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Social phobia and avoidant personality disorder (APD) may be given as comorbid diagnoses. However, it is not known if the labels provide independent, useful diagnostic information. We classified social phobics by social phobia subtype and presence of APD. Generalized social phobics with and without APD (ns = 10 and 10) and nongeneralized social phobics without APD (n = 10) were distinguished on measures of phobic severity. The generalized groups also showed earlier age at onset and higher scores on measures of depression, fear of negative evaluation, and social anxiety and avoidance than did the nongeneralized group. APD criteria of general timidity and risk aversion were more frequently endorsed by social phobics with APD. The data suggest that both the generalized subtype of social phobia and the presence of APD do provide useful diagnostic information but the additional diagnosis of APD may simply identify a severe subgroup of social phobics.
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PMID:Avoidant personality disorder and the generalized subtype of social phobia. 158 29

In addition to being effective in depressive disorders, monoamine oxidase inhibitors (MAOIs) have been shown to be effective in controlled studies of patient with panic disorder with agoraphobia, social phobia, atypical depression or mixed anxiety and depression, bulimia, posttraumatic stress disorder (PTSD) and borderline personality disorder. Uncontrolled case reports have noted MAOI efficacy in obsessive-compulsive disorder (OCD), trichotillomania, dysmorphophobia and avoidant personality disorder. Reversible inhibitors of MAO-A (RIMAs) appear safer than the classical irreversible MAOIs since they have less potential to increase blood pressure. They have not been studied as yet, however, in most of the conditions responsive to MAOIs. If RIMAs are found effective in these disorders, they would probably achieve wider use than MAOIs because they are safer and tend to cause fewer side effects.
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PMID:Reversible and irreversible monoamine oxidase inhibitors in other psychiatric disorders. 224 64

Fifty-two patients with panic disorder who had been receiving active benzodiazepine treatment for 8 weeks were assessed by using the outcome measures of spontaneous and situational panic attacks, scores on the Hamilton scales for anxiety and for depression, and scores on self-rated disability scales. Although spontaneous panic attacks were not affected by the presence of any personality disorder, the remaining outcome measures showed a strong and negative association with DSM-III antisocial, borderline, histrionic, and narcissistic personality disorders. There was also a mild negative association with avoidant personality disorder. A subgroup of patients with both major depression and panic disorder appeared more strongly affected.
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PMID:DSM-III personality disorders and the outcome of treated panic disorder. 290 Dec 36

Body dysmorphic disorder (BDD) refers to preoccupation with an imagined physical defect or the exaggeration of a slight physical anomaly. Since BDD's inclusion in the DSM-III-R, there have been only a handful of reports of its cognitive-behavioral treatment. We describe one successful short-term cognitive-behavioral therapy treatment of a BDD patient whose presenting concern was small hand size. After nine sessions of therapy, the patient evidenced substantial change on indices measuring affective, cognitive, and behavioral facets of BDD. There was also clinically meaningful improvement in overall levels of depression and anxiety. It is suggested that cognitive-behavioral treatment programs for BDD should take into account comorbid conditions such as social phobia, and avoidant personality disorder.
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PMID:Cognitive-behavioral treatment of body dysmorphic disorder: a case report. 759 90

Humans are social animals attuned to reactions of others; however, some are exquisitely sensitive to--and often misperceive--perceptions of those they encounter. The core feature of social phobia is marked and persistent fear of embarrassment or humiliation in social situations where the individual worries that others may judge his or her performance as too much or too little. Anticipatory anxiety and avoidance occur when the individual is under scrutiny while speaking or performing publicly, eating with others, writing in public, or using public bathrooms. Diagnosis of social phobia is based largely on history obtained from the patient. Onset is usually around puberty; its course is chronic with comorbid depression common and alcohol and other substances routinely abused in misguided attempts to minimize anxiety and depressive symptoms. At examination, patients often have a moist hand, averted gaze, blushing, and other manifest signs of anxiety. Slight shyness is familiar to most, but a substantial number suffer dysfunctional and distressing social anxiety to the point that they become phobic. A few patients satisfy criteria for avoidant personality disorder, which can be socially incapacitating.
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PMID:The diagnosis of social phobia. 778 74

This article delineates the conceptual models used when medications are prescribed for patients with personality disorders and reviews the data on the efficacy of these medications. Studies before 1980 are difficult to interpret because of changes in diagnostic criteria. Nonetheless, early studies on non-DSM-III disorders such as pseudoneurotic schizophrenia, emotionally unstable character disorder, hysteroid dysphoria, and subaffective disorders indicated the potential utility of pharmacotherapy for treating personality disorders. Models to consider in evaluating the possible use of medications for treating personality disorders are: (1) treating the disorder itself; (2) treating symptom clusters within and across disorders; and (3) treating associated axis I disorders. Among the current personality disorders, borderline personality disorder has been the most extensively studied, with antipsychotic agents being the most well-documented treatment. Monoamine oxidase inhibitors, fluoxetine, and carbamazepine show promise. Schizotypal disorders may respond to low-dose antipsychotic drugs. Although heuristically valuable, the symptom cluster approach to treatment has not yet been validated. Axis I disorders, especially depression, are frequently associated with all personality disorders. Dependent personality disorder is linked to panic disorder with agoraphobia, whereas avoidant personality disorder is associated with social phobia and panic. In general, pharmacotherapy for axis I disorders is less effective in the presence of a comorbid personality disorder. Despite the modest benefits seen in many studies, pharmacotherapy can add significantly to the overall treatment of those with personality disorders. Future research must carefully assess the effect of comorbid axis I disorders on responses. The symptom cluster/psychobiologic dimension approach should be investigated in clinical studies.
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PMID:Pharmacotherapy of personality disorders: conceptual framework and clinical strategies. 822 92

Our study investigated the convergent and discriminant validity of five of Chapman's Schizotypia Scales (i.e., Physical Anhedonia, Revised Social Anhedonia, Perceptual Aberration, Magical Ideation, and Impulsive Nonconformity; L.J. Chapman, J.P. Chapman, & Raulin 1976, 1978; Eckblad & L.J. Chapman, 1983) and Meehl's Schizoidia Scale (Meehl, 1964) within a sample of 50 personality disordered subjects, many of whom possessed schizotypic traits. It was hypothesized in part that all five of the Chapman scales and the Schizoidia Scale would correlate with the schizotypal personality disorder; the Physical Anhedonia and Revised Social Anhedonia Scales would correlate with the schizoid personality disorder, whereas the Magical Ideation and Perceptual Aberration Scales would not; the Physical and Revised Social Anhedonia Scales would not correlate with the avoidant personality disorder; and the Impulsive Nonconformity Scale would correlate with the borderline and antisocial personality disorders. Only the hypotheses concerning the avoidant personality disorder and the Schizoidia Scale were not supported. The findings remained even when the effects of state anxiety and state depression were controlled. Implications of the findings with respect to the validity of the Chapman and Schizoidia Scales and the personality disorders are discussed.
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PMID:The convergent and discriminant validity of the Chapman Scales. 837 97

The psychiatric history and presenting clinical characteristics of 276 depressed primary care patients with and without a lifetime comorbid anxiety disorder were studied in a randomized control trial of treatments for major depression. Our findings indicate that distinctive patterns of depressive symptoms and severity, functional impairment, comorbidity of other DSM-III-R Axis I and Axis II disorders, and treatment participation are associated with lifetime histories of panic and generalized anxiety disorder. The most consistent differences are evident between patients with major depression alone and those with major depression and a lifetime panic disorder. The latter presented with greater depressive severity, greater impairment in physical and psychosocial functioning, and were more likely to have a history of alcohol dependence, somatization disorder, and avoidant personality disorder. Discriminant function analysis indicated that 66% of depressed patients with lifetime panic disorder could be correctly distinguished from those without such comorbidity on the basis of the severity of somatic and affective symptoms but not cognitive symptoms of depression. Further, depressed patients with lifetime panic disorder were more likely to prematurely terminate both pharmacotherapy and psychotherapy during each treatment's acute phase. Implications for the diagnosis and treatment of major depression with comorbid anxiety disorder in primary care patients are discussed.
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PMID:Phenomenology and severity of major depression and comorbid lifetime anxiety disorders in primary medical care practice. 916 Jun 25

The person's perception of his or her quality of life has been neglected in studies of mental health in general and anxiety disorders in particular. However, the judgement of the impact of a mental disorder based on symptomatic distress while ignoring one's overall quality of life is incomplete. In the present study, we examined social phobic patients' judgments of their satisfaction with various domains of life they deem important using the Quality of Life Inventory (QOLI; Frisch, unpublished). Social phobics judged their overall quality of life lower than Frisch's (unpublished) normative sample. Quality of life was inversely associated with various measures of severity of social phobia (especially social interaction anxiety), functional impairment, and depression. It was not, however, related to performance anxiety or trait anxiety. Quality of life also varied across combinations of subtype of social phobia and the presence/absence of avoidant personality disorder, and as a function of marital status. Patients showed significant improvement in quality of life scores after completion of cognitive-behavioral group therapy for social phobia.
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PMID:Quality of life in social phobia. 916 41

In this open, prospective, structured, naturalistic study of the efficacy of long-term treatment in social phobia 93 consecutive outpatients suffering from severe generalized or circumscribed social phobia (median Liebowitz Social Anxiety Scale score 83) and a high degree of concomitant psychiatric disease were administered treatment with moclobemide (712 +/- 75 mg/day at steady state). Fifty-nine patients who responded (Clinical Global Impression for Change: very much/much improved) completed 2 years of treatment. Patients then entered a drug-free period of at least 1 month during which 88% of the patients deteriorated. In a further 2-year treatment period with moclobemide those patients who had deteriorated became responders again. Symptoms recurred in a substantial number of the patients at the end of the study when the dose was reduced and then discontinued. Post-study follow up at 6-24 months after study completion found that 63.2% of patients were almost asymptomatic or had only mild symptoms, 15.8% were off all treatment, 28.1% were back on moclobemide, 10.6% were taking another psychotropic drug and 8.8% were in psychotherapy. All previous non-responders to moclobemide and mostly alcohol abusers (36.9%), had moderate or severe social phobia and were off all treatment (13.3%), on psychotherapy (15.9%) or on another psychotropic drug (8.8%). Discriminant analysis correctly predicted outcome in 93.5% of all patients. Alcohol abuse was by far the strongest predictor of negative outcome. Coexisting generalized anxiety disorder and dysthymia were less potent in this regard, whereas high baseline Hamilton anxiety or depression scale scores, circumscribed social phobia, or social phobia unassociated with avoidant personality disorder were predictors of a positive outcome. In conclusion, severe social phobia can be successfully treated in the long-term but many patients may need medication or psychotherapy for many years. Treatment should start as early as possible because complications such as alcohol abuse make treatment difficult.
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PMID:Social phobia: long-term treatment outcome and prediction of response--a moclobemide study. 946 58


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