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Biomedical subjects

J R Davidson

Publications and source records attributed to J R Davidson.

At least 109 records · Page 6Linked to original sources
PubMed1997

Trauma: prevalence, impairment, service use, and cost.

A review of the literature on the epidemiology of trauma reveals that traumatic events are common: most Americans experience at least one over the course of their lives. According to recent estimates, 5% of men and 10% to 12% of women will suffer from posttraumatic stress disorder (PTSD) sometime in their lives, and for victims of traumas such as rape, the rate may be as high as 60% to 80%. For at least a third of sufferers, PTSD is a persistent condition lasting many years. Over 80% of persons with PTSD suffer from other psychiatric disorders. Many also experience marital, occupational, financial, and health problems. While trauma victims are disproportionate users of the health care system, they are reluctant to seek mental health treatment. Consequences of exposure to trauma are enormously costly, not only to the victims, but also to our health care system and to society as a whole.

Adult↗
PubMed1997

Biological therapies for posttraumatic stress disorder: an overview.

Both core and secondary symptoms of posttraumatic stress disorder (PTSD) respond to medication, a valuable part of overall PTSD treatment. Treatment options include antidepressants, anxiolytics, anticonvulsants, and mood stabilizers. A growing data base of results from double-blind, placebo-controlled clinical trials supports the use of antidepressants, especially tricyclics, monoamine oxidase inhibitors (MAOIs), and serotonin selective reuptake inhibitors (SSRIs). Although heightened anxiety is characteristic of PTSD, benzodiazepines have not yet proved useful in controlled trials and may be associated with a rebound effect on discontinuation. The small, open studies of anticonvulsant drugs indicate moderate to good improvement with these agents. Tricyclic, SSRI, and MAOI antidepressants have demonstrated efficacy in larger, longer-term controlled trials. Drug/psychotherapy combinations may enhance the usefulness of psychotherapeutics in the management of PTSD. Studies with tricyclics and fluoxetine indicate that magnitude and type of trauma may determine the degree of response.

Adaptation, Psychological↗
PubMed1996

The association of sexual assault and attempted suicide within the community.

BACKGROUND: Lifetime community rates of attempted suicide were compared between those who reported a history of sexual assault and a control group without such a history. METHODS: The 2918 respondents in the Duke University Epidemiological Catchment Area Study were placed into groups with reported sexual assault (n = 67) and those with no known history of such (n = 2851). Multivariate and bivariate procedures were used to examine the relation between sexual assault and attempted suicide. RESULTS: Subjects reporting a history of sexual assault were more likely to be female, younger, and to report higher rates of lifetime suicide attempt and post-traumatic stress symptoms; no differences were found in the number of chronic medical disorders, major depression, substance abuse or substance dependence, or panic attacks. Nine (14.9%) of the 67 index group subjects reported a suicide attempt, 4 of whom reported their first sexual assault as occurring before age 16 years. A sexual assault history was associated with increased prevalence of lifetime suicide attempt after controlling for sex, age, education, posttraumatic stress symptoms, and psychiatric disorder. Findings were similar in the female-only subsample (n = 1778). For women, the odds of attempting suicide was 3 to 4 times greater when the first reported sexual assault occurred prior to age 16 years compared with age 16 years or older. CONCLUSIONS: Sexual assault is associated with an increased lifetime rate of attempted suicide. In women, a history of sexual trauma before age 16 years is a particularly strong correlate of attempted suicide.

Adolescent↗
PubMed1996

Confidentiality and managed care: ethical and legal concerns.

As managed care companies take over the allocation of funds, the monitoring of treatment, and the measurement of outcomes, social workers encounter an ethical and legal dilemma with the demise of confidentiality in the professional-client relationship. Given that the profession has long heralded the protection of client confidentiality, it is timely that social workers re-examine traditional ethical and legal responsibilities to clients and challenge managed care personnel to protect clients' right to confidentiality. This article highlights problems concerning confidentiality that often arise for social workers working with managed care systems. It focuses also on ethical and legal standards related to confidentiality and social work responsibilities regarding informed consent.

Confidentiality↗
PubMed1996

Fluvoxamine versus clomipramine for obsessive-compulsive disorder: a double-blind comparison.

The efficacy and tolerability of fluvoxamine (100-300 mg/day) and clomipramine (100-250 mg/day) were compared in a randomized, double-blind, parallel-group study of 79 patients with obsessive-compulsive disorder (OCD) without coexisting major depression. After a 2-week placebo lead-in period, patients were randomized to fluvoxamine (37 patients) or clomipramine (42 patients) for 10 weeks. Efficacy was evaluated with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the National Institute of Mental Health Obsessive-Compulsive scale, and Patient and Clinical Global Improvement scales. Hamilton Rating Scale for Depression scores and somatic symptoms were also assessed. Seventy-eight percent of fluvoxamine patients and 64% of clomipramine patients completed the study. At the end of treatment, 56% of fluvoxamine patients were classified as responders (> or = 25% decrease in Y-BOCS score), compared with 54% of clomipramine patients. Both groups showed steady improvement throughout the study; no statistically significant differences were observed between the groups for any efficacy variable at any time. A similar percentage of patients in both groups withdrew because of adverse events. No serious adverse events related to drug occurred with either drug. Insomnia, nervousness, and dyspepsia were more statistically frequent with fluvoxamine; dry mouth and postural hypotension were more frequent with clomipramine. In this study, fluvoxamine and clomipramine were equally effective in reducing OCD symptoms over a 10-week treatment period but displayed different side effect profiles.

Adolescent↗
PubMed1996

Trial of trazodone for posttraumatic stress disorder using a multiple baseline group design.

Six patients with combat-related posttraumatic stress disorder (PTSD) entered a multiple-baseline trial of trazodone, beginning with 50 mg/day and increasing to 400 mg/day until response was maximal. Total Clinician-Administered PTSD Scale scores decreased from a mean of 92 at baseline to 79 at end point, and self-reported PTSD symptoms as measured by the Davidson Trauma Scale paralleled these results (mean of 102 at baseline to 88 at end point). Based on clinician global improvement scores, four patients were rated as much improved and two were rated to be minimally improved. Improvement in social and occupational functioning, and depression was minimal. Available follow-up scores for PTSD symptoms indicated that gains were maintained. Sleep was the first symptom to improve at 2 to 3 months. No dropouts during the treatment period occurred, and reported side effects were quite low. These preliminary data suggest that trazodone may be effective in reducing the three primary clusters of symptoms of PTSD. These findings should be confirmed by using a larger sample in a double-blind, placebo-controlled study.

Adult↗
PubMed1996

The neurobiology of social phobia.

Studies in the neurobiology of social phobia have used neuroendocrine, naturalistic and chemical challenges, pharmacological probes, neurotransmitter system measures, peripheral receptor binding and magnetic resonance measures. Studies of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-thyroid axes have been largely unrevealing; adrenaline, carbon dioxide, caffeine and yohimbine tests have provided mixed results; probe studies using L-dopa, clonidine and fenfluramine have provided some evidence of post-synaptic serotonergic abnormality; studies on platelet and lymphocyte binding have failed to distinguish social phobia from other groups; magnetic resonance imaging and magnetic resonance spectroscopy studies suggest possible differences between patients with social phobia and healthy controls in respect of dopamine, serotonin and second-messenger function. In aggregate, these studies have provided some neurobiological basis for separating social phobia from panic disorder and non-psychiatric healthy controls.

Brain↗
PubMed1996

A 2-year follow-up of social phobia. Status after a brief medication trial.

Although social phobia is thought to be a chronic disorder, little is known about its long-term course in patients who engage in brief treatment studies. We, therefore, conducted a follow-up study of social phobics who had participated in a brief, placebo-controlled treatment trial of clonazepam. Of the original 75 subjects, 56 were assessed through telephone interview and self-report questionnaires that evaluated current social phobia symptoms. Information was also gathered about treatment received in the 2-year interval since the initial pharmacotherapy trial. The group as a whole showed maintenance of the gains acquired during initial treatment. On a number of symptom scales, subjects initially treated with clonazepam exhibited significantly less severe scores compared with placebo subjects. This study provides evidence of long-term benefit for social phobics when treated with a brief medication trial.

Adult↗
PubMed1996

Functional status in depressed patients: the relationship to disease severity and disease resolution.

BACKGROUND: We set out to measure the impact of depression and its clinical resolution on patients' functional status. METHOD: The Work and Social Disability Scale (WSDS), a five-category investigator-rated scale measuring patient functional status, was completed at baseline and study discontinuation in a 56-day, open, uncontrolled study evaluating the safety of a sustained release (SR) formulation of bupropion in 3167 patients at 105 sites. To be included in the study, patients had to be 18 years or older, have a diagnosis of depression, and be considered appropriate for treatment with bupropion SR. The proportion of patients in each WSDS category, for those patients taking more than 7 days of bupropion SR (N = 2915), was assessed at screen and study discontinuation. The percentage of patients with improved WSDS scores at 56 days was also measured for all patients and correlated with patient and treatment characteristics. RESULTS: Of the patients entering the trial, 61.8% were markedly or severely impaired in their work or social activities, and only 5.4% were mildly or not impaired. At study discontinuation, more than 54% of patients were judged by the investigator to have very much or much improvement in their clinical symptoms. Results on the WSDS correlated with the clinical improvements; only 22.3% were markedly or severely impaired; and 50.0% were mildly or not impaired at study discontinuation. In addition, 63.9% of patients had less work or social disability at the end of the trial than at study entry. Functional status improved more in patients who had not previously been treated for the episode, had more severe depression at study entry, and had a higher dose and duration of treatment with bupropion SR. CONCLUSION: The results show that depression results in significant impairment in patients' functional status. Functional status improved in patients treated with bupropion SR for up to 56 days. This improvement was highly correlated with improvement in clinical symptoms and was related to patient characteristics at study entry as well as to treatment patterns during the study.

Adolescent↗
PubMed1996

Quality of life and cost factors in panic disorder.

Quality of life encompasses domains of personal happiness, role fulfillment, and health status. Increasing attention has been paid to the relationship between quality of life and panic disorder, with accumulating evidence now available to suggest impairment in several domains among subjects with panic disorder. This review summarizes the results of community-based and treatment-seeking populations of subjects with panic disorder. Impaired personal happiness, restricted role functioning, and increased use of health services are all described. Evidence suggests that accurate diagnosis and effective treatment can significantly lessen health service utilization, resulting in substantial cost offset and also leading to increased work productivity and personal effectiveness.

Humans↗
PubMed1995

Biological characterization of social phobia.

As social phobia has become clinically more clearly characterized, the search for biologic features of the disorder has been instituted. As with most psychiatric disorders, this undertaking is difficult, because of the heterogeneity of the disorder in affected individuals. However, with investigation into several different areas, i.e., the neuroendocrine system, neurotransmitter function via naturalistic challenges, chemical and pharmacologic probes, response to pharmacologic interventions, and neuroimaging, theories about the biologic characteristics of social phobia have been advanced. Neuroendocrine studies have not yet revealed any clear abnormalities specific to individuals with social phobia. Based on studies of neurotransmitter functions and pharmacologic response, the major neurotransmitter systems that have been implicated are the serotonergic, dopaminergic, and noradrenergic. Neuroimaging studies have demonstrated possible structural and metabolic differences in some patients with social phobia.

Arousal↗
PubMed1994

The boundary of social phobia. Exploring the threshold.

BACKGROUND: Individuals with subthreshold social phobia (SSP) in the community are characterized relative to nonphobic, healthy controls (C), and diagnosed social phobics (SP). METHODS: Data from 1488 subjects from the Duke University Epidemiological Catchment Area Study were examined. Bivariate and multivariate methods were used to compare the SSP, SP, and C groups on 10 sets of variables. RESULTS: Compared with C respondents, SSP respondents were more likely to be female and unmarried and to report less income and education. The SSP respondents were also more likely to report work attendance problems, poor grades in school, symptoms of conduct disturbance, impaired subjective social support, lack of self-confidence, lack of a close friend, use of psychotropic drugs in past year, and a greater number of life changes, chronic medical problems, and mental health visits within the past 6 months. In a multivariate logistic regression model with group membership as the dependent variable, compared with C respondents, SSP respondents were more likely to be female, to have less education, and to report more indicators of poor school performance and symptoms of adolescent conduct disturbance. In contrast, in a similar but separate multivariate model, compared with SP respondents, SSP respondents met the criteria for fewer DSM-III psychiatric disorders and were less likely to report impaired instrumental support. CONCLUSION: Social phobia adversely affects over 10% of the population. Previous epidemiologic catchment area-based prevalence estimates have probably been unrealistically low.

Achievement↗
PubMed1994

Patient Stage of Change predicts outcome in a panic disorder medication trial.

OBJECTIVE: The authors test the hypothesis that patient readiness to change predicts outcome in a placebo-controlled medication trial. METHOD: Out-patients with panic disorder and agoraphobia completed the Stages of Change (SOC) questionnaire, a measure of readiness to change, before being randomly assigned either sustained release (SR) adinazolam or placebo in a 4 week double-blind trial. RESULTS: In the "intent to treat" analysis, for the 202 subjects who made at least one visit after baseline, adinazolam SR was significantly more effective than placebo on most major outcome measures. Of the 126 subjects who completed the SOC questionnaire, regression analyses showed significant correlations between SOC scores and all 5 outcome measures. In a second analysis, cluster membership based on SOC scores was predictive of outcome on 3 of 5 measures. In each statistical analysis, subjects who were not predisposed to change as measured by the SOC were significantly less likely to change. CONCLUSIONS: Patient readiness to change was strongly correlated with outcome in a placebo-controlled panic disorder trial with an effective medication. In this study, the SOC category, Precontemplation (i.e., those subjects who reported the belief that they had no problem) were less likely to change compared to those who believed that they had a problem.

Agoraphobia↗
PubMed1994

Magnetic resonance imaging in social phobia.

Recent studies have implicated dopamine and the basal ganglia circuits in the pathophysiology of social phobia. Twenty-two patients who met DSM-III-R criteria for social phobia and 22 age- and sex-matched control subjects underwent magnetic resonance imaging (MRI). MRI was performed with a 1.5 Tesla General Electric Signa System. No statistically significant difference was demonstrated between social phobia patients and normal control subjects in respect to total cerebral, caudate, putamen, and thalamic volumes. Although this study failed to demonstrate any specific cerebral structure abnormalities in patients with social phobia, it did reveal an age-related reduction in putamen volumes in patients with social phobia that was greater than that seen in controls. This age-related reduction in putamen volumes in patients with social phobia was not correlated with the severity of their illness.

Adult↗