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4 results

  • Section 3 - Understanding the causes of anxiety

  • Edited by Helen Blair Simpson, Columbia University, New York, Yuval Neria, Columbia University, New York, Roberto Lewis-Fernández, Columbia University, New York, Franklin Schneier, Columbia University, New York
  • Book:
    Anxiety Disorders
    Published online:
    10 November 2010
    Print publication:
    26 August 2010, pp 139-248

  • Summary

    Social phobia turned out to be a severe clinical problem for patients whose fear of evaluation and scrutiny by others interfered with social functioning as well as performance. The study comparing phenelzine, atenolol, and placebo in social anxiety disorder became a model to be followed by subsequent trials. Social anxiety disorder appears to be a highly prevalent condition. While the most recent epidemiologic survey, the NESARC, has found a lifetime prevalence of 5% as opposed to the 13% found in the original National Comorbidity Survey (NCS) study, it would still appear that social anxiety disorder is one of the more common psychiatric conditions. Future studies should go a long way toward clarifying the pathophysiology of social anxiety disorder, which in turn should facilitate diagnosis as well as treatment. Positron emission tomography (PET) scans of patients giving speeches are beginning to delineate the brain circuits relevant to social phobic symptomatology.

  • A comparison of the predictive abilities of dimensional and categorical models of unipolar depression in the National Comorbidity Survey

  • J. J. Prisciandaro, J. E. Roberts
  • Journal:
    Psychological Medicine / Volume 39 / Issue 7 / July 2009
    Published online by Cambridge University Press:
    10 October 2008, pp. 1087-1096
  • Background

    Taxometric research on depression has yielded mixed results, with some studies supporting dimensional solutions and others supporting taxonic solutions. Although supplementary tests of construct validity might clarify these mixed findings, to date such analyses have not been reported. The present study represents a follow-up to our previous taxometric study of depression designed to evaluate the relative predictive validities of dimensional and categorical models of depression.

    Method

    Two sets of dimensional and categorical models of depression were constructed from the depression items of the Composite International Diagnostic Interview: (1) empirically derived models obtained using latent structure analyses and (2) rationally selected models, including an additive depressive symptoms scale (dimensional) and DSM major depressive episodes (categorical). Both sets of dimensional and categorical models were compared in terms of their abilities to predict various clinically relevant outcomes (psychiatric diagnoses and impairment).

    Results

    Factor analyses suggested a two-factor model (‘cognitive–affective’ and ‘somatic’ symptoms) and latent class analyses suggested a three-class model (‘severe depression’, ‘moderate depression’ and ‘cognitive–affective distress’). In predictive analyses that simultaneously included dimensional and categorical models as predictors, the dimensional models remained significant unique predictors of outcomes while the categorical models did not.

    Conclusions

    Both dimensional models provided superior predictive validity relative to their categorical counterparts. These results provide construct validity evidence for the dimensional findings from our previous taxometric study and thus inspire confidence in dimensional conceptualizations of depression. It remains for future research to evaluate the construct validity of the taxonic solutions reported in the literature.

  • 19 - Alcohol-use disorders: who should be treated and how?

  • from Part III - Unmet need: people with specific disorders
  • Edited by Gavin Andrews, University of New South Wales, Sydney, Scott Henderson, Australian National University, Canberra
  • Book:
    Unmet Need in Psychiatry
    Published online:
    21 August 2009
    Print publication:
    06 January 2000, pp 290-301

  • Summary

    Alcohol-use disorders are among the most prevalent mental disorders in the general community. The Epidemiologic Catchment Area (ECA) study involved personal interviews with 20,000 Americans in five states. In the ECA study individuals with alcohol-use disorders were at high risk of suffering from other mental disorders. The National Comorbidity Survey (NCS) is a population survey that was undertaken between 1990 and 1992 to examine the extent of comorbidity between substance-use and nonsubstance-use disorders in the USA. A public health approach adopts a broader explanation of the causes of alcohol-related health problems. Alcohol-use disorders complicated by other comorbid mental disorders have been recognized as having a poorer prognosis and being more difficult to treat than those without comorbid disorders. Public education about the risks of alcohol use may be the best way of preventing and ameliorating the public health impact of the prevalent, milder forms of alcohol disorders.

  • 3 - Meeting the unmet need with disease management

  • from Part I - Unmet need: defining the problem
  • Edited by Gavin Andrews, University of New South Wales, Sydney, Scott Henderson, Australian National University, Canberra
  • Book:
    Unmet Need in Psychiatry
    Published online:
    21 August 2009
    Print publication:
    06 January 2000, pp 11-36

  • Summary

    The unmet need on mental health services appears considerable and the discontent among consumers and carers is palpable. The 1990 National Comorbidity Survey (NCS) used a changed Composite International Diagnostic Interview (CIDI) for DSM-IIIR, modified with initial probes and commitment procedures, to identify a range of mental disorders in people aged 15-54. The 1990 Canadian survey used the same methodology as the NCS study. The UK Household survey used a checklist to identify a similar range of disorders to the ECA studies among people aged 16-65. The Australian Survey of Mental Health and Well-Being was a household survey of 10,600 adults aged 18 to 90 that attained an 80% response rate. The World Bank Burden of Disease project has issued a final report which may be of value in informing criteria that are independent of clinician whim and patient pressure, and criteria that will maximize the overall health gains.