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OBJECTIVE: The authors evaluated the efficacy, safety, and tolerability of sertraline, a selective serotonin reuptake inhibitor, in the treatment of generalized social phobia. METHOD: Adult outpatients with generalized ...
Research Interests: Treatment, Treatment Outcome, Diarrhea, Humans, Toxicity, and 15 moreFemale, Male, Placebos, Incidence, Nausea, Social phobia, Middle Aged, Adult, SERTRALINE, Serotonin Uptake Inhibitors, The American, Psychiatric Status Rating Scales, Psychology and Cognitive Sciences, Phobic disorders, and Medical and Health Sciences
Background: This study further examined the diagnostic specificity of the self-critical personality dimension, as measured by the Depressive Experiences Questionnaire (DEQ; Blatt et al., 1976. The Depressive Experiences Questionnaire.... more
Background: This study further examined the diagnostic specificity of the self-critical personality dimension, as measured by the Depressive Experiences Questionnaire (DEQ; Blatt et al., 1976. The Depressive Experiences Questionnaire. Yale University Press, New Haven). Methods: Patients with major depression (n 5 26) were compared to social phobia patients (n 5 32). Results: Depressed patients scored significantly higher on the DEQ Self-Criticism dimension. However, when current level of depressed mood was controlled for, self-criticism was not a significant predictor of diagnostic status. Further, the level of DEQ self-criticism reported by patients with social phobia was almost three times greater than the level reported in an earlier diagnostic specificity study with panic disorder patients [Bagby et al., 1992. Diagnostic specificity of the dependent and self-critical personality dimensions in major depression. J. Affect. Disord. 26, 59–64]. Limitations: Only one measure of self-criticism was used in this study, and the research design was cross-sectional rather than prospective. Conclusions: Self-criticism is not unique to major depression, and this personality dimension may be implicated in other forms of psychopathology [Blatt, 1991. A cognitive morphology of psychopathology. J. Nerv. Ment. Dis. 179, 449–458]. Some cognitive features believed to play an important role in depression may also be salient in persons with social phobia.
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Benzodiazepines (BDPs) are widely used drugs that are effective in controlling the symptoms of anxiety. Tolerance develops rapidly to some of the effects but not to anxiolytic effect in most patients. Dependence occurs at usual... more
Benzodiazepines (BDPs) are widely used drugs that are effective in controlling the symptoms of anxiety. Tolerance develops rapidly to some of the effects but not to anxiolytic effect in most patients. Dependence occurs at usual therapeutic doses and in a small proportion of patients is accompanied by an enormous increase in the dose taken. The majority of subjects using very high doses are dependent on other substances concurrently. On discontinuing BDPs patients may suffer from relapse of the original condition, rebound in the severity of the symptoms of the original condition or the onset of new symptoms in an abstinence syndrome. If BDPs are discontinued abruptly there may be severe consequences such as seizures. With tapering of the dose, even if this is rapid and from high dose, high potency BDP, the subject will probably experience considerable discomfort but rarely life-threatening effects. Whilst there is concern that BDPs are used too freely, the conditions treated are accompanied by significant morbidity and mortality. The prevalence of pure BDP dependence is low and it is still a matter of debate as to how often BDPs should be prescribed, for which conditions and for what length of time.
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The relationship between substance abuse and panic-related anxiety can be divided into two broad areas: the incidence of anxiety disorders in substance abuse patients and the incidence of substance abuse in patients with panic-related... more
The relationship between substance abuse and panic-related anxiety can be divided into two broad areas: the incidence of anxiety disorders in substance abuse patients and the incidence of substance abuse in patients with panic-related anxiety disorders. Studies indicate that approx. 10-40% of alcoholics have a panic-related anxiety disorder, and about 10-20% of anxiety disorder patients abuse alcohol or other drugs. The majority of patients with both an anxiety and alcohol disorder report that anxiety problems preceded alcohol problems. In some cases substance abuse (e.g. cocaine) triggers the onset of panic attacks. Most patients believe that self-medication is efficacious despite the fact that they appear to have a more serious clinical condition (e.g. higher rates of depression). Directions for future research are outlined, including the proposal for a study to examine the effects of an anxiety intervention procedure for anxious alcoholics to reduce relapse rates.
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... in Male Alcoholics By RICHARD P. SWINSON ... Various authors (Lehmann, Ban and Naltchayan, 1966; Semer, Friedland, Vaisberg and Greenberg, 1966; Bonfiglio and Donadio, 1966) confirmed the initial reports but none of these studies used... more
... in Male Alcoholics By RICHARD P. SWINSON ... Various authors (Lehmann, Ban and Naltchayan, 1966; Semer, Friedland, Vaisberg and Greenberg, 1966; Bonfiglio and Donadio, 1966) confirmed the initial reports but none of these studies used a control group. ...
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... Bravo! Richard Heimberg, Ph.D., Adult Anxiety Clinic in the department of psychology at Temple University in Philadelphia, PA Page 4. ... Finally, thank you to Lizabeth Roemer and Josh Bartok for their helpful comments on an early... more
... Bravo! Richard Heimberg, Ph.D., Adult Anxiety Clinic in the department of psychology at Temple University in Philadelphia, PA Page 4. ... Finally, thank you to Lizabeth Roemer and Josh Bartok for their helpful comments on an early draft of chapter 9. Page 11. Page 12. ...
The effects of acute oral administration of methylphenidate 40 mg versus dextroamphetamine 30 mg versus matched placebo were compared in 11 patients with primary obsessive-compulsive disorder. Dextroamphetamine but not methylphenidate had... more
The effects of acute oral administration of methylphenidate 40 mg versus dextroamphetamine 30 mg versus matched placebo were compared in 11 patients with primary obsessive-compulsive disorder. Dextroamphetamine but not methylphenidate had a significantly greater antiobsessive-compulsive effect as measured by the Comprehensive Psychiatric Rating Scale--Obsessive-Compulsive Subscale, as compared with placebo. This effect appeared unrelated to their effect on depression although a differential effect of the two psychostimulants on anxiety was observed. Although both these stimulants affect serotonin, the differences noted between dextroamphetamine and methylphenidate suggest that catecholamines may be implicated in the pathophysiology of obsessive-compulsive disorder.
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Abstract The most common effective treatments for obsessive-compulsive disorder include clomipramine, flouxetine, and exposure-based behavior therapy. A meta-analysis was conducted on the results from 25 appropriate treatment studies... more
Abstract The most common effective treatments for obsessive-compulsive disorder include clomipramine, flouxetine, and exposure-based behavior therapy. A meta-analysis was conducted on the results from 25 appropriate treatment studies (1975–1991). All three ...
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Discontinuation of alprazolam after long-term treatment of 142 patients with panic-related disorders was examined in five study sites using a telephone interview. The majority (67%) of patients interviewed discontinued alprazolam for a... more
Discontinuation of alprazolam after long-term treatment of 142 patients with panic-related disorders was examined in five study sites using a telephone interview. The majority (67%) of patients interviewed discontinued alprazolam for a period of at least 3 days after a gradual dosage reduction schedule over a 4-week period at the end of the long-term treatment study. A marked difference among the study sites in percentages of patients discontinuing therapy with alprazolam suggests that physician intervention played an important role in determining the ability of patients successfully to discontinue use of alprazolam: 90% and 95% of patients ceased therapy at two sites whereas only 21%, 38%, and 66% of patients discontinued therapy at the other three sites. The mean daily dosage for patients who continued using alprazolam decreased from 5.1 mg/day at the end of the long-term segment to 2.7 mg/day at the time of the poststudy interview. This decline indicates a lack of tolerance to the therapeutic effectiveness of alprazolam over an extended period of time.
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Clonazepam, a benzodiazepine with anticonvulsant properties, has recently been found to be effective in the control of acute mania. Its use in combination with lithium has been advocated. Here 5 cases are presented in which the... more
Clonazepam, a benzodiazepine with anticonvulsant properties, has recently been found to be effective in the control of acute mania. Its use in combination with lithium has been advocated. Here 5 cases are presented in which the combination of clonazepam (2 mg-16 mg) plus lithium (900 mg-2400 mg) produced a neurotoxic syndrome with ataxia and dysarthria. In all cases the syndrome was reversible.
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Secondary depressive symptomatology in 435 subjects with panic disorder and phobic avoidance was studied before and after alprazolam treatment. No subject who had a primary affective disorder was included. Calculation of Hamilton... more
Secondary depressive symptomatology in 435 subjects with panic disorder and phobic avoidance was studied before and after alprazolam treatment. No subject who had a primary affective disorder was included. Calculation of Hamilton Depression Rating Scale factor scores revealed that the agitation/anxiety, sleep disturbance, and somatization factors accounted for approximately 75% of the HAM-D total score; these all showed significant improvement with alprazolam treatment. There were few differences in dimensions of depressive symptomatology between those subjects with and those without major depression; the main difference was in the overall intensity of the depression.
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... 40, 249579. Regier, DA, Boyd, JH, Burke, JD, Rae, DS, Myers, JK, Kramer, M., Robins, LN, George, LK, Karno, M., Locke, BZ (1988). Onemonth prevalence of mental disorders in the United States. ... Archive der Psychiatrie and... more
... 40, 249579. Regier, DA, Boyd, JH, Burke, JD, Rae, DS, Myers, JK, Kramer, M., Robins, LN, George, LK, Karno, M., Locke, BZ (1988). Onemonth prevalence of mental disorders in the United States. ... Archive der Psychiatrie and Nervenkrankheiten, 138, 219222. Wolpe, J. (1973). ...
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... Bravo! Richard Heimberg, Ph.D., Adult Anxiety Clinic in the department of psychology at Temple University in Philadelphia, PA Page 4. ... Finally, thank you to Lizabeth Roemer and Josh Bartok for their helpful comments on an early... more
... Bravo! Richard Heimberg, Ph.D., Adult Anxiety Clinic in the department of psychology at Temple University in Philadelphia, PA Page 4. ... Finally, thank you to Lizabeth Roemer and Josh Bartok for their helpful comments on an early draft of chapter 9. Page 11. Page 12. ...
What is the best approach for treating patients with social phobia (social anxiety disorder) over the long term? Social phobia is the most common anxiety disorder, with reported prevalence rates of up to 18.7%. Social phobia is... more
What is the best approach for treating patients with social phobia (social anxiety disorder) over the long term? Social phobia is the most common anxiety disorder, with reported prevalence rates of up to 18.7%. Social phobia is characterized by a marked and persistent fear of being observed or evaluated by others in social performance or interaction situations and is associated with physical, cognitive, and behavioral (ie, avoidance) symptoms. The onset of social phobia typically occurs in childhood or adolescence and the clinical course, if left untreated, is usually chronic, unremitting, and associated with significant functional impairment. Social phobia exhibits a high degree of comorbidity with other psychiatric disorders, including mood disorders, anxiety disorders, and substance abuse/dependence. Few people with social phobia seek professional help despite the existence of beneficial treatment approaches. The efficacy, tolerability, and safety of the selective serotonin reuptake inhibitors (SSRIs), evidenced in randomized clinical trials, support these agents as first-line treatment. The benzodiazepine clonazepam and certain monoamine oxidase inhibitors (representing both reversible and nonreversible inhibitors) may also be of benefit. Treatment of social phobia may need to be continued for several months to consolidate response and achieve full remission. The SSRIs have shown benefit in long-term treatment trials, while long-term treatment data from clinical studies of clonazepam are limited but support the drug's efficacy. There is also evidence for the effectiveness of exposure-based strategies of cognitive-behavioral therapy, and controlled studies suggest that the effects of treatment are generally maintained at long-term follow-up. In light of the chronicity and disability associated with social phobia, as well as the high relapse rate after short-term therapy, it is recommended that effective treatment be continued for at least 12 months.
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ABSTRACT The behavioural treatment of agoraphobia and panic has evolved from graded imaginal exposure techniques, of limited power, to exposure based treatments that produce improvement in 65–75% of patients. Treatment based on... more
ABSTRACT The behavioural treatment of agoraphobia and panic has evolved from graded imaginal exposure techniques, of limited power, to exposure based treatments that produce improvement in 65–75% of patients. Treatment based on self-directed exposure principles is rapidly effective and the improvements are maintained over years. Therapy may occur singly or in groups and may involve spouses or significant others. There is little evidence that medication adds to the effects of self-directed in vivo exposure. Panics decrease during behavioural psychotherapy without concomitant medication. Variants of exposure therapy include the addition of congitive and marital therapy. These additions may add to the efficacy. Despite the success of exposure based therapy 20% of patients do not improve and a large proportion are left with residual symptoms.
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Posttraumatic stress disorder (PTSD) is a common and disabling condition. In addition to combat-related PTSD, the disorder occurs in civilians exposed to severe traumatic events, with the community prevalence rate for the combined... more
Posttraumatic stress disorder (PTSD) is a common and disabling condition. In addition to combat-related PTSD, the disorder occurs in civilians exposed to severe traumatic events, with the community prevalence rate for the combined populations reaching as high as 12%. If left untreated, PTSD may continue for years after the stressor event, resulting in severe functional and emotional impairment and a dramatic reduction in quality of life, with negative economic consequences for both the sufferer and society as a whole. Although PTSD is often overlooked, diagnosis is relatively straightforward once a triggering stressor event and the triad of persistent symptoms-reexperiencing the traumatic event, avoiding stimuli associated with the trauma, and hyperarousal have been identified. However, comorbid conditions of anxiety and depression frequently hamper accurate diagnosis. Treatment for PTSD includes psychotherapy and pharmacotherapy. The latter includes selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and monoamine oxidase inhibitors. Only SSRIs have been proven effective and safe in long-term randomized controlled trials. Current guidelines from the Expert Consensus Panel for PTSD recommend treatment of chronic PTSD for a minimum of 12-24 months.
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The most common pharmacological treatments for panic disorder with agoraphobia (PDA) include the use of imipramine and alprazolam while the most common behavior therapy is the use of graded in vivo exposure. Several studies have found... more
The most common pharmacological treatments for panic disorder with agoraphobia (PDA) include the use of imipramine and alprazolam while the most common behavior therapy is the use of graded in vivo exposure. Several studies have found these treatments to be superior to placebo in the treatment of PDA, but it has not been clear if there are differences among these three treatments. It has also not been clear for what aspects of PDA each treatment is the most effective. The purpose of this study was to conduct a meta-analysis of the results of relevant treatment outcome studies on a number of dependent variables (e.g., panic attack severity, dysphoria, avoidance behavior). Few studies satisfied the minimum criteria for inclusion and the final data pool consisted of 34 treatment studies. Imipramine was found to be generally ineffective for most variables. Alprazolam was significantly effective for panic and anxiety variables in PDA, while exposure was significantly effective for phobia variables. Exposure had the most consistently strong effect sizes.
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ABSTRACT This comprehensive volume provides up-to-date information on the 3 main types of phobic disorder: panic disorder and agoraphobia, social phobia, and specific phobia. The book integrates current research findings with practical... more
ABSTRACT This comprehensive volume provides up-to-date information on the 3 main types of phobic disorder: panic disorder and agoraphobia, social phobia, and specific phobia. The book integrates current research findings with practical recommendations for diagnosis and treatment. For each disorder, clinicians will find guidelines for assessment, including diagnostic interviews, behavioral assessments, symptom diaries, and standardized self-report measures that are highly useful for differential diagnosis and treatment planning. The authors present flexible and detailed treatment protocols for each disorder that include session frequency and duration, sequencing of cognitive and behavioral strategies, bibliotherapy, homework, and monitoring forms for tracking patient progress. Basic principles of exposure-based treatment and social skills training and the most effective cognitive techniques are described, illuminated by sample therapist–patient dialogue and troubleshooting tips. A chapter on the most commonly used medications, side effects, issues related to dosage, and strategies for discontinuing medication is included. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
ABSTRACT The γ-aminobutyric acid type A (GABA(A)) system may be implicated in obsessive-compulsive disorder, based on its major role in modulation of anxiety and its function as the principal inhibitory neurotransmitter system in the... more
ABSTRACT The γ-aminobutyric acid type A (GABA(A)) system may be implicated in obsessive-compulsive disorder, based on its major role in modulation of anxiety and its function as the principal inhibitory neurotransmitter system in the cortex. In addition, glutamatergic/GABAergic mechanisms appear to play a role in the pathophysiology of obsessive-compulsive disorder, making the GABA(A) receptor-γ2 (GABργ2) gene a good candidate for susceptibility in this disorder. 118 probands meeting DSM-IV criteria for primary obsessive-compulsive disorder and their available parents were recruited for participation in this study and informed consent was obtained. An NciI restriction site polymorphism in the second intron was genotyped and data was analyzed using the Transmission Disequilibrium Test. In total, 61 of the participating families were informative (i.e., with at least one heterozygous parent). No biases were observed in the transmission of either of the two alleles (chi² = 0.016, 1 d.f., p = 0.898) to the affected probands in the total sample. While these results do not provide support for a major role for the GABA(A) receptor-γ2 in obsessive-compulsive disorder, further investigations of this gene in larger samples are warranted.
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ABSTRACT The prevalence of echocardiographic mitral valve prolapse (MVP) and arrhythmias was studied in controls (n = 23) and patients with panic disorder (n = 14), bulimia nervosa (n = 14), and anorexia nervosa (n = 21). There was... more
ABSTRACT The prevalence of echocardiographic mitral valve prolapse (MVP) and arrhythmias was studied in controls (n = 23) and patients with panic disorder (n = 14), bulimia nervosa (n = 14), and anorexia nervosa (n = 21). There was approximately twice the rate of MVP in patient groups compared to controls, a statistically insignificant difference. Importantly, the presence of prolapse was not associated with measures of weight or depression but there was a trend for MVP to be associated with anxiety disorder in bulimic patients. There were no significant arrhythmias found. These results raise the possibility that MVP may not be a state weight-related phenomenon as has been proported, but rather a trait phenomenon reflecting comorbidity with anxiety disorder.
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The Illness Intrusiveness Rating Scale (IIRS) is a measure designed to assess the impact of illness on various domains of functioning (G. M. Devins, 1994). In anxiety disordered patients, illness intrusiveness ratings are higher than... more
The Illness Intrusiveness Rating Scale (IIRS) is a measure designed to assess the impact of illness on various domains of functioning (G. M. Devins, 1994). In anxiety disordered patients, illness intrusiveness ratings are higher than those of chronically ill medical patients, suggesting that the IIRS may have a different underlying structure in a sample of individuals with anxiety disorders. To
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ABSTRACT