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Biomedical subjects

M Van Ameringen

Publications and source records attributed to M Van Ameringen.

13 recordsLinked to original sources
PubMed2001

Pharmacotherapy of social anxiety disorder at the turn of the millennium.

Over the past 21 years since the birth of SP into the diagnostic nomenclature, there have been significant gains in knowledge about effective pharmacologic and psychotherapeutic treatments. The SSRIs have emerged as the first-line pharmacologic treatment, although good evidence shows efficacy of benzodiazepines; MAOIs; and anticonvulsant agents, such as gabapentin and pregabalin. There is also emerging evidence about the efficacy of the novel antidepressant venlafaxine and also optimism for the potential utility of nefazodone and possibly bupropion. However, there are many areas requiring further investigation. There has been a great deal of excitement about the publication of the RUPP Anxiety Study, demonstrating efficacy for fluvoxamine in socially phobic youth. Given that SP starts in childhood and adolescence, more data are needed to support the use of pharmacotherapy in this age group because early intervention may prevent the sequelae of chronic SP. There needs to be more investigation into what is required for social phobic individuals who obtain a good response to pharmacotherapy to move into full-remission status. Additional research is needed regarding the evaluation of the comparative efficacy of different drug classes and to develop an improved capability of predicting treatment response to a particular type of treatment. In addition, more research is needed regarding treatment resistance. In most of the anxiety disorders that have been studied, combining CBT with psychopharmacologic treatment has shown little advantage over either treatment alone. These findings may be due to methodologic problems. Research is needed on how to sequence treatments to maximize the benefits of combining the two types of effective treatments together. Finally, many clinicians are seeing an emerging trend of individuals who have had untreated SP all of their lives and are now presenting for treatment in their "golden years." The current established treatments need to be evaluated further in this geriatric population.

Adrenergic beta-Antagonists↗
PubMed2000

The neurobiology of social phobia: from pharmacotherapy to brain imaging.

Social phobia is a common psychiatric disorder that is often associated with significant psychiatric comorbidity and disability. There is currently considerable evidence for the efficacy of pharmacotherapy, especially the selective serotonin reuptake inhibitors, in the treatment of this disorder. In addition, researchers have recently begun to explore the underlying neurobiology of social phobia with results that will likely have important implications for future treatments. This article provides a review of the results to date of controlled medication trials. A review of chemical and neuroendocrine challenges, neurotransmitter functioning, and neuroimaging studies in social phobia is provided, followed by a discussion of the implications of these findings for future treatment and research.

Benzodiazepines↗
PubMed1999

Serotonergic agents in the treatment of social phobia in children and adolescents: a case series.

Serotonergic agents have become the treatment of choice for adult patients with social phobia. However, there are few reports of the use of these agents in the treatment of children and adolescents with this disorder. The pharmacological treatment of social anxiety in children and adolescents is briefly reviewed, and a consecutive series of child and adolescent patients who were treated with a variety of serotonin acting agents is described. Seven patients, aged 7 to 18 years, with a Primary DSM-IV diagnosis of generalized social phobia were treated with paroxetine, sertraline, or nefazodone for up to 7 months. Response to treatment was evaluated by retrospective chart review by the treating clinicians. All of the patients appeared to have a very positive clinical response to the serotonergic agents. No adverse events were reported and side effects were well tolerated. Results suggest that serotonergic agents may be an effective and safe treatment for children and adolescents with social phobia.

Adolescent↗
PubMed1999

The potential role of haloperidol in the treatment of trichotillomania.

BACKGROUND: Trichotillomania is categorized as an impulse control disorder in DSM-IV and is considered by some to be closely related to Obsessive Compulsive Disorder (OCD). We review the clinical phenomenology and pharmacological response of trichotillomania, and suggest that it may be more related to Tourette Syndrome than to OCD. Serotonin reuptake inhibitors (SRIs) are typically employed in the treatment of OCD, while neuroleptic medications such as haloperidol are typically used in the treatment of Tourette Syndrome. Evidence for the efficacy of treatment of trichotillomania with drugs typically used for OCD is equivocal. METHOD: Nine patients with trichotillomania were treated with haloperidol. Six patients unresponsive to SSRI medication had haloperidol added to their treatment. Three patients received only haloperidol. Response to treatment was assessed using descriptions of hair pulling, quantity of hair pulled, and severity of depilation at hair pulling sites. RESULTS: Eight of nine patients responded to haloperidol treatment, with seven experiencing complete or near complete cessation of hair pulling. LIMITATIONS: Inferences from the results of this study are limited by the lack of a control group, the small sample size, and the use of unstandardized ratings as measures of symptom severity. CONCLUSIONS: Results suggest that the addition of haloperidol to SSRIs or haloperidol alone may be effective in the treatment of trichotillomania. Results also encourage speculation about the relation between OCD, Tourette Syndrome, and trichotillomania.

Adult↗
PubMed1999

Childhood attention deficit/hyperactivity disorder in adults with anxiety disorders.

BACKGROUND: Previous research has reported co-morbidity between attention deficit hyperactivity disorder (ADHD) and anxiety disorders. Interpretation of these findings is complicated by symptom overlap in the clinical presentation of the disorders. We estimate the prevalence of ADHD in both the current and childhood histories of adults with anxiety disorders, while taking symptom overlap into account. We also evaluate the utility of the Wender Utah Rating Scale (WURS) for retrospective reporting of ADHD. METHODS: Consecutive admissions (N = 149) to an anxiety disorders clinic were given a diagnostic and psychometric assessment. The WURS was administered to obtain a retrospective diagnosis of childhood ADHD. Twenty-nine of the 35 people surpassing the cut-off score on the WURS were given a structured interview of adult ADHD symptoms. RESULTS: The WURS contains many 'internalizing' items that may inflate retrospective accounts of ADHD. After taking this into account, there is still a significantly higher prevalence of ADHD in the retrospective reports of adults with anxiety disorders (15%) than would be expected by chance (4%). Furthermore, of those who meet retrospective criteria for ADHD, 45% (13 of 29) continue to meet diagnostic criteria for ADHD as adults. CONCLUSIONS: The WURS may require considerable revision for use with clinical populations. In spite of these difficulties with retrospective assessment, available evidence indicates that ADHD is more prevalent in the histories of anxiety disordered patients than would be expected from base rates.

Adult↗
PubMed1999

Nefazodone in social phobia.

BACKGROUND: A variety of drug treatments have been shown to be effective in the treatment of social phobia. This study attempted to assess the efficacy of nefazodone, a new novel serotonergic drug, in the treatment of social phobia. METHOD: Nefazodone was administered to 23 patients who had a primary DSM-IV diagnosis of social phobia, generalized type (diagnosed by the Structured Clinical Interview for DSM-IV), in a 12-week open clinical trial. Treatment began at 100 mg of nefazodone daily and was increased according to clinical response and side effects. Patients completed self-report measures at baseline and at weeks 4, 8, and 12. These measures included the Fear of Negative Evaluation scale, the Social Avoidance and Distress scale, the Social Anxiety Thoughts Questionnaire, the Fear Questionnaire, the State-Trait Anxiety Inventory, the Beck Depression Inventory, the Social Adjustment Scale Self-Report, and the Sheehan Disability Scale. Clinicians completed the Liebowitz Panic and Social Phobic Disorders rating form and the Brief Social Phobia Scale. RESULTS: Twenty-one of the 23 patients completed the 12-week trial. Sixteen (69.6%) were considered responders (moderate or marked improvement), and 7 (30.4%) were considered to be nonresponders (minimal improvement or no change in symptoms). Measures of social anxiety, social phobic avoidance, depression, and social functioning showed a statistically significant change at endpoint. CONCLUSION: These findings support a role for nefazodone in the treatment of social phobia, generalized type. Controlled studies will be required to further investigate this preliminary finding as well as to compare nefazodone with other pharmacologic treatments of social phobia.

Adult↗
PubMed1998

The relationship of behavioral inhibition and shyness to anxiety disorder.

Behavioral inhibition to the unfamiliar is a temperamental construct that refers to a characteristic propensity to react to both social and nonsocial novelty with inhibition. In contrast, shyness refers to feelings of discomfort in social situations but not nonsocial situations. Both shyness and behavioral inhibition are associated with anxiety disorders in children and adults. We compared the role of social and nonsocial inhibition in predicting anxiety disorder symptomatology. Patients (N = 225) at a university affiliated Anxiety Disorders Clinic completed several psychometric measures including the Retrospective Self-Report of Behavioral Inhibition (RSRI) and the Revised Shyness Scale. The RSRI has two replicable factors: social fears and general fearfulness. The social fears factor shows a stronger pattern of relationships to clinically relevant variables such as self-reports of symptomatology, social adjustment, and disability. Social, rather than nonsocial, fearfulness may account for the relationship between behavioral inhibition and anxiety disorder symptomatology.

Adult↗
PubMed1996

Buspirone augmentation of selective serotonin reuptake inhibitors (SSRIs) in social phobia.

We evaluated the efficacy of buspirone, in the augmentation of social phobic symptom response to the selective serotonin reuptake inhibitors (SSRIs). Ten patients meeting DSM-III-R criteria for generalized social phobia were studied. Patients obtaining only a partial response to an adequate trial of an SSRI, received buspirone in addition to the SSRI for 8 weeks in an open trial. Seven patients (70%) were considered responders (moderate or marked improvement) and 3 (30%) were considered nonresponders (minimal improvement or no change). This study provides clinical evidence suggesting that buspirone augmentation may be a useful clinical strategy in social phobic patients who show a partial response to an SSRI.

Adolescent↗
PubMed1995

Relationship of childhood sexual and physical abuse to anxiety disorders.

This study reports on the relationship of childhood sexual and physical abuse in adult outpatients of an anxiety disorders clinic. A total of 205 consecutive patients admitted to two anxiety disorders clinics in Hamilton, Ontario, Canada, were given the Child Maltreatment History-Self-Report to elicit a history of childhood sexual or physical abuse. Childhood sexual abuse was reported by 23.4% and childhood physical abuse by 44.9%. Patients with a history of childhood sexual or physical abuse had significantly higher Beck depression scores and concurrent major depression, as well as more significant impairment in social functioning. They also demonstrated significantly higher state and trait anxiety scores. The occurrence of sexual or physical abuse was not associated with the presence of any particular primary anxiety disorder diagnosis. However, childhood sexual and/or physical abuse may affect the severity of the anxiety disorder as well as the presence of concurrent major depression.

Adult↗
PubMed1994

Sertraline in social phobia.

Twenty-two patients meeting a primary DSM-III-R diagnosis of Social Phobia, entered a 12 week open trial of sertraline. Twenty patients completed at least 8 weeks of treatment. Sixteen patients (80%) were considered responders and 4 (20%) were considered non-responders. All measures of social anxiety and avoidance, depression and social functioning showed a statistically significant change from baseline to end point.

Adolescent↗
PubMed1993

Fluoxetine efficacy in social phobia.

BACKGROUND: To determine the efficacy of fluoxetine in the treatment of social phobia, fluoxetine was administered to 16 patients with a primary DSM-III-R diagnosis of social phobia in a 12-week, open, clinical trial. METHOD: Treatment began at 20 mg of fluoxetine daily and was increased according to clinical response and side effects every 4 weeks. Patients completed self-report measures of anxiety and depression at baseline and at Weeks 4, 8, and 12. These included the Beck Depression Inventory, the Social Avoidance and Distress Scale, the Fear of Negative Evaluation Scale, the State-Trait Anxiety Inventory, the Fear Questionnaire, the Social Anxiety Thoughts Questionnaire, and the Social Adjustment Scale-Self-Report. Clinicians completed a Clinical Global Improvement Scale. RESULTS: Thirteen of the 16 patients completed the trial. Three patients (18.8%) were unable to complete the trial due to adverse side effects. Of the 13 (81.2%) remaining patients, 10 were considered to be responders and 3 were considered to be nonresponders. Measures of social anxiety and phobic avoidance showed a significant improvement from baseline to endpoint, achieving a significance of p < .005. Responders to fluoxetine were more likely to have been older at onset of the social phobic symptoms and had a shorter duration of illness. CONCLUSION: These findings suggest that fluoxetine may be effective in the treatment of social phobia. Double-blind studies will be required to further investigate these findings.

Adult↗
PubMed1991

Relationship of social phobia with other psychiatric illness.

Fifty-seven social phobic patients were studied to identify the comorbidity with other psychiatric illnesses and their temporal relationships. Mood disorders, particularly major depression, was the most common other lifetime diagnosis (70.2%). A large majority (70.2%) suffered from, at least, one other anxiety disorder in their lifetime and, in particular, panic disorder with or without agoraphobia (49.1%). Alcohol (28.1%) and substance (15.8%) abuse or dependence were also common lifetime diagnoses. Social phobia usually predated any episode of mood disorder (81.7%) or any other anxiety disorder (62.7%). Social phobia may predispose individuals to other psychiatric illnesses, in particular major depression.

Adolescent↗