Cocaine abuse and treatment.
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Behavior Therapy↗
Biomedical subjects
M H Pollack
Publications and source records attributed to M H Pollack.
Personality disorders in patients with panic disorder: association with childhood anxiety disorders, early trauma, comorbidity, and chronicity.
The rates of comorbid personality disorders in patients with panic disorder are reported to be elevated, have an adverse impact on the response to treatment, and increase the likelihood of relapse on treatment discontinuation. We examined the rates of personality disorders in panic disorder patients in a longitudinal, naturalistic study of panic disorder. Of 100 panic disorder patients studied, 42 met criteria for at least one personality disorder as determined by the Personality Disorder Questionnaire-Revised (PDQ-R). The presence of a personality disorder as determined by the PDQ-R was associated with a past history of childhood anxiety disorders, comorbidity with other anxiety disorders and depression, and a chronic, unremitting course of panic disorder in adulthood. The presence of a personality disorder in these patients was not significantly associated with a history of physical or sexual abuse in childhood. Our findings support the notion that an anxiety diathesis, demonstrated by significant difficulties with anxiety in childhood, influences the development of apparent personality dysfunction in panic patients. In other cases, personality pathology may reflect the presence of comorbid anxiety disorders or depression. The association of personality disorder in panic patients with a more unremitting course of illness underscores the importance of axis II pathology in understanding the longitudinal course of panic disorder.
Adult↗
Olfactory-triggered panic attacks among Cambodian refugees attending a psychiatric clinic.
Olfactory panic attacks have not been systematically assessed in a psychiatric population by any previous studies. Among Cambodian refugees attending a psychiatric clinic, the present investigation determines the following: (a) 1-month current prevalence of olfactory-triggered panic attacks, (b) associated psychopathology (Hopkins Symptom Checklist and the Structured Clinical Interview for DSM-IV-diagnosed posttraumatic stress disorder [PTSD]), and (c) frequency in events of olfactory panic of catastrophic cognitions (Panic Attack Cognitions Scale [PACQ]) and flashbacks (Clinician-Administered PTSD flashback scale). Forty-five percent of 100 consecutive psychiatric patients were found to have suffered an olfactory-triggered panic attack in the previous month; having current olfactory panic attacks was highly correlated with psychopathology (e.g., to PTSD diagnosis: and chi(2)=50.0; df=1; p<.001); and during olfactory-triggered panic attacks, catastrophic cognitions and flashbacks were common. Possible mechanisms for generation of high rates of olfactory-triggered panic attacks in this population are discussed (the "traumatic memory/catastrophic cognitions/interoceptive conditioning/escalating arousal" or "TCIE" model of panic generation) as are treatment implications.
Adult↗
Rate of improvement during cognitive-behavioral group treatment for panic disorder.
This study examined the rate of symptom improvement in patients receiving cognitive-behavioral group treatment for panic disorder in an outpatient clinic setting. Treatment was a standard program of 12 sessions that emphasized information, interoceptive and situational exposure, and cognitive restructuring, but also included diaphragmatic breathing and relaxation training as elements of treatment. Subjects were 37 patients selected from sequential admissions into an outpatient treatment program; all data were derived from ongoing quality assurance measures that are a standard part of clinical monitoring. Consequently, this study provides data not on the relative efficacy of cognitive-behavioral therapy (CBT), but on rate of improvement and effectiveness of CBT for panic disorder in actual clinical practice. Patients achieved significant treatment gains on all panic disorder dimensions assessed, and the largest reduction in symptoms was during the first third of the treatment program, thereby challenging the notion that CBT delivers its gains slowly over time. Information on rats of symptom improvement is valuable for providing patients with accurate expectations about potential treatment benefits and for helping to maintain motivation during initial treatment sessions.
Adult↗
Sertraline effects on dyspnea in patients with obstructive airways disease.
Dyspnea can have a debilitating effect on psychosocial and physical functioning in patients with chronic obstructive airways disease. Previous research has suggested that treatment of concomitant mood or anxiety symptoms can improve dyspnea and exercise intolerance among patients with respiratory disease. The authors report here on a case series of 7 patients with obstructive airways disease who reported improvements in dyspnea after sertraline 25-100 mg/day was added to their medication regimens. Four of the seven patients did not appear to meet syndromal criteria for a mood or anxiety disorder. Subjective improvements in dyspnea may have been related to relief of mood or anxiety symptoms or to direct effects on central respiratory systems. Controlled studies are needed to clarify the potential antidyspneic effects of sertraline.
1-Naphthylamine↗
A comparison of the efficacy of clonazepam and cognitive-behavioral group therapy for the treatment of social phobia.
There is a growing body of evidence that social phobia may be treated effectively by either pharmacologic or cognitive-behavioral interventions. but few studies have examined the relative benefits of these treatments. In this study, we examined the relative efficacy of pharmacotherapy with clonazepam and cognitive-behavioral group therapy (CBGT) for treating social phobia. In addition, we examined potential predictors of differential treatment response. Outpatients meeting Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised) criteria for social phobia were randomly assigned to treatment. Clinician-rated and patient-rated symptom severity was examined at baseline and after 4, 8, and 12 weeks of treatment. All clinician-rated assessments were completed by individuals blind to treatment condition. Patients in both conditions improved significantly, and differences between treatment conditions were absent, except for greater improvement on clonazepam on several measures at the 12-week assessment. Symptom severity was negatively associated with treatment success for both methods of treatment, and additional predictors-sex, comorbidity with other anxiety or mood disorders, fear of anxiety symptoms, and dysfunctional attitudes-failed to predict treatment outcome above and beyond severity measures. In summary, we found that patients randomized to clinical care with clonazepam or CBGT were equally likely to respond to acute treatment, and pretreatment measures of symptom severity provided no guidance for the selection of one treatment over another.
Adult↗
Prevalence of body dysmorphic disorder in patients with anxiety disorders.
Body Dysmorphic Disorder (BDD) is a debilitating disorder that often goes undetected in clinical practice. To provide information on the diagnostic correlates of BDD, we examined rates among outpatients seeking treatment for anxiety disorders. Participants (N = 165) were evaluated with a structured clinical interview and received the following primary diagnoses: panic disorder (n = 80), obsessive-compulsive disorder (n = 40), social phobia (n = 25) and generalized anxiety disorder (n = 20). Overall, 6.7% of patients met criteria for BDD. Rates were highest for social phobia (12%). When comorbid social phobia was excluded, rates of BDD were 1.5% in panic disorder, 6.7% in generalized anxiety disorder, and 7.7% in obsessive-compulsive disorder. In all cases, onset of social phobia preceded onset of BDD. Our findings draw attention to the prevalence of BDD in patients with social phobia. The potential etiologic significance of our findings is discussed.
Adult↗
Additional findings on the association between anxiety sensitivity and hypochondriacal concerns: examination of patients with major depression.
Hypochondriacal concerns ranging from disease phobias to bodily preoccupations are common among patients with panic disorder. In a previous study of patients with panic disorder, we found that, of a number of symptom dimensions examined, anxiety sensitivity was the strongest predictor of hypochondriacal concerns. This finding has been the topic of subsequent debate in the anxiety literature, with concerns raised whether true hypochondriacal concerns were confounded with typical panic-related concerns. To clarify this issue, we now report on the association between anxiety sensitivity and hypochondriacal concerns in 100 patients with major depression and no history of panic disorder. Consistent with our previous study, we found that of the symptoms examined--anxiety sensitivity, depressed mood, anxious mood, somatic symptoms, and anger/hostility--anxiety sensitivity was the strongest predictor of hypochondriacal concerns. Findings are discussed in relation to the role of catastrophic interpretations of somatic symptoms in depression, panic disorder, and hypochondriasis.
Adult↗
Is panic disorder linked to cognitive avoidance of threatening information?
We used a directed-forgetting paradigm to investigate whether panic disorder patients cognitively avoid threatening information. To determine if hemispheric laterality predicts processing biases in this paradigm, we used dichotic listening methods to ascertain participants' auditory perceptual asymmetry (PA). Panic disorder patients and healthy control participants viewed a series of intermixed threat, positive, and neutral words, each followed by an instruction to either remember the word or forget it. They then performed free recall and recognition tests for all words, irrespective of initial instructions. Directed-forgetting effects occurred equally for all word types: both groups recalled remember-words better than forget-words. Because this task is strongly affected by encoding style, panic patients as a group do not seem to avoid encoding threat cues. However, PA analyses revealed that cognitive avoidance of threat forget-words was significantly associated with greater left hemisphere bias in the control group and nonsignificantly associated with lesser left hemisphere bias in the panic disorder group.
Adult↗
Childhood history of anxiety in adults with panic disorder: association with anxiety sensitivity and comorbidity.
Converging lines of evidence indicate a nonspecific link between childhood anxiety disorders and adult panic disorder. Anxiety sensitivity, defined as the fear of anxiety symptoms, was hypothesized to be a potential mediating variable in this link. This study examined the association among childhood history of anxiety disorders, current anxiety symptoms, and anxiety sensitivity in a sample of 100 patients with panic disorder undergoing treatment. Fifty-five percent of the patients had histories of one or more childhood anxiety disorders. Despite the heterogeneity of symptoms and treatment interventions among these patients, a childhood history of anxiety was associated with comorbid anxiety conditions, agoraphobic avoidance, and anxiety sensitivity scores. Anxiety sensitivity was itself a significant predictor of current severity of illness, but a childhood history of anxiety was not. These findings are consistent with the hypothesis that having an anxiety disorder during childhood is linked with patterns of anxiety and phobic avoidance in adulthood, including the level of anxiety sensitivity in patients with panic disorder.
Adult↗
Treatment strategies for panic disorder: a debate.
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Cognitive Behavioral Therapy↗
The hidden costs of untreated anxiety disorders.
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Anxiety Disorders↗
Social phobia: an update.
The literature on social phobia is reviewed in this article. Social phobia has undergone considerable diagnostic evolution to reach its present form in DSM-IV. Its differential diagnosis includes panic disorder with agoraphobia, avoidant personality disorder, depression, and "shyness." Cross-cultural issues are important to consider because the disorder may manifest differently in different cultures and social settings. It is common, with a lifetime prevalence of 13.3% in the United States according to recent epidemiological studies. Underrecognition of social phobia remains an issue of concern. Comorbidity with other psychiatric disorders, including other anxiety disorders, depression, alcohol abuse, and personality disorders, frequently occurs. Current conceptualizations of the etiology of social phobia reflect psychodynamic theories and evidence from family and genetic studies, neurobiological research, and neuroimaging. Drugs such as monoamine oxidase inhibitors, selective serotonin-reuptake inhibitors, benzodiazepines, and beta3-adrenergic blockers have proven to be efficacious, as has cognitive-behavioral treatment, including group approaches.
Cross-Cultural Comparison↗