Biomedical subjects

Michael R Liebowitz

Publications and source records attributed to Michael R Liebowitz.

At least 19 recordsLinked to original sources

PubMed2007

A controlled trial of paroxetine for chronic PTSD, dissociation, and interpersonal problems in mostly minority adults.

This study evaluated the efficacy of paroxetine for symptoms and associated features of chronic posttraumatic stress disorder (PTSD), interpersonal problems, and dissociative symptoms in an urban population of mostly minority adults. Adult outpatients with a primary DSM-IV diagnosis of chronic PTSD received 1 week of single-blind placebo (N = 70). Those not rated as significantly improved were then randomly assigned to placebo (N = 27) or paroxetine (N = 25) for 10 weeks, with a flexible dosage design (maximum 60 mg by week 7). Significantly more patients treated with paroxetine were rated as responders (14/21, 66.7%) on the Clinical Global Impression-Improvement Scale (CGI-I) compared to patients treated with placebo (6/22, 27.3%). Mixed effects models showed greater reductions on the Clinician-Administered PTSD Scale (CAPS) total score (primary plus associated features of PTSD) in the paroxetine versus placebo groups. Paroxetine was also superior to placebo on reduction of dissociative symptoms [Dissociative Experiences Scale (DES) score] and reduction in self-reported interpersonal problems [Inventory of Interpersonal Problems (IIP) score]. In a 12-week maintenance phase, paroxetine response continued to improve, but placebo response did not. Paroxetine was well tolerated and superior to placebo in ameliorating the symptoms of chronic PTSD, associated features of PTSD, dissociative symptoms, and interpersonal problems in the first trial conducted primarily in minority adults.

Adult↗

PubMed2006

The appraisal of social concerns scale: psychometric validation with a clinical sample of patients with social anxiety disorder.

The Appraisal of Social Concerns (ASC) Scale was created by Telch et al. (2004) to improve upon existing self-report measures of social anxiety-related cognition. In a largely nonclinical sample, the ASC was found to possess three factors and was psychometrically sound. In a smaller clinical sample, the ASC demonstrated sensitivity to the effects of cognitive behavioral therapy. In the present study, the psychometric properties of the ASC were examined in a larger sample of patients with social anxiety disorder. In this sample, the ASC exhibited a 2-factor structure; the nature of the factors was similar to the primary factors originally reported by Telch et al. The ASC also demonstrated strong validity, internal consistency, and sensitivity to treatment effects. It is concluded that the ASC may be useful in the assessment of cognition and cognitive change in patients with social anxiety disorder.

Adult↗

PubMed2006

The OCI-R: validation of the subscales in a clinical sample.

The psychometric properties of the Obsessive-Compulsive Inventory-Revised (OCI-R) subscales have not been validated in a clinical sample of individuals diagnosed with obsessive-compulsive disorder (OCD). Data were collected on 186 patients diagnosed with OCD and 17 patients diagnosed with generalized anxiety disorder (GAD) using the OCI-R and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Confirmatory factor analysis revealed an acceptable factor structure. Patients with a given primary symptom subtype were elevated on the corresponding subscale of the OCI-R compared to other OCD patients and patients with GAD. In addition, patients who acknowledged that symptom subtype as present but not primary on the Y-BOCS had elevated OCI-R scores on that scale compared to patients who did not endorse that symptom subtype and patients with GAD. Results indicate that the subscales of the OCI-R are valid measures of six symptom subtypes of OCD. The OCI-R is a psychometrically sound, brief instrument. The current data combined with previous efforts suggest that it is appropriate for clinical and non-clinical populations, and for clinical and research purposes. Further research should examine the sensitivity of the specific subscales to treatment effects, and the potential for adding more items to account for other symptom domains of OCD.

Adult↗

PubMed2006

Relations of the factors of the tripartite model of anxiety and depression to types of social anxiety.

Our primary goal was to examine the relations of the specific components of the tripartite model of anxiety and depression [Clark, L. A., Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316-336] to two types of social anxiety (social interaction anxiety and performance anxiety) in 148 individuals with social phobia. In line with previous research, overall social anxiety was more closely related to the anhedonic depression (AD) or low positive affect factor of the tripartite model than to the physiological hyerarousal factor, controlling for general distress. However, as hypothesized, performance anxiety was more closely associated with the physiological hyerarousal factor, whereas social interaction anxiety was more closely associated with the AD or low positive affect factor. We also examined the convergent and discriminant validity of the Mood and Anxiety Symptom Questionnaire (MASQ; [Watson, D., Clark, L. A. (1991). The mood and anxiety symptom questionnaire. Unpublished manuscript, University of Iowa City]). Intercorrelations of the MASQ subscales were as expected, but correlations with measures of social anxiety, nonsocial anxiety, and depression provided only modest support for convergent and discriminant validity. Findings from this study provide a more detailed account of the specific components of the tripartite model that characterize the diversity of symptoms subsumed by social phobia.

Adult↗

PubMed2006

Factor structure of the Liebowitz Social Anxiety Scale for Children and Adolescents.

The purpose of this study was to evaluate the factor structure of the Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA). The LSAS-CA was administered to 225 children and adolescents as a component of various clinical studies. In addition, other measures of psychopathology and impairment were administered to a subgroup of the sample. Confirmatory factor analyses of the social interaction and performance subscales for the anxiety and avoidance ratings yielded poor fit indices. Exploratory factor analysis supported a two-factor solution with a higher order factor for the LSAS-CA anxiety and avoidance ratings. Based on item content, factors were named Social and School Performance. The internal consistency of the factors was high and the convergent and divergent validity was supported vis-à-vis correlations with measures of depression and social anxiety, and clinician ratings of impairment and functioning. Findings suggest that the anxiety and avoidance ratings are best explained by a two-factor solution that measures social anxiety and avoidance in social and school performance interactions. This factor structure appears to be a reliable and valid framework for assessing childhood social phobia.

Achievement↗

PubMed2006

The factor structure and screening utility of the Social Interaction Anxiety Scale.

The widely used Social Interaction Anxiety Scale (SIAS; R. P. Mattick & J. C. Clarke, 1998) possesses favorable psychometric properties, but questions remain concerning its factor structure and item properties. Analyses included 445 people with social anxiety disorder and 1,689 undergraduates. Simple unifactorial models fit poorly, and models that accounted for differences due to item wording (i.e., reverse scoring) provided superior fit. It was further found that clients and undergraduates approached some items differently, and the SIAS may be somewhat overly conservative in selecting analogue participants from an undergraduate sample. Overall, this study provides support for the excellent properties of the SIAS's straightforwardly worded items, although questions remain regarding its reverse-scored items.

Anxiety Disorders↗

PubMed2006

Response versus remission in obsessive-compulsive disorder.

OBJECTIVE: To investigate rates of response and remission in adults with obsessive-compulsive disorder (OCD) after 12 weeks of evidence-based treatment. METHOD: Post hoc analyses of response and remission were conducted using data from a multisite, randomized, controlled trial comparing the effects of 12 weeks of exposure and ritual prevention (EX/RP), clomipramine (CMI), their combination (EX/RP+CMI), or pill placebo (PBO) in 122 adults with OCD (DSM-III-R or DSM-IV criteria). Response was defined as a decrease in symptoms; remission was defined as minimal symptoms after treatment. Different response and remission definitions were constructed based on criteria used in prior studies. For each definition, the proportion of responders or remitters in each treatment group was then compared. RESULTS: There were significant differences (p<.05) among the 4 treatment groups in the proportion of responders and remitters. In pairwise comparisons, EX/RP+CMI and EX/RP each produced significantly more responders and remitters than PBO; CMI produced significantly more responders and remitters than PBO for some definitions but not for others. When remission was defined as a Yale-Brown Obsessive Compulsive Scale (YBOCS) score of 12 or less, significantly more EX/RP+CMI (18/31 [58%]) and EX/RP (15/29 [52%]) patients entering treatment achieved remission than either CMI (9/36 [25%]) or PBO (0/26 [0%]) patients. However, even in treatment completers, many CMI and some EX/RP+CMI and EX/RP patients did not achieve remission (remission rates for YBOCS<or=12: EX/RP+CMI=13/19 [68%]; EX/RP=15/21 [71%]; CMI=8/27 [30%]; PBO=0/20 [0%]). CONCLUSION: EX/RP (with or without CMI) can lead to superior treatment outcome compared with CMI alone in OCD patients without comorbid depression. However, many OCD patients who receive evidence-based treatment do not achieve remission.

Adult↗

PubMed2005

Are there reliable neuropsychological deficits in obsessive-compulsive disorder?

The aim of this study was to confirm in a large clinical sample that subjects with obsessive-compulsive disorder (OCD) have deficits on certain tasks of executive functioning, non-verbal memory, and/or motor speed. Our ultimate goal was to evaluate whether these deficits contribute to functional impairment and could be the target of a novel treatment intervention. Therefore, in a sample of convenience, the clinical characteristics and neuropsychological performance of adults with OCD and matched healthy controls were evaluated; neuropsychological tasks of executive functioning, non-verbal memory, and motor speed that have shown strong effects in prior studies were used. Primary analyses compared subjects with current OCD only (current-OCD, n=30), subjects with current OCD plus a comorbid disorder (comorbid-OCD, n=15), subjects with a history of OCD (n=15), and matched healthy controls (n=35). Secondary analyses examined whether clinical characteristics (e.g., OCD severity or medication status) were associated with neuropsychological performance. We found no significant overall differences in neuropsychological performance among the four groups. In pairwise comparisons, current-OCD subjects differed significantly from healthy controls only on the Benton Visual Retention Test. OCD severity had little effect and medication status had no effect on neuropsychological performance. In sum, contrary to our expectations, we found few differences in neuropsychological performance between OCD subjects and healthy controls. Whether there are reliable neuropsychological deficits in OCD that can be easily identified in a clinical sample and that contribute to functional impairment remains unclear and requires further study.

Adult↗

PubMed2005

Venlafaxine extended release vs placebo and paroxetine in social anxiety disorder.

BACKGROUND: Evidence indicates that venlafaxine hydrochloride extended release (ER) effectively ameliorates anxiety symptoms. OBJECTIVES: To evaluate the efficacy, safety, and tolerability of flexible-dose venlafaxine ER compared with placebo in the short-term treatment of generalized social anxiety disorder and, secondarily, to compare paroxetine with venlafaxine ER and paroxetine with placebo. DESIGN: Adult outpatients with DSM-IV generalized social anxiety disorder for 6 months or longer were randomly assigned to receive venlafaxine hydrochloride ER (75-225 mg/d), paroxetine (20-50 mg/d), or placebo for 12 weeks or less at 26 centers in the United States. The primary outcome measure was the total Liebowitz Social Anxiety Scale score. Secondary measures included response (Clinical Global Impression-Improvement score, 1 or 2) rates and Clinical Global Impression-Severity of Illness and Social Phobia Inventory scores. RESULTS: Of 440 patients treated, 413 (93.9%) were included in the last-observation-carried-forward efficacy analysis; of the 429 patients in the safety population, 318 (74.1%) completed the study. Mean daily doses were 201.7 mg (SD, 38.1 mg) of venlafaxine hydrochloride ER and 46.0 mg (SD, 7.9 mg) of paroxetine. Venlafaxine ER treatment was significantly superior to placebo at weeks 1 through 12 on the Liebowitz Social Anxiety Scale and Social Phobia Inventory and at week 2 and weeks 6 through 12 for Clinical Global Impression-Severity of Illness and responder status, and was significantly superior to paroxetine treatment at weeks 1 and 2 for the Social Phobia Inventory (P < .05 for all). Paroxetine treatment was significantly superior to placebo at weeks 3 through 12 on the Liebowitz Social Anxiety Scale, the Clinical Global Impression-Severity of Illness scale, and the Social Phobia Inventory, and at weeks 4 through 12 for response (P < .05 for all). Week 12 response rates were significantly greater for the venlafaxine ER and paroxetine groups (58.6% and 62.5%, respectively) vs the placebo group (36.1%) (P < .001 for both). CONCLUSION: Venlafaxine ER is effective in the short-term treatment of generalized social anxiety disorder, with efficacy and tolerability comparable to paroxetine.

Adult↗

PubMed2005

Standard criteria for relapse are needed in obsessive-compulsive disorder.

To assess how different criteria for relapse affect inferences about relapse in obsessive-compulsive disorder (OCD), a post hoc analysis of relapse was conducted using data from a multisite randomized controlled trial comparing clomipramine (CMI), exposure and ritual prevention (EX/RP), and its combination (EX/RP+CMI) in adults with OCD. Different relapse definitions were constructed based on criteria used in prior studies. For each definition, the number of relapsers was computed, and the proportion of relapsers and time to relapse were compared. When applied to this data set, relapse criteria used in prior OCD studies yielded different observed relapse rates (range: 27-63% for CMI; 0-50% for EX/RP; and 7-67% for EX/RP+CMI). Most criteria found that EX/RP responders (with or without CMI) had a significantly lower relapse rate and longer time to relapse after treatment discontinuation than did responders to CMI alone. However, some relapse criteria (e.g., those requiring minimal worsening) found no significant treatment differences in relapse rates or time to relapse, and some generated biases against one treatment or another. Most definitions concurred: in adults with primary OCD, EX/RP treatment (with or without CMI) can produce more durable short-term gains after treatment discontinuation than CMI alone. However, different relapse criteria can lead to very different observed relapse rates and even contradictory inferences about relapse. Standard criteria for relapse are needed in OCD to facilitate comparisons between studies (enabling better treatment guidelines) and to advance research on mechanisms of relapse and relapse prevention.

Antidepressive Agents, Tricyclic↗

PubMed2005

Empirical validation and psychometric evaluation of the Brief Fear of Negative Evaluation Scale in patients with social anxiety disorder.

The Brief Fear of Negative Evaluation Scale (BFNE; M. R. Leary, 1983a) is often used to assess fear of negative evaluation, the core feature of social anxiety disorder. However, few studies have examined its psychometric properties in large samples of socially anxious patients. Although the BFNE yields a single total score, confirmatory factor analysis indicated a 2-factor solution to be more appropriate, with the 1st factor consisting of all straightforwardly worded items (BFNE-S) and the 2nd of all reverse-scored items (BFNE-R). Support was obtained for the convergent and discriminant validity of the BFNE and BFNE-S, but not the BFNE-R. These results suggest that standard scoring of the BFNE may not be optimal for patients with social anxiety disorder.

Adult↗

PubMed2005

Maternal mental representations of the child in an inner-city clinical sample: violence-related posttraumatic stress and reflective functioning.

Parental mental representations of the child have been described in the clinical literature as potentially useful risk-indicators for the intergenerational transmission of violent trauma. This study explored factors associated with the quality and content of maternal mental representations of her child and relationship with her child within an inner-city sample of referred, traumatized mothers. Specifically, it examined factors that have been hypothesized to support versus interfere with maternal self- and mutual-regulation of affect: posttraumatic stress disorder (PTSD) and maternal reflective functioning (RF). More severe PTSD, irrespective of level of RF, was significantly associated with the distorted classification of non-balanced mental representations on the Working Model of the Child Interview (WMCI) within this traumatized sample. Higher Levels of RF, irrespective of PTSD severity, were significantly associated with the balanced classification of maternal mental representations on the WMCI. Level of maternal reflective functioning and severity of PTSD were not significantly correlated in this sample. Clinical implications are discussed.

Adolescent↗

PubMed2005

Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder.

OBJECTIVE: The purpose of the study was to test the relative and combined efficacy of clomipramine and exposure and ritual prevention in the treatment of obsessive-compulsive disorder (OCD) in adults. Serotonin reuptake inhibitors (SRIs) and cognitive behavior therapy by exposure and ritual prevention are both established treatments for OCD, yet their relative and combined efficacy have not been demonstrated conclusively. METHOD: A double-blind, randomized, placebo-controlled trial comparing exposure and ritual prevention, clomipramine, their combination (exposure and ritual prevention plus clomipramine), and pill placebo was conducted at one center expert in pharmacotherapy, another with expertise in exposure and ritual prevention, and a third with expertise in both modalities. Participants were adult outpatients (N=122 entrants) with OCD. Interventions included intensive exposure and ritual prevention for 4 weeks, followed by eight weekly maintenance sessions, and/or clomipramine administered for 12 weeks, with a maximum dose of 250 mg/day. The main outcome measures were the Yale-Brown Obsessive Compulsive Scale total score and response rates determined by the Clinical Global Impression improvement scale. RESULTS: At week 12, the effects of all active treatments were superior to placebo. The effect of exposure and ritual prevention did not differ from that of exposure and ritual prevention plus clomipramine, and both were superior to clomipramine only. Treated and completer response rates were, respectively, 62% and 86% for exposure and ritual prevention, 42% and 48% for clomipramine, 70% and 79% for exposure and ritual prevention plus clomipramine, and 8% and 10% for placebo. CONCLUSIONS: Clomipramine, exposure and ritual prevention, and their combination are all efficacious treatments for OCD. Intensive exposure and ritual prevention may be superior to clomipramine and, by implication, to monotherapy with the other SRIs.

Adolescent↗

PubMed2005

A randomized controlled trial of venlafaxine extended release in generalized social anxiety disorder.

BACKGROUND: Generalized social anxiety disorder is a debilitating psychiatric illness characterized by maladaptive thoughts about social situations. This double-blind study evaluated the anxiolytic efficacy, safety, and tolerability of venlafaxine extended release (ER) in adult out-patients with generalized social anxiety disorder. METHOD: Patients were randomly assigned to receive 12 weeks of treatment with a flexible dose of venlafaxine ER (75 to 225 mg/day) or placebo. The Liebowitz Social Anxiety Scale (LSAS) total score was the primary efficacy variable. Secondary efficacy variables included scores on the Clinical Global Impressions-Severity of Illness (CGI-S) and -Improvement (CGI-I) scales, Social Phobia Inventory (SPIN), and LSAS subscales. Response was defined as a CGI-I score of 1 or 2. Two definitions of remission were used: LSAS total score < or = 30 and CGI-I score of 1. RESULTS: Data from 271 patients (intent-to-treat population) were analyzed for efficacy; 279 patients were analyzed for safety. Overall, 173 patients completed the study. Improvement on the LSAS was significantly greater with venlafaxine ER treatment than with placebo at weeks 6 through 12 (p < .05, weeks 6 and 8; p < .01, week 10; and p < .001, week 12) and at weeks 8 through 12 based on CGI-S and SPIN scores. Week 12 response and remission (LSAS score < or = 30) rates were significantly greater in the venlafaxine ER group than in the placebo group (response: 44% vs. 30%, respectively, p = .018; remission: 20% vs. 7%, respectively, p < .01). Patients experienced no unexpected or serious adverse events. CONCLUSION: Venlafaxine ER is safe, well tolerated, and efficacious in the short-term treatment of generalized social anxiety disorder.

Adolescent↗

PubMed2005

Integrating neurobiology and psychopathology into evidence-based treatment of social anxiety disorder.

Social anxiety disorder (SAD) is a common, chronic psychiatric disorder characterized by a persistent fear of social or performance situations in which embarrassment can occur. This disorder typically appears during the mid-adolescent years and is unremitting throughout life if not properly treated. SAD presents as two subtypes: the more common and debilitating generalized form, and the nongeneralized form, which consists predominantly of performance anxiety. The majority of patients with SAD have comorbid mental disorders, including mood, anxiety, and substance abuse. No single development theory has been proposed to account for the origins of SAD, although current understanding of the etiology of SAD posits an interaction between psychological and biological factors. Risk factors include environmental and parenting influences and dysfunctional cognitive and conditioning events in early childhood. The neurobiology of SAD appears to involve neurochemical dysfunction, as evidenced by studies of neuroreceptor imaging, neuroendocrine function, and profiles of response to specific medications. Clinical trials have demonstrated that benzodiazepines and antidepressants are effective in the treatment of SAD. The selective serotonin reuptake inhibitors are emerging as the first-line treatment for SAD, based on their proven safety, tolerability, and efficacy. Goals for ongoing future research include development of approaches to achieve remission, to convert nonresponders and partial responders to full responders, and to prevent relapse and maintain long-term efficacy. This monograph explores the epidemiology, clinical presentation, and differential diagnosis of SAD, with a focus on neural circuitry of social relationships and neurochemical dysfunction. The prevalence, rates of recognition and treatment, patterns of comorbidity, quality-of-life issues, and natural history of SAD are discussed as well as pharmacologic and psychosocial treatment strategies for SAD.

Adult↗

PubMed2004

Post-treatment effects of exposure therapy and clomipramine in obsessive-compulsive disorder.

We sought to determine whether adults with obsessive-compulsive disorder (OCD) who respond to intensive exposure and response (ritual) prevention (EX/RP) with or without clomipramine (CMI) fare better 12 weeks after treatment discontinuation than responders receiving CMI alone. After receiving 12 weeks of treatment (EX/RP, CMI, EX/RP+CMI, or pill placebo [PBO] in a randomized clinical trial conducted at three outpatient research centers), 46 adults with OCD who responded to treatment (18 EX/RP, 11 CMI, 15 EX/RP+CMI, 2 PBO) were followed after treatment discontinuation for 12 weeks. Patients were assessed every 4 weeks with the Yale-Brown Obsessive-Compulsive Scale, the National Institutes of Health Global Obsessive-Compulsive Scale, and the Clinical Global Impressions scale by an evaluator who was blind to original treatment assignment. The primary hypothesis was that EX/RP and EX/RP+CMI responders would be less likely to relapse 12 weeks after treatment discontinuation than responders to CMI alone. Twelve weeks after treatment discontinuation, EX/RP and EX/RP+CMI responders, compared to CMI responders, had a significantly lower relapse rate (4/33 = 12% versus 5/11 = 45%) and a significantly longer time to relapse. The CMI relapse rate was lower than previously reported. Nonetheless, responders receiving intensive EX/RP with or without CMI fared significantly better 12 weeks after treatment discontinuation than responders receiving CMI alone.

Acute Disease↗

PubMed2004

Psychometric properties of disability measures among patients with social anxiety disorder.

BACKGROUND: Although recognition of the importance of disability as a construct has increased in recent years, there has been little examination of the reliability and validity of disability measures. METHODS: This study examined three disability measures, the Liebowitz Self-Rated Disability Scale (LSRDS), the clinician-rated Disability Profile (DP), and the Sheehan Disability Scale (SDS) among patients with a primary diagnosis of social anxiety disorder. RESULTS: The disability measures correlated strongly with each other, as well as with measures of social anxiety, depressive symptoms, and patients' subjectively-evaluated quality of life. The LSRDS and DP were more internally consistent than the SDS Total Score. All measures discriminated between patients with generalized and non-generalized social anxiety disorder. However, the LSRDS and DP also showed greater sensitivity to ecological indicators of distress than the SDS. Social anxiety symptoms accounted for significant variance in disability, above and beyond that accounted for by depressive symptoms. CONCLUSIONS: Overall, the LSRDS, DP, and SDS appear to be valid tools in the study of disability in social anxiety disorder, although the LSRDS and the DP appear to be somewhat more sensitive to the experiences of socially anxious patients.

Adult↗

PubMed2004

Use of psychotropic medications for patients with office visits who receive a diagnosis of panic disorder.

OBJECTIVE: We sought to examine trends in the medication management of panic disorder from a nationally representative sample of visits to psychiatrists and primary care physicians in office-based practice. METHOD: We analyzed physician-reported data from the 1992-1995 and 1996-1999 National Ambulatory Medical Care Survey, focusing on medication management of panic disorder by primary care physicians and psychiatrists. Rates for which doctors prescribed medication for patients with a diagnosis of panic disorder were compared over the course of time to identify changes in medication management between physician groups. We used logistic regression models to identify predictors of medication prescription, adjusting for the presence of other covariates. RESULTS: Both physician groups prescribed a psychotropic medication to a majority of patients for panic disorder in each time period. In 1992-1995, primary care physicians were less likely than psychiatrists to prescribe psychotropic medications. This difference was not evident in 1996-1999. The prescribing of benzodiazepines was common in both physician groups and time periods. Overall rates of psychotropic prescriptions by physician groups converged over time, although no single drug class accounted individually for the convergence. CONCLUSION: In recent years, changes in the medication management of patients with panic disorder by primary care physicians have resulted in greater similarity with the pharmacologic treatment of panic disorder provided in psychiatric practice.

Adult↗