Jonathan M. Oakman

Quality of life and the anxiety disorders.

Quality of life (QoL) is a concept that has become increasingly used in mental health care. Recent studies have compared the impact of different anxiety disorders on different domains of QoL; however, instruments generally used to assess QoL in this population have varying specificity, considerable redundancy, and occasionally inappropriate content. Three hundred and sixty consecutive admissions to an anxiety disorders clinic were assessed. Participants and clinicians completed a number of QoL measures. Results indicated that impairment measures designed for use with anxiety-disordered samples in fact assess only occupational functioning and relationships and activities outside of occupation, and that individuals with Social Phobia (SP) were more impaired on the latter than those with Panic Disorder (PD). Furthermore, only Social Phobia accounted for unique variance in the three Medical Outcome Study Health Survey (MOS) subscales relevant to quality of life. Of the MOS subscales relevant to symptoms, mood regulation, physical functioning, and pain were associated with compromised overall QoL.

Individuals with social phobia are biased to become aware of negative faces

To evaluate whether individuals with social phobia are biased to become aware of negative faces participants searched visual displays containing varying number of neutral face distractors for the location of positive and negative faces. Individuals with social phobia had shallower search slopes for locating negative compared to positive faces, suggesting that they are biased to become aware of negative faces more readily than they become aware of positive faces. A similar bias was found for individuals with panic disorder; but no such bias was found either for individuals with obsessive-compulsive disorder or for control participants. The findings illustrate the importance of considering the characteristics of participants in the study of human attention.

A randomized, double-blind, placebo-controlled trial of olanzapine in the treatment of trichotillomania.

BACKGROUND Trichotillomania has been considered as part of the obsessive-compulsive disorder spectrum; however, trichotillomania treatment with obsessive-compulsive disorder medications has largely been unsuccessful. OBJECTIVE To determine whether a dopaminergic treatment as used in tics and Tourettes syndrome would be effective in trichotillomania. METHOD Twenty-five participants with DSM-IV trichotillomania participated in a 12-week, randomized, double-blind, placebo-controlled trial of flexible-dose olanzapine for trichotillomania. Recruitment occurred between August 2001 and December 2005, and follow-up was completed in February 2006. The primary outcome measure was the Clinical Global Impressions-Improvement (CGI-I) scale, and secondary measures of efficacy included the Yale-Brown Obsessive Compulsive Scale for Trichotillomania (TTM-YBOCS) and the Clinical Global Impressions-Severity of Illness (CGI-S) scale. RESULTS Eleven of 13 participants (85%) in the olanzapine group and 2 of 12 (17%) in the placebo group were considered responders according to the CGI-I (P = .001). There was a significant change from baseline to end point in the TTM-YBOCS (P < .01) and the CGI-S (P < .001). The mean ± SD dose of olanzapine at end point was 10.8 ± 5.7 mg/d. Twenty-one of 25 patients (84%) reported at least 1 adverse event, but no adverse events resulted in early withdrawal from the study. CONCLUSION Olanzapine seems to be a safe and effective treatment for primary DSM-IV trichotillomania. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00182507.

The potential role of haloperidol in the treatment of trichotillomania

BACKGROUND Trichotillomania is categorized as an impulse control disorder in DSM-IV and is considered by some to be closely related to Obsessive Compulsive Disorder (OCD). We review the clinical phenomenology and pharmacological response of trichotillomania, and suggest that it may be more related to Tourette Syndrome than to OCD. Serotonin reuptake inhibitors (SRIs) are typically employed in the treatment of OCD, while neuroleptic medications such as haloperidol are typically used in the treatment of Tourette Syndrome. Evidence for the efficacy of treatment of trichotillomania with drugs typically used for OCD is equivocal. METHOD Nine patients with trichotillomania were treated with haloperidol. Six patients unresponsive to SSRI medication had haloperidol added to their treatment. Three patients received only haloperidol. Response to treatment was assessed using descriptions of hair pulling, quantity of hair pulled, and severity of depilation at hair pulling sites. RESULTS Eight of nine patients responded to haloperidol treatment, with seven experiencing complete or near complete cessation of hair pulling. LIMITATIONS Inferences from the results of this study are limited by the lack of a control group, the small sample size, and the use of unstandardized ratings as measures of symptom severity. CONCLUSIONS Results suggest that the addition of haloperidol to SSRIs or haloperidol alone may be effective in the treatment of trichotillomania. Results also encourage speculation about the relation between OCD, Tourette Syndrome, and trichotillomania.

Predictors of response in generalized social phobia: effect of age of onset.

Abstract: Selective serotonin reuptake inhibitors (SSRIs) are the gold standard for the pharmacological treatment of generalized social phobia (GSP). However, little is known about the predictors of response to treatment. Two hundred and four outpatients with GSP were randomized to sertraline (Zoloft) or placebo, for a 20-week double-blind study, with a flexible dose range of sertraline 50 to 200 mg/d. Response was defined as the percentage of patients with a Clinical Global Impression-Improvement scale (CGI-I) of 1 (very much improved) or 2 (much improved). Outcome analyses were conducted using regression models including treatment group as a categorical predictor and study visit as a repeated measure. Dependent measures included Marks Fear Questionnaire (MFQ), Brief Social Phobia Scale (BSPS), CGI-I, and Sheehan Disability Scale (SDS). We investigated several possible predictors of response to treatment including DSM-IV comorbidity, age, sex, age of onset of GSP, and duration of illness. Patients with later-onset (especially adult-onset) GSP tend to have a better response to treatment than those with earlier-onset GSP. This result generally appears in our analyses as a 2-way interaction, where the association with response is greatest for patients with adult-onset GSP (in contrast to those with child or adolescent onset). This finding is most robust for symptom measures, but is still apparent for the Sheehan measure of disability at work. This advantage for later-onset GSP can be accounted for neither by severity of illness nor by duration of illness. Superior treatment outcome for later-onset GSP may be mediated by the degree of social and family disability.

Selective Serotonin Reuptake Inhibitors in the Treatment of Social Phobia

Social phobia is the third most common psychiatric illness in the community. It is characterised by a marked and persistent fear of one or more social or performance situations in which the individual is exposed to unfamiliar people or to possible scrutiny by others. Social phobia is often associated with significant morbidity and functional impairment. Treatments for social phobia have started to be extensively evaluated over the past decade and there is now evidence for the effectiveness of cognitive behavioural therapy and pharmacotherapy. Controlled studies support the efficacy of nonselective monoamine oxidase inhibitors (MAOIs), reversible inhibitors of monoamine oxidase-A (RIMAs), high potency benzodiazepines and, most recently, selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs).This article reviews the open and placebo-controlled trials of SSRIs in the treatment of social phobia. There is an accumulating body of evidence that supports the efficacy of SSRIs in the treatment of the disorder. Given the tolerability and efficacy of SSRIs in the treatment of social phobia, they are likely to become the new gold standard for the pharmacological treatment of this disorder.

Socially Desirable Responding on the Web: Investigating the Candor Hypothesis

The investigation presented here explores the hypothesis that participants are less likely to respond in a socially desirable fashion on self-report questionnaires completed on the Web relative to those completed in the laboratory—the candor hypothesis. A battery of social desirability questionnaires (i.e., Balanced Inventory of Desirable Responding [Paulhaus, 1984], Marlowe–Crowne Social Desirability Scale [Crowne & Marlowe, 1964], Eysenck Personality Questionnaire–Revised Lie Scale [Eysenck & Eysenck, 1994]) was administered to 3 groups: 2 groups consisted of undergraduate participants who were randomly assigned to complete the measures either in the laboratory (n = 60) or on the Web (n = 60), and 1 group consisted of self-selected participants who visited our experimental Web page and completed the measures online (n = 284). This design allowed us to assess the role of Web administration while controlling for differences in sample type, an oft-neglected issue in the Web literature. Results do not support the claim that administering self-report measures over the Web results in a decrease in socially desirable responding. Furthermore, these findings highlight the problems associated with confounding sample and medium. Implications for the use of Web as a research tool are discussed.

A reexamination of the role of nonhypnotic suggestibility in Hypnotic responding

An alcohol-placebo paradigm was used to measure individual differences in the tendency to have directly suggested, as well as unsuggested, alterations in experience. Using the spectral analytic technique of C. G. Balthazard and E. Z. Woody (1992), such alterations in experience were found to be differentially correlated with the easiest items of the Harvard Group Scale of Hypnotic Susceptibility, Form A. The results indicated that easy hypnotic performances depend on some kind of social suggestibility not unique to hypnosis, and this factor becomes less important as the difficulty of the hypnotic performances increases. The results may also shed light on hypnotic sequelae, context effects, and two-component models of hypnotic performance.

A taxometric analysis of hypnotic susceptibility.

The possibility that hypnotic ability is typological rather than dimensional was evaluated in a series of 4 studies. Study I used two samples of mass-testing measures of hypnotic ability, which were analyzed using the MAXCOV-HITMAX method ( P. E. Meehl, 1973). Results of these analyses were in keeping with the existence of a latent typology in hypnotic ability scores. Study 2 investigated the possibility that these results could be a false-positive artifact of factor structure. Results of the simulation analyses indicated that the possibility of a false-positive was unacceptably high. Studies 3 and 4 used larger samples, combined with data-simulation control analyses. Results of Studies 3 and 4 were in keeping with the existence of a latent typology in hypnotic ability scores, whereas data-simulation control analyses demonstrated that the risk of false-positive results was acceptably low.

Extraversion and behavioral activation: integrating the components of approach.

This investigation evaluates the structure and correlates of lower order traits related to approach, specifically, facets of extraversion and behavioral activation system (BAS) sensitivity. A 3-factor structure of approach was derived in community and clinical samples: assertiveness, enthusiasm, and sensation seeking. All factors were positively associated with Openness/Intellect scores. Enthusiasm and assertiveness were both negatively associated with Neuroticism scores, but were distinguished by associations with Agreeableness and Conscientiousness. Sensation seeking was negatively associated with Conscientiousness scores. The 3 factors demonstrated a unique profile of association with components of impulsivity. Enthusiasm and assertiveness were negatively related to psychopathological symptoms, whereas sensation seeking was largely independent of psychopathology. Results suggest that approach is associated with 3 subfactors, which differ in their pattern or magnitude of associations with other variables, thus underscoring the importance of distinguishing among them. Further, results support the construct validity of the Assertiveness and Enthusiasm aspect scales of the Big Five Aspect Scales to assess traits at this level of the personality hierarchy.