[Treatment of anxiety syndrome. A systematic literature review. Summary and conclusions by the SBU]. / Behandling av angestsyndrom. En systematisk litteraturöversikt. SBUs sammanfattning och slutsatser.

A report by the Swedish Council on Technology Assessment in Health Care (SBU) has reviewed, classified and evaluated the scientific literature on treatment of panic syndrome, specific phobias, social phobia, obsessive-compulsive syndrome (OCD), generalized anxiety syndrome (GAD) and post-traumatic stress disorder (PTSD). The review included treatment of children, adolescents and adults. The report concludes that there is effective treatment available for all anxiety syndromes. However in general, the effect is often moderate and symptoms reappear when the treatment period is discontinued. For adults, scientific evidence supports the use of paroxetine and sertraline for all syndromes except specific phobias. For the other SSRI's there is also evidence for the use of fluoxetin in OCD and PTSD, for fluvoxamine in social phobia and OCD and for escitalopram in social phobia. Other antidepressant drugs with a strong scientific support is venlafaxin in social phobia and GAD, imipramin in panic syndrome and chlomipramine in panic syndrome and OCD. Among psychological treatments, there is scientific evidence for cognitive behavior therapy (CBT) for treatment of panic syndrome, specific phobias, social phobia, PTSD and GAD. Exposure, with or without other psychotherapeutic interventions, has scientific support for efficacy in panic disorder (both in terms of number of panic attacks and for agoraphobia), specific phobias, OCD and PTSD. Use of eye movement desensitization and reprocessing (EMDR) has scientific support for treatment of PTSD.

Treatment of alcohol abuse: an evidence-based review.

This article represents the proceedings of a symposium at the 2002 annual meeting of the Research Society on Alcoholism in San Francisco, CA, organized and cochaired by Mats Berglund and Sten Thelander. The presentations were (1) Preventive interventions against hazardous consumption of alcohol, by Mikko Salaspuro; (2) Treatment of alcohol withdrawal, by Johan Franck; (3) Psychosocial treatment for alcohol problems, by Sven Andréasson and Agneta Ojehagen; and (4) Pharmacological treatment of alcohol dependence, by Mats Berglund.

Organizing mental health services: an evidence-based approach.

BACKGROUND AND AIMS: Health policy makers and program developers seek evidence-based guidance on how to organize and finance mental health services. The Swedish Council on Technology Assessment in Health Care (SBU) commissioned a conceptual framework for thinking about health care services as a medical technology. The following framework was developed, citing empirical research from mental health services research as the case example. FRAMEWORK: Historically, mental health services have focused on the organization and locus of care. Health care settings have been conceptualized as medical technologies, treatments in themselves. For example, the field speaks of an era of "asylum treatment" and "community care". Hospitals and community mental health centers are viewed as treatments with indications and "dosages", such as length of stay criteria. Assessment of mental health services often has focused on organizations and on administrative science. There are two principal perspectives for assessing the contribution of the organization of services on health. One perspective is derived from clinical services research, in which the focus is on the impact of organized treatments (and their most common settings) on health status of individuals. The other perspective is based in service systems research, in which the focus is on the impact of organizational strategies on intermediate service patterns, such as continuity of care or integration, as well as health status. METHODS: Examples of empirical investigations from clinical services research and service systems research are presented to demonstrate potential sources of evidence to support specific decisions for organizing mental health services. RESULTS: Evidence on organizing mental health services may be found in both types of services research. In clinical services research studies, service settings are viewed as treatments (e.g. "partial hospitalization"), some treatments are always embedded in a service matrix (e.g. assertive community treatment), and, where some treatments are organizationally combined (e.g. "integrated treatment" for co-occurring mental disorder and substance abuse), sometimes into a continuum of care. In service system research, integration of services and of the service system are the main focus of investigation. Studies focus on horizontal and vertical integration, primary care or specialty care and local mental health authorities - each of which may be conceptualized as a health care technology with a body of evidence assessing its effectiveness. IMPLICATIONS: A conceptual framework for assessing the organization of services as a health care technology focuses attention on evidence to guide program design and policy development. Mental health services research holds promise for such decision-making guidance.