Treatment of specific phobia in adults Choy, Yujuan; Fyer, Abby J.; Lipsitz, Josh D.
Clinical psychology review,
April 2007, 2007-Apr, 2007-04-00, 20070401, Volume:
27, Issue:
3
Journal Article
Peer reviewed
This is a comprehensive review of treatment studies in specific phobia. Acute and long-term efficacy studies of in vivo exposure, virtual reality, cognitive therapy and other treatments from 1960 to ...2005 were retrieved from computer search engines. Although specific phobia is a chronic illness and animal extinction studies suggest that relapse is a common phenomenon, little is known about long-term outcome. Treatment gains are generally maintained for one year, but longer follow-up studies are needed to better understand and prevent relapse. Acutely, the treatments are not equally effective among the phobia subtypes. Most phobias respond robustly to in vivo exposure, but it is associated with high dropout rates and low treatment acceptance. Response to systematic desensitization is more moderate. A few studies suggest that virtual reality may be effective in flying and height phobia, but this needs to be substantiated by more controlled trials. Cognitive therapy is most helpful in claustrophobia, and blood-injury phobia is uniquely responsive to applied tension. The limited data on medication have not been promising with the exception of adjunctive d-clycoserine. Despite the acute benefits of in vivo exposure, greater attention should be paid to improve treatment acceptance and retention, and additional controlled studies of more acceptable treatments are needed.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
This exploratory study sought demographic and clinical correlates of self-mutilation (self-injury without suicidal intent) in borderline personality disorder.
Among 124 consecutively admitted ...inpatients with borderline personality disorder, there were 62 who did not mutilate themselves, 23 who mutilated themselves infrequently (fewer than five lifetime events), and 39 who mutilated themselves frequently (five or more lifetime events); each received ratings on numerous measures of psychopathology.
Compared to nonmutilators, frequent mutilators were significantly more likely to be in outpatient treatment at the time of admission and had more weeks of prior outpatient and inpatient treatment; they were also more likely to receive comorbid diagnoses of current major depression, anorexia nervosa, and bulimia nervosa. Frequent mutilators had significantly higher group means on the Beck Scale for Suicidal Ideation, were more likely to have attempted suicide, and were more likely to have attempted suicide more often than both infrequent mutilators and nonmutilators. The adjusted odds ratios from logistic regression analyses demonstrated that major depression, bulimia nervosa, number of prior suicide attempts, and acute suicidal ideation were each associated with greater risk of frequent mutilation.
Borderline patients who frequently mutilate themselves may represent a subgroup of especially high utilizers of psychiatric treatment who are at particularly high risk for suicidal behavior and for comorbid major depression and eating disorders. Clinicians should consider aggressive treatment of comorbid axis I disorders and careful assessment of suicide risk in these patients.
Fluoxetine is a new antidepressant with pharmacologic effects apparently limited to blockade of neuronal serotonin reuptake. We entered 20 patients who met DSM-III criteria for either panic disorder ...or agoraphobia with panic attacks into an open, uncontrolled pilot study of fluoxetine. Four responded to placebo in the week before fluoxetine administration and were dropped from the study. Of the remaining 16 patients, nine were nonresponders and seven were responders, with complete cessation of their panic attacks. Eight of the nine nonresponders were unable to tolerate the side effects of fluoxetine. In contrast, all of the responders (and one nonresponder) experienced minimal side effects. Fluoxetine may be effective in the treatment of panic attacks, perhaps implicating the serotonergic system in the pathophysiology of panic disorder. Future studies should use very low doses of fluoxetine to initiate treatment.
The choice of phenotype definitions for genetic studies of panic and phobic disorders is complicated by family, twin, and neurobiological data indicating both distinct and shared risk factors as well ...as heterogeneity within categories. We have previously reported a genome scan in 120 multiplex panic disorder (PD) families using a phenotype that closely adhered to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., PD definition. Here, we extend this work by carrying out exploratory linkage analyses in this same pedigree set using ten additional literature-based panic and phobia-related phenotypes that take into account aspects of these hypothesized complexities.
Multiply affected families (>2 individuals with PD) were recruited from clinical and nonclinical sources, evaluated by a clinician-administered semistructured interview and a subsequent blind consensus best estimate procedure. Each phenotype was analyzed under dominant and recessive models using parametric two-point (homogeneity and heterogeneity), multipoint, and nonparametric methods. Empirically based permutations were used to estimate model-specific and global (across all phenotypes) P-values.
The highest score was a two-point lod (4.27, global P<0.08) on chromosome 13 (D13S793, 76 cM) for the phenotype 'specific or social phobia' under a recessive model and conditions of homogeneity. There was minimal support for linkage to any of the remaining nine phenotypes.
Although the interpretation of findings is limited by the sample size and the large number of phenotypes and models analyzed, these data suggest a region on chromosome 13 as a potential site for further exploration in relation to the risk for specific and social phobias.
Anxiety disorders, the most common psychiatric conditions in the United States, have generated a great deal of research and scientific debate. Panic disorder, the best-studied anxiety disorder, is ...often believed to be either a biological disease or a psychological disease. The authors present a neuroanatomical model of panic disorder that attempts to reconcile these views. The model locates the three components of the disease--the acute panic attack, anticipatory anxiety, and phobic avoidance--in three specific sites of the CNS: the brainstem, limbic system, and prefrontal cortex, respectively. The authors suggest experiments to test their model.
This and the companion paper present two sequential family studies of obsessive-compulsive disorder (OCD) conducted by the same research group, but with different sampling and best-estimate ...procedures. In addition to providing further data on familial transmission of OCD, we used comparison of disparate findings (moderate, specific familial aggregation in this first study versus a stronger effect for other anxiety disorders than for OCD alone in the second) to examine possible effects of proband characteristics and informant data on outcome.
In this initial study we interviewed 179 first-degree relatives of 72 OCD probands and 112 relatives of 32 never mentally ill (NMI) controls. Informant data were obtained on an additional 126 relatives (total "combined" samples of 263 and 154 respectively). Analyses used best-estimate diagnoses made by consensus of two "blinded" senior clinicians who reviewed all diagnostic materials including proband informant data about relatives.
Significantly higher risk for OCD but not other anxiety disorders was found in relatives of OCD probands compared to relatives of controls in both the directly interviewed and combined samples. There was no relationship between proband age at onset of OCD and strength of familial aggregation.
These data indicate moderate familial aggregation of OCD, but do not support increased transmission by early onset probands, or a familial relationship between OCD and other anxiety disorders with the possible exception of generalized anxiety disorder.
Growing animal data implicate cholecystokinin in the regulation of anxiety, while human clinical research confirms the role of cholecystokinin in the provocation of panic attacks. Antipanic ...medications suppress the ability of cholecystokinin to induce panic attacks, and may alter the expression of the cholecystokinin gene. Thus, there is increased interest in understanding the molecular genetic component of these observations. Recent association studies using persons with panic disorder described some association between polymorphisms in the genes encoding cholecystokinin and the cholecystokinin B-receptor and panic disorder. In this study, we used a family-based design, employing 596 individuals in 70 panic disorder pedigrees, as well as 77 haplotype relative risk 'triads'. Subjects were genotyped for two polymorphisms: the polymorphic microsatellite marker in the CCK-BR locus using PCR-based genotyping and at a single nucleotide polymorphism in the CCK promoter using a fluorescence polarization detection assay, and the data were analyzed for genetic association and linkage. Employing a variety of diagnostic and genetic models, linkage analysis produced no significant lod scores at either locus. Family-based tests of association, the haplotype-based haplotype relative risk statistic and the transmission disequilibrium test, were likewise non-significant. The results reported here provide little support for the role of these polymorphisms in panic disorder.
Full text
Available for:
DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
PDF
