treatment responders and non-responders.
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ABSTRACT: We examined the effects of sertraline and of desipramine on patients with OCD and comorbid major depressive episodes at study entry. Sixteen patients, 9 receiving sertraline and 7 desipramine, received HMPAO SPECT scans while free of medication and after 12 weeks of treatment. Patients on sertraline showed significantly reduced regional cerebral blood flow (rCBF) in the right prefrontal and temporal regions. Patients on desipramine showed more diffuse rCBF reductions in frontal and temporal regions, more so in the left side. In a second analysis, patients who had a symptom reduction on the Yale-Brown Obsessive Compulsive Scale (YBOCS), irrespective of the type of medication, were retrospectively classified as 'responders' to treatment. Eleven patients were 'responders' and 5 'non-responders'. Before being medicated, responders differed from non-responders through higher rCBF in prefrontal regions, mostly on the left, and higher rCBF in the cingulate and basal ganglia bilaterally. After 12 weeks of treatment, responders showed a diffuse reduction of rCBF in prefrontal regions while non-responders showed only a few scattered low-frequency responses. Thus, higher prefrontal and subcortical activity was associated with better response to drug treatment. In addition, clinical change, but not the administration of medication as such, was associated with a decrease of prefrontal rCBF.Psychiatry Research 12/2001; 108(2):89-100. · 2.52 Impact Factor -
Article: Anxiety and arousal: physiological changes and their perception.
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ABSTRACT: Contrary to self-reports, most patients with chronic anxiety disorders exhibit increased muscle tension but not autonomic hyperarousal when at rest. Under everyday stress they tend to react with less physiological flexibility than normal controls. However, they overreact subjectively and physiologically to stimuli that are anxiety-provoking. Diminished physiological flexibility may be either a constitutional trait in anxious individuals, a partial but inadequate adaptation to prolonged stress or the result of a disregard for stressors that are not related to psychopathology. The effects of diminished physiological flexibility on general health are not known. There is only a weak relationship, and in some instances a desynchrony, between physiological changes and perception of change under stress. The inconsistencies between self-reports of physiological states and physiological recordings can be explained by alterations of body sensations through psychological factors, predominantly expectations and attention to bodily states, that lead to perceptual distortions.Journal of Affective Disorders 01/2001; 61(3):217-24. · 3.52 Impact Factor -
Article: Therapeutic effects of imipramine are counteracted by its metabolite, desipramine, in patients with generalized anxiety disorder.
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ABSTRACT: Imipramine has been shown to reduce anxiety in patients with generalized anxiety disorder (GAD). However, some properties of imipramine may diminish or counteract its anxiolytic effects. The authors previously found that the greater the reduction in cardiac vagal control after 6 weeks of imipramine treatment, the smaller the improvement in anxiety-related symptoms. The purpose of this study was to determine whether the authors' previous findings were replicable and to gather information on the plasma levels of imipramine, desipramine (the major metabolite of imipramine), and anticholinergic levels. Fourteen patients with GAD were administered imipramine for 6 weeks. Their scores from self-administered and investigator-administered rating scales were obtained before and after the treatment, and the changes in these scores were contrasted with the changes in cardiac vagal tone, along with the absolute plasma levels of imipramine, desipramine, and anticholinergic activity at the end of week 6. The authors observed a greater improvement in symptoms of anxiety in those who showed the smallest decreases in cardiac vagal tone and in those who showed the smallest increases in desipramine and anticholinergic plasma levels. Moreover, strong relationships were observed between desipramine and anticholinergic levels. These results demonstrate that imipramine not only has therapeutic effects, but it may also have properties that result in physiologic states that counteract its therapeutic effects. Future research should investigate the direct anticholinergic effects of desipramine and determine whether there is a parallel between the anticholinergic effects and the clinical outcome of other pharmacologic treatments, including antidepressants with predominantly norepinephrine or serotonin reuptake inhibitory properties.Journal of Clinical Psychopharmacology 01/2001; 20(6):615-21. · 4.10 Impact Factor -
Article: Relative timing of inspiration and expiration affects respiratory sinus arrhythmia.
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ABSTRACT: 1. The effect of a variation in inspiration and expiration times on heart rate variability was studied in 12 healthy subjects (mean age 30+/-6 years; five females). 2. Two 2 min trials of controlled breathing, with either short inspiration followed by long expiration or long inspiration followed by short expiration, were compared. Average expiration/inspiration time ratios were 1.0 and 3.4, respectively. The respiration rate in both trials was approximately 10 cycles/min. 3. In trials with short inspiration followed by long expiration, respiratory sinus arrhythmia (RSA; as measured by mean absolute differences and by the high frequency band) was significantly larger than in trials with long inspiration followed by short expiration. This effect could not be accounted for by differences in respiration rate or respiratory amplitude. The higher RSA during fast/slow respiration is primarily due to a more pronounced phasic heart rate increase during inspiration, indicating that inspiratory vagal blockade is sensitive to the steepness of inspiration. 4. Respiration rate and tidal volume are respiratory variables known to modulate RSA. The results of the present study indicate that RSA can also be modulated by a third respiratory variable, the expiratory/inspiratory time ratio.Clinical and Experimental Pharmacology and Physiology 09/2000; 27(8):601-6. · 1.85 Impact Factor -
Article: Increased heart rate in depressed subjects in spite of unchanged autonomic balance?
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ABSTRACT: A clinical study was conducted to examine the effects of depression on cardiac autonomic control. Cardiac autonomic control was measured in 26 nonmedicated patients (19 females) suffering from Major Depression, melancholic type, and in 26 age- and sex-matched normal controls. We measured heart rate and high frequency heart rate variability (respiratory sinus arrhythmia), pulsewave velocity and blood pressure, during 10 min of supine rest under controlled conditions. Using a log transformed time domain measure of respiratory sinus arrhythmia (logRSA), we found an inverse linear dependence between cardiac vagal tone and age in the healthy subjects as well as the depressed patients. logRSA was 0.22+/-0.25 in the patients and 0.25+/-0.16 in the control group. While this difference was not significant (P > 0.1), the deviations from the regression line were significantly (P < 0.0005) greater in the patients (0.21+/-0.12) than in the control group (0.09+/-0.07), indicating a more heterogeneous vagal tone in the depressed patients. Heart rate was also significantly (P < 0.03) greater in the depressed patients (76.6+/-12.4) than in the control group (69.5+/-6.9). No between-group differences were found in pulsewave velocity or systolic blood pressure, but diastolic blood pressure was lower in depressed patients (73.5+/-8.7 vs. 80.8+/-9.1). We discuss the possibility that the increased heart rate seen in the absence of vagal tone changes may not be due to altered vagal or sympathetic tone, as measured in this study. Other factors, including altered autonomous heart rate, may be responsible for the higher heart rate in the depressed group.Journal of Affective Disorders 03/1998; 48(2-3):115-24. · 3.52 Impact Factor -
Article: Does muscle tension reflect arousal? Relationship between electromyographic and electroencephalographic recordings.
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ABSTRACT: Increased muscle tension and heightened arousal are the most consistent finding in patients with anxiety disorders. This study examined the relationship between frontalis and gastrocnemius electromyographic (EMG) and electroencephalographic activity on 14 female generalized anxiety disorder patients and 14 female control subjects. In GAD patients, gastrocnemius but not frontalis EMG was correlated with right but not left hemisphere activity. For the non-anxious subjects, there was a pattern for both beta 1 and beta 2 waves to be positively associated with both frontalis and gastrocnemius muscle tension levels. The results, while preliminary, suggest that EMG activity may reflect central nervous system arousal.Psychiatry Research 07/1997; 71(1):49-55. · 2.52 Impact Factor -
Article: Treatment, discontinuation, and psychomotor effects of diazepam in women with generalized anxiety disorder.
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ABSTRACT: Twenty-one women with generalized anxiety disorder (GAD) participated in a 6-week, double-blind, placebo-controlled trial to assess the treatment and abrupt withdrawal effects of diazepam on psychic and somatic symptoms of anxiety. The results confirmed those of previous studies reporting that (1) clinical doses of diazepam are effective in attenuating the symptoms of generalized anxiety to a greater extent than placebo during the first 3 weeks of treatment; (2) somatic symptoms are more responsive to diazepam treatment than psychic symptoms; and (3) patients taking diazepam exhibit increased anxiety upon abrupt withdrawal of medication. This finding, combined with the fact that diazepam discontinuation did not produce withdrawal effects in non-anxious volunteers, suggests that diazepam discontinuation after 6 weeks results in rebound anxiety rather than a physical withdrawal syndrome. Diazepam did not improve psychomotor performance in GAD patients. Psychomotor impairment after 6 weeks of diazepam was similar to that seen in nonanxious volunteers.Journal of Clinical Psychopharmacology 07/1996; 16(3):202-7. · 4.10 Impact Factor -
Article: Is hyperarousal essential to obsessive-compulsive disorder? Diminished physiologic flexibility, but not hyperarousal, characterizes patients with obsessive-compulsive disorder.
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ABSTRACT: To examine the hypothesis that the pathologic features of obsessive-compulsive disorder (OCD) are facilitated by abnormal levels of arousal, we compared patients with OCD with controls on self-reports and psychophysiologic measures. Twenty-three patients with OCD were compared with 21 controls on rating scales and on psychophysiologic measures (ie, heart interbeat interval, skin conductance, respiration, blood pressure, and electromyographic activity) during rest and during two psychologically stressful tasks. Patients rated themselves higher on psychic and somatic anxiety scales. Mean physiologic activities were not elevated at rest. During tasks, changes in electrodermal, cardiovascular (except blood pressure), and muscle activities were smaller in patients with OCD, indicating decreased physiologic flexibility. Hyperarousal, measured peripherally, is not an essential pathologic feature of OCD. Decreased physiologic flexibility indicates an anxiety-related, but not OCD-specific, impairment of psychophysiologic reactivity to one's environment.Archives of General Psychiatry 09/1995; 52(8):688-93. · 12.02 Impact Factor -
Article: Family history of alcoholism in women with generalized anxiety disorder who have premenstrual syndrome: patient reports of premenstrual alcohol consumption and symptoms of anxiety.
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ABSTRACT: This study sought to determine whether family history of alcoholism is related to patient reports of premenstrual alcohol consumption and whether family history of alcoholism is related to severity of anxiety-related symptoms, in women who suffer simultaneously from both premenstrual syndrome and generalized anxiety disorder. Fifty-four women with generalized anxiety disorder and prospectively demonstrated premenstrual syndrome were questioned about family history of alcoholism and alcohol consumption patterns across the menstrual cycle. Seventy-six percent of the sample reported having an alcoholic first- or second-degree relative. Furthermore, 74% of those women having a paternal-side family history of alcoholism, but only 22% of those without such a family history, reported increased alcohol consumption premenstrually. Forty-one of these women were assessed by means of psychiatric rating scales during both the premenstrual and follicular phases of the menstrual cycle. During the premenstrual, but not the follicular, phase of the menstrual cycle, women with a paternal-side family history of alcoholism experienced more severe anxiety-related somatic, but not psychic, symptoms of anxiety, than those without such a family history. These findings suggest that family history of alcoholism may be related to premenstrual alcohol consumption patterns and to the severity of premenstrually experienced somatic symptoms of anxiety in women with premenstrual syndrome, and that these women may be self-medicating with alcohol.Alcoholism Clinical and Experimental Research 07/1994; 18(3):664-70. · 3.34 Impact Factor -
Article: Muscle tension in generalized anxiety disorder: elevated muscle tonus or agitated movement?
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ABSTRACT: The purpose of this study was to investigate the amplitude characteristics of frontalis and gastrocnemius electromyographic (EMG) activity in clinically anxious and nonanxious populations. Eighteen women with generalized anxiety disorder (GAD) and 19 nonanxious women were compared during baseline, laboratory stressor, and recovery conditions. EMG mean levels were greater for the GAD group, but there were no group differences in EMG skewness. During the stressor the GAD group had a significant reduction in frontalis EMG variability. Gastrocnemius muscle activity for both groups during the stressor condition increased in mean levels and variability while decreasing in skewness. These results indicate that clinically anxious individuals have elevated muscular tonus and have reduced variability in frontalis activity during stressful tasks. Also, the gastrocnemius muscle exhibited a stressor reactivity, whereas the frontalis did not. This study presents an approach to EMG analysis that could be useful in distinguishing unique features of anxiety as well as other emotional disorders.Psychophysiology 04/1994; 31(2):189-95. · 3.29 Impact Factor -
Article: The influence of premenstrual syndrome on ratings of anxiety in women with generalized anxiety disorder.
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ABSTRACT: During the premenstrual and follicular phases of the menstrual cycle, 41 women who had generalized anxiety disorder (GAD) plus premenstrual syndrome (PMS) were assessed with psychiatric rating scales and compared with 21 GAD patients without PMS and 19 controls. The latter two groups were rated only once, in the typical open-ended manner. Symptoms during both phases of the menstrual cycle were more severe in the GAD + PMS patients than in the controls and were more severe during the premenstruum. For the GAD + PMS patients, ratings obtained in the typical open-ended manner were influenced by how patients felt during the premenstruum. Thus, the assessment of women with GAD + PMS may be complicated by cyclical fluctuations in symptom severity, and ratings obtained in the typical manner may be influenced disproportionately by how these patients feel premenstrually.Acta Psychiatrica Scandinavica 11/1993; 88(4):248-51. · 4.22 Impact Factor -
Article: Effect of fluvoxamine on panic disorder.
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ABSTRACT: Several reports suggest that selective serotonin reuptake blockers are helpful in the treatment of panic disorder. The aim of the study was to compare fluvoxamine with placebo in 50 panic disorder patients by using an 8-week, double-blind, parallel-groups design. Weekly assessment included a panic attack diary (frequency and severity), the Montgomery-Asberg Depression Scale, the Clinical Anxiety Scale, and the Sheehan Disability Scale. Although both groups improved on all measures, the fluvoxamine group experienced significantly less frequent major panic attacks from the third week on and significantly lower ratings on anxiety, depression, and disability from the sixth week on. Mean ratings of the severity of major and the severity and frequency of minor attacks were not affected differently by fluvoxamine and placebo. At the end of the study, significantly more patients on fluvoxamine were free of major and minor panic attacks. The results indicate that: (1) the administration of fluvoxamine, as compared with placebo, led to a significant reduction in the number of panic attacks. (2) The severity of panic attacks was not affected by fluvoxamine. (3) The effect of fluvoxamine on anxiety, depressive mood, and disability differed from placebo only after 6 weeks of treatment, after which the placebo group showed either no further improvement or a reversal of symptoms. (4) Participation in a drug study, even without additional psychotherapy, led to significant improvement in all patients.Journal of Clinical Psychopharmacology 11/1993; 13(5):321-6. · 4.10 Impact Factor -
Article: Symptoms and physiologic manifestations in obsessive compulsive patients before and after treatment with clomipramine.
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ABSTRACT: Anxiety and hyperarousal constitute important aspects of obsessive compulsive disorder (OCD). This study examined the effects of clomipramine on symptoms, arousal-related physiologic states, and stress reactions in OCD patients. Twenty-five OCD patients were randomly assigned to a clomipramine or placebo group and were assessed for 10 weeks using a double-blind parallel design. They were assessed clinically with the Yale-Brown Obsessive Compulsive Scale, the National Institute of Mental Health Global Obsessive-Compulsive Scale, the patient- and investigator-rated Global Improvement Scales, and the Hamilton Rating Scale for Depression. Prior to treatment, and again during the last day of medication, physiologic states (heart rate, respiration, skin conductance, blood pressure, and EMG) were measured at rest and during both nonspecific (psychomotor tasks) and pathology-specific (visualization) stressors. Patients taking clomipramine, but not those taking placebo, improved significantly on all clinical measures. With the exception of heart rate, treatment did not affect resting physiologic states. Heart rate increased in patients taking clomipramine and decreased in patients taking placebo. Autonomic reactivity to nonspecific and to pathology-specific stressors was attenuated by clomipramine, but not by placebo. Clinical improvement on clomipramine treatment was independent of the physiologic state of the patients and was not associated with autonomic down-regulation. The attenuation of autonomic reactivity to stressors appears not to be pathology-specific but may reflect either a direct pharmacologic effect of clomipramine on the autonomic nervous system or a heightened indifference to psychological stressors in general.The Journal of Clinical Psychiatry 08/1993; 54(7):272-6. · 5.80 Impact Factor -
Article: Effects of alprazolam and imipramine on parasympathetic cardiac control in patients with generalized anxiety disorder.
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ABSTRACT: A noninvasive measure was used to assess the effects of alprazolam, imipramine and placebo on parasympathetic (vagal) cardiac control following 6-weeks of medication in patients with generalized anxiety disorder. Flexible dosage at therapeutic levels resulted in increased heart rate and blood pressure and in decreased cardiac vagal control in patients receiving imipramine but not alprazolam or placebo. About 50% of the variance in heart rate changes and changes in mean arterial blood pressure following treatment with imipramine could be accounted for by changes in cardiac vagal control. Decreased cardiac vagal control can now be added to the list of cardiovascular changes seen following several weeks of treatment with imipramine.Psychopharmacologia 02/1992; 107(4):535-40. · 4.08 Impact Factor -
Article: Cortisol levels in generalized anxiety disorder.
Psychiatry Research 10/1991; 38(3):313-5. · 2.52 Impact Factor -
Article: The effects of NMDA receptor blockade on the acquisition of a conditioned emotional response.
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ABSTRACT: Excitatory amino acids, acting at the N-methyl-d-aspartate (NMDA) receptor, have been postulated to play an important role in the acquisition of behavior (learning). Previous studies have shown that some forms of response acquisition can be impaired by drugs that block the NMDA receptor. To determine whether excitatory amino acid blockade could also affect the ability to acquire an emotional response, the effects of the noncompetitive NMDA receptor antagonist MK-801 were studied on the development of response suppression under a conditioned emotional response (CER) procedure in the rat. The CER procedure progressively suppressed responding when saline was given prior to the eight daily sessions over which animals were initially exposed. Daily treatment with MK-801 blocked the development of response suppression. Thus, these data are consistent with the notion that excitatory amino acid blockade prevents or diminishes the development of a learned emotional response. This suggests a potential role for this receptor in the development of anxiety-related disorders in humans.Biological Psychiatry 08/1991; 30(2):170-6. · 8.28 Impact Factor -
Article: Psychophysiological response patterns in panic disorder.
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ABSTRACT: To determine whether panic disorder patients exhibit physiological hyperarousal during rest or during mild, non-panic-inducing stress, 18 patients who experienced frequent panic attacks were compared with nonanxious controls on a battery of physiological assessments. During baseline, patients with panic disorder exhibited higher forehead electromyographic activity, higher systolic blood pressure and higher heart rates than non-anxious volunteers. During psychological stress, heart rate and systolic blood pressure rose more in patients with panic disorder than in nonanxious controls. The skin conductance response, however, was greater and more variable in the nonanxious controls. The results suggest that panic disorder patients with frequent panic attacks exhibit heightened cardiovascular arousal and decreased electrodermal flexibility than nonanxious people, even in nonthreatening situations.Acta Psychiatrica Scandinavica 02/1991; 83(1):4-11. · 4.22 Impact Factor -
Article: Treatment effects of alprazolam and imipramine: physiological versus subjective changes in patients with generalized anxiety disorder.
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ABSTRACT: The correspondence between changes in physiological activity and somatic symptom reports was assessed in generalized anxiety disorder patients treated with alprazolam or imipramine. After 6 weeks, the two medications produced comparable reductions in self-reported somatic symptoms. However, patients taking alprazolam showed decreases in systolic blood pressure, epinephrine, and norepinephrine, and patients taking imipramine showed increases in heart rate, blood pressure, electromyographic activity, and norepinephrine. Thus, though the physiological changes associated with alprazolam treatment were consistent with changes in symptom reports, treatment with imipramine produced a desynchrony: patients reported significant decreases in cardiovascular symptoms and muscle tension in spite of the fact that heart rate, blood pressure, and electromyographic activity increased. Possible explanations for this counterintuitive phenomenon are discussed.Biological Psychiatry 12/1990; 28(10):849-61. · 8.28 Impact Factor
Top co-authors
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Institutions
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2006
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Ben-Gurion University of the Negev
Beersheba, Southern District, Israel
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1989–2006
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Johns Hopkins Medicine
- • Department of Neurology
- • Department of Psychiatry and Behavioral Sciences
Baltimore, MD, USA
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1988–2001
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Johns Hopkins University
- Department of Psychiatry and Behavioral Sciences
Baltimore, MD, USA
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