The Journal of clinical psychiatry
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Recently, changes have been proposed to DSM-IV diagnostic criteria for post-traumatic stress disorder (PTSD) to refine the diagnosis because of concerns about its construct validity. Specifically, Spitzer et al. suggested narrowing the PTSD definition of trauma, specifying a symptom onset time frame after the trauma, and removing symptoms that overlap with other anxiety and mood disorders. We examined whether removing these overlapping anxiety/mood disorder symptoms resulted in differences (compared to the original DSM-IV PTSD criteria) in PTSD prevalence rates, diagnostic caseness, comorbidity and mental health-related disability, structural validity, and internal consistency. ⋯ These data provide evidence that PTSD's overlapping anxiety and mood disorder symptoms are not responsible for PTSD's prevalence, diagnostic comorbidity, and construct validity. Although the proposed symptom criteria revision would result in fewer symptoms by which to evaluate PTSD, it may not address questions raised about the diagnosis' construct validity.
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Meta Analysis
Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials.
Cognitive-behavioral therapy (CBT) is frequently used for various adult anxiety disorders, but there has been no systematic review of the efficacy of CBT in randomized placebo-controlled trials. The present study meta-analytically reviewed the efficacy of CBT versus placebo for adult anxiety disorders. ⋯ Our review of randomized placebo-controlled trials indicates that CBT is efficacious for adult anxiety disorders. There is, however, considerable room for improvement. Also, more studies need to include ITT analyses in the future.
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Randomized Controlled Trial
Placebo-controlled trial of risperidone augmentation for selective serotonin reuptake inhibitor-resistant civilian posttraumatic stress disorder.
Treatment of posttraumatic stress disorder (PTSD) with pharmacotherapy is promising, although the response to medication has generally been modest, and strategies to improve the response to antidepressant medications are needed. The primary objective of this study was to examine risperidone augmentation in civilians with PTSD currently receiving sertraline without an optimal response. ⋯ Participants responded well to sertraline in phase 1, sustained their response, and displayed a placebo response comparable with that of risperidone in phase 2. There is some evidence to support the conclusion that risperidone augmentation was helpful in those subjects who did not remit with sertraline alone, particularly in the areas of global improvement, positive affect, and sleep.