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M B Stein

Publications and source records attributed to M B Stein.

At least 55 records · Page 3Linked to original sources
PubMed2000

Trends in the prevalence of social phobia in the United States: a synthetic cohort analysis of changes over four decades.

Previous analysis of data from the U.S. National Comorbidity Survey (NCS) [24] suggested that the lifetime prevalence of social phobia in the community has increased significantly in recent cohorts. Furthermore, a latent class analysis of NCS data [21] revealed two primary classes of persons with social phobia: those with exclusive speaking fears and those with one or more other social-evaluative fears. Social phobia in the other social fear group is more persistent, more impairing, and more highly co-morbid with other DSM-III-R disorders. The current report presents data on whether the cohort effect is a general aspect of social phobia or is specific to one of the NCS social phobia subtypes, and whether the cohort effect varies as a function of socio-demographic characteristics. Data were drawn from the NCS. Social phobia was assessed with a revised version of the Composite International Diagnostic Interview. Retrospective age of onset reports were used to estimate Kaplan-Meier survival curves for first onset of social phobia in each cohort represented in the survey. Comparison of these curves allowed us to make synthetic estimates based on retrospective reports of intercohort trends in lifetime prevalence. The lifetime prevalence of social phobia appears to have increased in recent cohorts. However, this increase does not exist among social phobics with exclusive fears of speaking. The increase is most pronounced among white, educated, and married persons, and it is not explained by increased co-morbidity with other mental disorders. The fact that the cohort effect is more pronounced for social phobia with one or more non-speaking fears is important in that this is generally a more severe form of the disorder with an earlier age of onset than social phobia with pure speaking fears. The fact that the cohort effect is most pronounced among people with social and economic advantage (i.e., white, married, well-educated) is intriguing and raises questions about the etiologic process that warrant further study in future research.

Adolescent↗
PubMed2000

Disability and quality of life in social phobia: epidemiologic findings.

OBJECTIVE: Social phobia in clinical studies is vividly associated with extensive disability and reduced quality of life. It is difficult to obtain a clear portrayal of the impairment associated with social phobia in community samples. Furthermore, it has been unclear in prior studies to what extent indices were attributable to social phobia as opposed to comorbid major depression. The authors examined relevant data from the Ontario Health Survey Mental Health Supplement. METHOD: The Ontario Health Survey Mental Health Supplement, a survey of more than 8,000 residents of Ontario, Canada, aged 15-64, used the University of Michigan Composite International Diagnostic Interview to assign DSM-III-R diagnoses. Several indicators of disability and quality of life were included. The authors compared these indices for persons with and without social phobia and adjusted where indicated for the effects of major depression and relevant sociodemographic factors. RESULTS: Persons with social phobia were impaired on a broad spectrum of measures, ranging from dropping out of school to experiencing disability in one's main activity. They were also significantly more likely than persons without social phobia to rate themselves as "low functioning" on the Quality of Well-Being Scale and to report dissatisfaction with many aspects of life. Depressive comorbidity seemed to contribute only modestly to these outcomes. CONCLUSIONS: Social phobia can be a serious, disabling anxiety disorder associated with marked reduction in quality of life. Impairment in social phobia is substantial, even in the absence of comorbid major depression.

Activities of Daily Living↗
PubMed2000

Quality of life in individuals with anxiety disorders.

OBJECTIVE: Quality-of-life indices have been used in medical practice to estimate the impact of different diseases on functioning and well-being and to compare outcomes between different treatment modalities. An integrated view of the issue of quality of life in patients with anxiety disorders can provide important information regarding the nature and extent of the burden associated with these disorders and may be useful in the development of strategies to deal with it. METHOD: A review of epidemiological and clinical studies that have investigated quality of life (broadly conceptualized) in patients with panic disorder, social phobia, posttraumatic stress disorder, generalized anxiety disorder, and obsessive-compulsive disorder was conducted by searching MEDLINE and PsycLIT citations from 1984 to 1999. A summary of the key articles published in this area is presented. RESULTS: The studies reviewed portray an almost uniform picture of anxiety disorders as illnesses that markedly compromise quality of life and psychosocial functioning. Significant impairment can also be found in individuals with subthreshold forms of anxiety disorders. Effective pharmacological or psychotherapeutic treatment has been shown to improve the quality of life for patients with panic disorder, social phobia, and posttraumatic stress disorder. Limitations in current knowledge in this area are identified, and suggestions for needed future research are provided. CONCLUSIONS: It is expected that a more thorough understanding of the impact on quality of life will lead to increased public awareness of anxiety disorders as serious mental disorders worthy of further investment in research, prevention, and treatment.

Adaptation, Psychological↗
PubMed1999

A comparison of people with and without nocturnal panic attacks.

This study examined differences in frequency and severity of diurnal panic attacks between patients with (n = 22) and without (n = 21) a history of nocturnal panic attacks. Subjects were assessed with a modified version of the SCID, and completed daily panic attack diaries, the Anxiety Sensitivity Index, and the Fear Questionnaire. No differences were found between the groups in the actual number of expected or unexpected diurnal panic attacks experienced. Subjects in the nocturnal panic group experienced significantly more symptoms during diurnal panic attacks than did the diurnal only group. More specifically, the nocturnal panic group experienced more symptoms during expected diurnal panic attacks, but not during unexpected/spontaneous diurnal panic attacks. A greater proportion of the nocturnal panic subjects reported "chest pain" during diurnal panic attacks and a trend toward greater "fear of dying". Otherwise, the two groups were very similar. Implications of the findings are discussed in relation to the findings of other recent studies of nocturnal panic.

Adult↗
PubMed1999

Depression in a primary care clinic: the prevalence and impact of an unrecognized disorder.

BACKGROUND: This study assesses depression among primary care patients, the relationship between depression and functioning, and how frequently depressed individuals receive mental health treatment. METHODS: Two hundred and thirteen participants completed a diagnostic interview and measures of functional impairment and service utilization. RESULTS: Sixty-two clinic patients were depressed, and depressed individuals experienced significant functional impairment even after controlling for comorbid anxiety disorders and medical problems. However, less than 40% of depressed individuals were receiving treatment for depression. Severity of impairment was related to likelihood of receiving mental health services. LIMITATIONS: Several factors to consider when evaluating this study are the cross-sectional design, use of self-report data, and lack of random sampling. CONCLUSIONS: These results show that depression has a unique and significant impact on the functioning of primary care patients, and emphasize the need for identification of depressive disorders in primary care.

Adolescent↗
PubMed1999

Social fears and social phobia in a community sample of adolescents and young adults: prevalence, risk factors and co-morbidity.

BACKGROUND: The paper describes prevalence, impairments, patterns of co-morbidity and other correlates of DSM-IV social phobia in adolescents and young adults, separating generalized and non-generalized social phobics. METHODS: Data are derived from the baseline investigation of the Early Developmental Stages of Psychopathology Study (EDSP), a prospective longitudinal community study of 3021 subjects, aged 14-24. Diagnoses were based on the DSM-IV algorithms of an expanded version of the Composite International Diagnostic Interview. RESULTS: Lifetime prevalence of DSM-IV/CIDI social phobia was 9.5% in females and 4.9% in males, with about one-third being classified as generalized social phobics. Twelve-month prevalence was only slightly lower, indicating considerable persistence. Respondents with generalized social phobia reported an earlier age of onset, higher symptom persistence, more co-morbidity, more severe impairments, higher treatment rates and indicated more frequently a parental history of mental disorders than respondents with non-generalized social phobia. CONCLUSIONS: History of DSM-IV social phobia was found to be quite prevalent in 14-24 year-olds. The generalized subtype of social phobia was found to have different correlates and to be considerably more persistent, impairing and co-morbid than non-generalized social phobia. Although generalized social phobics are more likely than non-generalized social phobics to receive mental health treatments, the treatment rate in this sample was low despite the fact that mental health services are free in Germany.

Adolescent↗
PubMed1999

Memory functioning in adult women traumatized by childhood sexual abuse.

Memory impairment has been reported in some studies of patients with combat-related posttraumatic stress disorder (PTSD) and in rape victims with PTSD. The authors tested whether explicit memory impairment was evident in adult women who were traumatized by severe sexual abuse in childhood. The California Verbal Learning Test (Delis, Kramer, Kaplan, & Ober, 1987) and the Benton Visual Retention Task (Benton, 1974), were administered to 22 female adult survivors of childhood sexual trauma and to 20 demographically and educationally similar nonvictimized women. No evidence was found of explicit memory impairment in the abuse survivors. Furthermore, neither PTSD severity, dissociative symptom severity, nor extent of preexisting amnesia for childhood trauma contributed to the variance in memory functioning. Additional studies are needed to determine the extent to which impaired explicit memory functioning is a common feature of posttraumatic stress syndromes.

Adult↗
PubMed1999

Heritability of anxiety sensitivity: a twin study.

OBJECTIVE: In attempting to explain the familial predisposition to panic disorder, most studies have focused on the heritability of physiologic characteristics (e.g., CO2 sensitivity). A heretofore unexplored possibility is that a psychological characteristic that predisposes to panic-anxiety sensitivity-might be inherited. In this study, the authors examined the heritability of anxiety sensitivity through use of a twin group. METHOD: Scores on the Anxiety Sensitivity Index were examined in a group of 179 monozygotic and 158 dizygotic twin pairs. Biometrical model fitting was conducted through use of standard statistical methods. RESULTS: Broad heritability estimate of the Anxiety Sensitivity Index as a unifactorial construct was 45%. Additive genetic effects and unique environmental effects emerged as the primary influences on anxiety sensitivity. There was no evidence of genetic discontinuity between normal and extreme scores on the Anxiety Sensitivity Index. CONCLUSIONS: This study suggests that one psychological risk factor for the development of panic disorder-anxiety sensitivity-may have a heritable component. As such, anxiety sensitivity should be considered in future research on the heritability of panic disorder.

Adolescent↗
PubMed1999

Fluvoxamine treatment of social phobia (social anxiety disorder): a double-blind, placebo-controlled study.

OBJECTIVE: The purpose of this study was to determine the efficacy of fluvoxamine for the treatment of social phobia (social anxiety disorder). METHOD: In a 12-week multicenter, double-blind, randomized, placebo-controlled trial, 92 patients with social phobia were treated with the selective serotonin reuptake inhibitor fluvoxamine; 91.3% of the patients had the generalized subtype of the disorder. The primary criterion for response was a rating of "much improved" or "very much improved" on the Clinical Global Impression of Improvement scale. Secondary response criteria were changes on three specialized rating scales for social phobia symptoms: the Brief Social Phobia Scale, the Social Phobia Inventory, and the Liebowitz Social Anxiety Scale. Psychosocial impairment was assessed in three domains (disruption of work, social life, and home/family life) by using the Sheehan Disability Scale. RESULTS: The mean daily dose of fluvoxamine was 202 mg (SD = 86). At study end or with the last observation carried forward, within the evaluable subjects (N = 86) there was a significantly higher proportion of responders in the fluvoxamine group (42.9%, N = 18) than in the placebo group (22.7%, N = 10). Similarly, fluvoxamine was superior to placebo on all social phobia rating scales at week 8 and beyond. Fluvoxamine also resulted in significantly greater decreases in measures of psychosocial disability than did placebo. Overall, fluvoxamine was well tolerated and safe. CONCLUSIONS: These findings indicate that fluvoxamine is efficacious in the pharmacologic management of serious forms of social phobia.

Adolescent↗
PubMed1999

Panic disorder in the primary care setting: comorbidity, disability, service utilization, and treatment.

BACKGROUND: Increased medical service utilization in patients with panic disorder has been described in epidemiologic studies, although service use in primary care panic patients relative to other primary care patients is less well characterized. Inadequate recognition of panic has been shown in several primary care studies, although the nature of usual care for panic in this setting has not been well documented. This study aimed to document increased service use in panic patients relative to other primary care patients and to characterize the nature of their usual care for panic and their outcome. METHOD: Using a waiting room screening questionnaire and follow-up telephone interview with the Composite International Diagnostic Interview, we identified a convenience sample of 81 patients with panic disorder (DSM-IV) and a control group of 183 psychiatrically healthy patients in 3 primary care settings on the West Coast and determined psychiatric diagnostic comorbidity, panic characteristics, disability, and medical and mental health service use, including medications. A subsample (N = 41) of panic patients was reinterviewed 4-10 months later to determine the persistence of panic and the adequacy of intervening treatment received using the Harvard/Brown Anxiety Disorders Research Program study criteria for cognitive-behavioral therapy (CBT) and an algorithm developed by the authors for medications. RESULTS: Seventy percent of panic patients had a comorbid psychiatric diagnosis. Patients had more disability in the last month (days missed or cut down activities) (p < .01), more utilization of emergency room and medical provider visits (p < .01), and more mental health visits (p < .05). Despite the latter, only 42% received psychotropic medication, 36% psychotherapy, and 64% any treatment. On follow-up, 85% still met diagnostic criteria for panic, and only 22% had received adequate medication (type and/or dose) and 12% adequate (i.e., CBT) psychotherapy. CONCLUSION: These findings suggest a need for improved treatment interventions for panic disorder in the primary care setting to decrease disability and potentially inappropriate medical service utilization.

Adult↗
PubMed1999

A factor analytic study of the dizziness handicap inventory: does it assess phobic avoidance in vestibular referrals?

Panic disorder and agoraphobia have been associated with increased functional disability in individuals who have vestibular problems. The Dizziness Handicap Inventory (DHI), a 25-item self-report questionnaire with three rationally derived subscales, was designed to measure functional, emotional, and physical disability associated with vestibular disturbance. Despite the apparent usefulness of the DHI, there have been few studies of its psychometric properties. The primary purpose of the present study was to assess the factor structure of the DHI. A principal components analysis with oblique rotation was conducted on data collected from 95 patients referred to a tertiary-care vestibular disorders clinic for assessment of vestibular disturbance. Both 2-factor and 3-factor solutions are reported. The 2-factor solution was indicative of General Functional Limitations and Postural Difficulties. In the 3-factor solution, General Functional Limitations was split into factors indicative of Disability in Activities of Daily Living and Phobic Avoidance, while the Postural Difficulties factor remained stable. We also characterized the 3-factor solution by assessing the correlation of factor scores with measures of vestibular symptoms, mood, and anxiety. The general pattern of results does not support the validity of the original subscale structure of the DHI. Implications for revising the DHI to provide a more comprehensive and factorially valid assessment of disability associated with vestibular disturbance are discussed.

Adult↗
PubMed1999

The history, epidemiology, and differential diagnosis of social anxiety disorder.

Social anxiety disorder has only recently garnered recognition as a unique anxiety disorder. Although social anxiety disorder is distinguishable from other psychiatric disorders, there are several areas in which this distinction is not straightforward. Furthermore, social anxiety disorder is associated with considerable comorbidity with other disorders, which may render differential diagnosis a challenging endeavor. This article will review those disorders that must be differentiated from social anxiety disorder, including major depression, panic disorder with agoraphobia, generalized anxiety disorder, obsessive-compulsive disorder, and body dysmorphic disorder. In addition, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) provides specific examples of disorders, e.g., verbal dysfluency (stuttering) and Parkinson's disease, in the context of which social anxiety disorder is not to be diagnosed. Social anxiety disorder is also frequently comorbid with the Axis II avoidant personality disorder. Interestingly, this may present a prime example of "comorbidity by committee," because it is growing increasingly clear that much avoidant personality disorder as defined by DSM-IV merely denotes a subgroup of patients with generalized social anxiety disorder. Because social anxiety disorder has a chronic course and is associated with significant morbidity, it is critical that patients receive an accurate diagnosis and appropriate treatment.

Adolescent↗
PubMed1999

Social phobia in the primary care medical setting.

BACKGROUND: Social phobia (social anxiety disorder) is a common disorder that is receiving more attention as new treatments become available. Little is known about social phobia as it appears in the primary care setting. The purpose of our study was to determine the prevalence of social phobia in a primary care clinic, the rates of comorbidity with other anxiety and mood disorders, the extent of disability, and patterns of healthcare utilization. METHODS: A total of 511 English-speaking adults presenting for routine medical care participated in a 2-stage screening consisting of the administration of a self-report measure for social phobia followed by a structured diagnostic interview. We determined current (1-month) prevalence of social phobia, current comorbid disorders, and we ascertained use of health care in the previous 6 months. We also administered brief functional impairment and disability indices. RESULTS: A lower-bound estimate of 7.0% of primary care attendees suffered from social phobia as defined in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. Comorbidity with major depression (58.3% of cases of social phobia) was extensive, somewhat less so with panic disorder (27.8%) and generalized anxiety disorder (30.6%). Social phobics reported significantly more impairment in all functional domains than primary care patients without mental disorders; this was most pronounced in patients with the generalized subtype of social phobia. Social phobics made greater use of health care resources than patients who were not mentally ill, yet few (<20%) were receiving appropriate psychotropic medications. CONCLUSIONS: Patients with social phobia frequently present to primary care medical settings, and manifest impairment in multiple functional domains. But, on the basis of the low rate of psychotropic prescription, it seems that social phobia is either undiagnosed or felt by physicians to be unlikely to benefit from such treatments. Social phobia is highly comorbid with major depression and with other anxiety disorders in the primary care setting. Attention by family physicians to the presence of depression or panic attacks should signal the need to query patients about possible social phobia.

Adolescent↗
PubMed1999

Relationship of childhood maltreatment to the onset and course of major depression in adulthood.

The objective of this research was to determine the prevalence of retrospectively recalled childhood trauma among depressed patients and to examine the relationship between retrospective recall of childhood maltreatment and the onset, course, and severity of major depression in adulthood. Forty-seven adults with DSM-IV major depression and forty-one healthy comparison subjects were administered the Childhood Trauma Questionnaire (CTQ), a self-report measure of traumatic experiences in childhood. Age at onset of first depressive episode, number of lifetime depressive episodes, current depressive severity, and presence of lifetime anxiety and substance use comorbidity were determined for the depressed patients using the Structured Clinical Interview for DSM-IV. Patients with major depression recalled significantly more severe emotional abuse, emotional neglect, and physical abuse than the healthy comparison subjects. Among the depressed subjects, the severity of childhood trauma (most notably emotional abuse) predicted 25-28% of the variance in age at onset of first depressive episode (earlier onset) and number of lifetime depressive episodes (more episodes). Depressed patients with recall of childhood trauma also experienced a significantly greater number of comorbid mental disorders (2.9 vs. 1.9) than depressed patients without trauma histories. The findings must be tempered by the possibility of a recall bias toward more adverse childhood experiences in the depressed patients. To the extent that these data are valid, they suggest that childhood maltreatment may influence the onset, course, and comorbid character of major depression.

Adult↗
PubMed1998

Neurobiological perspectives on social phobia: from affiliation to zoology.

Social phobia (or "social anxiety disorder") is a prevalent condition that has been the subject of increased scrutiny in recent years. The purpose of this paper is to review the neurobiology of social phobia. It is apparent from the extant literature that this disorder is poorly understood from a neurobiological perspective. There are nonetheless a number of clinical and preclinical observations which, at times, converge to illuminate areas worthy of further study. Included in this category are suggestive findings of central serotonergic dysregulation in social phobia, response to serotonin reuptake inhibitors in social phobia, and the role of serotonergic function in septohippocampal models of anxiety. Abnormalities in central dopaminergic function are also posited, supported to some extent by recent neuroimaging findings. There are in addition a number of animal and human behavioral models in existence that may be relevant to the study of social phobia. Included in this category are models of social dominance in wild baboons, social affiliation in the prairie vole, and behavioral inhibition to the unfamiliar in childhood. Newer technologies that are likely to play a major role in the delineation of the neural circuitry (e.g., functional magnetic resonance imaging) and heritability (e.g., molecular genetics) of social phobia are discussed. Finally, an interactive role for biology and experience in the expression of social phobia is considered.

Animals↗
PubMed1998

Genetic linkage to the serotonin transporter protein and 5HT2A receptor genes excluded in generalized social phobia.

Social phobia, particularly the generalized form, is strongly familial and frequently comorbid with major depression, panic disorder, and obsessive-compulsive disorder. It has also recently been shown to be responsive to selective serotonin reuptake inhibitors. We conducted a study to determine if generalized social phobia is genetically linked to either of two candidate genes: the serotonin transporter protein (5HTT) gene, or the 5HT2A receptor (5HT2AR) gene. Rates of social phobia (using several phenotype definitions) were ascertained and blood samples obtained from consenting first-degree family members of generalized social phobic probands. 5HT2AR and 5HTT genotyping was performed using the polymerase chain reaction (PCR). Linkage was tested using LINKAGE and GENEHUNTER software. No evidence of linkage was found; power analysis indicated that failure to find linkage was unlikely due to inadequate statistical power. These findings reasonably exclude linkage between generalized social phobia and the 5HTT or 5HT2AR genes in these samples, although modifier effects cannot be ruled out. Other 5HT receptor subtypes or indirect modulatory effects of 5HT on other neurotransmitter systems may be involved.

Adolescent↗
PubMed1998

Regional cerebral metabolic asymmetries replicated in an independent group of patients with panic disorders.

BACKGROUND: Abnormal left/right (L/R) hemispheric ratios of regional cerebral glucose metabolic rates (rCMRglc) (hippocampus and inferior prefrontal cortex) have been noted in unmedicated panic disorder patients. METHODS: An independent group of panic disorder patients placed on imipramine was studied with positron-emission tomography, testing for evidence of normalization versus persistence of the abnormal rCMRglc ratios. Differences in orbital frontal rCMRglc values between the imipramine-treated and the previously reported unmedicated panic disorder patients were tested examining for evidence that the differences would resemble those noted in obsessive-compulsive disorder (OCD) patients treated with clomipramine. RESULTS: We found the same abnormally low L/R hippocampal and posterior inferior prefrontal rCMRglc ratios in the imipramine-treated panic disorder patients. In addition, we found posterior orbital frontal rCMRglc decreases in the imipramine-treated panic disorder patients compared with the unmedicated panic disorder patients. CONCLUSIONS: These abnormal asymmetries found in unmedicated panic disorder patients and now in imipramine-treated panic disorder patients may reflect a trait abnormality. The orbital frontal rCMRglc differences between the imipramine-treated and unmedicated patients are similar to changes noted in OCD patients treated with clomipramine and may reflect direct or indirect effects of imipramine treatment in panic disorder patients.

Adult↗