Scientific symposium on obsessive compulsive neuroses and phobic disorders. Closing remarks.
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Humans↗
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Clinical experience in the treatment of phobic disorders.
The author describes his experience in treating phobic disorders with both parenteral and oral clomipramine. Other techniques are mentioned and it is suggested that it is not only possible, but also desirable, to incorporate some of these in a regime of parenteral therapy for hospital in-patients. It is recommended that oral administration of clomipramine be used in the case of out-patients.
Administration, Oral↗
The management of phobic disorders using clomipramine (Anafranil).
The problem of phobic anxiety is viewed in the context of the entire area of mental illness and of its epidemiology in the general population. The importance of the diagnosis of depression in phobic patients and its simultaneous treatment is emphasized. Psychotherapeutic and psychopharmacological methods are discussed and some results of recent trials of clomipramine (Anafranil) are reported. The author concludes that for the successful outcome of treatment an eclectic approach must be considered. The combination of behavioural techniques of desensitization along a hierarchy of anxiety-provoking situations, together with psychotherapeutic support and the simultaneous exhibition of the more specific antidepressant and antiphobic preparation clomipramine would offer the best hope of symptom relief.
Behavior Therapy↗
Clomipramine (Anafranil) and behaviour therapy in obsessive-compulsive and phobic disorders.
In a comparative study of three treatment regimens in patients with obsessive-compulsive or phobic manifestations, the most favourable therapeutic findings were seen in the clomipramine (Anafranil, Geigy Pharmaceuticals) plus behaviour therapy group and the least favourable therapeutic findings in the clomipramine plus simulated behaviour therapy group. The findings that a combination of behaviour therapy and clomipramine results in more favourable therapeutic changes than either of the two treatments alone is in line with reported studies in the literature.
Adult↗
The role of intravenous clomipramine in the treatment of obsessional and phobic disorders.
The results of intravenous clomipramine therapy in 118 patients suffering from obsessional syndromes and phobic anxiety states are reviewed. A remarkable consistency of improvement was observed especially in those patients suffering from obsessional symptoms. Better results were obtained in patients lacking hysterical personality traits. A brief reference is made to a pilot study involving the use of the 16PF personality test in assessing the effect of clomipramine.
Adult↗
The management of phobic disorders in general practice.
Over two thousand patients have been treated with a flexible drug regime, having presented with a wide spectrum of disorders. Common aetiology was found in these patients and all could be said to be phobic, and as such many produced "side-effects" which could by predicted with accuracy--and overcome. A method is described for inducing increased patient compliance and decreased drop-out rate.
Clomipramine↗
A large open multicentre trial of clomipramine (Anafranil) in the management of phobic disorders.
In a large, open, multicentre trial, conducted in general practice, 765 patients suffering from agoraphobia or social phobias were treated with clomipramine (Anafranil, Geigy Pharmaceuticals). Four hundred and eight patients completed a twelve-week course of treatment. Of 285 withdrawals, 139 were due to side-effects. Good results were obtained on all measures of phobias in those patients who completed the study, the improvements being of the order of 70-80%, and over 50% of patients being symptom-free.
Adolescent↗
The medical student as behavioural psychotherapist.
A group of medical students were randomly selected from a larger group to carry out behaviour therapy under supervision. Ten patients with phobic disorders and two with obsessive-compulsive neurosis were treated, and the results, assessed by ratings of proved reliability, compared favourably with other studies in which psychiatrists or nurses acted as therapists. A questionnaire survey showed that students involved in therapy had a more favourable opinion about this kind of treatment than those receiving only theoretical instruction. The results suggested not only that medical students make good behavioural psychotherapists but also that the subject is a worthwhile training experience which warrants inclusion in the curriculum.
Adolescent↗
Physiological measurements in phobic and obsessional disorders.
The various physiological measurements which can be made in obsessional and phobic disorders are described. Useful information can be obtained about the effects of acute stress and the changes that medication can produce in anxious patients and the clinical progress of behaviour therapy can be monitored. When physiological measurements are made it is important to record the emotional state of the patient simultaneously so that the level of physiological arousal is related to the subjective experience of the patient.
Anxiety↗
An investigation into the use of anafranil in phobic and obsessional disorders.
A multicentre clinical trial of clomipramine in the treatment of obsessional and phobic disorders in general practice is described. All phobias showed an improvement in situational anxiety, interference and autonomic side effects. With the exception of two cases of animal phobia there was also improvement in general anxiety and avoidance. Obsessional cases showed an overall improvement in all symptom areas.
Administration, Oral↗
Some aspects of the measurement of phobias and obsessions.
Two assessment schemes for assessing obsessional and phobic disorders are described. The schemes were constructed with the phenomenology and epidemiology of the disorders in mind and were designed for use in the setting of general practice.
Humans↗
[Psychodiagnostic examination of patients with functional urinary incontinence (author's transl)].
Psychometric personality questionnaires were used to test 100 patients with symptoms of urinary incontinence. The following findings were recorded: Accumulation with significance of increased psychasthenic values in patients with normal urogynaecological status was higher than that recordable from patients in pathological conditions. The group of patients with mere stress incontinence differed from the group with urge or combined urge-stress incontinence by statistically secured differentiated between means values recordable from neurosis-relevant, test scales, including psychosomatic disorders, depression, neuroticism, social introversion, and phobic disorders. Reference is made to psychogenic factors and their role within a set of multifactorial conditions conducive to functional urinary incontinence of women. Consequences regarding diagnosis and therapy are discussed.
Female↗
A pilot study of anafranil in the treatment of phobic states.
A pilot study of the use of Anafranil in the treatment of phobic disorders is described. Twenty-two patients were included in the investigation, 16 receiving intravenous and oral Anafranil combined and six oral Anafranil alone. After one month, four were free of phobic symptoms and 13 only mildly disabled. At six month follow-up 10 were free of symptoms and seven only mildly disabled.
Administration, Oral↗
Relationship between agoraphobia and field dependence.
In recent years agoraphobia has been viewed by clinicians as etiologically distinct from other phobic disorders, with conflicts over the developmentally early issue of separation and individuation (self-other differentiation) playing a central role. In an effort to adduce quantitative evidence for this clinical observation, three groups of phobic patients (totaling 166 outpatients in all) were distinguished on the basis of their symptomatology (agoraphobia, simple phobias, and mixed phobias) and were individually administered the Group Embedded Figures Test as a measure of field dependence, a cognitive style dimension that according to Witkin is, at least in part, a manifestation of self-other differentiation. A one-way analysis of variance, performed separately for men and women for differences among the three phobic groups on field dependence, showed significance (rho less than .05) for the females, with the famale agoraphobic being more field dependent than the female simple phobic groups, but not for the males. Implications for the understanding of agoraphobia are discussed.
Adult↗
Clinical pharmacology of phenelzine.
There is renewed interest in the clinical pharmacology of phenelzine sulfate and other monoamine oxidase (MAO) inhibitors. Newer clinical and analytic techniques recently have been applied to investigations of this class of drugs in man. The results show that drugs such as phenelzine are effective in nonendogenous depression and phobic disorders. Clinical response to phenelzine is related to platelet MAO inhibition and dosage per unit body weight. High percent MAO inhibition in platelets at two weeks is associated with greater improvement after a six-week course of treatment. Our data show that a safe, effective phenelzine dose in 1 mg/kg body weight per day. These results have delineated the pharmacologic and therapeutic effects of phenelzine and support a continuing role for MAO inhibitors in psychopharmacology.
Acetylation↗
Practical considerations on the use of clomipramine (Anafranil) in general practice: an updated review.
The subject of dosage of clomipramine (Anafranil) in depression and in obsessional and phobic disorders is discussed. The expectation of success is reported and a recommendation made to adopt flexible dosage. Some side-effects are considered and stress is laid on distinguishing between unwanted pharmacological effects and serious toxic effects. Serious adverse reactions are rare. Contra-indications, both relative and absolute, are discussed. The importance of possible drug interactions is emphasized.
Clomipramine↗
Agoraphobia: newer treatment approaches.
Agoraphobia is the commonest and most severe form of phobic disorder. Techniques presently available for its treatment fall into the broad categories of behavior therapy, pharmacotherapy, and psychotherapy. Of the behavioral approaches in current use flooding is probably most effective. Group exposure methods are valuable and have the advantage of conserving therapist time. Pharmacological agents of demonstrated value include monoamine oxidase inhibitors (phenelzine) and tricyclic antidepressants (imipramine). These drugs are capable of preventing the spontaneous panic attacks observed in agoraphobic patients. Psychotherapy, once the mainstay of treatment, has largely become an adjunctive procedure.
Agoraphobia↗
Losing a symptom through keeping it. A review of paradoxical treatment techniques and rationale.
The therapeutic technique of symptom prescription has been used by practitioners from a variety of clinical schools. This article reviews techniques based on learning theory, symptom redefinition, paradoxical intention, and directive therapy, among other approaches. A conceptual framework for understanding these various approaches is offered, utilizing data from psychoanalysis, learning theory, and interpersonal communication theory.
Acting Out↗