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R. Kellner
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ABSTRACT: ABSTRACT – Thirty-six patients who had hypochondriacal neurosis for 6 months or longer were treated with individual psychotherapy which focused predominantly on presenting complaints, fears and beliefs. Antianxiety drugs were used at times of anxiety. Sixty-four percent either recovered or improved to the extent that they no longer believed that they had a disease. The improvement was largely maintained on a 2-year follow-up. Good outcome was associated with illnesses of less than 3 years duration, the absence of an additional diagnosis of a personality disorder and there was a nonsignificant trend to belong to a higher social class. Outcome was not associated with age, sex, or severity of initial ratings of anxiety, depression or somatic symptoms. It appears that the prognosis of treated hypochondriacal neurosis is good in a substantial proportion of patients.
Acta Psychiatrica Scandinavica 08/2007; 67(2):69 - 79. · 4.22 Impact Factor
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B Krakow,
M Hollifield,
R Schrader,
M Koss,
D Tandberg,
J Lauriello,
L McBride,
T D Warner,
D Cheng,
T Edmond, R Kellner
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ABSTRACT: Imagery-rehearsal therapy for chronic nightmares was assessed in a randomized, controlled study of sexual assault survivors with posttraumatic stress disorder (PTSD). Nightmares, sleep quality, and PTSD were assessed at baseline for 169 women, who were randomized into two groups: treatment (n = 87) and wait-list control (n = 82). Treatment consisted of two 3-hr sessions and one 1-hr session conducted over 5 weeks. Of 169 participants, 91 women (Treatment, n = 43, Control, n = 48) completed a 3-month follow-up and 78 did not. At follow-up, nightmare frequency and PTSD severity decreased and sleep quality improved in the treatment group with small to minimal changes in the control group. Treatment effects were moderate to high (Cohen's d ranged from 0.57 to 1.26). Notwithstanding the large dropout rate, imagery-rehearsal therapy is an effective treatment for chronic nightmares in sexual assault survivors with PTSD and is associated with improvement in sleep quality and decreases in PTSD severity.
Journal of Traumatic Stress 11/2000; 13(4):589-609. · 2.72 Impact Factor
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ABSTRACT: Fifty-eight chronic nightmare sufferers were randomly assigned to two groups: treatment (n = 39) and wait-list control (n = 19). Treated Ss were taught a cognitive-behavioral technique called imagery rehearsal in which they learned in a waking state to change a nightmare and then to visualize the new set of images. Subjects were assessed pre-treatment and 3 months followup for nightmare frequency, self-rated distress and subjective sleep quality. Compared to controls, the treatment group showed significant and clinically meaningful decreases in nightmares. Treated Ss decreased nightmares as measured in nights/week (mean = -2.0, SD = 1.7, P = 0.0001) and actual number of nightmares (mean = -4.2, SD = 4.5, P = 0.0001). Significant improvement in self-rated sleep quality occurred in those treated compared with controls (P = 0.004); and, reduction in nightmares was a significant predictor of improvement in sleep (r = 0.55, P = 0.0001). These preliminary results lend support to the theory that, for some chronic sufferers, nightmares may be conceptualized as a primary sleep disorder which can be effectively and inexpensively treated with cognitive-behavioral therapy.
Behaviour Research and Therapy 10/1995; 33(7):837-43. · 3.30 Impact Factor
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ABSTRACT: Validation of animal models of hallucinogenic drugs' subjective effects requires human data. Previous human studies used varied groups of subjects and assessment methods. Rating scales for hallucinogen effects emphasized psychodynamic principles or the drugs' dysphoric properties. We describe the subjective effects of graded doses of N,N-dimethyltryptamine (DMT), an endogenous hallucinogen and drug of abuse, in a group of experienced hallucinogen users. We also present preliminary data from a new rating scale for these effects.
Twelve highly motivated volunteers received two doses (0.04 and 0.4 mg/kg) of intravenous (IV) dimethyltryptamine fumarate "nonblind," before entering a double-blind, saline placebo-controlled, randomized study using four doses of IV DMT. Subjects were carefully interviewed after resolution of drug effects, providing thorough and systematic descriptions of DMT's effects. They also were administered a new instrument, the Hallucinogen Rating Scale (HRS). The HRS was drafted from interviews obtained from an independent sample of 19 experienced DMT users, and modified during early stages of the study.
Psychological effects of IV DMT began almost immediately after administration, peaked at 90 to 120 seconds, and were almost completely resolved by 30 minutes. This time course paralleled DMT blood levels previously described. Hallucinogenic effects were seen after 0.2 and 0.4 mg/kg of dimethyltryptamine fumarate, and included a rapidly moving, brightly colored visual display of images. Auditory effects were less common. "Loss of control," associated with a brief, but overwhelming "rush," led to a dissociated state, where euphoria alternated or coexisted with anxiety. These effects completely replaced subjects' previously ongoing mental experience and were more vivid and compelling than dreams or waking awareness. Lower doses, 0.1 and 0.05 mg/kg, were primarily affective and somaesthetic, while 0.1 mg/kg elicited the least desirable effects. Clustering of HRS items, using either a clinical, mental status method or principal components factor analysis provided better resolution of dose effects than did the biological variables described previously.
These clinical and preliminary quantitative data provide bases for further psychopharmacologic characterization of DMT's properties in humans. They also may be used to compare the effects of other agents affecting relevant brain receptors in volunteer and psychiatric populations.
Archives of General Psychiatry 03/1994; 51(2):98-108. · 12.02 Impact Factor
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R Kellner
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ABSTRACT: A psychosomatic syndrome is defined as a syndrome in which psychological processes play a substantial role in the etiology of the illness in some of the patients. The main conclusions on the extent of the biological and psychosocial contributions to several psychosomatic syndromes are presented and the relationship of these syndromes to somatization and somatoform disorders is discussed. The syndromes summarized include fibromyalgia, chronic fatigue, motility disorders of the esophagus, nonulcer dyspepsia, irritable bowel syndrome, urethral syndrome, behaviors causing disturbances of physiology, and some defined pain syndromes. The findings suggest that the extent of the biological and psychosocial contributions vary among these syndromes as well as among individuals with the same syndrome. In some syndromes the extent and nature of the biological contribution has not been established with certainty. There is evidence to suggest that many of the phenomena of the somatoform disorders are caused by clustering of psychosomatic syndromes or their incomplete or atypical manifestations and a low sensation threshold. The results of the controlled studies of various methods of psychotherapy and drug treatments of the psychosomatic syndromes are listed; these studies have practical implications because the adoption of these methods is likely to enhance the efficacy of the treatment of somatoform disorders.
Psychotherapy and Psychosomatics 02/1994; 61(1-2):4-24. · 6.28 Impact Factor
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ABSTRACT: Nightmare frequency and self-rated distress were assessed retrospectively in two groups of chronic nightmare sufferers 30 months after treatment. In the initial phase, the image group (N = 9) learned a cognitive-behavioral technique (imagery rehearsal) for the treatment of nightmares. They were taught in one group session to: (1) record a nightmare; (2) change it (usually to something positive); and (3) rehearse the new images daily. The record group (N = 10) recorded nightmares during the first month only and learned imagery rehearsal subsequent to 3-month follow-up measurements. At 3 months and at 30 months, both groups had significantly fewer nightmares, but only the rehearsal group had less total distress. The results support the theory that nightmares are a primary sleep disorder rather than a symptom of an underlying psychiatric problem.
Journal of Behavior Therapy and Experimental Psychiatry 01/1994; 24(4):325-30. · 1.86 Impact Factor
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ABSTRACT: The staging method, whereby a disorder is characterized according to seriousness, extension and features, has achieved wide currency in medicine but is currently neglected in psychiatry. Studies addressing or related to the issue of staging in schizophrenia, unipolar depression, bipolar disorder and panic disorder are discussed. The phenomenological development of these mental disorders may be categorized according to stages.
Acta Psychiatrica Scandinavica 05/1993; 87(4):225-30. · 4.22 Impact Factor
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ABSTRACT: Ages of onset and the sequence of appearance of panic disorder (PD) and comorbid conditions were determined in a sample of 54 patients with the principal DSM-III-R diagnosis of PD. The onset of PD was earlier in patients with moderate to severe agoraphobia (AG) than in panic patients without AG. Patients with alcohol abuse and drug abuse before the onset of PD also had a tendency to develop PD earlier, which suggests that these conditions might have specifically predisposed to PD. All comorbid disorders, except for major depression, were more likely to precede the onset of PD so that, more often than not, PD appeared as a chronologically secondary condition. However, it was found that only for primary substance abuse such a temporal relationship might denote etiologic relatedness to PD, because of the reduced temporal distance between the onset of primary substance abuse and secondary PD.
Psychiatry Research 04/1993; 46(3):285-93. · 2.52 Impact Factor
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ABSTRACT: We examined the onsets of comorbid psychiatric disorders in patients with panic disorder (PD) (N = 54). In 42 patients (77.8%), PD was preceded by another psychiatric condition (secondary PD group), while in 12 patients (22.2%), PD occurred first or was the only diagnosed mental disorder (primary PD group). Patients with primary and secondary PD did not differ with respect to demographic variables, mean ages of onset of PD, mean duration of PD, number of patients with a personality disorder, and number of patients with different DSM-III-R subtypes of PD. Except for the anger and sleep scales of the Hopkins Symptom Checklist 90, patients with primary PD had significantly less self-rated psychopathology; they also displayed less extensive phobic avoidance, and had a lower rate of current psychiatric comorbidity. These findings are discussed in light of the value of the concepts of comorbidity and primary/secondary dichotomy.
Journal of Affective Disorders 03/1993; 27(2):81-6. · 3.52 Impact Factor
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ABSTRACT: Twenty subjects with chronic nightmares for 17.2 years mean duration were randomly divided into two groups: Rehearsal and Recording. At inception, subjects in both groups were instructed to write down their nightmares for one month. The Recording group received no other intervention. Rehearsal subjects received a single treatment group session teaching an imagery rehearsal technique to reduce nightmare frequency. At inception and three months follow-up, both groups were compared for nightmare frequency and for self-rated distress with scales (Symptom Checklist and Symptom Questionnaire) measuring anxiety, depression, hostility, somatization and total distress. Nightmare frequency decreased significantly in both groups: Rehearsal group-7.2 per month to 2.0 per month (72% reduction) (p < 0.006); Recording group-9.4 per month to 5.0 per month (47% reduction) (p < 0.02). There were no statistically significant differences in the nightmare frequency reductions between groups. All anxiety, depression, somatization, hostility and total distress scores decreased substantially in the Rehearsal group. Most changes were significant. Changes in the Recording group were inconsistent and not significant. Two brief case histories are presented.
Sleep 10/1992; 15(5):470-3. · 5.05 Impact Factor
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ABSTRACT: Diagnoses of comorbid disorders were determined in a sample of 54 patients with panic disorder as defined in DSM-III-R. The sample was divided into the following three groups: (1) uncomplicated panic disorder (PDU); (2) panic disorder with mild agoraphobia (PDM); and (3) panic disorder with moderate to severe agoraphobia (PDA). In comparison with patients with PDU, patients with PDA had higher comorbidity rates in general, received multiple comorbid diagnoses more frequently, had a higher prevalence of major depression, dysthymia, social phobia, generalized anxiety disorder, and obsessive-compulsive disorder, and scored higher on most measures of self-rated psychopathology. These findings support the notion that PDA may be a disorder essentially different from PDU.
Psychiatry Research 06/1992; 42(2):171-83. · 2.52 Impact Factor
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ABSTRACT: The purpose of this study was to examine the effects of one session of instructions on the frequency of chronic nightmares and on self-rated distress.
Twenty-eight volunteers with chronic nightmares (mean duration = 19 years) were treated with either one session of desensitization with instructions on how to practice this treatment or with one session of instructions to change the nightmare and how to rehearse the new version. The authors administered four scales of the SCL-90 and the corresponding scales of the Symptom Questionnaire.
At 7-month follow-up of 23 patients, there was a significant reduction in the frequency of nightmares and significant decreases in self-rated depression, anxiety, and hostility. There were no significant differences between the effects of the two types of treatment. In four patients, whose mean duration of nightmares was 23 years, the nightmares ceased.
The results of this preliminary study suggests that the instructions given to the patients reduced the frequency of their chronic nightmares and decreased their self-rated distress.
American Journal of Psychiatry 06/1992; 149(5):659-63. · 12.54 Impact Factor
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ABSTRACT: Four self-rating scales of hypochondriasis and the Symptom Checklist-90 were administered to 100 general practice (GP) patients and matched non-psychotic psychiatric out-patients. In a stepwise linear regression, self-rated somatic symptoms and anxiety predicted hypochondriacal fears and beliefs; self-rated depression did not appear as a predictor. There were differences between males and females and between psychiatric patients and GP patients in the associations of these constructs. These results varied in part with the scale of hypochondriasis used. Various scales of hypochondriasis appear to measure different features of the hypochondriasis syndrome. Fear of disease (disease phobia) was associated with anxiety, whereas a false belief of having a disease (disease conviction) was associated more with somatic symptoms.
The British Journal of Psychiatry 05/1992; 160:525-32. · 6.62 Impact Factor
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ABSTRACT: The purpose of this study was to examine correlates of hypochondriacal fears and beliefs in patients with panic disorder (PD) (n = 54). They were evaluated using the structured diagnostic interviews for axis I and axis II disorders (SCID-UP-R and SCID-II). They were administered the Illness Attitudes Scales (IAS) as a measure of hypochondriacal fears and beliefs, the Hopkins Symptom Checklist 90 (HSCL), and the Fear Questionnaire (FQ). One half of the patients rated themselves as having substantial hypochondriacal fears and beliefs. The sample was divided into groups of patients seeking predominantly treatment or relief from symptoms (treatment-oriented), and those who were searching for a cause of their illness (explanation-seeking): the latter had significantly more hypochondriacal concerns. Avoidant, histrionic, and borderline personalities were more common in the hypochondriacal group. The results of several analyses suggest that patients with PD who are also agoraphobic, fear physical disease more and have more false beliefs of having a disease than PD patients without agoraphobia.
Journal of Affective Disorders 03/1992; 24(2):73-85. · 3.52 Impact Factor
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ABSTRACT: In order to examine the relationship of dyspnea to anxiety and depression, the authors rated dyspnea using several methods in 50 patients with chronic respiratory impairment. Anxiety and depression were measured by the Symptom Checklist-90 and the Symptom Questionnaire. Results varied with the method of assessing dyspnea. Physician-rated dyspnea was significantly associated with patients' self-ratings of breathlessness as well as with pulmonary function tests, but not with any of the self-rating scales of emotions. Self-rated breathlessness was significantly associated with self-rated depression. In multiple regression analyses, depression was predictive of breathlessness. When the sample was limited to patients with chronic obstructive pulmonary disease, the results remained the same. The patients were significantly more depressed and anxious than matched family practice patients. In the study of the complex relationship of dyspnea to physical and emotional factors, it is desirable to use more than one measure of dyspnea because the results depend in part on the method of assessment.
General Hospital Psychiatry 02/1992; 14(1):20-8. · 2.74 Impact Factor
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ABSTRACT: In order to examine the relationship of self-rated inhibited anger to somatization, the authors administered several self-rating scales, including the SCL-90 and a Likert scale pertaining to inhibited anger, to psychiatric patients and family practice patients of both sexes. In a linear stepwise regression, depression predicted inhibited anger in all four groups. Previous studies have reported an association of inhibited anger and somatization; the present study suggests that depression is the link between the two in the majority of patients. The relationship of inhibited anger to depression may have implications for psychotherapy.
Psychotherapy and Psychosomatics 02/1992; 57(3):102-7. · 6.28 Impact Factor
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ABSTRACT: To review the published studies on the sex distribution of hypochondriasis, and to examine sex differences in hypochondriacal concerns and in attitudes toward illness.
The Illness Attitude Scales, Factors 2 and 3 of the Whiteley Index and the Symptom Checklist-90 (SCL-90) were administered to fifty randomly-selected female family practice patients ages eighteen to sixty-five, and to male patients matched by age in decades. From a pool of 130 consecutive nonpsychotic psychiatric outpatients, fifty females and fifty males were matched with the family practice patients.
Although females rated themselves as more depressed than males in both groups, there were no significant differences between the sexes in hypochondriacal fears and beliefs. Psychiatric male patients reported the most adverse effects of bodily symptoms on work and leisure. There were no other significant differences between the sexes in any of the other attitudes toward illness or symptoms. Hypochondriacal concerns were more common in the psychiatric patients than in the family practice patients of both sexes.
The review of published studies on the sex distribution of hypochondriasis suggests that disease phobia is more common in females, except for the cardiophobic syndrome, which is more common in males. The other reported differences are inconsistent and appear to be caused by referral biases, varying diagnostic criteria, and cultural factors. In our study, we found no substantial differences between males and females in hypochondriacal concerns and attitudes toward illness.
The International Journal of Psychiatry in Medicine 02/1992; 22(3):251-63. · 1.03 Impact Factor
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R Kellner
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ABSTRACT: There are controversies in the literature about the diagnosis and most appropriate treatment of hypochondriasis. The author offers guidelines for diagnosis of hypochondriacal syndromes that have not been adequately dealt with in the literature and discusses the choice of treatments.
Psychosomatics 02/1992; 33(3):278-89. · 2.12 Impact Factor
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ABSTRACT: The principles of measuring anxiety are reviewed. Scales of anxiety differ in their time focus: state-anxiety scales measure the present or recent past, whereas trait-anxiety scales measure the ways the subject generally feels. Commonly used scales have adequate validity, but there is incomplete agreement on the boundaries of the construct of anxiety. There are consistent differences in sensitivity among anxiety scales, and they vary greatly in the number of items, number of cues and in the method of scoring. For self-rating scales a large number of items with only two cues (e.g. 'yes' and 'no'), or only two scores for each item, increases the sensitivity of the scale for screening as well as for detecting differences between drug and placebo. A large number of cues decreases the sensitivity of a self-rating scale; it is unknown whether a large number of cues is advantageous in group research, but a small number of items is adequate both for rating and self-rating scales.
The British journal of psychiatry. Supplement 10/1991;
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ABSTRACT: The aim of this paper was to review the clinical and conceptual implications of the studies investigating prodromal symptoms of mania, depression, and panic disorder.
Twenty-four studies specifically addressing the issue of prodromal symptoms in mood and anxiety disorders were selected by computer search (Medline) and manual search of Index Medicus and the psychiatric literature.
Most of the studies have described a prodromal phase in the development of mania, depression, and panic attacks.
The appearance of prodromal symptoms may precede the full syndrome by weeks or months; if these symptoms are detected, recurrences of affective disorders (bipolar illness, unipolar depression, panic disorder) could be treated earlier and perhaps more effectively. DSM-III has emphasized the traditional clinical syndromes and cross-sectional descriptions. Appraisal of prodromal and residual phases may complement this approach. The longitudinal study of prodromes, the fully developed disorder, and residual states calls for an assessment of personality, neurotic traits, and their interaction in the evolution of affective disorders.
American Journal of Psychiatry 08/1991; 148(7):823-30. · 12.54 Impact Factor
