Anxiety disorders are associated with significant disability. There is growing interest in the question of whether pharmacotherapy that effectively reduces symptoms also restores function. Recovery could be defined as a lack of disability, with associated reduction in symptom severity. Conversely, relapse could be defined in terms of either increased disability or increased symptoms.

We analysed a database of randomised controlled trials of escitalopram in generalised anxiety disorder (GAD) and social anxiety disorder (SAD), focusing on the relationship between disorder-specific severity scales, and the Sheehan Disability Scale (SDS). In short-term studies, cut-points on symptom scales were derived for recovered function. In relapse prevention studies, the effects of defining relapse in terms of increased disability scores were examined.

In GAD and SAD, there is a close correlation between primary symptom severity scales and the SDS, both in the short-term and during relapse prevention. Thus, a lack of disability is associated with relatively low symptom severity scores, and rates of relapse - defined in terms of increased disability - are significantly lower on escitalopram than on placebo.

These data indicate that improvement in primary symptom scales in anxiety disorders is accompanied by improvement in functioning, and vice versa. Recovery and relapse can therefore be defined either in terms of symptom severity or in terms of functioning. Longer-term treatment of anxiety disorders is needed to ensure recovery.

This pooled analysis evaluated the predictors of clinical outcome in the short-term treatment of panic disorder.

Data were pooled from 4 randomized, placebo-controlled studies of venlafaxine XR in adult outpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) panic disorder with or without agoraphobia (n=1595). Patients were randomly assigned to 10 to 12 weeks' treatment with either placebo or venlafaxine (fixed or flexible dosing, range from 75 mg/d to 225 mg/d). The primary efficacy measure was the proportion of patients free of full-symptom panic attacks at end point. Predictors included panic severity (<8 or ≥8 full-symptom panic attacks during each 2 week period in the 4 weeks prior to baseline) and gender. Other predictors included panic disorder, clinical global impressions, anxiety, somatic and psychic anxiety, depression, mood, phobias, fear, and avoidance.

In both the active treatment and placebo groups, males (65% and 50%, respectively) and those with low symptom severity (69% and 53%, respectively) were significantly (P<0.05) more likely to be panic-free at end point. For nearly all baseline ratings on clinical measures, greater symptom severity was associated with lower proportions of patients who were free from full-symptom panic attacks at end point. Change scores showing improvement in symptom severity following treatment were associated with higher proportions of patients who were free from full-symptom panic attacks at end point.

Panic-free status at end point was predicted by gender, panic disorder severity, and most baseline and change scores of clinical ratings scales.

Despite the achievements made in the treatment of obsessive-compulsive disorder (OCD), there still remains a high non-response rate to SSRIs. Furthermore, response is often delayed, increasing non-compliance. Even among responders, many do not reach remission and although symptoms are alleviated, functional impairment is still significant for some patients. These unmet needs would benefit from the development of strategies and treatment algorithms, including data on the role of antipsychotics and the potential therapeutic effects of new pharmacological agents. A better understanding of neurotransmitter involvement in the pathogenesis of the disorder, and the neurobiology of OCD might also pave the way for new treatments.

Twelve international experts in the field of obsessive-compulsive related disorders produced a consensus statement with the goal of updating the data, and discussing controversies, following a two-day consensus meeting. The statement is divided into chapters discussing: dimensions and diagnosis, the neurobiology of OCD, current and emerging treatments, and populations of special concern.

With the suggested changes to the diagnosis of OCD in the upcoming DSM-V, and the broader view now taken towards disorders to be included in under this heading, the biology of impulsivity and uncontrollable urges takes on an additional meaning and opens up a variety of potential new treatments. The specific outcome of the statement will be discussed briefly in view of the limitations of a poster.

There is emerging evidence from basic science and imaging that can be potentially harnessed for improving diagnosis, and consequently treatment interventions, in OC-related disorders.

The efficacy and tolerability of escitalopram in obsessive-compulsive disorder (OCD) were investigated in a 24-week, randomised, placebo-controlled, active-referenced, double blind study.

466 adults with OCD were randomised to escitalopram 10mg/day (N=116), escitalopram 20mg/day (N=116), paroxetine 40mg/day (N=119), or placebo (N=115) for 24 weeks. The pre-specified primary efficacy endpoint was the mean change in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) total score from baseline to Week 12 based on the intent-to-treat population and last observation carried forward (LOCF) using analysis of variance (ANCOVA).

Escitalopram 20mg/day was superior to placebo on the primary endpoint. After 12 weeks, on the primary efficacy endpoint, there was a statistically significant difference from placebo for 20mg escitalopram and paroxetine. In the escitalopram 20mg/day group, the Y-BOCS total score was significantly lower than in the placebo group as early as Week 6. At Week 24, the proportion of remitters (Y-BOCS≤10, LOCF, pre-defined) was significantly greater (p<0.05) for 20mg escitalopram (41.2%) than placebo (27.4%), but not for 10mg escitalopram (36.6%) or paroxetine (37.9%). The response rate (≥25 decrease from baseline Y-BOCS, LOCF, pre-defined) was significantly greater than placebo (50.4%) for 20mg escitalopram (70.2%) and paroxetine (67.2%). Statistically significantly more patients withdrew from the placebo group (18%) due to lack of efficacy, than paroxetine (8%) or escitalopram 20mg/day groups (6%). More paroxetine-treated patients withdrew due to adverse events than escitalopram- or placebo-treated patients.

Escitalopram was efficacious and well tolerated in the treatment of OCD, with 20mg escitalopram showing statistically significant superiority at the primary efficacy endpoint.

Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database.

The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared.

There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups.

These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.

Obsessive-compulsive disorder (OCD) is a highly disabling condition, with frequent early onset. Adult/adolescent OCD has been extensively investigated, but little is known about prevalence and clinical characterization of geriatric patients with OCD (G-OCD = 65 years). The present study aimed to assess prevalence of G-OCD and associated socio-demographic and clinical correlates in a large international sample.

Data from 416 outpatients, participating in the ICOCS network, were assessed and categorized into 2 groups, age < vs = 65 years, and then divided on the basis of the median age of the sample (age < vs = 42 years). Socio-demographic and clinical variables were compared between groups (Pearson Chi-squared and t tests).

G-OCD compared with younger patients represented a significant minority of the sample (6% vs 94%, P < .001), showing a significantly later age at onset (29.4 ± 15.1 vs 18.7 ± 9.2 years, P < .001), a more frequent adult onset (75% vs 41.1%, P < .001) and a less frequent use of cognitive-behavioural therapy (CBT) (20.8% vs 41.8%, P < .05). Female gender was more represented in G-OCD patients, though not at a statistically significant level (75% vs 56.4%, P = .07). When the whole sample was divided on the basis of the median age, previous results were confirmed for older patients, including a significantly higher presence of women (52.1% vs 63.1%, P < .05).

G-OCD compared with younger patients represented a small minority of the sample and showed later age at onset, more frequent adult onset and lower CBT use. Age at onset may influence course and overall management of OCD, with additional investigation needed.