Objectives:To examine the relation between phobic disorders and alcoholism in a Canadian communit... more Objectives:To examine the relation between phobic disorders and alcoholism in a Canadian community sample.Method:Data came from the Mental Health Supplement of the Ontario Health Survey. The University of Michigan revision of the Composite International Diagnostic Interview (UM-CIDI) was used to diagnose DSM-III-R psychiatric disorders in 8116 Canadian respondents between ages 15 and 64 years. Since the cross-system agreement (ICD-10 and DSM-III-R or DSM-IV) on the diagnosis of alcohol abuse is much lower than that for alcohol dependence, we also examined a WHO category, “hazardous alcohol use.” Logistic regression controlling for age and sex was used to determine odds ratios (ORs) for phobic disorders and alcohol-use diagnoses.Results:Individuals with lifetime alcohol abuse or dependence had two- to threefold increased odds of having a phobic disorder. Simple phobia and social phobia with multiple fears were significantly associated (ORs 1.5 to 2) with hazardous alcohol use (which ...
Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obs... more Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders
Social phobia is the most common anxiety disorder in the community with a prevalence rate in the ... more Social phobia is the most common anxiety disorder in the community with a prevalence rate in the range of 5-8%. The problem most often emerges in childhood or adolescence. Individuals with generalized social phobia are at risk of developing other psychiatric disorders such as major depression, alcohol abuse and other anxiety disorders. Sufferers of social phobia often do not seek treatment until they encounter difficulty with comorbid disorders. Recent research indicates that social anxiety disorder is associated with higher levels of disability and greater reductions in quality of life than previously understood, with difficulties encountered in social relationships, education and employment. In previous years, there has been little or no known available effective treatment, and the disorder frequently goes unrecognized in primary care. However, new pharmacological (selective serotonin reuptake inhibitors, SSRIs) and psychological treatments are emerging that are able to produce significant symptom reduction and improvements in functioning and quality of life. In recent years, the SSRIs have been the focus of considerable research and are becoming one of the first-line treatments for social phobia. Early intervention in social phobia may improve quality of life, reduce disability and reduce the development of comorbid disorders.
Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obs... more Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2004
Many anxiety disorders are not treated to remission (symptom-free state); however, this should be... more Many anxiety disorders are not treated to remission (symptom-free state); however, this should be the minimum goal of therapy. Antidepressant therapies have shown significant beneficial effects in the management of anxiety disorders, with some variability in results in specific disorders. In social anxiety disorder, selective serotonin reuptake inhibitors and venlafaxine extended release (XR) have demonstrated efficacy, with response rates varying between 40% and 68%. Monoamine oxidase inhibitors and cognitive-behavioural therapies are also effective. In patients with generalized anxiety disorder, benzodiazepines, paroxetine, and venlafaxine XR have demonstrated remission rates that are 15% to 25% higher than placebo. In patients with posttraumatic stress disorder, about 60% to 70% of patients experienced a response with antidepressant therapy, compared with about 40% on placebo, while remission rates in one study were 30% with venlafaxine, 24% with sertraline, and 20% with placebo....
Journal of Behavior Therapy and Experimental Psychiatry, 1999
Promising cognitive-behavioral and medication treatments for hypochondriasis are in the early sta... more Promising cognitive-behavioral and medication treatments for hypochondriasis are in the early stages of evaluation. Little is known about the treatment preferences and opinions of individuals seeking help for this problem. In this exploratory study, 23 volunteers from the community with a DSM-IV diagnosis of hypochondriasis were recruited through a newspaper advertisement. Participants were presented with a survey which included balanced descriptions of both a medication and a cognitive-behavioral treatment for intense illness concerns (hypochondriasis). The brief descriptions of the treatments discussed the time commitment required as well as the major advantages and disadvantages of each. Results showed that, relative to medication treatment, cognitive-behavioral treatment was predicted to be more effective in both the short and long terms and was rated as more acceptable. Psychological treatment was indicated as the first choice by 74% of respondents, medication by 4%, and 22% indicated an equal preference. Forty-eight percent of respondents would only accept the psychological treatment.
Although evidence suggests the involvement of the amygdala in generalized social phobia (GSP), fe... more Although evidence suggests the involvement of the amygdala in generalized social phobia (GSP), few studies have examined other neural regions. Clinical, preclinical, and dopamine receptor imaging studies demonstrating altered dopaminergic functioning in GSP suggest an association with striatal dysfunction. This is the first functional magnetic resonance imaging (fMRI) study to use a cognitive task known to involve the striatum to examine the neural correlates of GSP. We examined whether subjects with GSP had differential activation in striatal regions compared with healthy control subjects while engaged in a cognitive task that has been shown to activate striatal regions reliably. Ten adult, unmedicated subjects with a primary DSM-IV diagnosis of GSP and 10 age-, gender-, and education-matched healthy comparison subjects underwent fMRI while performing the implicit sequence learning task. The GSP and healthy comparison subjects did not differ significantly on the behavioral performance of the task. Subjects with GSP, however, had significantly reduced neural activation related to implicit learning compared with healthy comparison subjects in the left caudate head, left inferior parietal lobe, and bilateral insula. These findings support the hypothesis that GSP is associated with striatal dysfunction and further the neurobiological understanding of this complex anxiety disorder.
The Primary Care Companion For CNS Disorders, 2016
This article presents the case that a more rapid, individualized approach to treating major depre... more This article presents the case that a more rapid, individualized approach to treating major depressive disorder (MDD) may increase the likelihood of achieving full symptomatic and functional recovery for individual patients and that studies show it is possible to make earlier decisions about appropriateness of treatment in order to rapidly optimize that treatment. A PubMed search was conducted using terms including major depressive disorder, early improvement, predictor, duration of untreated illness, and function. English-language articles published before September 2015 were included. Additional studies were found within identified research articles and reviews. Thirty antidepressant studies reporting predictor criteria and outcome measures are included in this review. Studies were reviewed to extract definitions of predictors, outcome measures, and results of the predictor analysis. Results were summarized separately for studies reporting effects of early improvement, baseline characteristics, and duration of untreated depression. Shorter duration of the current depressive episode and duration of untreated depression are associated with better symptomatic and functional outcomes in MDD. Early improvement of depressive symptoms predicts positive symptomatic outcomes (response and remission), and early functional improvement predicts an increased likelihood of functional remission. The approach to treatment of depression that exhibits the greatest potential for achieving full symptomatic and functional recovery is early optimized treatment: early diagnosis followed by rapid individualized treatment. Monitoring symptoms and function early in treatment is crucial to ensuring that patients do not remain on ineffective or poorly tolerated treatment, which may delay recovery and heighten the risk of residual functional deficits.
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2004
Many anxiety disorders are not treated to remission (symptom-free state); however, this should be... more Many anxiety disorders are not treated to remission (symptom-free state); however, this should be the minimum goal of therapy. Antidepressant therapies have shown significant beneficial effects in the management of anxiety disorders, with some variability in results in specific disorders. In social anxiety disorder, selective serotonin reuptake inhibitors and venlafaxine extended release (XR) have demonstrated efficacy, with response rates varying between 40% and 68%. Monoamine oxidase inhibitors and cognitive-behavioural therapies are also effective. In patients with generalized anxiety disorder, benzodiazepines, paroxetine, and venlafaxine XR have demonstrated remission rates that are 15% to 25% higher than placebo. In patients with posttraumatic stress disorder, about 60% to 70% of patients experienced a response with antidepressant therapy, compared with about 40% on placebo, while remission rates in one study were 30% with venlafaxine, 24% with sertraline, and 20% with placebo....
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2001
To examine the relation between phobic disorders and alcoholism in a Canadian community sample. D... more To examine the relation between phobic disorders and alcoholism in a Canadian community sample. Data came from the Mental Health Supplement of the Ontario Health Survey. The University of Michigan revision of the Composite International Diagnostic Interview (UM-CIDI) was used to diagnose DSM-III-R psychiatric disorders in 8116 Canadian respondents between ages 15 and 64 years. Since the cross-system agreement (ICD-10 and DSM-III-R or DSM-IV) on the diagnosis of alcohol abuse is much lower than that for alcohol dependence, we also examined a WHO category, "hazardous alcohol use." Logistic regression controlling for age and sex was used to determine odds ratios (ORs) for phobic disorders and alcohol-use diagnoses. Individuals with lifetime alcohol abuse or dependence had two- to threefold increased odds of having a phobic disorder. Simple phobia and social phobia with multiple fears were significantly associated (ORs 1.5 to 2) with hazardous alcohol use (which had a prevalen...
Objectives:To examine the relation between phobic disorders and alcoholism in a Canadian communit... more Objectives:To examine the relation between phobic disorders and alcoholism in a Canadian community sample.Method:Data came from the Mental Health Supplement of the Ontario Health Survey. The University of Michigan revision of the Composite International Diagnostic Interview (UM-CIDI) was used to diagnose DSM-III-R psychiatric disorders in 8116 Canadian respondents between ages 15 and 64 years. Since the cross-system agreement (ICD-10 and DSM-III-R or DSM-IV) on the diagnosis of alcohol abuse is much lower than that for alcohol dependence, we also examined a WHO category, “hazardous alcohol use.” Logistic regression controlling for age and sex was used to determine odds ratios (ORs) for phobic disorders and alcohol-use diagnoses.Results:Individuals with lifetime alcohol abuse or dependence had two- to threefold increased odds of having a phobic disorder. Simple phobia and social phobia with multiple fears were significantly associated (ORs 1.5 to 2) with hazardous alcohol use (which ...
Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obs... more Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders
Social phobia is the most common anxiety disorder in the community with a prevalence rate in the ... more Social phobia is the most common anxiety disorder in the community with a prevalence rate in the range of 5-8%. The problem most often emerges in childhood or adolescence. Individuals with generalized social phobia are at risk of developing other psychiatric disorders such as major depression, alcohol abuse and other anxiety disorders. Sufferers of social phobia often do not seek treatment until they encounter difficulty with comorbid disorders. Recent research indicates that social anxiety disorder is associated with higher levels of disability and greater reductions in quality of life than previously understood, with difficulties encountered in social relationships, education and employment. In previous years, there has been little or no known available effective treatment, and the disorder frequently goes unrecognized in primary care. However, new pharmacological (selective serotonin reuptake inhibitors, SSRIs) and psychological treatments are emerging that are able to produce significant symptom reduction and improvements in functioning and quality of life. In recent years, the SSRIs have been the focus of considerable research and are becoming one of the first-line treatments for social phobia. Early intervention in social phobia may improve quality of life, reduce disability and reduce the development of comorbid disorders.
Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obs... more Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2004
Many anxiety disorders are not treated to remission (symptom-free state); however, this should be... more Many anxiety disorders are not treated to remission (symptom-free state); however, this should be the minimum goal of therapy. Antidepressant therapies have shown significant beneficial effects in the management of anxiety disorders, with some variability in results in specific disorders. In social anxiety disorder, selective serotonin reuptake inhibitors and venlafaxine extended release (XR) have demonstrated efficacy, with response rates varying between 40% and 68%. Monoamine oxidase inhibitors and cognitive-behavioural therapies are also effective. In patients with generalized anxiety disorder, benzodiazepines, paroxetine, and venlafaxine XR have demonstrated remission rates that are 15% to 25% higher than placebo. In patients with posttraumatic stress disorder, about 60% to 70% of patients experienced a response with antidepressant therapy, compared with about 40% on placebo, while remission rates in one study were 30% with venlafaxine, 24% with sertraline, and 20% with placebo....
Journal of Behavior Therapy and Experimental Psychiatry, 1999
Promising cognitive-behavioral and medication treatments for hypochondriasis are in the early sta... more Promising cognitive-behavioral and medication treatments for hypochondriasis are in the early stages of evaluation. Little is known about the treatment preferences and opinions of individuals seeking help for this problem. In this exploratory study, 23 volunteers from the community with a DSM-IV diagnosis of hypochondriasis were recruited through a newspaper advertisement. Participants were presented with a survey which included balanced descriptions of both a medication and a cognitive-behavioral treatment for intense illness concerns (hypochondriasis). The brief descriptions of the treatments discussed the time commitment required as well as the major advantages and disadvantages of each. Results showed that, relative to medication treatment, cognitive-behavioral treatment was predicted to be more effective in both the short and long terms and was rated as more acceptable. Psychological treatment was indicated as the first choice by 74% of respondents, medication by 4%, and 22% indicated an equal preference. Forty-eight percent of respondents would only accept the psychological treatment.
Although evidence suggests the involvement of the amygdala in generalized social phobia (GSP), fe... more Although evidence suggests the involvement of the amygdala in generalized social phobia (GSP), few studies have examined other neural regions. Clinical, preclinical, and dopamine receptor imaging studies demonstrating altered dopaminergic functioning in GSP suggest an association with striatal dysfunction. This is the first functional magnetic resonance imaging (fMRI) study to use a cognitive task known to involve the striatum to examine the neural correlates of GSP. We examined whether subjects with GSP had differential activation in striatal regions compared with healthy control subjects while engaged in a cognitive task that has been shown to activate striatal regions reliably. Ten adult, unmedicated subjects with a primary DSM-IV diagnosis of GSP and 10 age-, gender-, and education-matched healthy comparison subjects underwent fMRI while performing the implicit sequence learning task. The GSP and healthy comparison subjects did not differ significantly on the behavioral performance of the task. Subjects with GSP, however, had significantly reduced neural activation related to implicit learning compared with healthy comparison subjects in the left caudate head, left inferior parietal lobe, and bilateral insula. These findings support the hypothesis that GSP is associated with striatal dysfunction and further the neurobiological understanding of this complex anxiety disorder.
The Primary Care Companion For CNS Disorders, 2016
This article presents the case that a more rapid, individualized approach to treating major depre... more This article presents the case that a more rapid, individualized approach to treating major depressive disorder (MDD) may increase the likelihood of achieving full symptomatic and functional recovery for individual patients and that studies show it is possible to make earlier decisions about appropriateness of treatment in order to rapidly optimize that treatment. A PubMed search was conducted using terms including major depressive disorder, early improvement, predictor, duration of untreated illness, and function. English-language articles published before September 2015 were included. Additional studies were found within identified research articles and reviews. Thirty antidepressant studies reporting predictor criteria and outcome measures are included in this review. Studies were reviewed to extract definitions of predictors, outcome measures, and results of the predictor analysis. Results were summarized separately for studies reporting effects of early improvement, baseline characteristics, and duration of untreated depression. Shorter duration of the current depressive episode and duration of untreated depression are associated with better symptomatic and functional outcomes in MDD. Early improvement of depressive symptoms predicts positive symptomatic outcomes (response and remission), and early functional improvement predicts an increased likelihood of functional remission. The approach to treatment of depression that exhibits the greatest potential for achieving full symptomatic and functional recovery is early optimized treatment: early diagnosis followed by rapid individualized treatment. Monitoring symptoms and function early in treatment is crucial to ensuring that patients do not remain on ineffective or poorly tolerated treatment, which may delay recovery and heighten the risk of residual functional deficits.
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2004
Many anxiety disorders are not treated to remission (symptom-free state); however, this should be... more Many anxiety disorders are not treated to remission (symptom-free state); however, this should be the minimum goal of therapy. Antidepressant therapies have shown significant beneficial effects in the management of anxiety disorders, with some variability in results in specific disorders. In social anxiety disorder, selective serotonin reuptake inhibitors and venlafaxine extended release (XR) have demonstrated efficacy, with response rates varying between 40% and 68%. Monoamine oxidase inhibitors and cognitive-behavioural therapies are also effective. In patients with generalized anxiety disorder, benzodiazepines, paroxetine, and venlafaxine XR have demonstrated remission rates that are 15% to 25% higher than placebo. In patients with posttraumatic stress disorder, about 60% to 70% of patients experienced a response with antidepressant therapy, compared with about 40% on placebo, while remission rates in one study were 30% with venlafaxine, 24% with sertraline, and 20% with placebo....
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2001
To examine the relation between phobic disorders and alcoholism in a Canadian community sample. D... more To examine the relation between phobic disorders and alcoholism in a Canadian community sample. Data came from the Mental Health Supplement of the Ontario Health Survey. The University of Michigan revision of the Composite International Diagnostic Interview (UM-CIDI) was used to diagnose DSM-III-R psychiatric disorders in 8116 Canadian respondents between ages 15 and 64 years. Since the cross-system agreement (ICD-10 and DSM-III-R or DSM-IV) on the diagnosis of alcohol abuse is much lower than that for alcohol dependence, we also examined a WHO category, "hazardous alcohol use." Logistic regression controlling for age and sex was used to determine odds ratios (ORs) for phobic disorders and alcohol-use diagnoses. Individuals with lifetime alcohol abuse or dependence had two- to threefold increased odds of having a phobic disorder. Simple phobia and social phobia with multiple fears were significantly associated (ORs 1.5 to 2) with hazardous alcohol use (which had a prevalen...
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