How shy is too shy?
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Diagnosis, Differential↗
Biomedical subjects
M B Stein
Publications and source records attributed to M B Stein.
Plasma neuropeptide Y in anxiety disorders: findings in panic disorder and social phobia.
The demonstration in preclinical studies that centrally administered neuropeptide Y (NPY) has anxiolytic effects had led to speculation that NPY may play a role in human anxiety disorders. We therefore decided to study plasma NPY levels in 22 patients with DSM-III-R anxiety disorders (11 with panic disorder and 11 with social phobia, generalized type) and 12 never psychiatrically ill comparison subjects. Under resting conditions, plasma NPY levels did not differ among the three diagnostic groups. Following hand immersion in ice water, plasma NE levels--but not NPY levels--increased immediately, but there were no significant differential diagnostic effects. These results are convergent with prior reports of normal sympathetic nerve activity in patients with anxiety disorders.
Adult↗
Public-speaking fears in a community sample. Prevalence, impact on functioning, and diagnostic classification.
BACKGROUND: Recent epidemiologic studies have revealed that social phobia is more prevalent than has been previously believed. An unresolved issue is the extent to which public-speaking fears constitute a recognizable form of social phobia in a community sample and, moreover, to what extent these fears are associated with functional morbidity. METHODS: To examine the prevalence and impact of public-speaking fears and their relationship to social phobia in a community sample, we conducted a randomized telephone survey of 499 residents of Winnipeg, Manitoba, a medium-sized midwestern metropolitan area. RESULTS: One third of the respondents reported that they had excessive anxiety when they spoke to a large audience. The onset of fears was early (ie, 50%, 75%, and 90% by the ages of 13, 17, and 20 years, respectively). Anxious cognitions about public speaking included the following fears: doing or saying something embarrassing (64%), one's mind going blank (74%), being unable to continue talking (63%), saying foolish things or not making sense (59%), and trembling, shaking, or showing other signs of anxiety (80%). In total, 10% (n = 49) of the respondents reported that public-speaking anxiety had resulted in a marked interference with their work (2%), social life (1%), or education (4%), or had caused them marked distress (8%). Twenty-three persons (5%) had public-speaking anxiety in isolation (ie, without evidence of additional kinds of social fears). CONCLUSIONS: These data support the inclusion of severe forms of public-speaking fears within the social phobia construct and, furthermore, suggest that public-speaking anxiety may have a detrimental impact on the lives of many individuals in the community.
Adolescent↗
Anxiety symptoms in panic disorder and social phobia: support for suffocation theory of panic?
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Adult↗
Panic disorder or social phobia: which is worse?
Twenty-eight patients with panic disorder (PD) and 30 with social phobia (SP) were compared on demographic and psychopathology measures. The demographic comparisons showed that, although people with SP were better educated, they were more likely to be single, living alone, and unemployed. The comparisons of psychopathology showed that the proportion of people with PD and SP with a life time major affective disorder did not differ, nor did the two groups differ on the proportion of Ss reporting past suicide attempts. However, a greater proportion of patients with SP had Brief Michigan Alcohol Screening Test scores above 5, indicating alcohol abuse problems. The implications of these findings are discussed.
Activities of Daily Living↗
G-protein level quantification in platelets and leukocytes from patients with panic disorder.
The objective of our study was to investigate if there are abnormalities in signal transducing G proteins in patients with panic disorder. We utilized selective antibodies to quantitate the levels of the G protein alpha subunits that regulate adenylyl cyclase activity (G alpha s and G alpha i2) and phosphoinositide turnover (G alpha q/11) in platelet membranes (and leukocyte membranes for G alpha s), and also carried out pertussis toxin (PT) catalyzed [32P]ADP-ribosylation in platelet membranes from a group of 13 untreated panic disorder patients, 10 untreated social phobia patients, and 12 healthy subjects. There were no significant differences among the three groups in the immunolabeling of G alpha s in platelets or leukocytes, or in the immunolabeling of G alpha i1/2, G alpha q/11, or PT-catalyzed [32P]ADP-ribosylation in platelets. Within the constraints imposed by using peripheral blood cells to reflect brain composition, our results do not provide support for G protein abnormalities in patients with panic disorder. These results contrast with those obtained using identical methodology in bipolar affective disorder, where elevated G alpha s in leukocytes has been reported (Manji et al. 1995).
Adenosine Diphosphate Ribose↗
Paroxetine in the treatment of generalized social phobia: open-label treatment and double-blind placebo-controlled discontinuation.
We conducted an 11-week forced-escalation open-label study of paroxetine in the treatment of 36 patients with generalized social phobia. At the mean dosage of 47.9 +/- 6.2 mg/day, 23 of 30 completers (77%) were deemed responders on the basis of a clinician rating of either "very much improved" or "much improved" on the Clinical Global Impressions scale. Duke Social Phobia Scale ratings declined from 35.5 +/- 13.1 at baseline to 19.7 +/- 17.4 at week 11 (p < 0.0005), and Liebowitz Social Anxiety Scale ratings declined from 75.1 +/- 25.4 at baseline to 37.2 +/- 32.5 at week 11 (p < 0.0005). Sixteen responders were randomized to an additional 12 weeks of either paroxetine (with no dosage change) or placebo (after a taper period) on a double-blind basis. To the best of our knowledge, this is the first controlled medication-discontinuation study in social phobia. One of eight patients randomized to continue paroxetine relapsed versus five of eight patients randomized to placebo. These findings call for a double-blind, placebo-controlled treatment study of paroxetine in generalized social phobia. They also suggest that relapse rates are high if medication is discontinued early and that further study is needed to determine (1) the optimal duration of maintenance pharmacotherapy for social phobia and (2) if specific psychotherapeutic interventions before medication discontinuation may prevent relapse.
Adult↗
Childhood physical and sexual abuse in patients with anxiety disorders and in a community sample.
OBJECTIVE: The authors investigated whether histories of childhood physical or sexual abuse were reported more frequently in a clinical sample of patients with anxiety disorders than in a matched community comparison sample. METHOD: A standardized interview with an extensive series of trauma probes was administered to 125 patients with DSM-IV anxiety disorders (panic disorder, social phobia, or obsessive-compulsive disorder) and to 125 age- and gender-matched subjects drawn from a random community sample. RESULTS: Childhood physical abuse was higher among both men (15.5%) and women (33.3%) with anxiety disorders than among comparison subjects (8.1%). Childhood sexual abuse was higher among women with anxiety disorders (45.1%) than among comparison women (15.4%) and was higher among women with panic disorder (60.0%) than among women with other anxiety disorders (30.8%). CONCLUSIONS: These findings confirm the association between anxiety disorders and reported childhood physical and sexual abuse and extend earlier findings by pointing to a particular association between sexual abuse and panic disorder in women.
Adolescent↗
Social phobia in adults with stuttering.
OBJECTIVE: The authors evaluated features of social anxiety in a group of adult stutterers to explore the soundness of the DSM-IV requirement that social phobia not be diagnosed in patients who stutter if their phobia relates to their stuttering. METHOD: They conducted diagnostic interviews and verbal fluency assessments with 16 consecutive adults seeking speech therapy for stuttering. Patients also completed scales measuring social phobia symptoms and associated disability. RESULTS: When DSM-IV criteria were modified to permit a diagnosis of social phobia if phobic symptoms were clearly excessive in relation to the severity of stuttering, seven of the 16 patients were given a diagnosis of social phobia. All seven identified social anxiety as an important source of role impairment. Three of the seven patients entered cognitive-behavioral group therapy and benefited from this intervention. CONCLUSIONS: Many adults seeking treatment for stuttering have salient difficulties with social anxiety that may prove amenable to cognitive-behavioral interventions. By precluding a diagnosis of social phobia in these patients, DSM-IV may hinder the identification of social anxiety as a source of disability and may limit access to treatment.
Adult↗
Mixed anxiety-depression in a primary-care clinic.
To determine the prevalence and clinical significance of a mixed anxiety-depressive (MAD) syndrome in primary care, a two-stage sampling design was applied to 796 consecutive clinic attendees without known psychiatric illness. Among 78 systematically interviewed subjects, 10.3% (n = 8) had a depressive disorder alone, 12.8% (n = 10) had an anxiety disorder alone, 19.2% (n = 15) had a comorbid anxiety and depressive disorder and 12.8% (n = 10) had a combination of subsyndromal anxiety and depressive features that fulfilled either ICD-10 or our own operational criteria for MAD. Patients with MAD rated their disability as being comparable to that of patients with anxiety or depressive disorders. These findings lend support to the notion that there is a sizeable subgroup of patients in primary care who appear to be suffering from a psychiatric syndrome with an admixture of subsyndromal depressive and anxiety features. Questions about the temporal stability of MAD and preferred approaches to treatment have yet to be answered.
Adjustment Disorders↗
[3H]paroxetine binding to platelets of patients with social phobia: comparison to patients with panic disorder and healthy volunteers.
Recent studies suggest that serotonergic functioning may be aberrant in patients with social phobia. Capacity of the serotonin (5-HT) transporter, as determined by 3H-paroxetine binding, was measured in 18 drug-free patients with generalized social phobia and compared to 15 drug-free patients with panic disorder and 23 healthy control subjects. The density (Bmax) and affinity (1/Kd) of 3H-paroxetine binding sites was similar in all three groups. To the extent that the serotonin transporter in platelets and neurons is comparable, these findings suggest that this aspect of serotonergic function is normal in patients with social phobia.
Adult↗
Irregular breathing during sleep in patients with panic disorder.
OBJECTIVE: The authors examined the nocturnal breathing patterns of patients with panic disorder to determine whether these individuals had respiratory irregularities at a time when anxiety was not manifest. METHOD: Respiratory polysomnography was conducted on 14 medication-free patients with panic disorder and 14 healthy comparison subjects. Semiautomated indices of ventilatory variability were calculated for representative 3-minute, artifact-free sleep samples, and manually scored indices of irregular breathing were rated (blind to diagnosis) for the entire last 2 nights of sleep. RESULTS: Patients with panic disorder had evidence of abnormal sleep breathing as indicated by increased irregularity in tidal volume during REM and an increased rate of microapneas (i.e., brief [5-10-second] pauses in breathing). A subgroup of patients (including some with recent sleep panic attacks) had indices of subtle disorders in breathing during sleep that were above the 95th percentile for the comparison subjects. CONCLUSIONS: These findings extend the observations in the awake state that patients with panic disorder breathe more irregularly than healthy comparison subjects. The irregularities may be attributable to altered brainstem sensitivity to CO2 or to other as yet unexplained factors. A possible relationship between irregular nocturnal breathing and sleep panic attacks is discussed.
Adult↗
Autonomic function in panic disorder: cardiorespiratory and plasma catecholamine responsivity to multiple challenges of the autonomic nervous system.
Panic disorder has been widely hypothesized to be associated with dysfunction of the autonomic nervous system. In this study, 24 patients with panic disorder and 26 healthy control subjects took part in a broad battery of autonomic function tests, each designed to stress the autonomic nervous system in a particular fashion. Testing consisted of postural challenge, isometric exercise, cold pressor, and Valsalva maneuver. Dependent measures included heart rate, vagal tone, blood pressure, respiratory frequency, end-tidal CO2 levels, and plasma norepinephrine and epinephrine levels. The testing procedures reliably produced changes in autonomic output in the expected directions, but patients with panic disorder were not found to differ from healthy controls in their cardiorespiratory or plasma catecholaminergic responses. This pattern of normal autonomic responsivity in the patients with panic disorder was evident across multiple test conditions with varying autonomic demand characteristics, thereby supporting the integrity of autonomic regulatory systems in this illness. These data run counter to a simple notion of autonomic dysfunction in panic disorder.
Adult↗
Serum cytokine and soluble interleukin-2 receptors in patients with panic disorder.
There has been very little research investigating the interface between panic disorder and the immune system. This preliminary study explores the relationship between panic disorder and serum levels of cytokines, which have potent immune and central nervous system activity, and soluble interleukin-2 receptors, a well-known marker of T-cell activation. Fifteen women with panic disorder and 19 healthy female subjects had serum levels of interleukin-1, interleukin-2, and soluble interleukin-2 receptors (SIL-2Rs) measured by enzyme-linked immunoassay. Women with panic disorder had slightly increased serum levels of interleukin-2 but did not differ from age-comparable and gender-matched controls in serum interleukin-1 alpha, or interleukin-1 beta. And although the mean SIL-2R levels were not different for the two groups, the SIL-2R levels were present across a wider range of values in the women with panic disorder. Our data suggest that more extensive investigation of circulating levels of interleukin-2 and the soluble interleukin-2 receptor in patients with panic disorder may be warranted.
Adult↗
Resting cardiovascular measures in patients with panic disorder and social phobia and health control subjects: relationship to habitual exercise frequency.
Weekly aerobic exercise frequency was evaluated and compared to resting cardiovascular measures in 22 patients with panic disorder, 11 patients with social phobia and 24 healthy control subjects. There were no diagnostic differences in resting cardiovascular activity or levels of habitual aerobic exercise. However, it was evident that, regardless of diagnostic status, individuals who participated in regular aerobic exercise (20 minutes duration at a minimum frequency of 2x/week) had lower heart rate and higher vagal tone than those who did not exercise aerobically. Implications for previous and future reports of resting cardiovascular measures in anxiety disorder patients are discussed.
Adult↗
Serum interleukin-2 and soluble interleukin-2 receptor levels in generalized social phobia.
Alternations in immune function have been described in a variety of psychiatric disorders including schizophrenia and depression; however, we do not know of any research involving social phobia and the immune system. This preliminary study explores the relationship between social phobia and two well-established immune parameters, serum interleukin-2 (IL-2) levels, a potent immune and central nervous system modulator, and soluble interleukin-2 receptors (SIL-2Rs), a well-known marker of T-cell activation. Fifteen subjects with generalized social phobia and 15 healthy volunteers had serum IL-2, and SIL-2Rs measured by enzyme-linked immunoassay. Subjects with social phobia and normal volunteers had similar mean serum IL-2 and SIL-2R levels. The data suggest that, unlike other psychiatric disorders, these immune measures may not be used to differentiate patients with generalized social phobia from normal volunteers.
Adolescent↗
Autonomic responsivity in generalized social phobia.
To determine whether patients with generalized social phobia exhibit evidence of abnormal autonomic nervous system (ANS) functioning, 15 non-depressed, medication-free subjects with DSM-IV social phobia (generalized type) and 15 healthy control subjects participated in a series of autonomic function tests. Generalized social phobics exhibited increased blood pressure responsivity to Valsalva and exaggerated vagal withdrawal in response to isometric exercise, but normal cardiovascular responsivity to all other tasks. Plasma norepinephrine and epinephrine levels were also normal. Studies with larger sample sizes and the use of specific neuropharmacologic probes seem warranted to further delineate a role for autonomic dysfunction in the pathophysiology of this disorder.
Adult↗
Panic disorder in patients attending a clinic for vestibular disorders.
In a study of the prevalence of panic and other anxiety disorders in persons with complaints of dizziness, 87 patients referred to a clinic for vestibular disorders completed self-rating measures of anxiety and depression; 32 also underwent a structured diagnostic interview. Thirteen (14.9%) of the patients met the DSM-III-R criteria for panic disorder, agoraphobia, or both. They rated themselves as much more disabled by their dizziness than the patients with no psychiatric disorder. Panic disorder was equally prevalent among patients with and without vestibular disease. In some cases panic disorder may provide an explanation for the dizziness, whereas in others it may be a comorbid condition compounding the disability attributable to the vestibular disorder.
Adult↗