The Journal of clinical psychiatry
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Multicenter Study
A multisite study of the capacity of acute stress disorder diagnosis to predict posttraumatic stress disorder.
Previous studies investigating the relationship between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) have reported mixed findings and have been flawed by small sample sizes and single sites. This study addresses these limitations by conducting a large-scale and multisite study to evaluate the extent to which ASD predicts subsequent PTSD. ⋯ The majority of people who develop PTSD do not initially meet criteria for ASD. These data challenge the proposition that the ASD diagnosis is an adequate tool to predict chronic PTSD.
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To raise awareness of potentially lethal clozapine-induced gastrointestinal hypomotility (CIGH) by reviewing cases from the literature and unpublished pharmacovigilance data and to offer strategies aimed at prevention and early treatment. ⋯ The paucity of literature on CIGH suggests that the significance of this uncommon but important and frequently fatal side effect has not been recognized. Clozapine can affect the entire gastrointestinal system, from esophagus to rectum, and may cause bowel obstruction, ischemia, perforation, and aspiration. The mechanism is likely to be anticholinergic and antiserotonergic. Clozapine prescribing should be accompanied by regular physical monitoring, appropriate and timely use of laxatives, and early referral of constipated patients--before life-threatening pathologic processes develop.
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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.