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Jonathan R T Davidson

Publications and source records attributed to Jonathan R T Davidson.

66 records · Page 4Linked to original sources
PubMed2002

Tolerability of fluoxetine in posttraumatic stress disorder.

PURPOSE: In response to earlier reports that raised concerns about the tolerability of fluoxetine in the treatment of posttraumatic stress disorder (PTSD), this study was conducted to systematically delineate treatment-emergent symptoms (TES) associated with fluoxetine treatment of PTSD. METHODS: Sixty-five patients with PTSD enrolled in one of two identical-protocol, 12-week studies and received double-blind fluoxetine or placebo. TES data were obtained using a patient-rated checklist, Severity of Symptoms Scale (SOSS). RESULTS: Only a single patient discontinued treatment due to medication side effects. Compared to placebo, only three statistically significant TES (nausea, diarrhea, and thirst) occurred more frequently in fluoxetine subjects. Fluoxetine was not associated with any statistically significant activating effects. There were no statistically significant associations between the total number of TES experienced and treatment, gender, or comorbid depressive or panic disorders. CONCLUSIONS: This systematic assessment of TES indicated that PTSD patients tolerated fluoxetine well without pronounced activating side effects.

Administration, Oral↗
PubMed2002

Hyperhidrosis in social anxiety disorder.

PURPOSE: Excessive sweating (hyperhidrosis) is an overlooked and potentially disabling symptom, which is often seen in social anxiety disorder (SAD). We conducted a retrospective review of data acquired in patients with SAD who had participated in placebo-controlled clinical trials of fluoxetine, cognitive behavior therapy, clonazepam and gabapentin. Four specific topics were addressed: (1) overall levels of sweating; (2) characteristics of those with hyperhidrosis; (3) a comparison of active treatments relative to placebo on hyperhidrosis; and (4) an examination of baseline sweating severity as a predictor of treatment outcome. METHODS: Using the Brief Social Phobia Scale (BSPS) and Social Phobia Inventory (SPIN), we examined the above questions. RESULTS: Hyperhidrosis was found in 24.8-32.3% of 375 subjects assessed, depending upon the scale used. Hyperhidrosis was associated with higher levels of disability, fear, avoidance, and other physiologic symptoms. While treatment in general was associated with a reduction in the rate of hyperhidrosis from 23.7% to 9.7% (BSPS), and 34.0% to 15.5% (SPIN), only fluoxetine differed significantly from placebo in respect of change in sweating score from baseline to endpoint. In an ANCOVA, gabapentin differed from placebo on the SPIN. CONCLUSION: We conclude that hyperhidrosis is frequently seen in patients with SAD, and that its response to treatment is variable. Further attention should be paid to the possible importance of this symptom in social anxiety.

Acetates↗
PubMed2002

Three- to four-year follow-up to an open trial of nefazodone for combat-related posttraumatic stress disorder.

Multiyear (37-51 months) follow-up data was obtained on patients who had participated in an open label trial of nefazodone that originally showed nefazodone may be useful for symptom management in posttraumatic stress disorder (PTSD) patients. Ten patients with combat-related DSM-IV posttraumatic stress disorder (PTSD) entered an open-label 12-week trial of nefazodone, beginning with 100 mg/day and increasing as necessary to achieve a maximal response or until reaching a maximum dosage of 600 mg/day. All 10 patients were followed for over 3-4 years and used nefazodone with dosages of 400-600 mg a day. The entire dosagewas shifted to bedtime to facilitate sleep in 7 patients. Data on PTSD symptoms, depression, sleep, and anger were examined. Nefazodone was well tolerated and no significant changes in sexual function were reported. All participants reported compliance with the prescribed nefazodone over 3-4 years. Nine patients reported that it remained effective, and expressed a desire to remain on the medication. On the basis of clinician global impression ratings (compared to baseline), 10 patients were rated as much improved at 12 weeks. Seven of the 10 patients continued to be much improved, 2 were minimally improved, and 1 was rated as worse (compared to baseline assessment) on 3-4-year follow-up. At 3-4-year follow-up, improvements in PTSD symptoms, sleep, and anger were maintained. These improvements were statistically significant with moderate-to-large effect sizes. These data suggest that clinical improvement in PTSD patients administered nefazodone may be maintained with continued treatment. The medication was tolerated well in long-term treatment, compliance was high, and improvement was maintained over several years. Length of treatment, appropriate dose, long-term efficacy, and compliance are all clinically significant issues with little guiding data available. Controlled studies are needed to (a) further investigate the long-term efficacy of nefazodone in the treatment of PTSD; (b) provide information for length of treatment guidelines; and (c) document if discontinuation is possible and efficacious.

Adult↗
PubMed2002

Efficacy of olanzapine in social anxiety disorder: a pilot study.

Based on evidence suggesting anxiolytic properties of the atypical antipsychotic olanzapine, this study was conducted to evaluate whether olanzapine may be efficacious in treating social anxiety disorder (SAD). This study was an 8-week, double-blind, placebo-controlled evaluation of olanzapine as monotherapy in which 12 patients with the DSM-IV diagnosis of SAD were randomized to either olanzapine (n = 7) or placebo (n = 5). An initial dose of 5 mg/day was titrated to a maximum of 20 mg/day. Baseline to endpoint scores from the Brief Social Phobia Scale (BSPS), Social Phobia Inventory (SPIN), Liebowitz Social Anxiety Scale and Sheehan Disability Scale, as well as Clinical Global Impression-Improvement ratings, were compared for olanzapine versus placebo. Seven subjects completed all 8 weeks of the study, four in the olanzapine group and three in the placebo group. In the intent-to-treat analysis, olanzapine yielded greater improvement than placebo on the primary measures: BSPS (p = 0.02) and SPIN (p = 0.01). Both treatments were well tolerated, although the olanzapine group had more drowsiness and dry mouth. Olanzapine and placebo were both associated with negligible weight gain. Olanzapine was superior to placebo on the primary outcome measures in this preliminary study of SAD. Additional studies of olanzapine as a treatment for SAD are warranted.

Adolescent↗
PubMedDate not supplied

Trauma and posttraumatic stress in users of the Anxiety Disorders Association of America Web site.

The Web site for the Anxiety Disorders Association of America (ADAA) receives more than 5 million visits per month and thus represents a unique medium for the study of anxiety disorders. ADAA Web site users from October 2002 to January 2003 were invited to complete a survey oriented toward trauma history and psychiatric sequelae. A diagnostic approximation of posttraumatic stress disorder (PTSD) was based on responses to the Trauma Questionnaire, the Davidson Trauma Scale, and questions about impairment. The Connor-Davidson Resilience Scale was also used. Variables were tested for their association with PTSD. Among 1558 participants, 87% had a history of trauma, and 38% had current PTSD. The population was comprised predominantly of white middle-class women, half of whom were married. More than 90% were first-time users of the site. Factors associated with PTSD included death of, or harm to, a loved one; personal history of incest, rape, or physical abuse; lower age; lower income; unemployment; missed work; increased medical care; dissatisfaction with psychotropic medication; depressive symptoms; and lower resilience. In this selective convenience sample, there were high rates of traumatization and PTSD. The demographics of this group are similar to those seen in previously studied populations that had contacted the ADAA. Furthermore, the factors associated with PTSD were like those in many community surveys. The ADAA Web site has the opportunity to benefit large numbers of highly distressed individuals.

Adult↗
PubMedDate not supplied

Full and partial PTSD among earthquake survivors in rural Taiwan.

In 1999, a major earthquake struck central Taiwan. Ten months after the earthquake, survivors were surveyed to examine the background factors of demographics and exposure that are associated with posttraumatic stress disorder (PTSD) and subthreshold posttraumatic stress disorder (PTSS) and to investigate the relationships between other psychiatric problems and PTSD and PTSS following the earthquake. Subjects (n=252) randomly selected from two rural communities near the epicenter of the earthquake were interviewed to obtain the following information: demographic characteristics; extent of earthquake exposure; severity of posttraumatic stress symptoms; other psychiatric morbidity; and other morbidity-related factors, including general mental health, disability, stress vulnerability, social support, and wellbeing. Three diagnostic groups were identified with regard to trauma-related symptoms: full PTSD, partial PTSD (PTSS), and non-PTSD. Prevalence rates were calculated and bivariate and multivariate comparisons adjusted for age, sex and education were performed. The prevalence rates for PTSD (n=26) and PTSS (n=48) were 10.3% and 19.0%, respectively. The PTSD and PTSS groups differed significantly from non-PTSD on most variables, with greater likelihood of the following: female gender; total trauma exposure; generalized anxiety disorder; suicidality; any other axis I disorder; general psychopathology, disability; and impaired wellbeing. Few differences were observed between the PTSD and PTSS groups, although greater likelihood for major depression, trauma-related loss of life, and impaired stress vulnerability were noted in the PTSD group. In conclusion, PTSD and PTSS are commonly observed following earthquake exposure and are associated with similarly high levels of psychosocial impairment.

Adult↗
PubMedDate not supplied

Pharmacologic treatment of posttraumatic stress disorder: a focus on antipsychotic use.

To review the literature on the pharmacologic treatment of posttraumatic stress disorder (PTSD), with a focus on reports of antipsychotic use for this illness. A MEDLINE search (1966-Oct 2002) for English only articles about pharmacologic treatment of PTSD. Antipsychotic medications are being used with some frequency for PTSD. There are few studies and scant evidence to recommend the traditional antipsychotics. There are a number of reports (mostly case reports and open trials) in which atypical antipsychotics improved sleep and decreased the frequency of nightmares and flashbacks. Some studies showed global improvement across symptom clusters. The newer atypical antipsychotics show promise for the treatment of PTSD, mainly ameliorating intrusive symptoms. The paucity of double-blind studies prevents firm conclusions, however, this class of medications may be useful particularly for refractory symptoms.

Antipsychotic Agents↗
PubMedDate not supplied

The impact of borderline personality disorder on post-traumatic stress in the community: a study of health status, health utilization, and functioning.

This study examines impairment and health status and resource utilization among individuals with and without borderline personality disorder (BPD), all of whom had post-traumatic stress symptoms (PTSS). Using data from the community-based Piedmont Health Survey, 150 adult respondents who had experienced clinically significant PTSS during their life were identified. The Diagnostic Interview Schedule (DIS) Borderline Index was used to distinguish a subset of respondents who met criteria for BPD. Compared with adults with PTSS (n = 135), individuals with PTSS and BPD (PTSS-BPD) (n = 15) exhibited impaired health status and greater utilization of mental health services and psychotropic medications, as well as more functional impairment based on social, occupational, and early adverse life-event measures. Individuals with comorbid PTSS and BPD demonstrate greater overall impairment and usage of health care resources.

Adult↗
PubMedDate not supplied

A double-blind combination study of clonazepam with sertraline in obsessive-compulsive disorder.

This double blind, randomized, parallel, placebo-controlled study investigates whether clonazepam accelerates and/ or increases the overall response in patients with obsessive compulsive disorder (OCD) who are treated with sertraline. Thirty-seven patients were randomized with 20 in the sertraline and clonazepam group and 17 in the sertraline and placebo groups. Male and female outpatients, age 18-65 years, met criteria for a primary diagnosis of obsessive compulsive disorder according to DSM-IV, as determined by the structured clinical MINI interview. Appropriate safety and efficacy parameters were measured throughout the study. The determination of efficacy was based primarily on changes from baseline to the last observation taken through week 12. Analysis revealed no significant difference between groups at endpoint on the main scale.

Adolescent↗
PubMedDate not supplied

Obsessive-compulsive disorder in callers to the Anxiety Disorders Association of America.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a chronic, impairing and often comorbid disorder. METHODS: 1000 subjects who called the Anxiety Disorders Association of America (ADAA) were surveyed and divided in three groups: (a) callers with OCD (OCD) and two overlapping control groups: (b) callers with no axis I disorder (NAC) and (c) with no-OCD (NOC) using a 97-item questionnaire. RESULTS: The rate of OCD was 14.5% (N = 145). Relative to the NOC group, OCD subjects were more likely to be female, White, younger and not married. Relative to the NAC group, subjects with OCD were more likely to be White, not married and younger. OCD was accompanied by significant comorbidity and was associated with an increased number of visits to health professionals than NAC subjects. There was no significant difference regarding unemployment rates among the three groups. However, OCD callers were more likely than both control groups to have missed work or have decreased productivity due to their mental condition. OCD subjects took an average of 1 psychotropic medication in the past year and were statistically more likely than the control groups to experience sleepiness and nervousness as side effects. CONCLUSIONS: OCD was fairly prevalent among ADAA callers and presented high levels of comorbidity, impairment, health care utilization and sensitivity to psychotropic side effects.

Absenteeism↗
PubMedDate not supplied

Phobic anxiety, depression, and risk of ventricular arrhythmias in patients with coronary heart disease.

OBJECTIVE: Findings of an association between phobic anxiety and elevated risks of sudden cardiac death suggest that phobic anxiety may be related to increased risk of ventricular arrhythmias. The purpose of this study was to examine whether phobic anxiety is associated with ventricular arrhythmias in patients with documented coronary artery disease (CAD). METHODS: Phobic anxiety level was measured using the Crown-Crisp phobic anxiety scale in 940 patients (660 men, 280 women) hospitalized for diagnostic cardiac catheterization between April 1999 and June 2002. Depressive symptomatology was assessed using the Beck Depression Inventory. Patients were followed for a median follow-up period of 3 years, and the occurrence of ventricular arrhythmias was determined through review of medical records. RESULTS: Ventricular arrhythmias occurred in 97 patients and were significantly related to higher phobic anxiety after statistical adjustment for established medical and demographic determinants of arrhythmias (odds ratio = 1.40; p = .012). Depressive symptomatology was significantly correlated with phobic anxiety (r = 0.44, p < .001) and was also related to ventricular arrhythmias (odds ratio = 1.40; p = .006). The composite of depression and phobic anxiety predicted ventricular arrhythmias with a larger effect size than either depression or phobic anxiety score alone (odds ratio = 1.6, 95% confidence interval, 1.2-2.1, p = .002). CONCLUSIONS: Both phobic anxiety and depressive symptomatology predict ventricular arrhythmias in patients with CAD and may share a common factor predictive of ventricular arrhythmias.

Adult↗