Biomedical subjects

Alexander Bystritsky

Publications and source records attributed to Alexander Bystritsky.

22 records · Page 2Linked to original sources

PubMedDate not supplied

Treating panic disorder in primary care: a collaborative care intervention.

Efficacy research indicates the success of cognitive behavioral treatment and medication treatment for panic disorder with or without agoraphobia. However, research findings to date possess limited generalizability beyond specialty mental health settings. We present a model for collaborative care treatment for panic disorder in the primary care setting that combines cognitive behavioral therapy and medications, and involves a behavioral health specialist, psychiatrist, and primary care physician. Educational aids that are aimed to educate and activate patients to participate as partners in their care are provided. We outline the ways in which the standard treatment was modified, in light of the nature of the sample and setting, such as fewer sessions and management of comorbidity. Also, we provide evidence for acceptability of this intervention to primary care physicians and patients. This description is intended to lay the groundwork for continued research efforts in the extension of efficacious treatments into primary care settings.

Cooperative Behavior↗

PubMedDate not supplied

Predictors of willingness to consider medication and psychosocial treatment for panic disorder in primary care patients.

The purpose of this investigation was to identify demographic and clinical patient characteristics related to willingness to consider panic disorder treatments in the primary care setting. Given the prevalence of anxiety disorders and the increased provision of mental health treatments in general medical settings, patients were selected from primary care settings. An unselected sample of 4,198 patients completed a brief questionnaire containing questions about demographic characteristics, physical health status, and symptoms of panic disorder, social phobia and PTSD. The 1,043 patients indicating a recent panic attack episode answered additional questions about their willingness to consider both medication and psychosocial forms of intervention for panic. Of these panic patients, 64% reported willingness to consider medication and 67% reported willingness to consider a psychosocial intervention for their panic. Logistic regression analyses for these panic patients revealed that willingness to consider medication treatment for panic was associated with older age, lower education, poorer health status and the presence of social phobia and/or PTSD symptoms. In addition, Asian and African American patients were less likely than Caucasian patients to indicate willingness to consider medication treatment for their panic. However, only the presence of comorbid social phobia and PTSD symptoms predicted willingness to consider a psychosocial intervention. Results suggest that acceptability of psychosocial treatment is unrelated to demographic and physical health factors, while primary care patients with certain demographic characteristics, good physical health, or who suffer from fewer comorbid mental health conditions may need additional encouragement to begin medication treatment for panic.

Adult↗

PubMedDate not supplied

Fluoxetine treatment and testosterone levels.

BACKGROUND: Two published case studies have reported SRI/SNRI-associated low testosterone levels. Apathy and low testosterone, observed during venlafaxine treatment in one report, both resolved upon venlafaxine discontinuation. No studies have investigated the effect of chronic SRI treatment on human testosterone levels. As decreased testosterone has several negative health effects, we conducted a pilot study investigating the effect of fluoxetine treatment on testosterone levels. METHODS: Fourteen depressive disorder patients in good health (BDI = 15) were studied. In addition, 4 non-depressed patients were studied. Testosterone levels were drawn, and an apathy questionnaire (under development, not yet validated) was administered at intake. Fluoxetine was provided (10 mg/day for 7 days then 20 mg/day). To measure outcome, a follow-up testosterone level was drawn after 1 month's treatment. RESULTS: Eleven depressed, and 3 non-depressed, patients completed the study. While there were large differences-both increases and decreases-in some individuals' testosterone levels after fluoxetine treatment, for the study population as a whole, there was no relationship (depressed patients, p = 0.4; non-depressed patients, p 0.3) between fluoxetine treatment and testosterone levels.In patients with BDI = 20, testosterone levels at intake were highly associated with intake apathy levels (p = 0.0033). CONCLUSIONS: Further, larger, studies correlating changes in testosterone levels during SRI treatment with treatment response, apathy levels and possibly sexual dysfunction seem indicated.

Adult↗

PubMedDate not supplied

Use of herbal medicine in primary care patients with mood and anxiety disorders.

Studies have documented the increasing use of complementary and alternative medicine over the last decade, especially in distressed individuals with symptoms of anxiety, depression, and pain. Herbal medicine is a specific form of complementary and alternative medicine often used by individuals seeing traditional medical practitioners and, hence, has the potential to interact with other medically prescribed treatments. The study examined the use of herbal medicine in a group of primary care patients with symptoms of anxiety and depression. The rate of use of herbal medicines was 11%, and use was selectively associated with a diagnosis of major depression, higher education, and a lower burden of medical illness. Use was not associated with receipt of pharmacotherapy or psychotherapy for anxiety or depression.

Adolescent↗