EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, SEPTEMBER 22, 2003
To contact Jordan W. Smoller, M.D., Sc.D., call Sue McGreevey at 617/724-2764.

PANIC ATTACKS MAY BE COMMON AMONG POSTMENOPAUSAL WOMEN

CHICAGO—Panic attacks may be relatively common among postmenopausal women and may be associated with stressful life events, medical illness and functional impairment, according to an article in the September 22 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

Panic attacks and panic disorder are more common in women than in men, but little is known about the frequency of panic attacks after menopause, according to the article.

Jordan W. Smoller, M.D., Sc.D., of Massachusetts General Hospital, Boston, and colleagues surveyed a group of women participating in the Women's Health Initiative (WHI) to determine the prevalence of panic attacks.

The researchers surveyed 3,369 postmenopausal women who enrolled in the Myocardial Ischemia and Migraine Study (MIMS, a smaller study that was part of the WHI) between December 1, 1997 and November 30, 2000. The women were aged 50 to 79 years old (73 percent white) and completed questionnaires about the occurrence of panic attacks and migraine headaches in the previous six months. Based on responses to the questionnaire, "full blown panic" attack was defined as "reporting an attack of sudden fear, anxiety, or extreme discomfort during the past six months accompanied by four or more panic symptoms," whereas "limited-symptom panic" attack was defined as full-blown panic, except that fewer than four panic symptoms were indicated.

Panic attacks were reported by 17.9 percent of women (full-blown attacks, 9.8 percent; limited-symptom attacks, 8.1 percent). Full-blown panic attacks were more common in women with a history of migraine, emphysema, cardiovascular disease, chest pain, and symptoms of depression. Full-blown attacks were also associated with negative life events during the previous year (deaths, illness, etc.). However, there was no significant association with self-reported use of postmenopausal hormone therapy.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, SEPTEMBER 22, 2003
To contact Chia-Long Lee, M.D., e-mail cghleecl{at}hotmail.com.

MAINTENANCE THERAPY NOT ALWAYS NECESSARY TO PREVENT RECURRENCE OF ULCERS

CHICAGO—Among patients with bleeding peptic ulcers, long-term anti-ulcer maintenance therapy might not be necessary after successful eradication of Helicobacter pylori (the bacteria associated with peptic ulcers) and complete ulcer healing, according to an article in the September 22 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

Bleeding from ulcers is one of the most common complications of peptic ulcer disease, and is associated with substantial morbidity, death rates and health care costs, according to the article. It is well established that the bacteria H. pylori plays a role in the development of peptic ulcer disease and ulcer recurrence. Previous studies have shown that eliminating H. pylori infection decreases the rate of ulcer recurrence.

Chia-Long Lee, M.D., of Cathay General Hospital, Taipei, Taiwan, and colleagues investigated whether long-term maintenance treatment is needed for patients with bleeding ulcers whose H. pylori infections were successfully eradicated and whose ulcers had healed.

The researchers studied 82 patients with bleeding ulcers that were associated with H. Pylori infection. The patients' ulcers and H. pylori infections were treated successfully with a combination regimen of anti-ulcer drugs and antibiotics, and their ulcers were allowed to heal. The patients were then assigned to one of four groups: group A received 15 milliliters of an antacid four times per day; group B received 300 milligrams of colloidal bismuth subcitrate (an antacid) four times per day; group C received 20 milligrams of famotidine (medication that reduces the secretion of stomach acid) twice daily; and group D received a placebo twice daily. Each group continued with their treatment for 16 weeks. All patients were seen in outpatient clinics every 4 months for the first year after the maintenance therapy ended, and then at 6-month intervals.

The researchers found that during an average follow-up time of nearly 5 years, there was no peptic ulcer recurrence among the three treatment groups or the placebo group, and all of the patients remained free of H. pylori infection during the study period.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, SEPTEMBER 22, 2003
To contact Terri R. Fried, M.D., call Karen Peart at 203/432-1326.

PATIENTS AND CAREGIVERS DO NOT ALWAYS AGREE ABOUT THE ACCEPTABILITY OF HEALTH OUTCOMES FOLLOWING TREATMENT

CHICAGO—Seriously ill patients and their caregivers may not always agree on the acceptability of various states of health that result from different treatments, according to an article in the September 22 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

In cases where dying patients are unable to participate in decision making regarding their treatment, physicians usually turn to a surrogate decision maker, usually a family member, according to the article. Previous studies have suggested that surrogates are poor predictors of patients preferences for certain treatments.

Terri R. Fried, M.D., of VA Connecticut Healthcare System, West Haven, Conn., and colleagues compared seriously ill patients' and their surrogates' attitudes toward treatment outcomes resulting in different states of health.

The researchers interviewed 193 patients aged 60 years or older and seriously ill with cancer, congestive heart failure, or chronic obstructive pulmonary disease, and their caregivers. Patients were asked whether, if they faced a further decline in health, they would find a series of health states (mild memory impairment, pain, coma, etc.) acceptable as a result of treatment. A rating of "unacceptable" would indicate a wish to die rather than receive the treatment. Caregivers were asked whether they would find these states acceptable for the patient.

The researchers found that there was 80 percent or greater agreement for health states that were rated acceptable (current health state, or unchanged; mild memory impairment; mild pain or other symptoms) or unacceptable (coma). There was 58 percent to 62 percent agreement about states with more severe physical or cognitive impairment. When there was disagreement, caregivers were more likely to rate the state as acceptable. In states with severe pain or other symptoms, there was 61 percent to 65 percent agreement between patients and caregivers.

"There was substantial agreement between patients and caregivers only for states that were rated as acceptable by most patients and caregivers, such as the patient's current health, mild memory impairment, mild pain, mild other symptoms, or rated as unacceptable by most patients and caregivers, such as coma," write the authors. "Other health states with more variability in their acceptability ratings, including moderate and severe functional impairment, severe cognitive impairment, severe pain, and other severe symptoms, had lower levels of agreement."