RESUMEN
PURPOSE: To examine the relationship of adolescent alcohol and drug use over a 5-year period to cumulative health problems in late adolescence and young adulthood. METHODS: We prospectively examined self-reported health problems in a sample of adolescents, some of whom received treatment for substance use disorders and had consistently poor substance use outcomes (n = 38), some of whom received treatment for substance use disorders and had positive substance use outcomes (n = 30), and a low alcohol and drug use community comparison group (n = 48). Data regarding health-related problems of these adolescents (mean, 15.9 years; 83% Caucasian; 56.5% female) were collected at 2, 4, and 6 years following initial assessments. RESULTS: Alcohol and/or drug involvement severe enough to warrant treatment during adolescence was associated with more cumulative health problems and severe health problems for girls and more cumulative health problems for boys. Protracted and continuous abuse of alcohol and drugs was associated with more cumulative and severe health problems for girls and more severe health problems for boys. CONCLUSIONS: These results suggest that significant health problems and concerns are related to both brief and protracted alcohol and drug abuse during adolescence. Health problems will likely become even more evident as early-onset, chronic substance abusers continue to age.
Asunto(s)
Alcoholismo/epidemiología , Estado de Salud , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Niño , Femenino , Indicadores de Salud , Humanos , Estudios Longitudinales , Masculino , Prevalencia , Estudios Prospectivos , Factores Sexuales , Factores de TiempoRESUMEN
This study describes the natural course of social phobia as recalled by a sample of nonclinical subjects and explores, using qualitative research methods, perceived risk factors and factors that may cause changes in its course. Thirty-nine respondents with a lifetime diagnosis of social phobia were interviewed using a semistructured interview schedule based on DSM-IV criteria. Four main lifetime patterns emerged: a slight worsening of social phobic symptoms over time, no change, slight improvement and complete remission. Thirty-eight percent of the sample was in remission at the time of interview. The mean age of onset was 12.8 +/- 4.1 years. The average duration of illness was 29.0 +/- 12.7 years. Factors perceived by respondents to precipitate social phobia, using contract analysis, were family and school environment, onset of adolescence, low self-esteem, temperament and poverty. Factors perceived to improve symptoms were building self-esteem, exposure, determination, maturity and counseling. Factors perceived to worsen symptoms were avoidance, exposure to negative attention and comorbid disorders.
Asunto(s)
Trastornos Fóbicos/psicología , Autoimagen , Ajuste Social , Adolescente , Conducta del Adolescente , Adulto , Distribución por Edad , Edad de Inicio , Niño , Comorbilidad , Depresión/epidemiología , Diagnóstico Diferencial , Progresión de la Enfermedad , Familia , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Entrevista Psicológica/métodos , Entrevista Psicológica/normas , Acontecimientos que Cambian la Vida , Masculino , Persona de Mediana Edad , Trastorno de Pánico/epidemiología , Desarrollo de la Personalidad , Trastornos Fóbicos/clasificación , Trastornos Fóbicos/epidemiología , Trastornos Fóbicos/terapia , Escalas de Valoración Psiquiátrica , Inducción de Remisión , Estudios Retrospectivos , Factores de Riesgo , Distribución por Sexo , Medio Social , Factores Socioeconómicos , Resultado del TratamientoRESUMEN
OBJECTIVE: The goal of this direct-interview family study was to replicate and extend an earlier finding of a familial liability for social phobia. The authors hypothesized that there would be higher rates of the generalized type of social phobia--but not the nongeneralized (or "discrete") type--among relatives of probands with generalized social phobia. They also hypothesized that rates of avoidant personality disorder, a frequent comorbid condition, would be higher in relatives of probands with generalized social phobia. METHOD: The authors examined rates of three social phobia subtypes defined a priori--discrete, nongeneralized, and generalized--as well as rates of avoidant personality disorder by direct interview of 106 first-degree relatives of 23 patients with generalized social phobia and 74 first-degree relatives of 24 comparison subjects without social phobia. RESULTS: Relative risks for generalized social phobia and avoidant personality disorder were markedly higher (approximately 10-fold) among first-degree relatives of probands with generalized social phobia than among first-degree relatives of comparison probands. In contrast, relative risks for discrete social phobia and nongeneralized social phobia were not significantly different between the two groups of first-degree relatives. CONCLUSIONS: These results confirm earlier findings of a higher rate of social phobia among relatives of probands with generalized social phobia and extend these findings by specifically indicating that it is only the generalized type (and its probable axis II counterpart, avoidant personality disorder) that occurs more often among the families of probands with generalized social phobia. Implications for subsequent genetic studies are discussed.
Asunto(s)
Familia , Trastornos Fóbicos/diagnóstico , Trastornos Fóbicos/epidemiología , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Edad de Inicio , Anciano , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/genética , Comorbilidad , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Trastorno Depresivo/genética , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Personalidad/diagnóstico , Trastornos de la Personalidad/epidemiología , Trastornos de la Personalidad/genética , Trastornos Fóbicos/genética , Prevalencia , Factores de RiesgoRESUMEN
OBJECTIVE: Full and partial posttraumatic stress disorder (PTSD) following trauma exposure were examined in a community sample in order to determine their prevalence and their relative importance and functional significance. METHOD: A standardized telephone interview with a series of trauma probes and a DSM-IV PTSD checklist was administered to a random sample of 1,002 persons in a midsized Midwestern Canadian city. The authors determined current (i.e., 1-months) prevalence rates of full PTSD, i.e., all DSM-IV criteria, and partial PTSD, i.e., fewer than the required number of DSM-IV criterion C symptoms (avoidance/numbing) or criterion D symptoms (increased arousal). Additional questions about interference with functioning were also posed. RESULTS: The estimated prevalence of full PTSD was 2.7% for women and 1.2% for men. The prevalence of partial PTSD was 3.4% for women and 0.3% for men. Interference with work or school was significantly more pronounced in persons with full PTSD than in those with only partial symptoms, although the latter were significantly more occupationally impaired than traumatized persons without PTSD. CONCLUSIONS: These findings in an epidemiologic sample underscore observations from patient and military groups that many traumatized persons suffer from a subsyndromal form of PTSD. These persons with partial PTSD, although somewhat less impaired than persons with the full syndrome, nonetheless exhibit clinically meaningful levels of functional impairment in association with their symptoms. This subthreshold form of PTSD may be especially prevalent in women. Additional study of partial PTSD is warranted.
Asunto(s)
Trastornos por Estrés Postraumático/epidemiología , Adolescente , Adulto , Anciano , Intervalos de Confianza , Crimen/estadística & datos numéricos , Violencia Doméstica/estadística & datos numéricos , Escolaridad , Empleo , Femenino , Encuestas Epidemiológicas , Humanos , Renta , Acontecimientos que Cambian la Vida , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Prevalencia , Violación/estadística & datos numéricos , Factores de Riesgo , Factores Sexuales , Trastornos por Estrés Postraumático/clasificación , Trastornos por Estrés Postraumático/diagnóstico , Encuestas y Cuestionarios , Teléfono , Violencia/estadística & datos numéricosRESUMEN
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.
Asunto(s)
Antidepresivos de Segunda Generación/uso terapéutico , Paroxetina/uso terapéutico , Trastornos Fóbicos/tratamiento farmacológico , Adulto , Método Doble Ciego , Femenino , Humanos , Masculino , Factores de TiempoRESUMEN
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.
Asunto(s)
Trastornos de Ansiedad/epidemiología , Abuso Sexual Infantil/estadística & datos numéricos , Maltrato a los Niños/estadística & datos numéricos , Adolescente , Adulto , Trastornos de Ansiedad/diagnóstico , Niño , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Escalas de Valoración Psiquiátrica , Factores de Riesgo , Factores SexualesRESUMEN
The purpose of this study was to examine the relationship between change in anxiety sensitivity, as measured by the Anxiety Sensitivity Index (ASI), and treatment outcome in a sample of 106 subjects with a DSM-III-R diagnosis of panic disorder (with or without agoraphobia) who were participants in an evaluation study of cognitive-behavioral treatment. Results revealed that subjects who received active treatment had significantly lower anxiety sensitivity scores at post-treatment than the wait-list control group. We also examined change in anxiety sensitivity from pre- to post-treatment in reference to Clinical Global Improvement (CGI) ratings and with the effect size statistic. Subjects who showed improvement based on CGI ratings also demonstrated a reduction in anxiety sensitivity. Furthermore, the effect sizes obtained with the ASI were greater in magnitude than those obtained with other widely used anxiety self-report measures. Taken together, the finds supported the use of the Anxiety Sensitivity Index as a treatment outcome measure in panic disorder research.
Asunto(s)
Trastornos de Ansiedad/terapia , Nivel de Alerta , Terapia Cognitivo-Conductual/métodos , Trastorno de Pánico/terapia , Inventario de Personalidad/estadística & datos numéricos , Adulto , Anciano , Agorafobia/psicología , Agorafobia/terapia , Trastornos de Ansiedad/psicología , Femenino , Humanos , Masculino , Manuales como Asunto , Persona de Mediana Edad , Trastorno de Pánico/psicología , Instrucciones Programadas como Asunto , Psicometría , Resultado del TratamientoAsunto(s)
Trastornos de Ansiedad/psicología , Asfixia/psicología , Trastorno de Pánico/psicología , Trastornos Fóbicos/psicología , Adulto , Trastornos de Ansiedad/diagnóstico , Nivel de Alerta , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastorno de Pánico/diagnóstico , Determinación de la Personalidad , Trastornos Fóbicos/diagnóstico , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/psicologíaRESUMEN
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.