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Biomedical subjects

M K Shear

Publications and source records attributed to M K Shear.

At least 55 records · Page 3Linked to original sources
PubMed1998

Effects of panic disorder treatments on personality disorder characteristics.

Ninety-three patients with panic disorder and mild or no agoraphobia were treated for their panic disorder by using either 11 sessions of individual cognitive-behavior therapy or imipramine. Before and after treatment, their panic disorder symptomatology was assessed, and a self-report measure was administered to measure personality disorder characteristics [Klein et al., 1990: Wisconsin Personality Disorders Inventory]. In addition, some patients received this personality assessment again after six monthly maintenance sessions. Both treatments were equally effective in reducing panic disorder symptomatology, and both treatments had a positive influence on personality disorder characteristics. Personality disorder characteristics did not predict treatment outcome in either group. The implications of the findings for the assessment of personality and the treatment of panic disorder are discussed.

Adolescent↗
PubMed1998

Psychotherapy in the overall management strategy for social anxiety disorder.

Cognitive-behavioral therapies (CBTs) are effective treatments for social anxiety disorder/social phobia. Although a variety of procedures are included under the term cognitive-behavioral treatment, it is, however, clear that the key factor influencing treatment outcome for social anxiety disorder is exposure to feared situations. Two formalized CBT programs are cognitive-behavioral group therapy (CBGT) and social effectiveness training (SET). They both involve exposure, but differ in that CBGT focuses on correction of cognitive errors, whereas SET uses social skills training in addition to exposure to feared social situations. CBGT is more efficacious than a psychological placebo and has shown efficacy comparable to that of phenelzine in a double-blind, placebo-controlled study. The onset of effect of phenelzine was more rapid, whereas the effect of CBGT was more sustained. The major component of SET, imaginal and/or in vivo exposure, has been demonstrated to be more effective than pill placebo or the beta-blocker atenolol. Many questions remain regarding CBT strategies and their place in the overall management of patients with social anxiety disorder. Depending upon the particular patient profile, various combinations of drug and/or CBT may prove to be the optimal treatment strategy.

Behavior Therapy↗
PubMed1998

Anxiety as a predictor of response to interpersonal psychotherapy for recurrent major depression: an exploratory investigation.

Major depression and anxiety frequently co-occur, but the implications for psychological treatments have rarely been studied. We examined predictors of acute response to interpersonal psychotherapy in 134 consecutively treated female outpatients with recurrent unipolar depression. Women who failed to remit with interpersonal psychotherapy alone experienced higher levels of somatic anxiety, were more likely to meet criteria for lifetime panic disorder, were more likely to meet criteria for nonendogenous or nonmelancholic depression, and reported greater vocational impairment, higher levels of global severity, a longer duration of the index episode, and, somewhat surprisingly, lower levels of social impairment at pretreatment evaluation. A series of backwards stepping logistic regression analyses showed higher levels of baseline somatic anxiety and social functioning to be the most consistent predictors of nonresponse. Our findings strengthen existing evidence that concomitant anxiety can adversely affect the outcome of interpersonal therapy for depression.

Adult↗
PubMed1997

Systematic assessment of social phobia in clinical practice.

The purpose of this review is to propose a systematic approach to the assessment of social phobia for monitoring treatment outcome in clinical settings. A selection of measures is available, including questionnaires and structured interviews varying in length, complexity, and content. To design an assessment protocol for a particular patient or patient population, the clinician needs to be familiar with the characteristics of these available measures. The measures selected for detailed description and discussion here: (a) are specifically designed to assess social anxiety and social phobia, (b) have been demonstrated to have acceptable psychometric characteristics, and (c) have been utilized in treatment outcome research. Five questionnaire measures will be reviewed: (1) the Social Phobia and Anxiety Inventory (SPAI) (Turner et al., 1989a: Psychol Assessment 1:35-40), (2) the Social Interaction and Anxiety Scale (SIAS) (Mattick and Clarke, 1989 in Heimberg et al., 1992), (3) the Social Phobia Scale (SPS) (Mattick and Clarke, 1989 in Heimberg et al., 1992: Behav Therapy 23:53-73), (4) the Fear of Negative Evaluation Scale (FNES) (Watson and Friend, 1969: J Consult Clin Psychol 33:448-457), and (5) The Social Anxiety and Distress Scale (SADS) (Watson and Friend, 1969: J Consult Clin Psychol 33:448-457). Two interview measures will be reviewed, the Liebowitz Social Anxiety Scale (LSAS) (Liebowitz, 1987: Modern Problems Pharmacopsych 22:141-173) and Brief Social Phobia Scale (BSPS) (Davidson et al., 1991: J Clin Psychiatry 52:48-51). Measures developed for specific subgroups, including patients with speech anxiety and musical performance anxiety, as well as the application of other evaluation methods, such as the Behavioral Assessment Test, will also be discussed. Guidelines for selecting appropriate social phobia measures for varying clinical and research situations will be proposed that take into consideration the strengths and weaknesses of these methods.

Anxiety Disorders↗
PubMed1997

Anxiety disorders in women: gender-related modulation of neurobiology and behavior.

The study of psychobiology of gender is in its infancy, but already there are emerging findings of interest to clinicians and researchers in the area of anxiety disorders. There is much work yet to be done, but findings provide initial support for hypotheses that ovarian and other gonadal and maternal hormones play important regulatory roles in determining behavior as well as neurotransmitter function in women. These regulatory effects clearly involve areas known to be important in the onset and maintenance of anxiety symptoms and anxiety disorders. It is important to note that although neurophysiologic mechanisms are definitely in need of study and attention, this should not occur at the expense of further psychosocial research in this area. Social changes in gender-role functioning may well produce important neurobiologic changes, and this may be the most effective and efficient way of producing such changes, which can ultimately reduce women's risk of anxiety disorders.

Adult↗
PubMed1997

Phenomenology and treatment of bereavement-related distress in the elderly.

While brief periods of bereavement-related distress should be neither pathologized nor treated, periods of distress lasting several months that meet criteria for major depressive episode and, in particular, for what we now refer to as traumatic grief reactions, are strongly associated with considerable psychiatric and physical morbidity and deserve careful clinical attention. Our current efforts at treatment development for traumatic grief come directly from treatment for Post-Traumatic Stress Disorder. We conceptualize this as a nine-session intervention with an emphasis on reliving the moment of the death, saying goodbye to the deceased, and in vivo exposure to situations that the subject has come to avoid since the death. As yet, we have no objective data on the outcome of this procedure in traumatic grievers, but clinical outcomes have been consistent with Foa's theory that re-experiencing the trauma and exposure to avoided situations under controlled conditions ultimately leads to reductions in subjective distress. We are currently planning an open treatment development trial of this form of traumatic grief therapy. Assuming outcomes are positive, we plan to test it in a randomized controlled trial comparing the efficacy of this intervention with a more standard form of non-behavioral psychotherapy and with pharmacotherapy.

Aged↗
PubMed1997

Multicenter collaborative panic disorder severity scale.

OBJECTIVE: To address the lack of a simple and standardized instrument to assess overall panic disorder severity, the authors developed a scale for the measurement of panic disorder severity. METHOD: Ten independent evaluators used the seven-item Panic Disorder Severity Scale to assess 186 patients with principal DSM-III-R diagnoses of panic disorder (with no or mild agoraphobia) who were participating in the Multicenter Collaborative Treatment Study of Panic Disorder. In addition, 89 of these patients were reevaluated with the same scale after short-term treatment. A subset of 24 patients underwent two independent assessments to establish interrater reliability. Internal consistency, convergent and discriminant validity, and sensitivity to change were also determined. RESULTS: The Panic Disorder Severity Scale was associated with excellent interrater reliability, moderate internal consistency, and favorable levels of validity and sensitivity to change. Individual items showed good convergent and discriminant validity. Analysis suggested a two-factor model fit the data best. CONCLUSIONS: The Panic Disorder Severity Scale is a simple, efficient way for clinicians to rate severity in patients with established diagnoses of panic disorder. However, further research with more diverse groups of panic disorder patients and with a broader range of convergent and discriminant validity measures is needed.

Agoraphobia↗
PubMed1997

Self-reported anxiety, general medical conditions, and disability bed days.

OBJECTIVE: This study examined the effect of self-reported anxiety on the number of days persons with various general medical conditions spend in bed owing to disability. METHOD: Self-reported medical illness and disability data from a nationally representative household survey sample (N = 20,884) were analyzed. RESULTS: Among respondents with general medical conditions, those with self-reported anxiety had a nearly fourfold greater length of disability (mean = 18.0 bed days) than the nonanxious respondents (mean = 4.8 bed days). After adjustment for differences in demographic characteristics and burden of general medical illness, anxiety was associated with an additional 3.8 bed days. CONCLUSIONS: Self-reported anxiety in combination with general medical conditions may be associated with extensive functional impairment.

Adult↗
PubMed1997

Traumatic grief as a risk factor for mental and physical morbidity.

OBJECTIVE: The aim of this study was to confirm and extend the authors' previous work indicating that symptoms of traumatic grief are predictors of future physical and mental health outcomes. METHOD: The study group consisted of 150 future widows and widowers interviewed at the time of their spouse's hospital admission and at 6-week and 6-, 13-, and 25- month follow-ups. Traumatic grief was measured with a modified version of the Grief Measurement Scale. Mental and physical health outcomes were assessed by self-report and interviewer evaluation. Survival analysis and linear and logistic regressions were used to determine the risk for adverse mental and physical health outcomes posed by traumatic grief. RESULTS: Survival and regression analyses indicated that the presence of traumatic grief symptoms approximately 6 months after the death of the spouse predicted such negative health outcomes as cancer, heart trouble, high blood pressure, suicidal ideation, and changes in eating habits at 13- or 25-month follow-up. CONCLUSIONS: The results suggest that it may not be the stress of bereavement, per se, that puts individuals at risk for long-term mental and physical health impairments and adverse health behaviors. Rather, it appears that psychiatric sequelae such as traumatic grief are of critical importance in determining which bereaved individuals will be at risk for long-term dysfunction.

Anxiety Disorders↗
PubMed1997

The panic-agoraphobic spectrum: a descriptive approach to the assessment and treatment of subtle symptoms.

OBJECTIVE: Psychiatric classification is still a topic of considerable discussion and debate in spite of major advances in the past two decades. The debate involves categorical versus dimensional approaches, cutoff numbers of symptoms to define a case, degree of impairment, objective diagnostic criteria versus more theoretically based criteria, episodic versus trait-like symptoms, and the role of atypical and subclinical symptoms. All of these issues have been raised for the anxiety disorders and depression. This article presents the conceptualization of a relatively novel and testable approach to the diagnosis and classification of panic and agoraphobia, the panic-agoraphobic spectrum, and pilot data on a new questionnaire to assess it. METHOD: Pilot testing of the Panic-Agoraphobic Spectrum Questionnaire was undertaken with 100 inpatients who had lifetime diagnoses of panic disorder, unipolar depression, comorbid panic and unipolar depressive disorders, or an eating disorder. The instrument emphasizes impairment related to 144 behaviors and experiences in seven panic-agoraphobic symptom domains. RESULTS: Patients with panic disorder scored highest on the questionnaire, and those with comorbid depression showed even greater severity of illness. The scores of the patients with eating disorders and of the depressed patients differed from those of the other groups but also differed from 0. CONCLUSIONS: The spectrum model of panic and agoraphobia is a flexible and comprehensive means of describing this clinical complex. The proposed model, complementary to the categorical approach, presumably expresses a unitary pathophysiology. Its usefulness is discussed in terms of its value for patient-therapist communication, outcome measures, identification of subtle personality traits, and subtyping of patients for research and treatment.

Adult↗
PubMed1997

Psychotherapy for panic disorder.

Although medications and panic-focused cognitive behavior therapy are considered standard treatments for panic disorder, other types of psychotherapy may also be helpful. Many patients with panic disorder have some residual underlying vulnerability, as suggested by the continued occurrence of symptoms. These patients may benefit from a more broad-based psychotherapy, as might those in whom comorbid symptoms occur. Some patients are unable or choose not to participate in a structured prescriptive treatment requiring homework. Our psychotherapeutic approach to treating panic disorder, called emotion-focused treatment, targets identifying and managing negative emotions, especially as they relate to common psychological themes of fear of separation, fear of constriction, and the need for interpersonal control.

Adaptation, Psychological↗
PubMed1997

Anxiety disorders in primary care: a life-span perspective.

From a family-oriented life-span perspective, the authors highlight issues involved in recognition, assessment, and treatment of anxiety disorders. After reviewing prevalence rates for these disorders in child, adult, and geriatric groups, they discuss cross-generational transmission of illness and identify cross-cutting themes, such as comorbidity of anxiety and depression, relationship between anxiety disorders and quality of life, and links among disability, adversity, and anxiety. They also discuss issues specific to childbearing, motherhood, and bereavement, and conclude with a brief summary of treatment approaches.

Adolescent↗
PubMed1997

Generalized covariance-adjusted discriminants: perspective and application.

When discriminant analysis is used in practice for assessing the usefulness of diagnostic markers, the lack of control over covariates motivates the need for their adjustment in the analysis. This necessity for adjustment arises especially when the researcher's aim is classification based on a set of diagnostic markers and is not based on a set of covariates for which there exists known heterogeneity among the subjects with respect to the groups under consideration. The traditional covariance-adjusted approach is restrictive for such applications in that they assume linear covariates and a normal distribution for the the feature vector. Further, there is no available method for variable selection in using such covariance-adjusted models. In this paper, we generalize the traditional covariance-adjusted model to a general normal and logistic model, where these generalized models not only relax the distributional assumptions on the feature vector but also allow for nonlinear covariates. Exact and asymptotic tests are also derived for the problem of variable selection for these new models. The methodology is illustrated with both simulated data and an actual data set from a psychiatric study on using the Social Rhythm Metric for patients with anxiety disorders.

Activities of Daily Living↗
PubMed1996

Anxiety among widowed elders: is it distinct from depression and grief?

The purpose of this study was to test the validity and utility of distinguishing symptoms of anxiety from those of depression and grief in recently spousally bereaved elders. We also examined pathways from baseline (six months or less post-spousal death) to follow-up (12 and 18 months post-death) levels of anxiety, depression and grief-related symptoms. Baseline and follow-up data were available from 56 recently widowed elderly subjects recruited for an investigation of physiological changes in bereavement. Confirmatory factor analyses indicated that a model in which anxiety was specified as a third factor, apart from depression and grief factors, fit the data well and significantly better than either the one or two factor models. Path analyses revealed that both baseline severity of grief and anxiety had significant lagged effects and predicted follow-up severity of depression. Symptoms of anxiety appeared distinct from those of depression and grief, and the anxiety, depression and grief factors differentially predicted subsequent symptomatology. These findings suggest a need for more specific identification and treatment of anxiety, depression and grief symptoms within the context of late-life spousal bereavement.

Aged↗
PubMed1996

Theme of current journal issue: anxiety disorders across the lifespan.

The papers presented in this issue of Anxiety document various aspects of vulnerability to, and consequences of, anxiety disorders in subjects from different periods of the lifespan. Several themes are represented in one or more of these studies, (1) effects of anxiety disorders on quality of life, (2) effects on presentation and outcome of comorbid depression, and (3) the role of learning processes and early experiences, including abuse, attachment disturbances and personality disorders, in the ongoing predilection to anxiety disorders. We encourage clinicians and researchers to take a life course perspective in working with anxiety disorder patients, in order to better understand, prevent and treat these debilitating conditions.

Adolescent↗
PubMed1996

Phenomenology and severity of major depression and comorbid lifetime anxiety disorders in primary medical care practice.

The psychiatric history and presenting clinical characteristics of 276 depressed primary care patients with and without a lifetime comorbid anxiety disorder were studied in a randomized control trial of treatments for major depression. Our findings indicate that distinctive patterns of depressive symptoms and severity, functional impairment, comorbidity of other DSM-III-R Axis I and Axis II disorders, and treatment participation are associated with lifetime histories of panic and generalized anxiety disorder. The most consistent differences are evident between patients with major depression alone and those with major depression and a lifetime panic disorder. The latter presented with greater depressive severity, greater impairment in physical and psychosocial functioning, and were more likely to have a history of alcohol dependence, somatization disorder, and avoidant personality disorder. Discriminant function analysis indicated that 66% of depressed patients with lifetime panic disorder could be correctly distinguished from those without such comorbidity on the basis of the severity of somatic and affective symptoms but not cognitive symptoms of depression. Further, depressed patients with lifetime panic disorder were more likely to prematurely terminate both pharmacotherapy and psychotherapy during each treatment's acute phase. Implications for the diagnosis and treatment of major depression with comorbid anxiety disorder in primary care patients are discussed.

Adolescent↗
PubMed1996

Childhood adversity, attachment and personality styles as predictors of anxiety among elderly caregivers.

The purpose of this study was to examine the ways in which childhood adversity, attachment and personality styles influenced the likelihood of having an anxiety disorder among aged caregivers for terminally ill spouses. We also sought to determine how childhood adversity and attachment/personality styles jointly influenced the likelihood of developing an anxiety disorder among aged caregivers. Data were derived from semistructured interviews with 50 spouses (aged 60 and above) of terminally ill patients. The Childhood Experience of Care and Abuse (CECA) record provided retrospective, behaviorally based information on childhood adversity. Measures of attachment and personality styles were obtained from self-report questionnaires, and the Structured Clinical Interview for the DSM-III-R (SCID) was used to determine diagnoses for anxiety disorders. Logistic regression models estimated the effects of childhood adversity, attachment/personality disturbances, and the interaction between the two on the likelihood of having an anxiety disorder. Results indicated that childhood adversity and paranoid, histrionic and self-defeating styles all directly increase the odds of having an anxiety disorder as an elderly spousal caregiver. In addition, childhood adversity in conjunction with borderline, antisocial and excessively dependent styles increased the likelihood of having an anxiety disorder. The results indicate the need to investigate further the interaction between childhood experiences and current attachment/personality styles in their effects on the development of anxiety disorders.

Aged↗