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Biomedical subjects

Jonathan R T Davidson

Publications and source records attributed to Jonathan R T Davidson.

At least 19 recordsLinked to original sources
PubMed2007

Profiling posttraumatic functional impairment.

Many individuals who have been exposed to psychological trauma suffer from impaired functioning, regardless of whether they have PTSD. Our purpose was to identify a subset of PTSD symptoms linked to functional impairment to a) improve the likelihood that individuals with posttraumatic impairment receive treatment, and b) offer a method to assess cost-burden of trauma history in epidemiological studies. We examined patterns of trauma-related symptoms in two independent community surveys (N=1002 and 630). Rank ordering of symptoms and their associations with impairment guided construction of an impairment-related profile in the first data set. The profile was then tested in the second data set. The derived symptom profile, consisting of intense recollections and/or emotional symptoms upon exposure to reminders, plus one or more of numbing/detachment, avoidance, sleep problems, concentration problems, or hypervigilance, detected the majority (88% and 74%) of persons with posttraumatic functional impairment. The symptom profile can help identify traumatized individuals who may benefit from treatment but do not necessarily meet criteria for PTSD.

Adaptation, Psychological↗
PubMed2007

The efficacy and tolerability of tiagabine in adult patients with post-traumatic stress disorder.

The aim of this study was to evaluate the efficacy and tolerability of tiagabine in adult patients with post-traumatic stress disorder (PTSD). This 12-week, multicenter, double-blind study randomized patients to receive either tiagabine or placebo. Tiagabine (administered in divided doses) was initiated at 4 mg/d (2 mg BID) and individually titrated of up to 4 mg/d weekly to a maximum dose of 16 mg/d. Assessments included the Clinician-Administered PTSD Scale, Clinical Global Impressions of Change, Treatment Outcome PTSD Scale, Davidson Trauma Scale, Connor-Davidson Resilience Scale, Sheehan Disability Scale, Massachusetts General Hospital Sexual Functioning Questionnaire, and Montgomery-Asberg Depression Rating Scale. A total of 232 patients (tiagabine, n = 116; placebo, n = 116) were randomized. There were no significant differences in change from baseline in the Clinician-Administered PTSD Scale total score at final visit for tiagabine compared with placebo (P = 0.85). Similarly, no significant differences were observed with tiagabine on the other efficacy outcome measures (described above) compared with placebo. Tiagabine was generally well tolerated and not associated with weight gain, changes in sexual function, or worsening of depressive symptoms. Tiagabine was not significantly different from placebo in the treatment of symptoms of PTSD. Additional studies are needed to assess the role of drugs that target the gamma-aminobutyric acid system in the treatment of PTSD.

Adult↗
PubMed2006

Multidimensional effects of sertraline in social anxiety disorder.

Clinical trials of social anxiety disorder (SAD) have largely focused on the effect of treatment on symptoms of fear and avoidance, while neglecting the third clinically relevant dimension, physiological arousal. Data were combined from two previously reported placebo-controlled trials of sertraline in the treatment of moderate-to-severe generalized SAD. Efficacy was evaluated using the Brief Social Phobia Scale (BSPS). Three hundred forty-six subjects were randomized to 12-13 weeks of treatment with sertraline and 273 subjects to placebo. Following treatment, significant improvement was noted in favor of sertraline on the full BSPS (P < .001), as well as on each of the individual BSPS subscales: fear (P = .001); avoidance (P < .0001); and physiological arousal (P < .0001). Of the physiological symptoms assessed, the treatment advantage with sertraline was maintained for blushing (P < .003) and palpitations (P < .03), but not for trembling and sweating. These results confirm the efficacy of treatment with a selective serotonin reuptake inhibitor (SSRI), sertraline, across the spectrum of fear, avoidance, and physiological arousal in generalized SAD (GSAD). Among common physiological symptoms in this population, blushing and palpitations appear more treatment responsive than trembling and sweating to acute treatment with sertraline.

Acute Disease↗
PubMed2006

A comparison of the SPRINT and CAPS assessment scales for posttraumatic stress disorder.

The Clinician-Administered PTSD Scale for DSM-IV (CAPS) is a widely used assessment tool for (posttraumatic stress disorder) (PTSD). However, a shorter assessment tool may be beneficial for clinical work. Here, we compare such a tool, the Short PTSD Rating Interview (SPRINT) to the CAPS. We found that the SPRINT rating scale performs similarly to the CAPS rating scale in the assessment of PTSD symptom clusters and total scores, and that the SPRINT takes significantly less time to administer than the CAPS.

Adult↗
PubMed2006

Augmentation of sertraline with prolonged exposure in the treatment of posttraumatic stress disorder.

The present study was designed to determine whether augmenting sertraline with prolonged exposure (PE) would result in greater improvement than continuation with sertraline alone. Outpatient men and women with chronic PTSD completed 10 weeks of open label sertraline and then were randomly assigned to five additional weeks of sertraline alone (n = 31) or sertraline plus 10 sessions of twice-weekly PE (n = 34). Results indicated that sertraline led to a significant reduction in PTSD severity after 10 weeks but was associated with no further reductions after five more weeks. Participants who received PE showed further reduction in PTSD severity. This augmentation effect was observed only for participants who showed a partial response to medication.

Adult↗
PubMed2006

Kava in generalized anxiety disorder: three placebo-controlled trials.

In this study, we evaluated the efficacy and safety of kava kava (Piper methysticum) in generalized anxiety disorder. Data were analyzed from three randomized, double-blind, placebo-controlled trials of kava, including one study with an active comparator (venlafaxine), in adult outpatients with DSM-IV generalized anxiety disorder. The pooled sample (n=64) included the following number of participants: kava, n=28; placebo, n=30; and venlafaxine, n=6. Given the comparability of the study designs, the data comparing kava and placebo were then pooled for further efficacy and safety analyses. No significant differences were observed between the treatment groups in any of the trials. In the pooled analyses, no effects were found for kava, while a significant effect in favor of placebo was observed in participants with higher anxiety at baseline. No evidence of hepatotoxicity was found with kava, and all of the treatments were well tolerated. Findings from these three controlled trials do not support the use of kava in DSM-IV generalized anxiety disorder.

Anxiety Disorders↗
PubMed2006

Modafinil for atypical depression: effects of open-label and double-blind discontinuation treatment.

Atypical depression, with features of hypersomnia, hyperphagia, anergia, and rejection sensitivity, is a common presentation of major depressive disorder. There are few available effective therapies for this disorder. We test modafinil, a novel wake-promoting agent, as monotherapy for atypical depression in a double-blind, placebo-controlled, relapse prevention trial after open-label treatment. We found that modafinil significantly improved atypical depression symptoms during 12 weeks of open-label treatment (mean +/- SD Hamilton Depression Scale (29-item version) score changed from 34 +/- 8.2 at baseline to 9.7 +/- 9.3, P < 0.0001), and that benefits were maintained alike in both the continuation and placebo arms during the double-blind treatment phase (P = 0.92). Modafinil was well tolerated and the drug was associated with significant weight loss compared with placebo (P = 0.01).

Adult↗
PubMed2006

Mental illness in U.S. Presidents between 1776 and 1974: a review of biographical sources.

Numerous historical accounts suggest the presence of mental illness in US Presidents, but no systematic review has been undertaken for all holders of this office. We reviewed biographical sources regarding mental illness in 37 US Presidents from 1776 to 1974. Material was extracted by one of the authors and given to experienced psychiatrists for independent review of the correspondence of behaviors, symptoms, and medical information in source material to DSM-IV criteria for Axis I disorders. Levels of confidence were given for each diagnosis. Eighteen (49%) Presidents met criteria suggesting psychiatric disorder: depression (24%), anxiety (8%), bipolar disorder (8%), and alcohol abuse/dependence (8%) were the most common. In 10 instances (27%), a disorder was evident during presidential office, which in most cases probably impaired job performance. Mental illness in heads of state is a topic deserving further attention. Methodological limitations of using biography to determine psychopathology are discussed.

Data Collection↗
PubMed2006

High-dose sertraline strategy for nonresponders to acute treatment for obsessive-compulsive disorder: a multicenter double-blind trial.

OBJECTIVE: To evaluate the efficacy and safety of high-dose sertraline for patients with obsessive-compulsive disorder (OCD) who failed to respond to standard sertraline acute treatment. METHOD: Sixty-six nonresponders to 16 weeks of sertraline treatment who met DSM-III-R criteria for current OCD were randomly assigned, in a double-blind continuation phase of a multicenter trial, either to continue on 200 mg/day of sertraline or to increase their dose to between 250 and 400 mg/day for 12 additional weeks. Efficacy measures included the Yale-Brown Obsessive Compulsive Scale (YBOCS), the National Institute of Mental Health Global Obsessive Compulsive Scale (NIMH Global OC Scale), and the Clinical Global Impressions-Severity of Illness and -Improvement (CGI-I) scales. Data were collected from July 26, 1994, to October 26, 1995. RESULTS: The high-dose (250-400 mg/day, mean final dose = 357, SD = 60, N = 30) group showed significantly greater symptom improvement than the 200-mg/day group (N = 36) as measured by the YBOCS (p = .033), NIMH Global OC Scale (p = .003), and CGI-I (p = .011). Responder rates (decrease in YBOCS score of > or = 25% and a CGI-I rating < or = 3) were not significantly different for the 200-mg/day versus the high-dose sertraline group, either on completer analysis, 34% versus 52%, or on endpoint analysis, 33% versus 40%. Both treatments showed similar adverse event rates. CONCLUSION: Greater symptom improvement was seen in the high-dose sertraline group compared to the 200-mg/day dose group during continuation treatment. Both dosages yielded similar safety profiles. Administration of higher than labeled doses of selective serotonin reuptake inhibitors may be a treatment option for certain OCD patients who fail to respond to standard acute treatment.

Adult↗
PubMed2006

Botulinum toxin treatment of social anxiety disorder with hyperhidrosis: a placebo-controlled double-blind trial.

OBJECTIVE: Given the often prominent and persistent nature of hyperhidrosis in social anxiety disorder (SAD), to compare botulinum toxin type A to placebo for generalized SAD with hyperhidrosis, in combination with paroxetine. METHOD: Adults with severe axillary hyperhidrosis who met DSM-IV criteria for generalized SAD were randomly assigned to receive 1-time, bilateral, intradermal injections with either botulinum toxin type A or placebo (50 units/axilla). All subjects also received 8 weeks of open-label treatment with paroxetine. The primary outcome measure was the Hyperhidrosis Disease Severity Scale (HDSS). Secondary measures included the Hyperhidrosis Impact Questionnaire, Brief Social Phobia Scale, Liebowitz Social Anxiety Scale, Social Phobia Inventory, and Sheehan Disability Scale. Enrollment occurred from June 2002 to July 2004. RESULTS: Forty subjects were randomly assigned to treatment and included in the analyses. Response rates were 75% (15/20) for botulinum toxin type A versus 15% (3/20) for placebo on the HDSS (p < .001). Botulinum toxin type A produced significantly more improvement in many daily activities that had been limited (p < .01), as well as greater improvement in work and social functioning and in overall disability (p < .05). Botulinum toxin type A was well tolerated, as was paroxetine. CONCLUSION: Botulinum toxin is effective in reducing hyperhidrosis disability and limitations in everyday activities when given in association with paroxetine to subjects with SAD. While further assessment of botulinum toxin type A in SAD is recommended, including a trial of botulinum toxin type A monotherapy, the results suggest that this well-tolerated treatment deserves further consideration in overall management of SAD accompanied by hyperhidrosis.

Botulinum Toxins, Type A↗
PubMed2006

The extent and impact of mental health problems after disaster.

Disasters are events that challenge the individual's ability to adapt, which carries the risk of adverse mental health outcomes including serious posttraumatic psychopathologies. While risk is related to degree of exposure to psychological toxins, the unique vulnerabilities of special populations within the affected community as well as secondary stressors play an important role in determining the nature and amount of morbidity. Disasters in developing countries and those associated with substantial community destruction are associated with worse outcome. Although acute responses are ubiquitous, few disasters lead to posttraumatic psychopathology in the majority of people exposed. However, the shortage of human resources in psychiatry, particularly in developing countries, places a considerable burden on psychiatric services even without the additional constraints imposed by disaster. Hence, disasters are events that invite a public health approach to mental health that better serves the needs of the individual and the affected community. Such an approach considers all available human resources and is intended to mitigate the effects of disaster before serious psychopathologic sequelae arise. This community mental health strategy allows peripheral mental health workers to mediate between survivors and specialized mental health professionals while assisting in removing barriers to treatment. To be effective when disaster occurs, this approach requires careful planning in conjunction with community consultation before implementation of formal disaster mitigation policies.

Community Mental Health Services↗
PubMed2006

Practical assessment and evaluation of mental health problems following a mass disaster.

Almost all individuals who experience a severe trauma will develop symptoms of posttraumatic stress disorder (PTSD) shortly after the traumatic event. Although the natural history of PTSD varies according to the type of trauma, most people do not develop enduring PTSD, and, in many of those who do, it resolves within 1 year without treatment. To the extent that is possible, maintenance of normal daily activities is believed to help patients cope more successfully in the aftermath of major trauma. In the case of a disaster such as the Asian tsunami, the whole community is involved, and it is impossible to continue with normal daily activities. To improve overall outcome after trauma, it would be optimal to identify individuals at increased risk for developing PTSD. This article describes screening and assessment tools for posttrauma mental health problems, particularly PTSD, and examines in more detail instruments that can be used in rapid field assessment of individuals who may be affected or who have already been identified and require monitoring. Self-rated instruments are most appropriate, but the choice of instrument will depend on the local situation and availability of appropriately validated questionnaires. The article also addresses important aspects of training nonmedical personnel in screening and assessment.

Adaptation, Psychological↗
PubMed2006

Pharmacologic treatment of acute and chronic stress following trauma: 2006.

This article reviews pharmacologic treatment options for posttraumatic stress disorder (PTSD), focusing on goals of pharmacotherapy and the clinical trial evidence for drug treatments available for PTSD. The selective serotonin reuptake inhibitors (SSRIs) are recommended as first-line therapy for PTSD; the roles of these and other drug classes including anticonvulsants, mood enhancers, atypical antipsychotic agents, benzodiazepines, alpha1-adrenergic antagonists, and beta-blockers in achieving improvement in PTSD symptom and outcome scores, achieving remission, and avoiding relapse are discussed. Treatment of PTSD in association with other comorbid conditions is addressed, and the role of pharmacotherapy in treating early PTSD and acute stress disorder is examined. Dosing strategies for the SSRIs sertraline and paroxetine are provided, and an algorithm for PTSD pharmacotherapy is discussed.

Algorithms↗
PubMed2006

Pharmacotherapy of social anxiety disorder: what does the evidence tell us?

The treatment goals for social anxiety disorder (SAD) are to reduce fear, avoidance, physical distress, disability, and comorbidity. This review illustrates some of the primary studies used to evaluate efficacy of treatments for SAD. The selective serotonin reuptake inhibitors (SSRIs) paroxetine, sertraline, fluoxetine, fluvoxamine, and escitalopram and the serotonin-norepinephrine reuptake inhibitor venlafaxine are effective treatments. They have the additional benefit of being able to treat comorbid conditions. For people who do not respond to serotonin reuptake inhibitors, treatment options include benzodiazepines (clonazepam, alprazolam, and bromazepam), alpha2delta calcium-channel blockers (gabapentin and pregabalin), reversible inhibitors of monoamine oxidase A (moclobemide, although agents in this class are not available in the United States), antiepileptics (levetiracetam), and atypical antipsychotics (olanzapine). The irreversible monoamine oxidase inhibitor phenelzine can be considered an effective third-line therapy. Combination treatments may be beneficial, but more research is needed. Benefits of beta-blockers (propranolol and atenolol) are limited to performance anxiety. Botulinum toxin A may be an effective augmentation treatment option for severe axillary hyperhidrosis in patients with SAD. Studies show that patients with SAD who are maintained on paroxetine, sertraline, or clonazepam have a low relapse rate.

Clonazepam↗
PubMed2005

Tiagabine for posttraumatic stress disorder: effects of open-label and double-blind discontinuation treatment.

RATIONALE: Preliminary results suggest a potential benefit of agents that enhance gamma-aminobutyric acid (GABA) neurotransmission in treating posttraumatic stress disorder (PTSD). OBJECTIVES: It is the aim of this study to evaluate the effect of a selective GABA reuptake inhibitor (SGRI), tiagabine, in patients with PTSD. METHODS: Twenty-nine adult outpatients with PTSD were treated with open-label tiagabine for 12 weeks. Those who responded to treatment (i.e., demonstrated at least minimal clinical improvement) were randomly assigned to double-blind treatment with either tiagabine or matching placebo. Efficacy assessments included measures of PTSD, anxiety, depression, sleep quality, resilience, and disability. Safety evaluation included changes in vital signs and weight and treatment-emergent adverse events. RESULTS: In subjects completing open-label treatment (n=19), significant improvement was observed on all outcome measures (P<0.05) and the treatment was well tolerated. Eighteen subjects responded and were randomized into the double-blind phase. Following randomization, benefits of treatment were generally upheld, but there was no greater incidence of relapse in the placebo group. However, continued treatment with tiagabine was associated with a greater trend toward likelihood of remission than if one was switched to placebo (P<0.08). CONCLUSIONS: These findings suggest a possible role for the SGRI tiagabine in the treatment of PTSD. As the role of GABAergic drugs in PTSD is poorly defined, larger, randomized, double-blind, placebo-controlled trials are needed.

Adult↗
PubMed2005

Impact of depressive symptoms on the treatment of generalized social anxiety disorder.

Patients with depression are often excluded from studies on the treatment of social anxiety disorder (SAD), leaving gaps in our knowledge about the impact of depressive affect on treatment for SAD. Patients participated in a randomized, placebo-controlled study of treatment for SAD. As in previous studies, patients were excluded from the study if they met criteria for major depressive disorder in the past 6 months. This exclusion notwithstanding, patients who enrolled in the study exhibited a range of depressive symptoms, permitting an examination of the impact of depressive symptoms on treatment outcome for SAD. Assessment measures included the Clinical Global Impression Scale, Hamilton Rating Scale for Depression, Brief Social Phobia Scale, and Beck Depression Inventory. Higher levels of depressive symptoms were related to more severe social anxiety overall, and to less change in social anxiety symptoms over the course of the study. Patients who were deemed nonresponders to treatment had higher levels of depressive symptoms at pretreatment than those who responded. In addition, patients who dropped out of the study had higher levels of depressive symptoms at pretreatment than those who completed the study. These results suggest that modifications should be made to existing treatments to improve outcomes and decrease attrition in the substantial proportion of patients with SAD who also evidence depressive symptoms. Such modifications are likely to be more important when treating patients with SAD and comorbid major depressive disorder.

Adult↗
PubMed2005

Beliefs in karma and reincarnation among survivors of violent trauma--a community survey.

BACKGROUND: This survey was designed to examine beliefs in karma and reincarnation among survivors of violent trauma in the general US population. METHODS: Two community surveys were conducted in 2001. From a sample of 1,969 respondents, two groups were created based on level of agreement with karmic belief. This sample forms the basis of this report. Information was obtained as to mental and physical health, resilience, exposure to violent trauma, and posttraumatic stress disorder (PTSD) symptom severity, and the cohorts were compared on these variables. RESULTS: Five percent of the sample admitted strong agreement to a belief in karma and reincarnation (n=99), while 77% strongly disagreed with these beliefs (n=1,511). Characteristics associated with agreement included being non-white, unmarried, and in poor physical and mental health. Moreover, agreement was associated with more extensive traumatization, including abuse, rape, and loss of a family member through violent death, as well as more severe posttraumatic stress symptoms. CONCLUSIONS: Few people subscribe strongly to a belief in karma and reincarnation in the US population, but personal experience of trauma may be associated with greater acceptance, as well as certain demographic and health-associated variables. The importance of holding such beliefs, which may represent an important way of coping following violent trauma, deserves further study.

Adult↗