Brief treatment with alprazolam and behavioral guidance in panic disorder

Abstract

Thirty-two patients with panic disorder, with or without agoraphobic limitations, were treated with alprazolam (mean dose 3.5 mg/d) plus brief behavioral guidance in an open study during eight weeks. The sample had a notorious severity in the frequency of panics and phobic avoidance but was only mildly depressed. Before starting treatment the presence of demoralized mood and extensive avoidance were significant indicators of clinical severity, whereas the presence of dizziness as a relevant somatic complaint was not related to higher severity. After eight weeks of treatment a clinical improvement equal to or exceeding 80% of change was obtained in all cases (29) who completed treatment. Ninety-two percent of the patients were panic free at the end of treatment. There were significant reductions in all the scales with comparable declines in the subgroups formed according to the presence or absence of agoraphobic avoidance and demoralization. The data suggested that moderate doses of alprazolam could be a quick and effective treatment for panic-agoraphobic patients in the short term. The behavioral guidance probably helped in reducing agoraphobic avoidance and in obtaining global good effectiveness although this awaits controlled tests. Finally, the similarity in the response to treatment regardless of the presence of extensive avoidance or demoralized mood argues in favor of not considering the different variants of panic-agoraphobic syndrome differently, at least in samples with similar severity to the present one.     

HOW INVESTMENT IN GENDER IDEALS AFFECTS WELL-BEING: THE ROLE OF EXTERNAL CONTINGENCIES OF SELF-WORTH

The present study examined the relationship between investment in gender ideals and well-being and the role of external contingencies of self-worth in a longitudinal survey of 677 college freshmen. We propose a model of how investment in gender ideals affects external contingencies and the consequences for self-esteem, depression, and symptoms of disordered eating. Specifically, we find that the negative relationship between investment in gender ideals and well-being is mediated through externally contingent self-worth. The model showed a good fit for the overall sample. Comparative model testing revealed a good fit for men and women as well as White Americans, Asian Americans, and African Americans.     

Psychometric Evaluation of the Rage Outbursts and Anger Rating Scale in an Outpatient Psychiatric Sample

The primary objective of this study was to examine the psychometric properties of a measure of anger/rage attacks—the Rage Outburst and Anger Rating Scale (ROARS)—in a sample of youth (n = 81, ages 7–17 years, 72.8 % male) receiving treatment at an outpatient pediatric psychiatric clinic. A trained rater completed the ROARS and Clinical Global Impression-Rage (CGI-Rage). Children completed the Spence Children’s Anxiety Scale for Children and Center for Epidemiological Studies Depression Scale. Parents completed the Spence Children’s Anxiety Scale for Parents. Internal consistency (α = .89), inter-rater reliability (κ = .94) and 1-week test–retest reliability (r = .72) were calculated for the ROARS. The ROARS was correlated with CGI-Rage (r = .68, ρ < .001), although not with parent- and child-rated anxiety symptoms or with child-rated depressive symptoms. Implications regarding clinical utility of the ROARS and directions for future research are discussed.     

Exploring Divergent Patterns in Racial Identity Profiles Between Caribbean Black American and African American Adolescents: The Links to Perceived Discrimination and Psychological Concerns

Using cluster analyses, this study explored the relations among racial identity, perceived discrimination, and psychological concerns among 189 Caribbean Black American and African American adolescents. Findings showed that for all participants, less mature racial identity profiles were significantly related to perceived discrimination and psychological concerns. However, nuances in racial identity profiles between Caribbean Black American and African American participants suggest subtle ethnic group differences in racial identity development. Implications for practitioners and research are discussed. Usando análisis cluster, este estudio exploró las relaciones entre identidad racial, discriminación percibida y preocupaciones psicológicas en 189 adolescentes afroamericanos y americanos negros caribeños. Los hallazgos mostraron que, para todos los participantes, los perfiles de identidad racial menos maduros estaban significativamente relacionados con una discriminación percibida y preocupaciones psicológicas. Sin embargo, los matices de los perfiles de identidad racial entre los participantes afroamericanos y americanos negros caribeños sugieren unas diferencias sutiles entre ambos grupos étnicos en el desarrollo de la identidad racial. Se discuten las implicaciones para practicantes e investigadores.     

The Occipital Cortex in the Blind

ABSTRACT— Studying the brains of blind individuals provides a unique opportunity to investigate how the brain changes and adapts in response to afferent (input) and efferent (output) demands. We discuss evidence suggesting that regions of the brain normally associated with the processing of visual information undergo remarkable dynamic change in response to blindness. These neuroplastic changes implicate not only processing carried out by the remaining senses but also higher cognitive functions such as language and memory. A strong emphasis is placed on evidence obtained from advanced neuroimaging techniques that allow researchers to identify areas of human brain activity, as well as from lesion approaches (both reversible and irreversible) to address the functional relevance and role of these activated areas. A possible mechanism and conceptual framework for these physiological and behavioral changes is proposed.     

Did lifetime rates of alcohol use disorders increase by 67% in 10 years? A comparison of NLAES and NESARC

Two nationally representative epidemiological samples (the National Longitudinal Alcohol Epidemiological Survey and the National Epidemiological Survey of Alcohol and Related Conditions) have been used to track changes in the prevalence of alcohol use disorders (AUDs) between 1992 and 2002 in the United States. Strikingly, estimates from these two data sets suggest that the lifetime prevalence of AUD increased by approximately 67% (from 18.2% to 30.3%) during this time frame. This article explores potential reasons for these discrepant estimates. Analyses indicated that a vast majority of change in lifetime AUD occurred with respect to alcohol abuse and not alcohol dependence. Most of this increase in abuse was attributable to self-reported changes in hazardous use that did not track with other archival measures of outcomes related to hazardous use in the population. Key methodological differences regarding the frequency requirements for prior-to-past-year alcohol abuse appeared to explain most of the discrepancy in lifetime AUD estimates. These findings, in conjunction with the relative lack of differences in the 12-month prevalence of AUDs, suggest that the discrepant lifetime estimates are likely due to methodological differences between the two surveys. These findings have important implications for substance use and other psychiatric surveillance and epidemiology where meaningful cross-temporal comparisons are desired.     

A validation of well-being and happiness surveys for administration via the Internet

Internet research is appealing because it is a cost- and time-efficient way to access a large number of participants; however, the validity of Internet research for important subjective well-being (SWB) surveys has not been adequately assessed. The goal of the present study was to validate the Satisfaction With Life Scale (SWLS; Diener, Emmons, Larsen, & Griffin, 1985), the Positive and Negative Affect Schedule (PANAS-X; Watson & Clark, 1994), and the Subjective Happiness Scale (SHS; Lyubomirsky & Lepper, 1999) for use on the Internet. This study compared the quality of data collected using paper-based (paper-and-pencil version in a lab setting), computer-based (Web-based version in a lab setting), and Internet (Web-based version on a computer of the participant’s choosing) surveys for these three measures of SWB. The paper-based and computer-based experiment recruited two college student samples; the Internet experiments recruited a college student sample and an adult sample responding to ads on different social-networking Web sites. This study provides support for the reliability, validity, and generalizability of the Internet format of the SWLS, PANAS-X, and SHS. Across the three experiments, the results indicate that the computer-based and Internet surveys had means, standard deviations, reliabilities, and factor structures that were similar to those of the paper-based versions. The discussion examines the difficulty of higher attrition for the Internet version, the need to examine reverse-coded items in the future, and the possibility that unhappy individuals are more likely to participate in Internet surveys of SWB.