Randomised controlled general practice trial of sertraline, exposure therapy and combined treatment in generalised social phobia.

BACKGROUND: No controlled trial of treatment of generalised social phobia has been conducted in general practice. AIMS: To examine the efficacy of sertraline or exposure therapy, administered alone or in combination in this setting. METHOD: Study was of a randomised, double-blind design. Patients (n = 387) received sertraline 50-150 mg or placebo for 24 weeks. Patients were additionally randomised to exposure therapy or general medical care. RESULTS: Sertraline-treated patients were significantly more improved than non-sertraline-treated patients (chi(2)=12.53, P<0.001; odds ratio=0.534; 95% Cl 0.347-0.835). No significant difference was observed between exposure- and non-exposure-treated patients (chi(2)=2.18, P=0.140; odds ratio=0.732; 95% Cl 0.475-1.134). In the pairwise comparisons, combined sertraline and exposure (chi(2)=12.32; P<0.001) and sertraline (chi(2)=10.13; P=0.002) were significantly superior to placebo. CONCLUSIONS: Sertraline is an effective treatment for generalised social phobia. Combined treatment with sertraline and exposure therapy, conducted by the general practitioner, may enhance the treatment efficacy in primary care.

The treatment of social phobia in general practice. is exposure therapy feasible?

BACKGROUND: Exposure therapy is an effective treatment for generalized social phobia. Most patients with social phobia are treated in primary care, but family doctors are not usually trained to perform exposure therapy. We have conducted a study in primary care of the effect of exposure therapy alone or in combination with sertraline on generalized social phobia. OBJECTIVES: The purpose of this article is to describe the training of GPs and the application of the treatment programme in general practice. METHOD: Forty-five GPs were trained for approximately 30 h in assessing patients with social phobia and conducting exposure therapy. The training programme included scoring of videotaped interviews of five patients on several social phobia scales, and a videotape demonstrating different steps of an exposure therapy was used as a model for role play in group training. RESULTS: All of the GPs completed the training programme. The doctors expressed satisfaction with the programme and also found it useful in the treatment of patients with conditions other than social phobia. There was a significant difference in response between the treatment groups (P = 0.001), and the combination of exposure therapy and sertraline seemed to be particularly beneficial.

The Norwegian naturalistic treatment study of depression in general practice (NORDEP)-I: randomised double blind study.

OBJECTIVE: To evaluate the efficacy of emotional support and counselling combined with placebo or antidepressants with single or dual mechanism of action in the treatment of depression in primary care. DESIGN: Randomised double blind study. SETTING: Several locations in Norway. SUBJECTS: 372 patients with depression. MAIN OUTCOME MEASURES: Improvement (clinical remission) reported both by the patient (Montgomery Asberg depression rating scale) and the physician (clinical global improvement and impression scales). RESULTS: Intention to treat analyses showed 47% remission in patients randomised to placebo compared with 61% remission in patients randomised to sertraline (odds ratio 0.56, 95% confidence interval 0.33 to 0.96) and 54% in patients randomised to mianserin (0.75, 0.44 to 1.27). Women responded better than men (1.86, 1.17 to 2.96). Subgroup analyses showed that subjects with recurrent depression (n=273) responded more frequently to sertraline than to placebo (0.43, 0.23 to 0.82) than those having their first episode of depression (1.18, 0.39 to 3.61). Statistically significant interactions between type of drug treatment and history of depression were not shown by logistic regression. CONCLUSION: The combination of active drug and simple psychological treatment (counselling, emotional support, and close follow up over a 24 week period) was more effective than simple psychological treatment alone, in particular for those with recurrent depression. Overall, women may benefit more than men. If confirmed in future studies, the findings should lead to more differentiated treatment guidelines for depression in primary care.

An open one-year comparison of doxazosin and prazosin for mild to moderate essential hypertension.

The long-term safety, efficacy and effect on serum lipid profile of doxazosin, a new alpha 1-adrenoceptor inhibitor administered once daily, were compared with those of prazosin, administered twice daily, in 104 patients with essential hypertension treated for 1 year. Doxazosin produced clinically significant decreases in standing and supine blood pressures over a period of 1 year. These decreases were similar to those produced after an initial period of 12 weeks of double-blind therapy. The reductions in blood pressure produced by doxazosin were greater than those produced by prazosin. Minor and clinically nonsignificant changes in heart rate were observed with both drugs. The favorable changes from baseline in plasma lipid concentrations observed after 12 weeks of double-blind therapy were maintained throughout the 1-year open study. These were average increases in the mean high density lipoprotein cholesterol concentration and the derived high density lipoprotein/total cholesterol ratio, and average decreases in total cholesterol and total triglyceride concentrations. The incidence of side effects reported was similar for doxazosin and prazosin. Most were rated as being mild or moderate in severity and were tolerated or disappeared with continued therapy. Results of laboratory tests, electrocardiograms, ophthalmoscopy and body weight measurements revealed only minor changes from baseline, and none was judged to be of clinical significance. These findings demonstrate that doxazosin is a safe and effective antihypertensive agent suitable for once-daily dosing, and has favorable effects on the serum lipid profile.

Multicentre 12-week double-blind comparison of doxazosin, prazosin and placebo in patients with mild to moderate essential hypertension.

A 12-week double-blind study was performed to compare the safety and efficacy of doxazosin, prazosin and placebo in 172 patients with essential hypertension. According to response, patients received doxazosin 1-16 mg once daily, prazosin 0.5-10 mg twice daily, or placebo. Mean final daily doses were doxazosin 11.3 mg and prazosin 13.8 mg. Doxazosin once daily and prazosin twice daily both produced statistically significant reductions in both standing and supine blood pressures when compared with placebo. No significant differences between treatments were recorded for standing and supine heart rates. Doxazosin, prazosin and placebo all had a similar effect on plasma lipid profiles, i.e. an increase in HDL/total cholesterol of approximately 10%. The differences between treatments were not statistically significant. The HDL/total cholesterol ratio significantly increased from baseline to the end of treatment for all three groups, the decrease in triglycerides being statistically significant only in the doxazosin-treated group.