Recovery and Recurrence in GAD, Social Phobia, and Panic Disorder

[Tom]

Am J Psychiatry 162:1179-1187, June 2005

Influence of Psychiatric Comorbidity on Recovery and Recurrence in
Generalized Anxiety Disorder, Social Phobia, and Panic Disorder: A
12-Year Prospective Study

Steven E. Bruce, Ph.D., Kimberly A. Yonkers, M.D., Michael W. Otto,
Ph.D., Jane L. Eisen, M.D., Risa B. Weisberg, Ph.D., Maria Pagano,
Ph.D., M. Tracie Shea, Ph.D., and Martin B. Keller, M.D.

OBJECTIVE: The authors sought to observe the long-term clinical course
of anxiety disorders over 12 years and to examine the influence of
comorbid psychiatric disorders on recovery from or recurrence of panic
disorder, generalized anxiety disorder, and social phobia.

METHOD: Data were drawn from the Harvard/Brown Anxiety Disorders
Research Program, a prospective, naturalistic, longitudinal, multicenter
study of adults with a current or past history of anxiety disorders.
Probabilities of recovery and recurrence were calculated by using
standard survival analysis methods. Proportional hazards regression
analyses with time-varying covariates were conducted to determine risk
ratios for possible comorbid psychiatric predictors of recovery and
recurrence.

RESULTS: Survival analyses revealed an overall chronic course for the
majority of the anxiety disorders. Social phobia had the smallest
probability of recovery after 12 years of follow-up. Moreover, patients
who had prospectively observed recovery from their intake anxiety
disorder had a high probability of recurrence over the follow-up period.
The overall clinical course was worsened by several comorbid psychiatric
conditions, including major depression and alcohol and other substance
use disorders, and by comorbidity of generalized anxiety disorder and
panic disorder with agoraphobia.

CONCLUSIONS: These data depict the anxiety disorders as insidious, with
a chronic clinical course, low rates of recovery, and relatively high
probabilities of recurrence. The presence of particular comorbid
psychiatric disorders significantly lowered the likelihood of recovery
from anxiety disorders and increased the likelihood of their recurrence.
The findings add to the understanding of the nosology and treatment of
these disorders.



http://anxpangazette.blog-city.com/
http://anxpangazette.blog-city.com/read/1319231.htm

[Brian Denton]

Very *SAD(;)), if true! Still it's not too clear, were the ppl being
treated /w meds+behavioral-therapy, or only meds, or only
Behavioral-Therapy?

This convinces me more that SSRIs are not the best drug for SAD.
Benzodiazepines(sp) IMO, and *low-anti-psychotics(from what I've
read), and or Nardil seem to be the most effective for SAD...SSRIs may
be useful for the other anxiety disorders, and for SAD's secondary
depression, but if the SA is removed the depression goes too.



On Thu, 02 Jun 2005 07:00:24 GMT, Tom

Post by Tom
Am J Psychiatry 162:1179-1187, June 2005
Influence of Psychiatric Comorbidity on Recovery and Recurrence in
Generalized Anxiety Disorder, Social Phobia, and Panic Disorder: A
12-Year Prospective Study
Steven E. Bruce, Ph.D., Kimberly A. Yonkers, M.D., Michael W. Otto,
Ph.D., Jane L. Eisen, M.D., Risa B. Weisberg, Ph.D., Maria Pagano,
Ph.D., M. Tracie Shea, Ph.D., and Martin B. Keller, M.D.
OBJECTIVE: The authors sought to observe the long-term clinical course
of anxiety disorders over 12 years and to examine the influence of
comorbid psychiatric disorders on recovery from or recurrence of panic
disorder, generalized anxiety disorder, and social phobia.
METHOD: Data were drawn from the Harvard/Brown Anxiety Disorders
Research Program, a prospective, naturalistic, longitudinal, multicenter
study of adults with a current or past history of anxiety disorders.
Probabilities of recovery and recurrence were calculated by using
standard survival analysis methods. Proportional hazards regression
analyses with time-varying covariates were conducted to determine risk
ratios for possible comorbid psychiatric predictors of recovery and
recurrence.
RESULTS: Survival analyses revealed an overall chronic course for the
majority of the anxiety disorders. Social phobia had the smallest
probability of recovery after 12 years of follow-up. Moreover, patients
who had prospectively observed recovery from their intake anxiety
disorder had a high probability of recurrence over the follow-up period.
The overall clinical course was worsened by several comorbid psychiatric
conditions, including major depression and alcohol and other substance
use disorders, and by comorbidity of generalized anxiety disorder and
panic disorder with agoraphobia.
CONCLUSIONS: These data depict the anxiety disorders as insidious, with
a chronic clinical course, low rates of recovery, and relatively high
probabilities of recurrence. The presence of particular comorbid
psychiatric disorders significantly lowered the likelihood of recovery
from anxiety disorders and increased the likelihood of their recurrence.
The findings add to the understanding of the nosology and treatment of
these disorders.
http://anxpangazette.blog-city.com/
http://anxpangazette.blog-city.com/read/1319231.htm

[GFX]

Thank you for sharing the results of this study. I'm tending to see it in
much the same light, however it is worthy of note that low likelihood of
"recovery" does not spell doom - the disorders are manageable, in the same
sense as diabetes etc..

G

Post by Brian Denton
Very *SAD(;)), if true! Still it's not too clear, were the ppl being
treated /w meds+behavioral-therapy, or only meds, or only
Behavioral-Therapy?
This convinces me more that SSRIs are not the best drug for SAD.
Benzodiazepines(sp) IMO, and *low-anti-psychotics(from what I've
read), and or Nardil seem to be the most effective for SAD...SSRIs may
be useful for the other anxiety disorders, and for SAD's secondary
depression, but if the SA is removed the depression goes too.
On Thu, 02 Jun 2005 07:00:24 GMT, Tom

Post by Tom
Am J Psychiatry 162:1179-1187, June 2005
Influence of Psychiatric Comorbidity on Recovery and Recurrence in
Generalized Anxiety Disorder, Social Phobia, and Panic Disorder: A
12-Year Prospective Study
Steven E. Bruce, Ph.D., Kimberly A. Yonkers, M.D., Michael W. Otto,
Ph.D., Jane L. Eisen, M.D., Risa B. Weisberg, Ph.D., Maria Pagano,
Ph.D., M. Tracie Shea, Ph.D., and Martin B. Keller, M.D.
OBJECTIVE: The authors sought to observe the long-term clinical course
of anxiety disorders over 12 years and to examine the influence of
comorbid psychiatric disorders on recovery from or recurrence of panic
disorder, generalized anxiety disorder, and social phobia.
METHOD: Data were drawn from the Harvard/Brown Anxiety Disorders
Research Program, a prospective, naturalistic, longitudinal, multicenter
study of adults with a current or past history of anxiety disorders.
Probabilities of recovery and recurrence were calculated by using
standard survival analysis methods. Proportional hazards regression
analyses with time-varying covariates were conducted to determine risk
ratios for possible comorbid psychiatric predictors of recovery and
recurrence.
RESULTS: Survival analyses revealed an overall chronic course for the
majority of the anxiety disorders. Social phobia had the smallest
probability of recovery after 12 years of follow-up. Moreover, patients
who had prospectively observed recovery from their intake anxiety
disorder had a high probability of recurrence over the follow-up period.
The overall clinical course was worsened by several comorbid psychiatric
conditions, including major depression and alcohol and other substance
use disorders, and by comorbidity of generalized anxiety disorder and
panic disorder with agoraphobia.
CONCLUSIONS: These data depict the anxiety disorders as insidious, with
a chronic clinical course, low rates of recovery, and relatively high
probabilities of recurrence. The presence of particular comorbid
psychiatric disorders significantly lowered the likelihood of recovery
from anxiety disorders and increased the likelihood of their recurrence.
The findings add to the understanding of the nosology and treatment of
these disorders.
http://anxpangazette.blog-city.com/
http://anxpangazette.blog-city.com/read/1319231.htm

[Blues Ma]

Thank you for sharing the results of this study.� I'm tending to see it in
much the same light, however it is worthy of note that low likelihood of
"recovery" does not spell doom - the disorders are manageable, in the same
sense as diabetes etc..
G

Perfect analogy.
These are conditions that can be managed and lived with very successfully.
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