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Biomedical subjects

B J Cox

Publications and source records attributed to B J Cox.

At least 73 records · Page 4Linked to original sources
PubMed1993

Anxiety sensitivity and response to cholecystokinin tetrapeptide in healthy volunteers.

The authors determined whether fear of anxiety symptoms mediates panicogenic responses to cholecystokinin tetrapeptide (CCK-4) in healthy subjects. Individuals with a preexisting high level of anxiety sensitivity (N = 10) experienced significantly more catastrophic cognitions and fear of somatic symptoms than did subjects with low (N = 9) or medium (N = 17) anxiety sensitivity, but they were not more susceptible to experiencing a panic attack. Thus, cognitive factors do not appear to be critical determinants of CCK-4-induced panic attacks.

Adolescent↗
PubMed1993

The symptom structure of panic attacks in depressed and anxious patients.

This study examined the panic symptom profiles of three diagnostic groups: those with panic disorder and no history of major depression; those with panic disorder with a history of major depressive episode but no current depression; and those current major depression with panic disorder. Patients were compared on the frequency of specific panic attack symptoms based on structured interview responses. The symptom profiles of all three groups were significantly correlated. The patients with past and current depressive episodes had the most similar symptom structure.

Adult↗
PubMed1992

Use of medical services and treatment for panic disorder with agoraphobia and for social phobia.

OBJECTIVE: To examine the medical services and treatment for anxiety disorders reported by patients who had either panic disorder with agoraphobia or else social phobia. DESIGN: Archival research of consecutive records of psychiatric interviews conducted between January 1990 and December 1991. The records were examined by a trained research assistant who had had no contact with the patients. PATIENTS: One hundred patients who had panic disorder with agoraphobia and twenty-eight patients who had social phobia. SETTING: An anxiety disorders clinic in a university-affiliated psychiatric institute. OUTCOME MEASURES: Variables related to the use of medical services included history of hospitalization, emergency department visits and referrals to specialists. Variables related to treatment included types of medication received, whether behaviour therapy was received and types of health care professionals seen. RESULTS: Almost 30% of the patients with panic disorder and more than 20% of those with social phobia had a history of a major depressive episode at some time in their lives; 30% and 25% respectively had a current nonpsychiatric medical diagnosis. In the past year nearly one-third of both patient groups had seen three or more different health care professionals and almost one-fifth of those with panic disorder had gone to a general hospital emergency department. Of the patients with panic disorder 9% had previously been assessed by a cardiologist and 17% by a neurologist. At least two-thirds of each group had received benzodiazepines, often for use as needed. Although most of the patients in both groups had been seen by mental health professionals such as psychiatrists, few had received optimal treatment. Of those with panic disorder, only 15% had received the tricyclic antidepressant imipramine, 13% alprazolam and 11% cognitive-behavioural therapy. Only 4% of the patients with social phobia had received cognitive-behavioural therapy. CONCLUSIONS: Both groups of patients, and particularly those with panic disorder, are frequent users of medical services. Although most have had contact with mental health professionals, few have received appropriate treatment. Benzodiazepines appear to be overprescribed, whereas forms of treatment that have been shown to reduce the use of medical services, such as cognitive-behavioural therapy, are infrequently given.

Adult↗
PubMed1992

A meta-analysis of treatments for panic disorder with agoraphobia: imipramine, alprazolam, and in vivo exposure.

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.

Agoraphobia↗
PubMed1992

Medication use and the assessment of agoraphobic avoidance.

Many anxiety disorder patients who present for behaviour therapy are already taking anxiolytic medications. The present study added a new subscale to the Mobility Inventory labelled 'Without Medication' to assess possible reliance on medication for coping with phobic situations. 121 Patients with panic-related disorders were administered the scale. The results supported the reliability and validity of the existing Mobility Inventory subscales in general and of the new subscale in particular. It appears to reliably assess a clinically important domain that is not measured in traditional self-report measures of phobic avoidance.

Adult↗
PubMed1992

Situations and specific coping strategies associated with clinical and nonclinical panic attacks.

The present paper reports the results of further comparisons between clinical and nonclinical panickers. Both panic disorder patients and nonclinical panickers reported a variety of situational contexts associated with panic attacks, and differed markedly in their attempts to cope with panic. Nonclinical panickers tended to use more 'positive' coping strategies in response to panic. Conversely, one of the most commonly used and subjectively effective coping strategies reported by panic disorder patients was to escape the situation.

Adaptation, Psychological↗
PubMed1992

Diagnostic specificity of the dependent and self-critical personality dimensions in major depression.

Validational studies of self-critical and dependent personality dimensions as vulnerability factors for depression have been tested primarily with depressed samples, employing research designs devised to address state vs. trait and trait-situational congruity issues. In this study we examined the diagnostic specificity to depression of these two personality dimensions, comparing Self-Criticism and Dependency scores as measured by the Depressive Experiences Questionnaire (DEQ) in two samples of outpatients: (1) panic disorder with agoraphobia; and (2) non-psychotic, unipolar major depression. As hypothesized, the two groups differed on Self-Criticism, with the depressed group scoring higher, but no differences were found for Dependency. These findings were similar even when depressed mood was partialed out. These results complement a growing body of research associating Self-Criticism, as specifically measured by the DEQ, with depression.

Adult↗
PubMed1992

Self-reports of depression and state-trait anxiety: evidence for differential assessment.

Several researchers have found anxiety and depression to be indistinguishable in nonclinical samples and have suggested that both constructs may be components of a general psychological distress process. Another possibility is that overlap is due to the psychometric limitations of scales used. A series of exploratory factor analyses were conducted in a nonclinical sample (N = 605) using the Beck Depression Inventory (BDI; Beck, 1978), the State-Trait Anxiety Inventory (STAI; Spielberger, 1983), and the Endler Multidimensional Anxiety Scales (EMAS; Endler, Edwards, & Vitelli, 1991). Both state and trait anxiety and depression could be differentiated with the BDI and the EMAS but not with the STAI. Some theoretical models of negative affectivity or general psychopathology may be premature.

Adult↗
PubMed1992

Symptoms of PTSD in 124 survivors of the Holocaust.

OBJECTIVE: Survivors of the Holocaust are expected to be at risk for posttraumatic stress disorder (PTSD), but few empirical data are available. This study investigated PTSD symptoms in Holocaust survivors with well-documented exposure to trauma. METHOD: The German files of 124 Jewish Holocaust survivors who were judged to be free from bipolar affective disorder, obsessive-compulsive disorder, and organic brain syndrome were selected from those of 145 applicants to West German compensation boards. The psychiatric assessments were reexamined for explicit descriptions of current PTSD symptoms according to the DSM-III-R diagnostic criteria. A subgroup of 20 Auschwitz survivors with tattooed identification numbers were also compared with the 45 survivors who had not been in concentration camps. RESULTS: Sixty-three percent of the total sample had been detained in concentration camps, and an average of 78% of their first-degree relatives were reported killed in the Holocaust. Forty-six percent of the total sample met the DSM-III-R criteria for PTSD. The most common symptoms were sleep disturbance, recurrent nightmares, and intense distress over reminders. The tattooed Auschwitz survivors had significantly more symptoms and were three times more likely to meet diagnostic criteria for PTSD than the survivors who had not been in concentration camps. CONCLUSIONS: The results suggest a greater risk of chronic PTSD in survivors who were exposed to atrocities. Most survivors had not received adequate psychiatric care.

Adult↗
PubMed1992

Brief treatment of emergency room patients with panic attacks.

OBJECTIVE: Most research on treatment for panic disorder has involved chronic forms of the illness. To determine the efficacy of early intervention, the authors examined the effects of treatment for patients with panic attacks who were seen in the emergency room, which is the first point of contact with the health delivery system for many persons with panic attacks. METHOD: The subjects were 33 patients with panic attacks seen in two emergency rooms. The presence of panic attacks was confirmed with a modified version of the Structured Clinical Interview for DSM-III-R; approximately 40% of the patients met the DSM-III-R criteria for panic disorder with agoraphobia. The patients were randomly assigned to groups receiving reassurance (N = 16) or exposure instruction (N = 17). Scores on the Fear Questionnaire agoraphobia subscale, Mobility Inventory, and Beck Depression Inventory and the frequency of panic attacks were determined at baseline, 3 months, and 6 months. RESULTS: The subjects who received exposure instruction significantly improved over the 6-month period on depression, avoidance, and panic frequency. The reassurance subjects did not improve on any measure and eventually reported more agoraphobic avoidance. CONCLUSIONS: These results suggest that early intervention with exposure instruction may reduce the long-term consequences of panic attacks. The exposure instruction was of value even though the subjects had relatively low levels of avoidance at the outset of the study.

Adult↗
PubMed1992

A survey of anxiety disorders clinics in Canadian hospitals.

A questionnaire on anxiety disorder services was sent to 240 Canadian hospitals, of which 117 responded. Eighteen of the responding hospitals had anxiety disorder clinics and saw an average of 208 patients a year. These clinics appear to be scarce although, according to epidemiological studies, there is a high prevalence of anxiety disorders in the community. The specific diagnoses of the patients seen in the specialty clinics and the treatments offered generally followed international patterns.

Agoraphobia↗
PubMed1991

Chronic pain in panic disorder.

Studies indicate that panic disorder is often associated with high levels of somatic preoccupation, but the nature of these somatic complaints have not been investigated in detail. One hundred and forty-one consecutive panic disorder patients were administered a pain questionnaire and pain location diagram. Almost 40% of the patients reported chronic pain and 7.8% reported using analgesics daily. The most common locations of pain were the head, shoulders, and lower back. When compared with panic disorder patients with no reports of pain, these patients scored significantly higher on several measures of psychopathology. Panic patients with chronic pain may have more functional illness behaviors that require specific treatment considerations and may represent a subset of panic disorder that is particularly at risk for somatization, hypochondriasis, and excessive health care utilization.

Adult↗
PubMed1991

Anticipatory anxiety and avoidance in panic disorder with agoraphobia.

The present study utilized the responses of 34 patients with panic disorder with agoraphobia to investigate the occurrence and anticipation of panic attacks in relation to the avoidance of specific situations from the Fear Questionnaire [Marks & Mathews (1979) Behaviour Research and Therapy, 17, 263-267]. Results indicated that self-reports of avoidance of specific situations were often significantly correlated with the anticipation of panic but rarely with the occurrence of panic. The occurrence and anticipation of panic were also frequently associated with social phobic situations in addition to agoraphobic situations.

Adult↗