The nonpharmacologic treatment of generalized anxiety disorder.

This article describes the latest nonpharmacologic therapies for generalized anxiety disorder. In addition, a review of available nonpharmacologic treatment outcome studies and studies that compare the efficacy of pharmacologic and nonpharmacologic treatment is presented. The authors conclude that, of the nonpharmacologic therapies available, cognitive-behavioral therapy may be the preferred first-line treatment. Results of comparison studies have suggested that medication acts more quickly than does therapy in reducing symptoms, whereas therapy has more long-lasting effects. The authors recommend that further research be conducted in identifying the essential components of treatment and the most efficacious treatment combinations.

Experience with anxiety and depression treatment studies: implications for designing irritable bowel syndrome clinical trials.

This report highlights various considerations regarding the potential effects of concurrent psychiatric conditions and a history of abuse in patient volunteers for clinical trials in irritable bowel syndrome (IBS). Even though many studies have used psychological rating scales to assess personality and psychological traits of patients with IBS, the prevalence of the different psychiatric diagnoses (i.e., categorical assessment) in patients with IBS has only recently been assessed systematically. Recent studies of treatment-seeking patients have indicated that the majority of individuals (50% to 90%) who seek treatment for IBS have a lifetime history or currently have one or more common psychiatric conditions: major depressive disorder, generalized anxiety disorder, panic disorder, social phobia, somatization disorder, and posttraumatic stress disorder. Traditional clinical wisdom is that the presence of a psychiatric disorder increases the likelihood that an IBS patient will seek treatment. However, recent data suggest that IBS and psychiatric disorders are associated regardless of treatment-seeking status. Patients with psychiatric disorders should be included in clinical IBS studies, because this reflects the actual patient population. Extrapolating from the psychiatric literature, inclusion of patients with IBS with mild to moderate anxiety or depression is warranted.

Screening for PTSD in a substance abuse sample: psychometric properties of a modified version of the PTSD Symptom Scale Self-Report. Posttraumatic stress disorder.

The high rate of posttraumatic stress disorder (PTSD) among substance use disorder (SUD) patients has been documented in research protocols, but there is evidence that it is markedly under-diagnosed in clinical settings. To address the need for a brief self-report measure to identify SUD patients who may benefit from further assessment and/or treatment for PTSD, the psychometric properties of a modified version of the PTSD Symptom Scale Self-Report (PSS-SR) were examined in a treatment-seeking SUD sample (N = 118). The modified version of the PSS-SR, which measures both frequency and severity of PTSD symptoms, demonstrated good internal consistency reliability and was correlated with other self-report measures of trauma-related symptomatology. Comparisons between a structured PTSD diagnostic interview and the modified PSS-SR indicated that 89% of the PTSD positive patients were correctly classified by the modified PSS-SR. The clinical relevance of these findings was discussed.

Frequency and severity of panic attack symptoms in a treatment seeking sample of trauma victims.

This study assessed the frequency and severity of panic attack symptoms and panic attacks that develop in relation to the experience of traumatic events in 62 subjects seeking treatment for trauma-related symptomatology. Results indicated a high incidence of panic attacks (69%). Many individuals also thought they were going crazy or losing control (72%) or having a heart attack (38%) within the 2 weeks prior to assessment. These findings indicate that similar to panic disordered patients, many trauma victims with posttraumatic stress disorder (PTSD) not only experience physiological symptoms of panic, but are also fearful of these symptoms.

Comorbidity of posttraumatic stress disorder and irritable bowel syndrome.

BACKGROUND: Irritable bowel syndrome (IBS) is a chronic disorder that has been found to be associated with psychiatric disorders and a history of physical and/or sexual abuse. To date, the relationship of posttraumatic stress disorder (PTSD) and IBS has not been investigated. The primary purpose of this study was to examine the relationship of IBS and PTSD. METHOD: Fifty consecutive IBS patients admitted to a clinical treatment study were assessed for IBS, trauma history, and psychiatric disorders. RESULTS: Twenty-seven IBS patients (54%) met criteria for a psychiatric diagnosis at some time in their lives. Twenty-two patients (44%) reported a trauma history. Eighteen (36%) were diagnosed with PTSD. Those IBS patients with a trauma history were more likely to have other comorbid psychiatric diagnoses. CONCLUSION: These results suggest that IBS is often associated with psychiatric disorders, indicating that assessment and treatment of these comorbid conditions may be important in the treatment of IBS. PTSD, which had not been previously investigated in relation to IBS, had a high prevalence, indicating the need for careful trauma and PTSD assessment in patients with IBS. Patients with IBS who have a trauma history may be more at risk for other comorbid psychiatric disorders than IBS patients without a trauma history.