Search PubMed⌕ Search

Biomedical subjects

M K Shear

Publications and source records attributed to M K Shear.

At least 91 records · Page 5Linked to original sources
PubMed1993

Evaluation of the ratings comprising the associated symptom criterion of DSM-III-R generalized anxiety disorder.

In light of ongoing considerations for DSM-IV, the 18 ratings comprising the associated symptom criterion of DSM-III-R generalized anxiety disorder were evaluated. The interrater reliability and endorsement rates of each symptom were calculated from interview-based ratings of generalized anxiety disorder patients at four sites (total N = 204). Interrater reliability analyses indicated high agreement for the majority of the 18 symptoms. Regarding the frequency of symptom endorsement, significant Spearman correlations (range = .69 to .94) revealed marked consistency in the rates of symptom endorsement across the four sites. A list of "satisfactory" symptoms was generated from those meeting certain reliability and endorsement criteria. Seven symptoms were identified: irritability, restlessness, muscle tension, difficulty concentrating, sleep difficulties, feeling keyed up, and easy fatigability. Interestingly, all of the above belong to either the motor tension or vigilance and scanning clusters of the DSM-III-R associated symptom ratings. In contrast, symptoms belonging to the autonomic hyperactivity cluster were endorsed infrequently at all sites. Although additional research is needed (e.g., examination of the symptoms' discriminant validity), these findings essentially support revising the associated symptom criterion of generalized anxiety disorder in accord with option E3 in the DSM-IV Options Book.

Adult↗
PubMed1993

A psychodynamic model of panic disorder.

Current psychiatric research on panic disorder and its treatment are heavily influenced by neurobiological and cognitive-behavioral models rather than psychodynamic propositions, and psychodynamic treatment is generally considered to be of little benefit in amelioration of symptoms. However, because neither of the current models fully explains the clinical psychopathology, etiology, or pathogenesis of panic disorder, there is a need for further model building. The authors suggest that a psychodynamic approach may add to the understanding of patients with panic disorder. They base their psychodynamic formulation on pilot interviews with nine patients with panic disorder, published reports of psychological characteristics of patients with panic disorder, and data from infant and animal research on temperament. Interview results included the following: 1) all of the patients described themselves as fearful, nervous, or shy as children, 2) they remembered their parents as angry, frightening, critical, or controlling, 3) they frequently indicated discomfort with aggression, 4) most described chronic feelings of low self-esteem, 5) their spouses were characterized as passive, kind, and nonaggressive, and 6) stressors associated with frustration and resentment preceded the onset of panic. The authors propose a model in which inborn neurophysiological irritability predisposes to early fearfulness. Exposure to parental behaviors that augment fearfulness results in disturbances in object relations and persistence of conflicts between dependence and independence, which predispose to fears of feeling trapped, suffocated, and unable to escape and/or feeling alone and unable to get help. Catastrophic fears of helplessness in the face of suffocation or abandonment are easily accessible.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

An empirical study of defense mechanisms in dysthymia.

OBJECTIVE: The psychodynamic approach to understanding dysthymia has rarely been empirically tested. In this pilot study the Defense Mechanism Rating Scales were used to examine psychodynamic data from patients with dysthymia and patients with panic disorder in order to test the hypotheses that 1) dysthymic patients would be similar to panic patients in endorsing primarily lower-maturity defense mechanisms, 2) dysthymic patients would use a distinct pattern of defense mechanisms, different from that of panic patients, and 3) dysthymic patients would endorse more frequently than panic patients four individual defenses that tend to handle anger and low self-esteem poorly: devaluation, passive aggression, projection, and hypochondriasis. METHOD: Twenty-two subjects meeting the DSM-III-R criteria for primary early-onset dysthymia and 22 subjects meeting the DSM-III-R criteria for primary panic disorder were interviewed on videotape and rated on the Defense Mechanism Rating Scales. RESULTS: The dysthymic subjects scored significantly higher on narcissistic, disavowal, and action defense levels and on the four individual defenses of devaluation, projection, passive aggression, and hypochondriasis, as predicted, as well as on two additional defenses, acting out and projective identification. Both groups tended to use lower-maturity defense mechanisms. CONCLUSIONS: The defense mechanism profile identified for dysthymia differs from that for panic disorder and supports particular psychodynamic hypotheses about chronic depression. It could be useful in devising treatment strategies and as a measure of treatment efficacy.

Acting Out↗
PubMed1993

A comparison of symptom determinants of patient and clinician global ratings in patients with panic disorder and depression.

The Clinical Global Impression (CGI) is a standard assessment tool that generally shows good sensitivity to change in psychopharmacology trials. However, systematic assessment has not been conducted to determine how rating decisions are made. In this article, we examine the relationship between syndromal symptomatology and the CGI severity and improvement ratings in a study of 116 patients who met DSM-III-R criteria for both Panic Disorder and Depression. Anticipatory anxiety and depression ratings were significantly associated with each CGI item. Frequency of panic attacks was consistently related to the clinician's rating of severity but was only sporadically related to the clinician and patient improvement ratings. These findings are fairly consistent during the course of treatment. Our empirical examination of symptom determinants of the CGI demonstrates that it appears to be used systematically, yet global ratings are not merely a composite of symptomatology. Its widespread application in clinical trials is well justified.

Adult↗
PubMed1993

Effect size as a measure of symptom-specific drug change in clinical trials.

A data-analytic strategy is proposed for identifying the symptom-specific effects of each medication in a clinical trial. The within-group effect size is a standardized ratio of the pre-post change relative to the stability of change for each treatment group. Advantages of using this descriptive approach are illustrated by examining antidepressant effects of alprazolam, imipramine, and placebo in a clinical trial for patients meeting criteria for both panic disorder and depression. There was a significant difference between active medication and placebo on the Hamilton Rating Scale for Depression (HAM-D) total, but no difference between the anti-depressant effects of the active medications despite their diverse psychopharmacologic properties. Examination of effect sizes for each HAM-D item revealed distinct symptom-specific effects of each active medication in this study sample. Although these descriptive findings cannot be used for inferential conclusions, they can be used to guide the design of future trials.

Adult↗
PubMed1992

Neuroendocrine and behavioral responses to challenge with the indirect serotonin agonist dl-fenfluramine in adults with obsessive-compulsive disorder.

Neuroendocrine and behavioral responses to a single 60-mg oral dose of the indirect serotonin agonist dl-fenfluramine were assessed in unmedicated adults with obsessive-compulsive disorder (OCD) and neuroendocrine results contrasted with those in normal control subjects. Net fenfluramine-induced prolactin release did not differ significantly between OCD patients and normal controls. Prolactin responses in the OCD group were not significantly correlated with baseline Yale-Brown Obsessive Compulsive Scale scores for either obsessions or compulsions, but were positively correlated with the baseline Hamilton Depression Scale score and Hamilton Anxiety Scale score. No clear difference in the severity of patients' obsessions or compulsions was found following challenge with fenfluramine versus placebo. Although the present study does not demonstrate a serotonergic abnormality in OCD, this may be more a reflection of limitations of the test procedures than evidence that central nervous system (CNS) serotonergic function is normal in the disorder.

Adult↗
PubMed1992

Assessing impairment in patients with panic disorder: the Sheehan Disability Scale.

The DSM-III-R incorporates both distress (symptoms) and disability (impairment) in the definition of a psychiatric disorder. In psychiatric research there is a wide array of instruments used to measure symptom severity, but a limited selection for the assessment of impairment. The psychometric properties of one such instrument, The Sheehan Disability Scale (Sheehan 1983), are evaluated in this paper. The data analyzed come from two studies of patients with panic disorder, the Cross National Collaborative Panic Study--Phase I and the Panic Depression Study. In this report both the alpha coefficients and factor analyses indicate that the reliability of the scale is acceptable. The factor structure of the items and the sensitivity to change of their composite demonstrate satisfactory construct validity. The criterion-related validity is substantiated by the significant relationship between symptomatology and impairment. These analyses were limited to patients with panic disorder. Further work is needed to evaluate the instrument in assessing patients with other disorders.

Activities of Daily Living↗
PubMed1992

Pursuit eye movement dysfunction in obsessive-compulsive disorder.

Disturbances in neural circuitry including the basal ganglia and prefrontal cortex have been hypothesized to be a cause of obsessive-compulsive disorder (OCD). Because eye movements are often impaired in neurologic diseases affecting these brain areas, oculomotor functioning was assessed in 17 unmedicated patients with OCD and in 25 normal controls. As compared with control subjects, patients with OCD demonstrated low-gain (slow) pursuit eye movements and an increased frequency of square wave jerk intrusions, but no increase in anticipatory saccades. In addition, several OCD patients showed an unusual pattern of intrusive, brief epochs of high-gain (fast) pursuit lasting on the order of 50 to 130 msec. These epochs of fast pursuit moved the eyes ahead of the target being tracked, and were terminated by corrective reversal saccades. Studies of eye movement abnormalities may provide an informative neurophysiologic approach for studying disturbances in basal ganglia and frontal cortical function that have been observed in functional neuroimaging and neuropsychological studies of OCD.

Adult↗
PubMed1991

Cognitive-behavioral therapy for panic: an open study.

This paper reports results of an open prospective study of 26 patients who met DSM-III criteria for panic disorder or agoraphobia with panic attacks. Cognitive-behavioral treatment alone produced clinically and statistically significant improvement in panic symptoms, including both full-blown and limited symptom episodes. In addition, the treatment produced improvement in associated symptoms of phobic avoidance and generalized anxiety. This work provides further preliminary indication of the usefulness of cognitive-behavioral strategies as an alternative to medication in symptom-oriented treatments.

Adult↗
PubMed1991

Dynamic treatment of panic disorder: a review.

A review was conducted of the psychoanalytic and psychodynamic literature in order to identify patients with panic disorder who received dynamic treatment. Thirty-five cases were located that fit the description of panic disorder. Their characteristics are compared with those of a current anxiety disorder clinic panic disorder population. Features of the successful dynamic treatment of panic disorder are summarized.

Adult↗
PubMed1991

Vulnerability to sodium lactate in panic disorder patients given cognitive-behavioral therapy.

Six patients with panic disorder who had panicked during sodium lactate infusion were given cognitive-behavioral treatment for 12-24 weeks. After treatment they underwent another lactate infusion, and four patients were rates as having no panic, suggesting that reduced vulnerability to lactate accompanies remission of panic. Controlled trials of cognitive-behavioral therapy and use of lactate infusion as a measure of remission are recommended.

Adolescent↗
PubMed1987

Contrasting patterns of autonomic dysfunction in patients with mitral valve prolapse and panic attacks.

Both mitral valve prolapse (MVP) and panic attacks have been reported to be associated with autonomic dysfunction, but previous studies have been limited by the lack of clear separation between patients with MVP and those with panic attacks and the use of noncomparable control subjects. Accordingly, heart rate and blood pressure responses to deep breathing, five minutes' quiet standing, and the Valsalva maneuver were studied in age- and cardiac symptom-matched groups of 33 control subjects, 66 patients with MVP, 20 patients with panic attacks, and 17 patients with both MVP and panic attacks. Compared with control subjects, patients with MVP exhibited more syncope (13 of 66, or 20 percent, versus none of 33, or 0 percent; p less than 0.01), more orthostatic hypotension during quiet standing (11 of 66, or 17 percent, versus one of 33, or 3 percent; p less than 0.01), loss of the normal decrease with age in vagally-mediated heart rate variability during deep breathing (r = 0.13, p = NS versus r = -0.44, p = 0.01), and lower 24-hour epinephrine excretion (6.1 +/- 0.7 versus 11.0 +/- 2.7 micrograms; p less than 0.01). In contrast, patients with panic attacks had greater increases than control subjects or patients with MVP without panic attacks in heart rate, mean blood pressure, and the product of heart rate and mean blood pressure during each minute of quiet standing and during the early strain phase of the Valsalva maneuver. These findings indicate that autonomic dysfunction occurs both in patients with MVP and in those with panic attacks in comparison with symptomatic control subjects, but that the patterns of abnormality differ. Patients with MVP exhibit decreased effectiveness of responses to orthostatic stress, reduced epinephrine excretion, and abnormal vagal tone, whereas patients with panic attacks have heightened cardiovascular responses to postural and positive intrathoracic pressure stresses.

Adult↗
PubMed1987

Family satisfaction with psychiatric evaluations.

In the current study, psychiatric patient, family, and evaluator satisfaction with initial treatment recommendations was examined in relation to patient compliance with treatment methods and clinical improvement. Only family satisfaction was positively correlated with both compliance and improvement. This finding challenges the predominant view that families play negative roles in psychiatric illness by exacerbating symptomatology and, instead, stresses the positive facilitating role of the family. Implications for involving families in treatment evaluations and social work practice are discussed.

Consumer Behavior↗
PubMed1987

Cardiac rate and rhythm in panic patients.

This study assessed cardiac rate and rhythm by ambulatory monitoring in 23 patients with panic disorder or agoraphobia with panic attacks. The patients had a higher than normal mean daily density of ventricular premature complexes (VPCs), but complex ventricular arrhythmias were uncommon. Heart rate was greater during panic intervals than during asymptomatic periods. The prevalence of arrhythmias within symptomatic intervals was similar during panic, partial panic, and anxiety and was significantly higher than during asymptomatic intervals. However, most panic episodes had no arrhythmias, and arrhythmias during panic intervals were simple VPCs.

Adolescent↗