Psychotherapy in the overall management strategy for social anxiety disorder.

Cognitive-behavioral therapies (CBTs) are effective treatments for social anxiety disorder/social phobia. Although a variety of procedures are included under the term cognitive-behavioral treatment, it is, however, clear that the key factor influencing treatment outcome for social anxiety disorder is exposure to feared situations. Two formalized CBT programs are cognitive-behavioral group therapy (CBGT) and social effectiveness training (SET).

Efficient allocation of patients to treatment cells in clinical trials with more than two treatment conditions.

Objective: Clinical trials generally allocate patients to equal-sized treatment groups. The authors propose that it may be more efficient to allocate unequal proportions of the total sample size to treatments when more than two treatments are being compared.

Method: This proposal is illustrated with two examples.

Effects of panic disorder treatments on personality disorder characteristics.

Ninety-three patients with panic disorder and mild or no agoraphobia were treated for their panic disorder by using either 11 sessions of individual cognitive-behavior therapy or imipramine. Before and after treatment, their panic disorder symptomatology was assessed, and a self-report measure was administered to measure personality disorder characteristics [Klein et al., 1990: Wisconsin Personality Disorders Inventory].

Psychiatric disorders and gynecological oncology: a review of the literature.

It is likely that patients with gynecological cancers are at risk for psychiatric disorders such as major depression and anxiety disorders. However, relatively little attention has been focused on studying these women. We review here papers that report rates and treatment of psychiatric illness in women with gynecological cancer.

Consensus statement on panic disorder from the International Consensus Group on Depression and Anxiety.

Objective: To provide primary care clinicians with a better understanding of management issues in panic disorder and guide clinical practice with recommendations for appropriate pharmacotherapy.

Participants: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R.

The road to recovery in panic disorder: response, remission, and relapse.

A standard set of definitions and criteria for the terms commonly used in panic disorder research is required to aid clinicians in their management of patients with panic disorder. Furthermore, the use of a simple, psychometrically sound assessment procedure such as the Panic Disorder Severity Scale, which considers all of the essential domains of panic disorder, will provide clinicians with an appropriate instrument for diagnosing and monitoring patients. The use of this more comprehensive scale for monitoring patients should alert clinicians to the reemergence of associated symptoms of panic disorder and allow for the rapid modification of treatment.

Morbidity of homebound versus inpatient elderly psychiatric patients.

This study compares the demographic and clinical characteristics of homebound (HB) elders referred for psychiatric services (N = 251) with those of inpatients (IP) admitted to a geriatric psychiatry unit (N = 594). Demographically, HB patients were older (78.8 vs 74.

A post hoc comparison of paroxetine and nortriptyline for symptoms of traumatic grief.

Background: This report presents the results of an open-trial pilot study of paroxetine for symptoms of traumatic grief, compared with the effects of nortriptyline in an archival contrast group.

Method: Data are presented on 15 subjects (4 men, 11 women), ranging in age from 40 to 79 years (mean age = 57 years), who experienced the loss of a spouse (N = 8), child (N =5), grandchild (N = 1), or parent (N = 1). Subjects were required to have a baseline score on the Inventory of Complicated Grief (ICG) of > or = 20.

Phenomenology and treatment of bereavement-related distress in the elderly.

While brief periods of bereavement-related distress should be neither pathologized nor treated, periods of distress lasting several months that meet criteria for major depressive episode and, in particular, for what we now refer to as traumatic grief reactions, are strongly associated with considerable psychiatric and physical morbidity and deserve careful clinical attention. Our current efforts at treatment development for traumatic grief come directly from treatment for Post-Traumatic Stress Disorder. We conceptualize this as a nine-session intervention with an emphasis on reliving the moment of the death, saying goodbye to the deceased, and in vivo exposure to situations that the subject has come to avoid since the death.

Pretreatment attrition in a comparative treatment outcome study on panic disorder.

Objective: Whereas the fact of attrition during the course of treatment is well documented, little is known about the factors that affect sample selection before the beginning of a study ("pretreatment attrition"). The present study reports on the degree and sources of pretreatment attrition at two sites of a multicenter study on panic disorder that compared treatment outcomes for imipramine and cognitive behavior therapy.

Method: Data were collected at two clinical research sites, one with a pharmacological treatment orientation (N = 420) and one with a psychosocial treatment orientation (N = 208).

Self-reported anxiety, general medical conditions, and disability bed days.

Objective: This study examined the effect of self-reported anxiety on the number of days persons with various general medical conditions spend in bed owing to disability.

Method: Self-reported medical illness and disability data from a nationally representative household survey sample (N = 20,884) were analyzed.

Results: Among respondents with general medical conditions, those with self-reported anxiety had a nearly fourfold greater length of disability (mean = 18.

Multicenter collaborative panic disorder severity scale.

Objective: To address the lack of a simple and standardized instrument to assess overall panic disorder severity, the authors developed a scale for the measurement of panic disorder severity.

Method: Ten independent evaluators used the seven-item Panic Disorder Severity Scale to assess 186 patients with principal DSM-III-R diagnoses of panic disorder (with no or mild agoraphobia) who were participating in the Multicenter Collaborative Treatment Study of Panic Disorder. In addition, 89 of these patients were reevaluated with the same scale after short-term treatment.

Generalized covariance-adjusted discriminants: perspective and application.

When discriminant analysis is used in practice for assessing the usefulness of diagnostic markers, the lack of control over covariates motivates the need for their adjustment in the analysis. This necessity for adjustment arises especially when the researcher's aim is classification based on a set of diagnostic markers and is not based on a set of covariates for which there exists known heterogeneity among the subjects with respect to the groups under consideration. The traditional covariance-adjusted approach is restrictive for such applications in that they assume linear covariates and a normal distribution for the the feature vector.

The panic-agoraphobic spectrum: a descriptive approach to the assessment and treatment of subtle symptoms.

Objective: Psychiatric classification is still a topic of considerable discussion and debate in spite of major advances in the past two decades. The debate involves categorical versus dimensional approaches, cutoff numbers of symptoms to define a case, degree of impairment, objective diagnostic criteria versus more theoretically based criteria, episodic versus trait-like symptoms, and the role of atypical and subclinical symptoms. All of these issues have been raised for the anxiety disorders and depression.

Traumatic grief as a risk factor for mental and physical morbidity.

Objective: The aim of this study was to confirm and extend the authors' previous work indicating that symptoms of traumatic grief are predictors of future physical and mental health outcomes.

Method: The study group consisted of 150 future widows and widowers interviewed at the time of their spouse's hospital admission and at 6-week and 6-, 13-, and 25- month follow-ups. Traumatic grief was measured with a modified version of the Grief Measurement Scale.

Anxiety disorders in primary care: a life-span perspective.

From a family-oriented life-span perspective, the authors highlight issues involved in recognition, assessment, and treatment of anxiety disorders. After reviewing prevalence rates for these disorders in child, adult, and geriatric groups, they discuss cross-generational transmission of illness and identify cross-cutting themes, such as comorbidity of anxiety and depression, relationship between anxiety disorders and quality of life, and links among disability, adversity, and anxiety. They also discuss issues specific to childbearing, motherhood, and bereavement, and conclude with a brief summary of treatment approaches.

Anxiety disorders in women: gender-related modulation of neurobiology and behavior.

The study of psychobiology of gender is in its infancy, but already there are emerging findings of interest to clinicians and researchers in the area of anxiety disorders. There is much work yet to be done, but findings provide initial support for hypotheses that ovarian and other gonadal and maternal hormones play important regulatory roles in determining behavior as well as neurotransmitter function in women. These regulatory effects clearly involve areas known to be important in the onset and maintenance of anxiety symptoms and anxiety disorders.

Systematic assessment of social phobia in clinical practice.

The purpose of this review is to propose a systematic approach to the assessment of social phobia for monitoring treatment outcome in clinical settings. A selection of measures is available, including questionnaires and structured interviews varying in length, complexity, and content. To design an assessment protocol for a particular patient or patient population, the clinician needs to be familiar with the characteristics of these available measures.

Psychotherapy for panic disorder.

Although medications and panic-focused cognitive behavior therapy are considered standard treatments for panic disorder, other types of psychotherapy may also be helpful. Many patients with panic disorder have some residual underlying vulnerability, as suggested by the continued occurrence of symptoms. These patients may benefit from a more broad-based psychotherapy, as might those in whom comorbid symptoms occur.

Age standardized incidence rates of oral cancer in South Africa, 1988-1991.

While numbers of papers on oral cancer in South Africa have been published, there have been very few studies on standardized morbidity rates. This paper has developed data collected by the National Cancer Registry from the entire country for the four year period 1988-1991 to present frequency, age standardized incidence rates (ASIRs) and life-time risk (LR) for histologically-diagnosed intra-oral cancers in female and male Asian, black, coloured and white South Africans. During this period 5396 cases of oral cancer were diagnosed in a total number of 157,307 cancer cases (3.

Complicated grief as a disorder distinct from bereavement-related depression and anxiety: a replication study.

Objective: This study sought to confirm in an independent, nonclinical study group previous work which demonstrated that the symptoms of complicated grief were distinct from the symptoms of bereavement related depression and anxiety.

Method: Data used in the analyses were derived from a group of 150 widowed individuals who were interviewed 6 months after their deceased spouses' hospital admission (study entry). Complicated grief was measured with a modified version of the Grief Measurement Scale.

High relapse rate after discontinuation of adjunctive medication for elderly patients with recurrent major depression.

Objective: The authors documented outcomes of elderly depressed patients requiring adjunctive medication during acute-phase pharmacotherapy because of slow or partial response to nortriptyline. Twenty-eight patients (17.7%) received inpatient care at some point during acute-phase treatment.