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Exaggerated illness and appearance concerns and related compulsive behaviors are seen in the psychiatric disorders of hypochondriasis (HYP), body dysmorphic disorder (BDD), and obsessive-compulsive disorder (OCD). It has been argued that these conditions may cluster in clinical samples and that our current categorical diagnostic policies, which assume independence of these disorders, are arbitrary and fail to capture the dimensional nature of these disorders.
We present retrospective clinical data on 21 randomly selected patients who presented with symptoms that involved anxiety about illness and appearance and who were evaluated for cognitive-behavioral treatment or pharmacotherapy. We also review the symptoms, associated features, and response to treatment of three patients from the sample who were each diagnosed with all three of these disorders (HYP, BDD, and OCD).
Three patients met criteria for HYP, BDD, and OCD, and the other 18 patients met criteria for at least two of the above conditions. The most frequently reported source of anxiety had to do with one's hair. Nine out of the 12 patients treated with behavioral therapy were considered to be responders, and the one treated solely with medication was “very much improved.” Of the eight treated with a combination of behavioral therapy and medication, five were judged to be responders.
Overlap in phenomenology, associated features, and treatment response suggests that these three disorders may be difficult to distinguish from each other and that a “cluster analysis” model may prove helpful in evaluating clinical samples.
Epidemiologic surveys consistently document that anxiety disorders are the most prevalent class of mental disorders. This chapter reviews the prevalence and distribution of DSM-IV anxiety disorders across the life span, drawing predominantly on large-scale epidemiologic surveys conducted in developed regions of the world, where the most rigorous work has been conducted. Sex differences in the prevalence of anxiety disorders are consistent across cultures and survey methods. Across cultures, epidemiologic work typically finds women to be at greater risk for social anxiety disorder (SAD) than men. Across several DSM iterations, generalized anxiety disorder (GAD) has evolved from a non-specific residual anxiety category to its current status as a primary anxiety disorder. Across cultures, lifetime panic disorder (PD) rates range roughly from 2% to 4%, and 1-3% reports the presence of PD within the past year. Increased efforts are needed to document population- based prevalence estimates of childhood anxiety disorders.
There is controversy regarding the nature and degree of intellectual
and memory deficits in chronic Lyme disease. In this study, 81
participants with rigorously diagnosed chronic Lyme disease were
administered the newest revisions of the Wechsler Adult Intelligence Scale
(WAIS-III) and Wechsler Memory Scale (WMS-III), and compared to 39
nonpatients. On the WAIS-III, Lyme disease participants had poorer Full
Scale and Performance IQ's. At the subtest level, differences were
restricted to Information and the Processing Speed subtests. On the
WMS-III, Lyme disease participants performed more poorly on Auditory
Immediate, Immediate, Auditory Delayed, Auditory Recognition Delayed, and
General Memory indices. Among WMS-III subtests, however, differences were
restricted to Logical Memory (immediate and delayed) and Family Pictures
(delayed only), a Visual Memory subtest. Discriminant analyses suggest
deficits in chronic Lyme are best characterized as a combination of memory
difficulty and diminished processing speed. Deficits were modest, between
one-third and two-thirds of a standard deviation, consistent with earlier
studies. Depression severity had a weak relationship to processing speed,
but little other association to test performance. Deficits in chronic Lyme
disease are consistent with a subtle neuropathological process affecting
multiple performance tasks, although further work is needed to
definitively rule out nonspecific illness effects. (JINS, 2006,
Moclobemide, a reversible inhibitor of monoamine oxidase A, previously has been reported to have efficacy in the treatment of social phobia.
Seventy-seven non-responders to one week of single-blind placebo were randomly assigned to moclobemide or placebo for eight weeks of double-blind treatment. Outcome was assessed by independent evaluator, treating psychiatrist and self-ratings. After eight weeks, patients who were at least minimally improved continued treatment for a further eight weeks.
Intention-to-treat sample response rates at week 8 were 7/40 (17.5%) for the moclobemide group and 5/37 (13.5%) for placebo (NS). Moclobemide was significantly superior to placebo on 2 of 10 primary outcome measures. Moclobemide was well tolerated.
Moclobemide may have efficacy in the treatment of social phobia, but absence of significant differences on most primary outcome measures and small effect sizes for all outcome measures suggest that the magnitude of its clinical effect is small.
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