Prevalence and management of panic attacks during infliximab infusion in psoriatic patients

Dermatology. 2012;225(3):236-41. doi: 10.1159/000343609. Epub 2012 Nov 22.

Abstract

Background: Psoriasis is a chronic, inflammatory skin disease associated with anxiety and depression. Infliximab (IFX) is a human/mouse chimeric anti-TNF-α antibody effective in the treatment of psoriasis.

Objective: The aim of this study was to evaluate the prevalence of panic disorders in psoriatic patients during IFX infusions.

Methods: A retrospective study was performed on patients affected with psoriasis who were treated with IFX from 2002 to 2011 at a single center. Panic disorders were defined using the clinical criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. A population of dermatological patients under treatment with IVG, rituximab, apheresis, intravenous corticosteroids and antibiotics was considered as the control group.

Results: A total of 141 patients were evaluated. Of these, 6 (4.25%) experienced panic attacks during the infusion; 16 (11.3%) had a medical history of panic attack and of those 5/16 (31%) experienced panic attacks during IFX infusion. In the control group panic attacks were not recorded.

Conclusion: We describe 6 cases of patients in whom panic attacks were triggered by IFX infusion. Premedication with oral benzodiazepine and a slow rate of infusion is recommended.

MeSH terms

  • Administration, Oral
  • Adult
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / adverse effects*
  • Benzodiazepines / therapeutic use
  • Case-Control Studies
  • Dermatologic Agents / administration & dosage
  • Dermatologic Agents / adverse effects*
  • Female
  • Humans
  • Infliximab
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Panic Disorder / chemically induced*
  • Panic Disorder / drug therapy
  • Prevalence
  • Psoriasis / drug therapy*
  • Psychiatric Status Rating Scales
  • Retrospective Studies

Substances

  • Antibodies, Monoclonal
  • Dermatologic Agents
  • Benzodiazepines
  • Infliximab