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Biomedical subjects

J H Greist

Publications and source records attributed to J H Greist.

At least 55 records · Page 3Linked to original sources
PubMed1995

The diagnosis of social phobia.

Humans are social animals attuned to reactions of others; however, some are exquisitely sensitive to--and often misperceive--perceptions of those they encounter. The core feature of social phobia is marked and persistent fear of embarrassment or humiliation in social situations where the individual worries that others may judge his or her performance as too much or too little. Anticipatory anxiety and avoidance occur when the individual is under scrutiny while speaking or performing publicly, eating with others, writing in public, or using public bathrooms. Diagnosis of social phobia is based largely on history obtained from the patient. Onset is usually around puberty; its course is chronic with comorbid depression common and alcohol and other substances routinely abused in misguided attempts to minimize anxiety and depressive symptoms. At examination, patients often have a moist hand, averted gaze, blushing, and other manifest signs of anxiety. Slight shyness is familiar to most, but a substantial number suffer dysfunctional and distressing social anxiety to the point that they become phobic. A few patients satisfy criteria for avoidant personality disorder, which can be socially incapacitating.

Adolescent↗
PubMed1994

Is baseline agitation a relative contraindication for a selective serotonin reuptake inhibitor: a comparative trial of fluoxetine versus imipramine.

A common presentation for major depression includes psychomotor agitation. However, this subtype has been the infrequent subject of controlled investigation during depression trials. Yet, the subcategorization of agitated depression has historically been associated with the belief that older, sedating compounds have a superior risk:benefit profile. In the 8-week, double-blind, randomized, parallel trial, 124 subjects with Research Diagnostic Criteria-compatible agitated depression were randomized to either imipramine (IMI) or fluoxetine (FLU). Both compounds proved to be similarly effective as measured by change in HAM-D17, HAM-D17 response, and HAM-D17 remission rates. Similar comparability was seen in secondary measures of agitation, anxiety, suicidality, and global impressions. However, of note, a statistically significant difference in early discontinuations because of intolerable adverse events emerged. Whereas 43.5% of IMI subjects discontinued early, only 9.7% of FLU subjects (p < 0.001) did. Significantly more central nervous system events characterized the IMI than the FLU subgroup (IMI, 24.2%, vs. FLU, 6.5%; p = 0.006). In conclusion, among subjects with major depression, subtype agitated, the risk:benefit profile favored FLU over IMI. This was driven by the superior tolerance of FLU. No evidence emerged in support of the clinical hypothesis that a "sedating" agent is the treatment of choice for this group. The results are important when striving to maximize compliance with pharmacotherapy in order to minimize recidivism and associated psychological and economic morbidity.

Adolescent↗
PubMed1994

Behavior therapy for obsessive compulsive disorder.

Exposure in vivo and ritual or response prevention are the essential elements of behavior therapy for obsessive compulsive disorder. Naturalistic behavior therapy helped a fortunate few before the effective elements of behavior therapy were identified and systematically applied. Homework exposure and response prevention are essential and therapist accompaniment is seldom necessary. Homework sessions are planned by patient and clinician and written records facilitate treatment modifications during homework sessions. About a quarter of patients refuse behavior therapy, but 90% of the remainder achieve worthwhile gains with exposure and response prevention. Limited availability of behavior therapy is a substantial public health problem.

Behavior Therapy↗
PubMed1994

Adinazolam sustained-release treatment of panic disorder: a double-blind study.

Two hundred six outpatients with panic disorder and agoraphobia were randomly assigned to receive 4 weeks of treatment with placebo or sustained-release adinazolam under double-blind conditions. Eighty-eight percent of patients receiving drug and 85% of patients receiving placebo remained in the study at week 4. This report describes the "intent-to-treat" analysis of 202 patients who made at least one follow-up visit after randomization at baseline. On the basis of the Clinical Global Impressions-Improvement Scale, 69.7% of the adinazolam-treated patients were much or very much improved compared with 39.6% of the placebo-treated patients at week 4 or end-point (p = 0.0001). At week 4, panic attacks were completely blocked in 57.1% of adinazolam-treated patients and in 39.2% of the placebo-treated patients (p = 0.009). Adinazolam sustained-release treatment was statistically more effective than placebo treatment on measures of global improvement, number of panic attacks, SCL-90 phobia severity, main phobia severity, and anticipatory and general anxiety. No drug-placebo differences were found for overall self-rated phobia severity, unexpected or situational panic attacks, or for work, family, or social disability.

Adult↗
PubMed1994

Relationship between concentrations of adinazolam and its primary metabolite in plasma and therapeutic/untoward effects in the treatment of panic disorder.

Adinazolam mesylate, a triazolobenzodiazepine with antidepressant and anxiolytic activity, has been shown in several studies to treat panic disorder effectively. This report presents the results of analysis of concentrations in plasma of adinazolam and its primary metabolite, N-desmethyladinazolam (NDMAD), determined as a part of a flexible-dose, double-blind study of the efficacy of adinazolam mesylate sustained release tablets in the treatment of panic disorder with agoraphobia. Dosages administered in the study were titrated from 30 mg/day up to a maximum of 120 mg/day. Concentrations in plasma were determined by high-performance liquid chromatography at clinical evaluations at the end of treatment weeks 1, 2, and 4. The concentrations of both compounds were proportional to the administered dose. An inverted U-shaped concentration-response curve was apparent, where response was based on a priori definitions contained in the study protocol. However, this was probably a result of the flexible-dose study design used. By use of the post hoc definitions of response, as measured by the Clinician's Global Improvement Scale and the total panic attack frequency, logistic regression analysis resulted in more adequate predictions of actual response frequencies. Results indicate that NDMAD contributes to the therapeutic effects of adinazolam mesylate sustained release tablets in the treatment of panic disorder. The exact contributions of adinazolam and NDMAD to response in panic disorder could not be determined, because of the correlation between adinazolam and NDMAD concentrations on multiple dosing.(ABSTRACT TRUNCATED AT 250 WORDS)

Agoraphobia↗
PubMed1992

A comparison of two computer-administered versions of the NIMH Diagnostic Interview Schedule.

This study compared three versions of the NIMH Diagnostic Interview Schedule (DIS): "traditional" interviewer-administered DIS; computer-administered DIS (subject interacting alone with computer); computer-prompted DIS (interviewer using computer program as a guide). Kappas for 20 diagnoses ranged from .15 to .94, and averages for the three method pairs ranged from .57 to .64, which are comparable to other DIS reliability studies. Agreement between pairs of methods were comparable. Subjects' attitudes toward the computer interview were positive. While they felt they could better describe their feelings and ideas to a human, they found the computer contact less embarrassing. Overall, subjects had no preference for one method over another. Measures of social desirability and deviant response biases were correlated with diagnostic results. Reading ability did not affect subject's ability to respond to the DIS, although subjects with lower reading levels preferred the computer interview more.

Adult↗
PubMed1992

Clomipramine hydrochloride in childhood and adolescent obsessive-compulsive disorder--a multicenter trial.

Children and adolescents with obsessive compulsive disorder were studied in an 8-week, multicenter, double-blind, parallel groups trial of clomipramine hydrochloride (CMI) versus placebo. Efficacy assessments included the child version of the Yale-Brown Obsessive Compulsive Scale and the National Institute of Mental Health Global rating scale. At the end of 8 weeks, CMI-treated patients showed a mean reduction in Yale-Brown Obsessive Compulsive Scale score of 37% compared to 8% in the placebo group. Side effects were typical of tricyclic antidepressants. In a 1-year open label treatment, CMI continued to be effective and well tolerated.

Adolescent↗
PubMed1992

The effect of enalapril on serum lithium levels in healthy men.

BACKGROUND: Several authors have recently described the development of lithium toxicity after the addition of angiotensin-converting enzyme inhibitors to a stable lithium regimen. This pilot study was designed to systematically investigate the effects of enalapril, an angiotensin-converting enzyme inhibitor, on the serum level of lithium. METHOD: In a 26-day outpatient study, nine healthy men took lithium for 10 days, lithium and enalapril for 10 days, and lithium alone again for 6 days. Serum lithium levels were measured while patients were taking lithium alone and while they were taking the lithium/enalapril combination. RESULTS: There were no statistically significant differences between mean serum lithium level during treatment with lithium alone and during treatment with the lithium/enalapril combination. However, one subject showed a 31% increase in serum lithium level after enalapril was added. CONCLUSION: Although no statistically significant differences between mean serum lithium level during treatment either with lithium alone or with lithium/enalapril were found, it is possible that the low dose of enalapril and low serum lithium levels employed for subject safety may have resulted in a type II statistical error. If enalapril doses or initial serum lithium levels were similar to those described in case reports, a significant difference in mean serum lithium levels may have been observed. While a predictable interaction between lithium and enalapril probably does not occur in all patients, factors such as enalapril dose, serum lithium level before addition of enalapril, or the presence of heart disease may make such an interaction more likely. At the levels of lithium and enalapril used in this study, elevated serum lithium concentration does not appear to be a universal event, but physicians must exercise appropriate caution.

Adolescent↗
PubMed1992

Behavior therapy for obsessive compulsive disorder.

Behavior therapy for OCD with exposure and response prevention is effective in reducing obsessions and rituals in at least half of those suffering this disabling disorder. Office-based sessions in which patients participate actively in designing exposure and response prevention homework are usually sufficient. Therapist assistance is sometimes needed for those who fail to perform these assignments on their own. Poor compliance, severe comorbid conditions, and CNS-depressing drugs can interfere with behavior therapy. Techniques to manage these difficulties, including modifications of behavior treatment and the use of serotonin reuptake inhibiting drugs, can increase substantially the number of patients responsive to behavior therapy.

Adaptation, Psychological↗
PubMed1992

An integrated approach to treatment of obsessive compulsive disorder.

Except for rarely performed psychosurgery, obsessive compulsive disorder seldom improved with reversible treatments before 1966. In that year, Victor Meyer reported successful treatment of OCD with behavior therapy, and clomipramine was first released. For the past 25 years, controlled research has demonstrated specific efficacy of exposure for obsessional anxiety and ritual or response prevention for reducing ritual time, interference, and associated distress. Over the same time span, clomipramine has been conclusively shown to be an effective treatment for obsessive compulsive disorder in double-blind controlled trials against placebo and other nonpotent serotonin uptake inhibitor antidepressants. Fluvoxamine, fluoxetine, and sertraline, all potent serotonin uptake inhibitors, have also demonstrated efficacy in obsessive compulsive disorder; fluvoxamine is the best studied of these three compounds. The combination of behavior therapy and a potent serotonin uptake inhibitor is currently the best treatment for most patients. Psychosurgery still has a part to play in the treatment of a small proportion of severely disabled and distressed obsessive compulsive patients unresponsive to other effective treatments.

Behavior Therapy↗
PubMed1991

Performance of two forms of a computer psychiatric screening interview: version I of the DISSI.

This study reports on the performance of two forms of version I of the Diagnostic Interview Schedule (DIS) computer screening interview, using the traditional interviewer-administered DIS (T-DIS) as the standard. The screening interview was either self-administered (called the S-DISSI) with the subject keying in responses, or interviewer-administered (I-DISSI), with the interviewer keying in the subject's responses. Sensitivity and specificity for both forms were ample (excluding antisocial personality), ranging from 60% to 100% for sensitivity and 54% to 95% for specificity. Concordances with the T-DIS were similar for both forms of the screening interview, ranging from .10 to .87 and compared favorably to those reported by other investigators. The I-DISSI took on average 30 min less than either the T-DIS and S-DISSI. Since the performances of both versions were equivalent, the decision to use either may be based on available resources and characteristics of the study population.

Adult↗