Standardized assessment for panic disorder research. A conference report.
ABSTRACT Lively controversies related to panic disorder are under active investigation by research groups around the world. However, publications from different laboratories are difficult to compare since there has been little consistency in measures or even in types of assessment used to characterize and follow up patients. Participants in the recently convened National Institutes of Health Consensus Development Conference on the Treatment of Panic Disorder noted this problem and recommended establishment of procedures to ensure comparability of studies. We organized a conference of clinical investigators whose objective was to develop a standard assessment package. Participants represented biological and psychosocial panic disorder treatment research sites in the United States and Canada. The 2-day conference resulted in agreement on a battery of assessments considered essential for panic disorder studies. The purposes of our report are to disseminate the conference conclusions and to encourage adoption of the proposed standards by clinical researchers, journal editors, Public Health Service peer review committees, and the Food and Drug Administration. We also identify some problematic issues that require further work.
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ABSTRACT: The main aim of this study was to examine prospectively the relationship between antidepressant prescriptions (ADP), as a proxy of depressive symptoms, and work-related stress, measured according to the demand-control model. A cohort of 2,046 union workers who participated in a survey on working conditions and health in 1999-2000 was followed up to 2005, through the Regional Drug Prescription Register, for an ADP. The relative risks associated with demand, control and job strain were estimated using Poisson regression, adjusting for age, sex and other workplace factors (shift work, overtime, loud noise and psychological violence). In final multivariable models, high demand significantly increased the risk of depressive symptoms among blue collars (RR = 1.82), whereas among white collars, it was significantly protective (RR = 0.38). No significant relationship was found for job control or strain in either occupational class. The direct association observed elsewhere among blue collars between depressive symptoms and demand was confirmed, but not for job control or job strain. It cannot be ruled out that the association with demand was at least in part determined by reverse causation, due to exposure over-reporting among subjects with subclinical depressive symptoms at baseline. The protective effect of demand among white collars is not consistent with the literature and may be attributable to the particular characteristics of this sample, which included mainly workers employed in public administrative positions.International Archives of Occupational and Environmental Health 10/2010; 84(4):413-24. DOI:10.1007/s00420-010-0586-3 · 2.20 Impact Factor
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ABSTRACT: Panic disorder (PD) is generally considered to be a chronic or intermittent disorder. This view may be biased because of a lack of general population studies investigating panic from the onset of an episode onwards. Data regarding the course of subthreshold panic disorder (sub-PD) and predictors of its course are lacking. Using data from a large community-based survey, the Netherlands Mental Health and Incidence Study (NEMESIS), that retrospectively assessed the 2-year course of panic with a Life Chart Interview (LCI), this study investigated remission, chronicity and recurrence in subjects with new episodes of PD or sub-PD. Predictor variables of remission consisted of sociodemographics, psychobiological, environmental, psychiatric and panic-related factors. In PD, remission of panic attacks occurred in 64.5% of subjects, mean time to remission was 5.7 months, and the remission rate was 5.8/100 person-months. In 43.3% of subjects panic was still present after 1 year. Recurrence of panic attacks occurred in 21.4% of those with PD who had achieved remission and for whom sufficient follow-up time was available. In general, the course of sub-PD was more favourable. Predictors of remission were female gender, the absence of ongoing difficulties, subthreshold panic and a low initial frequency of attacks. These results suggest that the course of panic is diverse in the general population, thereby underlining the need for accurate predictors. This requires further research including biological data and additional psychological data. In addition, given the large proportion with a relapse, relapse prevention should be part of any treatment programme.Psychological Medicine 05/2009; 40(1):147-57. DOI:10.1017/S0033291709005625 · 5.43 Impact Factor
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ABSTRACT: Eighty clients meeting criteria for panic disorder and receiving either panic control therapy (PCT; M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or treatment as usual (TAU) in a managed care setting were assessed 1 and 2 years following acute treatment. PCT was provided by therapists with little or no previous exposure to cognitive-behavioral therapies. Analyses of the full intent-to-treat sample revealed no significant differences between the treatments across the follow-up period. However, when treatment completer status was added as a moderator, those receiving PCT showed lower levels of panic severity and phobic avoidance and a greater likelihood of achieving and maintaining clinically significant change. Benzodiazepine use during follow-up was associated with greater panic severity for those clients who received PCT, but no such relationship was found for TAU clients. Results are discussed in relation to the dissemination and effectiveness of PCT as well as evidence-based psychotherapies more generally.Journal of Consulting and Clinical Psychology 04/2006; 74(2):377-85. DOI:10.1037/0022-006X.74.2.377 · 4.85 Impact Factor