Personality disorders and features in social phobia and panic disorder.

The hypothesis that there is a specific relationship between social phobia (SP) and avoidant personality disorder (APD) was investigated. Using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) Personality Disorders, 32 patients with SP and 85 patients with panic disorder (PD) for the presence of personality disorders were screened. Avoidant features were found significantly more often in SP than in PD, although the diagnosis of APD could not be established significantly more often. On the item level, APD Criterion 6 (fears being embarrassed) discriminated the strongest. Social phobics appeared to be more disturbed on Axis II than PD patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopharmacologic treatment of panic, generalized anxiety disorder, and social phobia

The anxiety disorders discussed in this article are common, affecting 5% to 10% of the general population. They may cause significant distress and disability and are often complicated by substance abuse and depression. Fortunately, these disorders can be treated successfully in the majority of patients, with alleviation of the most distressing symptoms and significant improvement in occupational and social functioning. Systematic research studies during the past decade have identified both specific medication-responsive anxiety syndromes and a variety of psychopharmacologic agents effective in their management. Psychopharmacologic treatment, often in combination with cognitive-behavioral therapies, can be tailored for the individual patient based on that patient's specific anxiety syndrome, comorbid disorders, and vulnerability to side effects. Careful monitoring of target symptoms can be used to assess the efficacy of treatment. Future research will help to develop new classes of antianxiety agents for currently treatment-resistant patients, and to investigate further the necessary duration of psychopharmacologic treatment.     

Comorbidity of panic disorder with agoraphobia and specific phobia: relationship with the subtypes of specific phobia

The study objectives were to determine comorbidity rates for various subtypes of specific phobia (SP) in a sample of patients with the principal diagnosis of panic disorder with agoraphobia (PDA) and to examine the possible etiologic relatedness of these SP subtypes to PDA. Ninety consecutive day clinic patients with PDA were administered the Structured Clinical Interview for DSM-III-R (SCID) modified for DSM-IV. The overall comorbidity rate for SP was 65.6%. The most frequent subtypes of SP were situational phobia and dental phobia, followed by natural environment phobia, phobia of funerals, cemeteries, dead bodies, and other death-related phenomena and objects (referred to as death-related phobia), and blood-injection-injury phobia. Except for death-related phobia, other subtypes of SP clearly tended to precede the onset of PDA, often by many years. The smallest difference between the age of onset for PDA and particular subtypes of SP (temporal distance) was found for death-related phobia, whereas the temporal difference was longer for situational phobia, hospital phobia, and blood-injection-injury phobia. The frequency and temporal distance data suggest that death-related phobia may constitute a risk factor for developing PDA or that it is a prodrome of PDA, whereas situational phobia, hospital phobia, and blood-injection-injury phobia appear to predispose to PDA to a lesser degree. Of the three broadly conceived groups of SP, mutilation phobias (which include death-related phobia, hospital phobia, blood-injection-injury phobia, and dental phobia) appear most etiologically relevant for PDA, with the group of situational phobias (which also includes the natural environment subtype of SP) being less relevant, and animal phobias showing a negligible etiologic relatedness to PDA.     

Ambulatory assessment in panic disorder and specific phobia.

Anxiety disorders are among the most prevalent mental disorders. In panic disorder, panic attacks often occur at unpredictable times, making it difficult to study these episodes in the laboratory. In specific phobias, symptoms occur in very circumscribed situations and specific triggers are sometimes difficult to reproduce in the laboratory. Ambulatory assessment, or ecological momentary assessment, can further the understanding of the natural course and scope of symptoms under ecologically valid circumstances. Because bodily symptoms are integral to the diagnosis of anxiety disorders, the objective assessment of physiological responses in the patients’ natural environment is particularly important. On the one hand, research has highlighted intriguing discrepancies between the experience of symptoms and physiology during panic attacks. On the other hand, it has validated symptom reporting during therapeutic exposure to phobic situations. Therefore, ambulatory assessment can yield useful information about the psychopathology of anxiety disorders, and it can be used to monitor change during clinical interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathology of social phobia and comparison to avoidant personality disorder.

Studied the clinical manifestations of social phobia in a diagnosed sample of 21 social phobics (aged 21–53 yrs). Social phobia was found to be a chronic and pervasive condition affecting a variety of life areas and producing significant emotional distress. In a 2nd study, individuals with a diagnosis of social phobia or avoidant personality disorder were compared using a subsample of 10 socially phobic Ss and a sample of 8 Ss with avoidant personality disorder (aged 30–60 yrs). Although physiological reactivity and cognitive content were essentially the same for both groups in a number of situational tasks, those Ss with a diagnosis of avoidant personality disorder were found to be more sensitive interpersonally, and exhibited significantly poorer social skill than did the social phobic Ss. Results are discussed in relation to Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria for social phobia, the significance of social phobia as a clinical syndrome, and the research and treatment implications of the difference found between individuals with a diagnosis of social phobia and those with avoidant personality disorders. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical features in panic disorder with agoraphobia: a comparison of men and women

This study compared 96 women and 58 men suffering from panic disorder with agoraphobia. Participants completed questionnaires assessing various clinical features associated with panic disorder with agoraphobia (PDA), general adjustment, and drug/alcohol use. Results showed that PDA is a more severe condition in women. Women reported more severe agoraphobic avoidance when facing situations or places alone, more catastrophic thoughts, more body sensations, and higher scores on the Fear Survey Schedule. Also, women more often had a comorbid social phobia or posttraumatic stress disorder. The lower agoraphobic avoidance of men was associated with their alcohol use. However, there were no differences between genders in other dimensions, including depression, situational and trait anxiety, stressful life events, social self-esteem, marital adjustment, and drug use.     

Sleep Deprivation in social phobia and generalized anxiety disorder

BACKGROUND: Sleep deprivation has been shown to improve depressive symptoms in some patients with major depressive disorder, but it has not been tested in patients with generalized anxiety disorder (GAD) or social phobia (SP). METHODS: To determine if sleep deprivation altered anxiety or depressive symptoms in patients with GAD (n = 7) or SP (n = 8), we sleep deprived patients and normal controls (n = 18) for one night. RESULTS: On one measure of anxiety, GAD patients improved compared with controls, but there were otherwise no significant change differences between controls and SP or GAD patients. CONCLUSIONS: The lack of benefit is consistent with previous findings that sleep deprivation provides no benefit to patients with other anxiety disorders. Sleep deprivation may be a biological intervention that distinguishes anxiety from affective disorders.     

Reduced benzodiazepine sensitivity in patients with panic disorder: comparison with patients with obsessive-compulsive disorder and normal subjects

OBJECTIVE: The authors sought to replicate their previous finding of reduced response to diazepam in patients with panic disorder, to test whether this effect was specific for panic disorder, and to determine whether this reduced response was merely an artifact of resistance to sedation from anxiety-related overarousal. METHOD: The effects of four increasing intravenous doses of diazepam on saccadic eye movement velocity and accuracy (the latter being a saccadic variable that is unaffected by sedation), short-term memory, and self- and observer-rated sedation were assessed in 18 patients with panic disorder, 15 patients with obsessive-compulsive disorder, and 14 normal comparison subjects. The ratios of effect to blood level areas under the curve for both ascending and descending limbs of the effect/blood level curves were compared for each variable. RESULTS: Patients with panic disorder showed significantly less diazepam effect on saccadic velocity and accuracy for the ascending limb of the blood level curve than comparison subjects. Patients with obsessive-compulsive disorder showed similar differences from comparison subjects but only for saccadic velocity. There were no group differences in diazepam effects on memory and sedation. CONCLUSIONS: Patients with panic disorder are less sensitive than comparison subjects to diazepam. Although this difference is not an artifact of resistance to sedation, it may not be specific for panic disorder but rather may reflect a more nonspecific aspect of anxiety disorders.     

Effects of the 5-HT3 antagonist, ondansetron, on the behavioral and physiological effects of pentagastrin in patients with panic disorder and social phobia

Pentagastrin, a cholecystokinin (CCK) agonist, produces anxiety and panic in patients with panic disorder and social phobia. Preclinical data suggests that pentagastrin-induced anxiogenesis may be mediated via 5-HT3 receptors. In the present study, 14 patients with panic disorder or social phobia underwent pharmacological challenge in three conditions: (1) pretreatment with saline followed by pentagastrin infusion; (2) pretreatment with ondansetron followed by pentagastrin infusion; and (3) pretreatment with saline followed by saline infusion. As expected, pentagastrin administration led to increased anxiety, physical symptoms of panic attacks, pulse, plasma adrenocorticotropic hormone (ACTH), and cortisol. Pentagastrin's behavioral effects were not blocked by ondansetron, and in fact, tended to be exaggerated. Ondansetron pretreatment did not alter the pentagastrin-induced cortisol increase but significantly prolonged the pentagastrin-induced increase in ACTH. These findings suggest that pentagastrin's behavioral effects are not mediated by 5HT3 receptors. Mechanisms by which peripherally administered CCK agonists lead to anxiety remain to be elucidated.     

Avoidant personality disorder and the generalized subtype of social phobia.

Social phobia and avoidant personality disorder (APD) may be given as comorbid diagnoses. However, it is not known if the labels provide independent, useful diagnostic information. The authors classified social phobics by social phobia subtype and presence of APD. Generalized social phobics with and without APD (ns?=?10 and 10) and nongeneralized social phobics without APD (n?=?10) were distinguished on measures of phobic severity. The generalized groups also showed earlier age at onset and higher scores on measures of depression, fear of negative evaluation, and social anxiety and avoidance than did the nongeneralized group. APD criteria of general timidity and risk aversion were more frequently endorsed by social phobics with AD. The data suggest that both the generalized subtype of social phobia and the presence of APD do provide useful diagnostic information, but the additional diagnosis of APD may simply identify a severe subgroup of social phobics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social phobia: a preliminary cross-national comparison

A simple protocol for the growth and differentiation of adult Mongolian gerbil epidermal cells is reported. Insulin (8 micrograms/ml) and reduced levels of serum supplementation (2%) were sufficient for the maintenance of these cells in culture. Primary cultures were maintained as a proliferative monolayer in a medium with low calcium concentration (< 0.3 mM). Terminal differentiation of cultures was induced by raising the calcium concentration (1.6 mM) in the medium. These results support the concept derived from mouse epidermal cell culture that calcium is an important regulator of mammalian epidermal cell growth and differentiation. The present protocol also represents a useful tool for studies of mechanisms involved in epidermal cell growth and differentiation in a laboratory animal.     

A comparison of social phobia outcome measures in cognitive-behavioral group therapy

Avirulence (Avr) genes exist in many fungi that share a gene-for-gene relationship with their host plant. They represent unique genetic determinants that prevent fungi from causing disease on plants that possess matching resistance (R) genes. Interaction between elicitors (primary or secondary products of Avr genes) and host receptors in resistant plants causes induction of various defense responses often involving a hypersensitive response. Avr genes have been successfully isolated by reverse genetics and positional cloning. Five cultivar-specific Avr genes (Avr4, Avr9, and Ecp2 from Cladosporium fulvum; nip1 from Rhynchosporium secalis; and Avr2-YAMO from Magnaporthe grisea) and three species-specific Avr genes (PWL1 and PWL2 from M. grisea and inf1 from Phytophthora infestans) have been cloned. Isolation of additional Avr genes from these fungi, but also from other fungi such as Uromyces vignae, Melampsora lini, Phytophthora sojae, and Leptosphaeria maculans, is in progress. Molecular analyses of nonfunctional Avr gene alleles show that these originate from deletions or mutations in the open reading frame or the promoter sequence of an Avr gene. Although intrinsic biological functions of most Avr gene products are still unknown, recent studies have shown that two Avr genes, nip1 and Ecp2, encode products that are important pathogenicity factors. All fungal Avr genes cloned so far have been demonstrated or predicted to encode extracellular proteins. Current studies focus on unraveling the mechanisms of perception of avirulence factors by plant receptors. The exploitation of Avr genes and the matching R genes in engineered resistance is also discussed.     

Measurement of panic disorder by a modified panic diary

The psychometric characteristics of panic diary measures were investigated in a sample of 37 patients suffering from panic disorder with agoraphobia. Following recommendations made in the recent consensus development conference on the assessment of panic disorder, daily ratings included not only the occurrence of panic attacks but also fear of panic, expectancy of panic, and expected aversiveness of panic. These new measures were reliable and, on the whole, demonstrated good divergent and convergent validity. Further, adding such measures increased the incremental validity of panic disorder assessment.     

Social phobia: A comparison of specific and generalized subtypes and avoidant personality disorder.

The validity of the social phobia subtype distinction was examined in a large sample of carefully diagnosed social phobics (N?=?89). Generalized and specific subtypes were diagnosed reliably, and the generalized subtype showed a consistent pattern of greater symptom severity than did the specific subtype. In addition, generalized social phobics with and without avoidant personality disorder were compared, and a difference was found for only 1 of 4 parameters. The results are discussed in terms of the validity of subtyping in social phobia and the diagnostic boundary between social phobia and avoidant personality disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of panic disorder with agoraphobia: comparison of fluvoxamine, placebo, and psychological panic management combined with exposure and of exposure in vivo alone

OBJECTIVE: The purpose of this comparative outcome study was to investigate whether the effects of exposure in vivo treatment for panic disorder with agoraphobia could be enhanced by adding interventions specifically for panic attacks before the start of exposure treatment. The additional effect of two types of treatment for panic attacks--pharmacological (fluvoxamine) and psychological (repeated hyperventilation provocations and respiratory training)--was examined. Thus, the combined treatment of panic interventions with exposure in vivo could be compared to exposure in vivo alone. METHOD: Ninety-six patients were randomly assigned to four treatment conditions: double-blind, placebo-controlled fluvoxamine followed by exposure in vivo, psychological panic management followed by exposure, and exposure in vivo alone. Outcome was assessed by self-report measures, a standardized multitask behavioral avoidance test, and continuous monitoring of panic attacks. Seventy-six patients completed the study. RESULTS: All four treatments were effective and resulted in a significant decrease of agoraphobic avoidance. Moreover, the combination of fluvoxamine and exposure in vivo demonstrated efficacy superior to that of the other treatments and had twice as large an effect size (difference between pre- and posttreatment scores) on self-reported agoraphobic avoidance. The other treatments did not differ among each other in effectiveness. CONCLUSIONS: Results of the study indicate that the short-term outcome of exposure in vivo treatment can be enhanced by adding fluvoxamine treatment. Psychological panic management combined with exposure was not superior to exposure alone of equal duration.     

Generalized social phobia versus avoidant personality disorder: A commentary on three studies.

The findings of J. D. Herbert et al (see record 1992-27377-001), C. S. Holt et al (see record 1992-27380-001), and S. M. Turner et al (see record 1992-27401-001) are largely consistent. Avoidant personality disorder and generalized social phobia appear to be overlapping constructs that have only minor differences with respect to severity of dysfunction. This commentary addresses the implications of the findings with respect to the validity of the categorical distinction in the Diagnostic and Statistical Manual of Mental Disorders-III—Revised (DSM-III—R) between avoidant personality and generalized social phobia, revisions of their respective diagnostic criteria, and their reclassification as either an anxiety or a personality disorder. Methodological and substantive suggestions for future research are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing reliable and clinically significant change in social phobia: validity of the social phobia and anxiety inventory

The ability of the Social Phobia and Anxiety Inventory (SPAI) to measure change as a function of treatment for social phobia was assessed. In addition to determining treatment sensitivity of the SPAI, changes over the course of treatment were examined to determine if they were reliable and clinically significant. The results indicated that although a number of measures showed statistically significant change, only on the SPAI was that change reliable and clinically significant. The use of outcome measures that are reliable and clinically significant for social phobia as well as other disorders is discussed.     

Case study: Treatment of herpes genitalis phobia and agoraphobia with panic attacks.

A 25-yr-old woman with incapacitating hypochondriasis (disease phobia and conviction of being infected with herpes genitalis) for 4 yrs and agoraphobia with panic attacks for 2 yrs was well after 6 mo of treatment and at 14-mo follow-up. Agoraphobia was treated with a combination of desensitization in imagery, aided by relaxation training using electromyogram (EMG) and skin temperature biofeedback, followed by exposure in vivo. Hypochondriasis was treated by psychotherapeutic techniques and presentation of medical facts. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of focused and standard cognitive therapy for panic disorder

A set of measures assessing abilities related to legal standards for competence in the adjudicative process were administered to mentally-disordered criminal defendants with diagnoses of schizophrenia, affective disorder, other psychiatric disorders, and to criminal defendants without diagnosed mental disorder. Mentally-disordered defendants were recruited from two groups: those who had been committed for restoration of competence and those who had been identified by jail personnel as mentally ill. Significant impairments in competence-related abilities were found for approximately half of the defendants with schizophrenia. Defendants with schizophrenia scored lower on measures of understanding, reasoning, and appreciation related to the adjudication process. The association between symptoms and competence-related abilities was explored within diagnostic groups. Conceptual disorganization was found to be inversely correlated with performance on all measures in both defendants with schizophrenia and those with affective disorders. For other psychotic symptoms, differing patterns of correlations were found in the two major diagnostic groups. The implications for policy designed to safeguard the rights of defendants to be tried while competent are discussed.     

Validity of the distinction between generalized social phobia and avoidant personality disorder.

Disorders of pervasive social anxiety and inhibition are divided into 2 categories: generalized social phobia (GSP) and avoidant personality disorder (APD). The authors explored the discriminative validity of this categorization by examining the comorbidity of GSP and APD and by comparing these groups on anxiety level, social skills, dysfunctional cognitions, impairment in functioning, and presence of concurrent disorders. Results from 23 Ss showed high comorbidity of the 2 diagnoses: All Ss who met criteria for APD also met criteria for GSP. APD was associated with greater social anxiety, impairment in functioning, and comorbidity with other psychopathology, but no differences in social skills or performance on an impromptu speech. GSP and APD seem to represent quantitatively different variants of the same spectrum of psychopathology rather than qualitatively distinct disorders. The authors also investigated a proposed social phobia subtyping scheme. (PsycINFO Database Record (c) 2010 APA, all rights reserved)