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Biomedical subjects

J R Davidson

Publications and source records attributed to J R Davidson.

At least 37 records · Page 2Linked to original sources
PubMed2001

Posttraumatic stress disorder: diagnosis and epidemiology, comorbidity and social consequences, biology and treatment.

Epidemiological studies clearly indicate that posttraumatic stress disorder (PTSD) is becoming a major health concern worldwide even if still poorly recognized and not well treated. PTSD commonly co-occurs with other psychiatric disorders, and several symptoms overlap with major depressive disorders, anxiety disorders and substance abuse; this may contribute to diagnostic confusion and underdiagnosis. This anxiety disorder provokes significant occupational, psychiatric, medical and psychosocial disability, and its consequences are enormously costly, not only to the survivors and their families, but also to the health care system and society. Work impairment associated with PTSD is very similar to the amount of work impairment associated with major depression. The pathophysiology of PTSD is multifactorial and involves dysregulation of the serotonergic as well as the noradrenergic system. A rational therapeutic approach should normalize the specific psychobiological alterations associated with PTSD. This can be achieved through the use of antidepressant drugs, mainly of those that potentiate serotonergic mechanisms. Recent double-blind placebo-controlled studies report the efficacy of selective serotonin reuptake inhibitors. Several cognitive-behavioral and psychosocial treatments have also been reported to be efficacious and could be considered when treating PTSD patients.

Antidepressive Agents↗
PubMed2001

Impact of generalized social anxiety disorder in managed care.

OBJECTIVE: The authors determined the costs associated with generalized social anxiety disorder in a managed care setting. METHOD: A three-phase mail and telephone survey was conducted from July to October 1998 in two outpatient clinics of a large health maintenance organization (HMO). The survey assessed direct costs, indirect costs, health-related quality of life, and clinical severity associated with generalized social anxiety disorder, both alone and with comorbid psychopathology. RESULTS: The weighted prevalence rate of current generalized social anxiety disorder was 8.2%. In the past year, only 0.5% of subjects with generalized social anxiety disorder had been accurately diagnosed. Yet 44.1% had a mental health specialty visit or had been prescribed an antidepressant, and psychiatric comorbidity was found in 43.6%. Noncomorbid generalized social anxiety disorder was associated with significantly lower health-related quality of life, work productivity, and earnings and greater utilization of health services; generalized social anxiety disorder with comorbid psychopathology was even more disabling. Suicide was attempted by 21.9% of subjects with noncomorbid generalized social anxiety disorder. Persons with average-severity generalized social anxiety disorder had probabilities of graduating from college that were 10 percentage points lower, earned wages that were 10% lower, and had probabilities of holding a technical, professional, or managerial job that were 14 percentage points lower than the comparison group. CONCLUSIONS: In a community cohort of HMO members, generalized social anxiety disorder was rarely diagnosed or treated despite being highly prevalent and associated with significant direct and indirect costs, comorbid depression, and impairment.

Adult↗
PubMed2001

Effect of kava extract on vagal cardiac control in generalized anxiety disorder: preliminary findings.

Anxiety disorders are associated with low vagal control of heart rate and increased risk of cardiac mortality and sudden cardiac death. This study examined whether the herbal anxiolytic, kava, produces improvement in vagal control in generalized anxiety disorder. Before and after treatment with placebo (n = 7) or kava (n = 6), two indices of vagal control were measured under supine conditions using power spectral analysis: baroreflex control of heart rate (BRC) and respiratory sinus arrhythmia (RSA). Significantly more patients treated with kava showed improved BRC compared to the placebo group (p < 0.05). Furthermore, the magnitude of improvement in BRC was significantly correlated with the degree of clinical improvement (p < 0.05). RSA did not respond to treatment. These preliminary findings suggest that kava might exert a favourable effect on reflex vagal control of heart rate in generalized anxiety disorder patients. The parallel clinical and BRC responses may reflect an underlying common effect of this herbal anxiolytic.

Adult↗
PubMed2001

Pharmacotherapy of generalized anxiety disorder.

Benzodiazepines have traditionally been used to treat acute anxiety disorders, but they are not ideal in the treatment of chronic generalized anxiety disorder (GAD). Following long-term therapy, benzodiazepines have the potential to produce dependency and withdrawal symptoms. In addition, although agents such as the benzodiazepines and buspirone alleviate anxiety, they have little effect on depression, which is a common comorbidity of GAD. Antidepressants have long been viewed as promising alternatives to benzodiazepines for the treatment of some types of anxiety. Although they have been shown to be useful in the treatment of panic disorder, social anxiety disorder/social phobia, and obsessive-compulsive disorder, they have not until recently been regarded as potential therapies for GAD. Treatment with antidepressants has opened up a new area of investigation into the pharmacotherapy of GAD, with a growing body of evidence supporting the role of therapies such as paroxetine and venlafaxine extended release.

Anti-Anxiety Agents↗
PubMed2001

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

OBJECTIVE: To provide primary care clinicians with a better understanding of management issues in generalized anxiety disorder (GAD) and guide clinical practice with recommendations on the appropriate treatment strategy. PARTICIPANTS: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R.T. Davidson, Yves Lecrubier, and David J. Nutt. Four additional faculty members invited by the chair were Karl Rickels, Hans-Ulrich Wittchen, Dan J. Stein, and Thomas D. Borkovec. EVIDENCE: The consensus statement is based on the 6 review articles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles. CONSENSUS PROCESS: Group meetings were held over a 2-day period. On day 1, the group discussed the review articles and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. CONCLUSIONS: GAD is the most common anxiety disorder in primary care and is highly debilitating. Furthermore, it is frequently comorbid with depression and other anxiety disorders, which exacerbates functional impairment. Antidepressants (serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and nonsedating tricyclic antidepressants) are generally the most appropriate first-line pharmacotherapy for GAD, since they are also effective against comorbid psychiatric disorders and are suitable for long-term use. Cognitive-behavioral therapy is the preferred form of psychotherapy for GAD, although when GAD is comorbid with depression, pharmacotherapy is increasingly indicated.

Age of Onset↗
PubMed2001

Consensus statement on transcultural issues in depression and anxiety from the International Consensus Group on Depression and Anxiety.

OBJECTIVE: To provide primary care physicians with a better understanding of transcultural issues in depression and anxiety. PARTICIPANTS: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Five faculty invited by the chair also participated: Laurence J. Kirmayer, Jean-Pierre Lepine, Keh-Ming Lin, Osamu Tajima, and Yutaka Ono. EVIDENCE: The consensus statement is based on the 5 review articles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles. CONSENSUS PROCESS: Group meetings were held over a 2-day period. On day 1, the group discussed the review articles, and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. CONCLUSION: The consensus statement underlines the prevalence of depression and anxiety disorders across all cultures and nations while recognizing that cultural differences exist in symptom presentation and prevalence estimates. In all countries, the recognition of depression by clinicians in the primary care setting is low (generally less than 50%), and the consensus group recommends a 2-step process to aid the recognition and diagnosis of depression. In line with the low recognition of depression and anxiety disorders is the finding that only a small proportion of patients with depression or anxiety are receiving appropriate treatments for their condition. Biological diversity across ethnic groups may account for the differential sensitivity of some groups to psychotropic medication, but this area requires further investigation.

Anxiety Disorders↗
PubMed2000

Completeness of response and quality of life in mood and anxiety disorders.

Mental health care has traditionally focused on the need to document relief of specific symptoms of a psychiatric disorder, as well as how the patient functions in social roles. Recently, there has been increased attention paid to the issue of quality of life (QOL) and psychiatric illness. There has been a growing recognition that different treatment options may vary in their effects on the patient's ability to function in multiple life domains. Studies focusing on the QOL in patients suffering from mood and anxiety disorders have become more prevalent. Depression and anxiety disorders impose a substantial cost on society in terms of both psychiatric service costs as well as the loss of the individual to society through lost work production. However, a change in the severity of depression or anxiety often correlates with a change in disability and health service utilization. Lately, there have been a number of treatment studies of anxiety and depressive disorders that have examined the effect of treatment on QOL. Although treatment may reduce the severity and frequency of target symptoms, the patient's assessment of QOL helps to differentiate a true treatment response and remission from a partial response. The evaluation of what constitutes an adequate treatment response or remission is complicated and likely requires multiple assessment instruments in order to develop a complete understanding. In both anxiety and depressive disorders, the patient suffers from impaired functioning, which results in increased healthcare utilization. Because these patients do respond to treatment, the idea of "wellness" as a high end state treatment outcome should be an important consideration when selecting a treatment option.

Anxiety Disorders↗
PubMed2000

Lack of efficacy for fluoxetine in PTSD: a placebo controlled trial in combat veterans.

BACKGROUND: Fluoxetine and placebo were studied in a population of combat veterans with severe, chronic PTSD. METHODS: Twelve male veterans with PTSD were enrolled in a 12 week double-blind evaluation of fluoxetine and placebo. Mean fluoxetine dose at endpoint (week 12) was 48 mg/day with a range of 10 mg to 60 mg. RESULTS: One fluoxetine patient responded (17%) and two of the six placebo patients responded (33%). CONCLUSIONS: Fluoxetine patients did not show a greater response than placebo patients in this small sample of male combat veterans with severe, chronic PTSD. Fluoxetine has displayed an efficacious response in controlled studies of patients with PTSD who were predominantly female, suffered civilian (noncombat) traumas, and were overall experiencing less severe PTSD. The reasons for the low response rate to fluoxetine in our study is unknown and will await further study examining variables other than symptoms that might influence outcome, such as gender, comorbidity, prior treatment history, trauma type, severity and chronicity.

Aged↗
PubMed2000

Ambulatory cardiovascular activity in Vietnam combat veterans with and without posttraumatic stress disorder.

The present study investigated the relationship between daily diary affect ratings and ambulatory cardiovascular activity in 117 male Vietnam combat veterans (61 with posttraumatic stress disorder [PTSD] and 56 without PTSD). Participants completed 12-14 hr of ambulatory monitoring and daily diary affect ratings. Compared with veterans without PTSD, veterans with PTSD reported higher negative affect and lower positive affect in daily diary ratings. No differences were detected for mean laboratory initial recordings or mean ambulatory heart rate (HR), systolic blood pressure (SBP), or diastolic blood pressure (DBP). However, compared with veterans without PTSD, veterans with PTSD demonstrated higher SBP and DBP variability and a higher proportion of HR activity (compared with initial recording values) during daily activity. There was a significant Time of Day x Group interaction for mean HR, with a trend for PTSD participants to maintain HR levels during evening hours.

Affect↗
PubMed2000

Defining an appropriate management strategy for social anxiety disorder.

Social anxiety disorder is a chronic and disabling, yet treatable, condition. Effective treatment should alleviate the core domains of fear, anxiety and physiological symptoms, as well as reduce overall disability and improve social functioning. Response to treatment can, therefore, be assessed at a global level where overall improvement is considered, and at the level of individual symptoms. In considering the way in which response to treatment can be measured, this review also identifies several factors that may worsen the prognosis of social anxiety disorder. Clinical studies of monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRIs), and benzodiazepines for the treatment of social anxiety disorder are presented and discussed. The accumulation of evidence supports the use of SSRIs as first line therapy for social anxiety disorder, and the majority of data come from well controlled studies of paroxetine. In line with the recommendations of the International Consensus Group on Depression and Anxiety, a strategy for the management of social anxiety disorder is provided.

Adult↗
PubMed2000

Symptom-specific effects of fluoxetine in post-traumatic stress disorder.

The selective serotonin reuptake inhibitors have become a first line treatment for post-traumatic stress disorder (PTSD). In a recent double-blind study in civilians, fluoxetine produced clinically and statistically significant effects on all general measures of PTSD. We examined the specific effects of fluoxetine versus placebo in the above mentioned study of PTSD clusters and individual symptoms. Individuals were included if they met criteria for PTSD according to the Structured Clinical Interview for DSM-III-R (SCID). Symptoms were assessed at sequential time points by the Structured Interview for PTSD (SIP), a clinician interview based assessment, and a self-report scale, the Davidson Trauma Scale (DTS). A total of 53 patients were included in the analysis. On the SIP and DTS, fluoxetine was found to produce statistically significant changes on all clusters. Significant effects for fluoxetine were noted on 10 items of the DTS, and 8 items of the SIP. The SIP and DTS had 6 items in common that were significant. Fluoxetine exerts a broad spectrum effect in reducing all the symptom clusters of PTSD in this sample. The symptoms of being physically upset at reminders of the trauma, avoiding thoughts of the trauma, having difficulty enjoying things, feeling distant/estranged, having a sense of foreshortened future, and impaired concentration, were the symptoms most responsive to the effects of treatment with fluoxetine on both scales.

Adult↗
PubMed2000

Selective serotonin reuptake inhibitors in post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is a complex psychiatric condition, which can be triggered by a variety of traumatic events. Lifetime prevalence rates range from 1.3% to 10.4%, with women twice as likely as men to be affected. The clinical management of this condition is complex, since PTSD is associated with high rates of comorbid psychiatric disorders, particularly major depression, other anxiety and panic disorders, substance abuse and antisocial behaviour. Broadly, there are two main approaches to treatment: pharmacotherapy and cognitive or behavioural therapy. This paper reviews available pharmacological approaches for the treatment of PTSD and comorbid disorders. Although the optimal pharmacological approach has yet to be established, there is increasing evidence to support the use of antidepressants, and particularly selective serotonin reuptake inhibitors (SSRIs), as first-line therapy. In addition to alleviating the core symptoms of PTSD, some SSRIs are also effective for the treatment of common comorbidities, such as depression, panic disorder and social anxiety disorder; a fact which would appear to have important implications for patient management.

Clinical Trials as Topic↗
PubMed2000

Trauma: the impact of post-traumatic stress disorder.

Trauma has an enormous impact on both individuals and society as a whole. Recognition of the extent of this impact by the medical profession has been relatively slow but, with our growing appreciation of the prevalence of trauma exposure in civilian as well as combat populations, the true scale of trauma-related psychiatric consequences is beginning to emerge. It has been reported that more than 60% of men and 51% of women experience at least one traumatic event in their lifetimes. Of these, 8% and 20%, respectively, fall victim to post-traumatic stress disorder (PTSD) indicating that more women are at risk for developing PTSD. Individuals experience severe psychiatric stress that is compounded by significant comorbid illness. This impacts critically upon quality of life resulting in grave functional and emotional impairment. In addition, there is a detrimental cost to society with high financial and social consequences from the significantly elevated rates of hospitalization, suicide attempts and alcohol abuse.

Cost of Illness↗
PubMed2000

Psychometric properties of the Social Phobia Inventory (SPIN). New self-rating scale.

BACKGROUND: Of available self-rated social phobia scales, none assesses the spectrum of fear, avoidance, and physiological symptoms, all of which are clinically important. Because of this limitation, we developed the Social Phobia Inventory (SPIN). AIMS: To establish psychometric validation of the SPIN. METHOD: Subjects from three clinical trials and two control groups were given the 17-item, self-rated SPIN. Validity was assessed against several established measures of social anxiety, global assessments of severity and improvement, and scales assessing physical health and disability. RESULTS: Good test-retest reliability, internal consistency, convergent and divergent validity were obtained. A SPIN score of 19 distinguished between social phobia subjects and controls. The SPIN was responsive to change in symptoms over time and reflected different responses to active drugs v. placebo. Factorial analysis identified five factors. CONCLUSIONS: The SPIN demonstrates solid psychometric properties and shows promise as a measurement for the screening of, and treatment response to, social phobia.

Adult↗
PubMed2000

Immunohistochemical and clinical evaluation of p53 in canine cutaneous mast cell tumors.

One hundred twenty-six cutaneous mast cell tumors obtained by excisional biopsy from 106 dogs were evaluated using immunohistochemical staining for the presence of p53 protein. A standard avidin-biotin immunohistochemical protocol was used incorporating a polyclonal antibody of rabbit origin (CM-1) as the primary antibody. Histopathologic grading of tumors was performed on hemotoxylin and eosin-stained samples. There was a significant difference in the percentage of cells staining positive for p53 for the histopathologic grades (P = 0.0005). Grade III tumors had a significantly greater p53 content than did grade I or II tumors (P < 0.05). Clinical data obtained retrospectively was available for 54 dogs. Tumor recurred in 19 of 54 (35.2%) dogs. Twenty-nine dogs died by the end of the study; 9 of 29 (31.0%) died of mast cell tumor disease. Histopathologic grade showed a significant negative association with survival time. Both clinical stage and histopathologic grade showed a significant negative association with time to recurrence. The percentage of cells staining positive for p53 did not significantly improve the forward analysis. Immunohistochemical detection of p53 did not appear useful in characterizing the clinical association between cutaneous mast cell tumor cellular features and survival time or time to tumor recurrence in dogs.

Animals↗