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Biomedical subjects

J R Davidson

Publications and source records attributed to J R Davidson.

At least 91 records · Page 5Linked to original sources
PubMed1997

A repeat proton magnetic resonance spectroscopy study in social phobia.

Peak spectral amplitudes for choline moieties (Cho), creatine (Cr), N-acetylaspartate (NAA), and myo-inositol (mI) were examined using proton magnetic resonance spectroscopy in 19 social-phobia patients and 10 controls. Compared with controls, social phobics demonstrated significantly lower NAA/Cho and higher Cho/Cr, mI/Cr, and mI/NAA amplitudes in cortical gray matter. Higher mI/Cr and mI/NAA amplitudes for social phobics were also observed in subcortical gray matter. Minimal between-group differences were noted for white matter. Symptom severity correlated inversely with amplitudes primarily in subcortical gray matter, and to a lesser extent in cortical gray matter. Inclusion of age and sex in statistical modeling strengthened comparisons with controls but eliminated those for symptom severity. No changes were observed in any amplitude measure following at least 8 weeks of clonazepam treatment, nor was a relationship observed between amplitudes and cumulative clonazepam dose. The possible psychobiological implications of our findings in social phobia are discussed.

Adult↗
PubMed1997

Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans.

A study was conducted to investigate chronic pain patterns in Vietnam veterans with posttraumatic stress disorder (PTSD). Combat veterans with PTSD completed standardized PTSD severity, pain, somatization, and depression measures. Of 129 consecutive out-patient combat veterans with PTSD, 80% reported chronic pain. In descending order were limb pain (83%), back pain (77%), torso pain (50%), and headache pain (32%). Compared to PTSD combat veterans without chronic pain, PTSD veterans who reported chronic pain reported significantly higher somatization as measured by the Minnesota Multiphasic Inventory 2 hypochondriasis and hysteria subscales. In the sample of 103 combat veterans with PTSD and chronic pain, MMPI 2 hypochondriasis scores and B PTSD symptoms (reexperiencing symptoms) were significantly related to pain disability, overall pain index, and current pain level MMPI 2 hypochondriasis and depression scores were also significantly related to percent body pain. These results are discussed in the context of current conceptualizations of PTSD.

Chronic Disease↗
PubMed1997

The Brief Social Phobia Scale: a psychometric evaluation.

The Brief Social Phobia Scale (BSPS) is an observer-rated scale designed to assess the characteristic symptoms of social phobia, using three subscales-fear, avoidance, and physiological arousal-which may be combined into a total score. Each of 18 BSPS items is anchored to a 5-point rating scale. Psychometric evaluation of the BSPS in a sample of 275 social-phobia patients yielded a high level of reliability and validity. Test-retest reliability was excellent, as was internal consistency. The fear and avoidance subscales demonstrated highly significant correlations with remaining item totals; however, the physiological subscale did not. The BSPS also demonstrated significant relationships with other established scales that assess anxiety and disability, and it proved sensitive to treatment effects in a trial of a 5-HT3 antagonist and placebo. Factor analysis yielded six meaningful factors. We conclude that the BSPS provides a reliable, valid, and sensitive measure for the evaluation of social phobia.

Analysis of Variance↗
PubMed1997

Assessment of a new self-rating scale for post-traumatic stress disorder.

BACKGROUND: In post-traumatic stress disorder (PTSD) there is a need for self-rating scales that are sensitive to treatment effects and have been tested in a broad range of trauma survivors. Separate measures of frequency and severity may also provide an advantage. METHODS: Three hundred and fifty-three men and women completed the Davidson Trauma Scale (DTS), a 17-item scale measuring each DSM-IV symptom of PTSD on 5-point frequency and severity scales. These subjects comprised war veterans, survivors of rape or hurricane and a mixed trauma group participating in a clinical trial. Other scales were included as validity checks as follows: Global ratings, SCL-90-R, Eysenck Scale, Impact of Event Scale and Structured Clinical Interview for DSM-III-R. RESULTS: The scale demonstrated good test-retest reliability (r = 0.86), internal consistency (r = 0.99). One main factor emerged for severity and a smaller one for intrusion. In PTSD diagnosed subjects, and the factor structure more closely resembled the traditional grouping of symptoms. Concurrent validity was obtained against the SCID, with a diagnostic accuracy of 83% at a DTS score of 40. Good convergent and divergent validity was obtained. The DTS showed predictive validity against response to treatment, as well as being sensitive to treatment effects. CONCLUSIONS: The DTS showed good reliability and validity, and offers promised as a scale which is particularly suited to assessing symptom severity, treatment outcome and in screening for the likely diagnosis of PTSD.

Adult↗
PubMed1997

Adjunctive use of olanzapine in mood disorders: five case reports.

Olanzapine has emerged as an atypical antipsychotic with few side effects and potentially superior efficacy in the treatment of schizophrenia. To our knowledge there have been few published reports of olanzapine in the treatment of mood disorders. We report on the adjunctive use of this medication in three subjects with mania and two with depression. Response occurred rapidly and patients tolerated the medication. Olanzapine offers promise in the treatment of mood disorders.

Adult↗
PubMed1997

Screening for trauma history on an inpatient affective-disorders unit: a pilot study.

Psychiatric inpatients (N = 343) admitted to an affective-disorders unit were administered a self-rating Trauma Questionnaire (TQ) to evaluate life history of traumatic experiences. Eighty four percent of the sample identified at least one traumatic-event category (M = 2.27 categories/patient). Symptoms consistent with posttraumatic stress disorder (PTSD), were highly prevalent. However, only six patients received a chart diagnosis of posttraumatic stress disorder. Female patients evidenced more PTSD symptoms than males, in contrast to an equal number of event categories identified by the two sexes. Age correlated negatively with number of symptoms endorsed. Implications for trauma screening in affective-disorder patients are discussed.

Adolescent↗
PubMed1997

Explained and unexplained medical symptoms in generalized anxiety and panic disorder: relationship to the somatoform disorders.

We have examined the numbers and types of symptoms in a sample of 90 patients with generalized anxiety disorder (GAD) and 77 patients with panic disorder (PD) collected from six different sites during the conduct of a multicenter clinical trial. This information was obtained utilizing the Health Questionnaire, a 47-item self-report list of medical symptoms, patterned after the Somatization Disorder section of the Diagnostic Interview Schedule. Although the patients in this sample had a wide variety of medically explained and unexplained physical symptoms, none of them qualified for a diagnosis of somatization disorder by DSM-III-R criteria. GAD and PD patients reported remarkably similar numbers of explained and unexplained medical symptoms. The panoply of somatic symptoms presented by these patients presents a formidable diagnostic challenge for clinicians. These findings suggest that the pattern of overutilization of medical services that is well documented for PD patients may also be found for GAD patients.

Adult↗
PubMed1997

Moclobemide in social phobia: a controlled dose-response trial.

Although the monoamine oxidase inhibitor phenelzine has proven efficacious in social phobia, the risk of hypertensive crises has reduced its acceptability. The reversible monoamine oxidase inhibitor moclobemide has less potential for such reactions, but its efficacy in this disorder remains unproven. A double-blind, placebo-controlled study was undertaken to assess the efficacy and safety of fixed doses of moclobemide. After a 1-week placebo run-in, subjects with social phobia were randomly assigned to placebo or one of five doses (75 mg, 150 mg, 300 mg, 600 mg, or 900 mg daily) of moclobemide for 12 weeks. Although a trend toward greater efficacy of higher doses of moclobemide was observed at 8 weeks, no differences in response to various doses of the drug and placebo were observed at 12 weeks. At 12 weeks, 35% of subjects on 900 mg of moclobemide and 33% of those on placebo were at least much improved. Moclobemide was well tolerated, insomnia being the only dose-related adverse event observed with the drug. In this dose-response trial, moclobemide did not demonstrate efficacy at 12 weeks. Some other controlled studies have found moclobemide and brofaromine, another reversible monoamine oxidase inhibitor, efficacious in social phobia. Possible reasons for inconsistent findings are discussed.

Adult↗
PubMed1997

The eight-item treatment-outcome post-traumatic stress disorder scale: a brief measure to assess treatment outcome in post-traumatic stress disorder.

This preliminary report describes a new brief interview based assessment of post-traumatic stress disorder using an 8-item treatment-outcome post-traumatic stress disorder scale (TOP-8). The TOP-8 was developed from a larger post-traumatic stress disorder evaluation scale based on items which occurred frequently in the population and which responded substantially to treatment across time. The 8 resultant items were drawn from all three symptom clusters for post-traumatic stress disorder, and showed an improved ability to detect drug versus placebo differences in comparison with the original scale. The eight-item treatment-outcome post-traumatic stress disorder scale also correlated significantly with a self-rated measure of post-traumatic stress disorder and distinguished at a highly significant level between responders and non-responders on an independently judged Clinical Global Impressions measure. The results of this study are discussed and future directions suggested.

Adult↗
PubMed1997

Response characteristics to antidepressants and placebo in post-traumatic stress disorder.

Characteristic response patterns are described for two antidepressant drugs and placebo in post-traumatic stress disorder. Early onset and steady improvement occurred on a global rating scale for both drugs and placebo in those who ultimately met responder criteria at the end of treatment. In certain cases, the magnitude of global response was greater for drug than for placebo. At weeks 2 or 4, the Clinical Global Impressions score for fluoxetine but not for amitriptyline, served as a good predictor of eventual response. In a review of numerous completed placebo-controlled trials, antidepressants were superior to placebo in seven out of eight comparisons using the Clinical Global Impressions, although specific effects on post-traumatic stress disorder scales were more variable. Drug response rates are similar for combat and civilian trauma samples, but placebo response rates may be higher in the latter. Effect sizes suggested a moderate-to-good effect for drug therapy.

Antidepressive Agents↗
PubMed1997

Trading treatment toxicity for survival in locally advanced non-small cell lung cancer.

PURPOSE: To determine how patients weigh potential survival benefits against the potential toxicity of different treatment strategies for locally advanced non-small cell lung cancer (NSCLC). Specifically, we were interested in what improvement in survival probability patients would want to have before accepting more toxic therapy. PATIENTS AND METHODS: Fifty-six outpatients who had experienced lung cancer (n = 22) or prostate cancer (n = 34), and 20 clinic nurses and radiation therapy technologists participated. A treatment trade-off interview was conducted with each participant that compared low-dose versus high-dose radiotherapy and high-dose radiotherapy versus combination chemo-radiotherapy. Preferences for treatments were assessed by systematically increasing the hypothetical survival advantage of the more toxic treatment until the person reached his or her threshold for choosing the more toxic treatment. RESULTS: A wide range of thresholds was observed for both groups. The distributions of survival advantage thresholds for lung cancer and prostate cancer patients were not significantly different but were generally lower thresholds than those declared by staff. If the 3-year survival advantage was 10%, 60% of patients and 15% of staff would consider combination therapy over high-dose radiotherapy. Within patients, apparent willingness to consider more toxic treatments was not significantly related to age, sex, education, or preferred role in decision making. The treatment trade-off method had good test-retest reliability. CONCLUSION: There is great interindividual variability in willingness to accept aggressive treatments for locally advanced NSCLC. When choosing NSCLC treatment, each patient should be provided with comprehensive information about the options so that he or she may express his or her preferences should he or she wish to participate in the decision.

Aged↗
PubMed1997

Decision analysis in locally advanced non-small-cell lung cancer: is it useful?

PURPOSE: The optimal management of locally advanced non-small-cell lung cancer (NSCLC) has not been established. While combined-modality treatments have been shown to increase the survival of patients with this illness, the appropriate balance between the benefit of increased quantity of life and the quality-of-life costs of the more toxic treatment combinations remains unresolved. Decision analysis has been promoted as useful when medical decisions must be made under conditions of uncertainty. We consider the potential of this method to guide therapy in locally advanced NSCLC. METHODS: We developed two types of decision models that addressed the choice between radiation alone and combined chemotherapy-radiation therapy in locally advanced NSCLC. The models were constructed using the principles of decision analysis. RESULTS: The models successfully replicated results of relevant clinical trials published in the literature. The analyses of both models showed that the treatment decision was sensitive to patients' values, despite significant increases in survival rates. The models clarified a need for further validation of the three fundamental components: structuring the decision, determining the probabilities of events, and assigning utilities to treatment outcomes. CONCLUSION: In the setting of NSCLC, the models suggest that quality-of-life considerations are important in the treatment choice. Further research is required to identify the health states critical to the decision, the probabilities for occurrence of these health states, and valid measures of their utility.

Carcinoma, Non-Small-Cell Lung↗
PubMed1997

The effects of clonazepam on quality of life and work productivity in panic disorder.

Although panic disorder has been associated with impaired quality of life (QOL) and financial dependence, no prior study has examined whether a clinical intervention will improve these outcomes. This study examines the effects of clinically titrated doses of clonazepam versus placebo on QOL and work productivity (WP) in patients with panic disorder. QOL and WP were measured in conjunction with a randomized, double-blind, placebo-controlled trial. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and Work Productivity and Impairment questionnaire were used to assess QOL and WP, respectively. Baseline assessments were obtained before randomizing patients to receive clinically titrated doses of clonazepam or placebo. Follow-up assessments were obtained after 6 weeks of therapy with the test drug or at premature termination from the study. Improvement on the SF-36 Mental Health Component Summary scale was more than twice as great with clonazepam than with placebo (P = 0.03). Clonazepam patients improved (P < 0.05) on all five measures of mental health-related QOL, and both measures of physical health-related QOL, and both measures of WP. Placebo patients improved on three of five measures of mental health-related QOL, but on no other measures. Patients with marked improvements on clinical measures of panic disorder severity, especially avoidance and fear of the main phobia, showed the greatest gains on the SF-36 Mental Health Component Summary scale. Clinically titrated doses of clonazepam significantly improved mental health-related QOL and WP in panic disorder patients. Lesser improvements were obtained with placebo.

Adult↗
PubMed1997

Homeopathic treatment of depression and anxiety.

BACKGROUND: Homeopathy is a well-established therapeutic system with potential relevance to psychiatry, but as yet it is largely untested. OBJECTIVE: To report the use of homeopathic treatment in patients with depression and anxiety. METHODS: Individually selected homeopathic remedies were used on an outpatient basis to treat 12 adults who had major depression, social phobia, or panic disorder. The patients either requested homeopathic treatment or received it on a physician's recommendation after partial or poor response to conventional therapies. Duration of treatment was 7 to 80 weeks. Response was monitored by using a clinical global scale (n = 12), the self-rated SCL-90 scale (n = 8), and the Brief Social Phobia Scale (n = 4). RESULTS: Overall response rates were 58% according to the clinical global improvement scale and 50% according to the SCL-90 or the Brief Social Phobia Scale. CONCLUSIONS: Homeopathy may be useful in the treatment of affective and anxiety disorders in patients with mildly to severely symptomatic conditions.

Adult↗
PubMed1997

Use of benzodiazepines in panic disorder.

Over the past 15 years, benzodiazepines have been used successfully to treat panic disorder with agoraphobia, but not without some controversy. Efficacy and side effect data from the principal benzodiazepine outcome studies of panic disorder demonstrate that alprazolam, lorazepam, and clonazepam are all clinically effective. Clonazepam has several advantages over other benzodiazepines and can be considered a first-line agent for panic disorder. Benzodiazepines in general are therapeutically effective for a broad range of panic disorder symptoms. Their effect is rapid and maintained without dose increase over a 7- to 8-month period. Discontinuation-related difficulties can occur in a considerable number of patients, but these can be decreased in several ways.

Alprazolam↗