Dan Stein

..No large-scale epidemiological study has ever examined the implications of this requirement for estimates of prevalence, severity, or correlates of GAD...

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..This paper reports on the perceived effectiveness of trichotillomania (TTM) internet support groups for people suffering from hair-pulling...

..Mindfulness Based Cognitive Therapy combines mindfulness meditation, a form of attentional training, along with aspects of cognitive therapy, and may improve attentional dysfunction in bipolar disorder patients...

..Dissatisfaction with psychiatric nosology may best be alleviated, not by new diagnostic criteria and categories, but by more realistic acknowledgment of the untidy landscape of mental and other medical disorders...

..To date, there have been no cohort studies of the impact of highly active anti-retroviral treatment (HAART) in South Africa where clade C HIV is predominant...

..While there are many published studies on HIV and functional limitations, there are few in the context of early abuse and its impact on functionality and Quality of Life (QoL) in HIV...

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..This pilot study evaluates the feasibility, acceptability and effectiveness of this PST program for CMD's in deprived communities around Cape Town...

..We aimed to determine whether this holds across a broader set of developed and developing countries, and whether subtyping according to number of performance versus interactional fears would be more useful...

..The clinical and genetic correlates of hoarding in OCD therefore deserve additional investigation...

..However, there are few prospective studies on the rates of psychiatric disorders in HIV/AIDS, particularly in the context of the developing world...

..Accurate assessment is challenging yet important. More reliable measures of anxiety disorders in patients with schizophrenia and other psychotic disorders are clearly needed to allow for timely identification and treatment...

..Against the backdrop of stressful life events and childhood abuse and neglect, we investigated the cumulative effect of multiple trauma exposure on PTSD, anxiety, and depression in an adolescent sample...

..Nevertheless, there is evidence of important differences between these two disorders. Some authors have conceptualized the disorders as lying on an OCD spectrum of conditions...

..In this population, trauma and PTSD were highly prevalent and associated with significant unidentified morbidity and comorbidity. Patients remain untreated for years in the current system of primary care consultations...

..In South Africa, given the high rates of violence and trauma, there is particular interest in traumatic exposures as potential risk factors for IED...

..Despite high rates of mental disorders and associated disability in South Africa, they are less likely to be treated than physical disorders...

..The response of OCD symptom dimensions to 12 weeks of treatment with escitalopram or placebo was investigated...

..Future work to assess the implications of overlap for clinical evaluation and intervention in the two conditions may be useful...

..Although evidence suggests that resilience may moderate the relationship between some of these risk factors and PTSD symptoms, no studies to date have examined these risk factors collectively...

..A six-factor model of social anxiety symptoms is supported by the distinctive association between these symptom dimensions and different areas of disability, but did not predict differential response to escitalopram...

..Misdiagnosis and ineffective treatment of survivors of human rights abuses are likely to pose a significant drain on primary care resources. Accurate diagnosis and appropriate treatment are important challenges in primary care settings...

..Future work, incorporating further investigation of the role of gender and psychobiological and treatment outcomes, is needed before definitive conclusions about hair-pulling subtypes can be drawn...

..These findings suggest that posttrauma factors may be as important as pretrauma and peritrauma variables in the development of PTSD...

..Genetic and environmental contributors to panic disorder are beginning to be delineated. Effective pharmacotherapy and psychotherapy are able to normalize the relevant psychobiology...

..A cognitive-affective neuroscience approach provides a conceptual basis from which clinical research can further explore how best to assess and treat a wide range of disruptions to the self...

..An affect regulation, behavioral addiction, and cognitive control (A-B-C) approach is outlined to conceptualizing and managing these conditions...

..The efficacy of selective serotonin reuptake inhibitors in the acute treatment of social anxiety disorder (social phobia) is well established...

..A number of rigorous studies of mindfulness-based cognitive therapy for depression have been positive. However, much remains to be discovered about the underlying mechanisms of and clinical indications for mindfulness-based approaches...

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..Conversely, many antidepressants result in decreased levels of 5-HT2A receptor levels, and blockade of 5-HT2A receptors has proven useful in the treatment of a number of psychiatric disorders...

..These findings highlight the high rates of exposure to multiple, noncombat-related trauma in military personnel, the potentially high rates of PTSD, and the role of inflicted trauma as an additional risk factor for PTSD...

..Comorbidity of the putative OCSDs in OCD has, however, not often been systematically investigated...

..There is increasing recognition that obsessive-compulsive disorder (OCD) is not a homogeneous entity. It has been suggested that gender may contribute to the clinical and biological heterogeneity of OCD...

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..A list of the meta-analyses included in this review is available on an evidence-based website of anxiety and trauma-related disorders...

..This analysis was conducted to specifically assess the efficacy of sertraline in the treatment of PTSD secondary to interpersonal trauma or childhood abuse...

..Moreover, few data are available on such associations in developing countries. The current study addresses each of these issues...

..These findings suggest that the ε4 allelic variant in HIV-positive individuals is not associated with the development of HAD in Southern Africa...

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..Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review...

..The paper closes by considering limitations of the review and possible future research avenues...

..An integrative framework is required in order to conceptualize this data and to apply it in the clinic...

..Advances in the cognitive-affective neuroscience of fear processing may ultimately lead to new approaches to the clinical management of phobias...

..Recommendations include the need for traditional healers to be trained to identify potential cases of mental illness in their communities and for dialogue between traditional and allopathic physicians in regard to mental health care...

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..Studies examining the long-term effects of HAART on HIV-associated neurocognitive disorders (HANDs) using uniform methods of data collection are needed, together with clear reporting of HAART regimens...

..At the same time, the rich range of revenge and forgiveness phenomena in real-life settings is likely to require explanatory concepts other than specialized modules and their computational outputs...

..Finally, some general conclusions that the majority of summit delegates participating in the discussion on research agreed to, are presented...

..It briefly covers seminal contributions in evolutionary theory, psychotherapy, and neuroscience, as well as conceptual and practical contributions to reconciliation...

..This study evaluated the efficacy and tolerability of agomelatine in the prevention of relapse in patients with generalized anxiety disorder (GAD)...

..The use of psychotropics for sub-threshold phenomena requires a judicious weighing of the relevant facts (which are often sparse) and values...

..Nevertheless, considerable strides have been made towards moving psychiatry from the periphery of society and medicine to a central discipline within the Faculty of Health Sciences at UCT...

..In creating this algorithm, we have drawn on the body of published evidence, as well as on expert opinion...

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..The early and persistent effect of venlafaxine ER over placebo on anger/irritability is noteworthy in view of the clinical significance of these symptoms in PTSD...

..A randomized, placebo controlled fixed-dose trial was undertaken to determine the efficacy and tolerability of escitalopram in obsessive-compulsive disorder (OCD), using paroxetine as the active reference...

..There is increasing evidence that the symptoms of obsessive-compulsive disorder lie on discrete dimensions. Relatively little work has, however, explored the relationship between such factors and response to pharmacotherapy...

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..If this change is made, the name of this category should be changed to reflect this proposed change...

..There is a growing evidence base on OCD symptom dimensions and subtyping, and it is timely to consider incorporating some of these emerging data into diagnostic classification systems...

..The algorithm comprises eight sequential steps, beginning with those focused on diagnosis and initiating treatment and ending with the management of the treatment-refractory patient...

..Prospectively planned pooled analysis evaluating efficacy and tolerability of acute quetiapine XR monotherapy in generalised anxiety disorder...

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..Despite the imperfections of any meta-structure, we are hopeful that each revision of the nosology will bring with it greater diagnostic validity and clinical utility...

..We conclude with a wish list for the way forwards...

..The most robust DGSS items were derived, and an exploratory factor analysis yielded a 2-factor structure of the DGSS. The DGSS is potentially a useful scale for the assessment of GAD in clinical trials of this disorder...

..Recovery could potentially be defined as a lack of disability, with an associated reduction in symptom severity. Conversely, relapse could potentially be defined in terms of either increased disability or increased symptoms...

..In this Review we discuss the advantages and disadvantages of medicalising trauma response, using examples from South Africa, the Armed Services, and post-disaster, to draw attention to our argument...

..We consider, in turn, the diagnosis and evaluation, psychobiology, pharmacotherapy, psychotherapy, and prevention of PTSD...

..However, there was also a concern that individuals with TRC relevant experience would simply be re-traumatized by participation in the process. To date, there has been little empirical data for either hypothesis...

..Such disorders deserve greater recognition in the official nosology, and there would seem to be clinical utility in classifying them in the same diagnostic category...

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..Assessment of these meta-analyses and guidelines provides an opportunity to review the strengths and weaknesses of the evidence-base...

..Prior work has suggested an association between perpetration and post-traumatic stress disorder (PTSD), but this remains controversial...

..Comorbidity of symptoms might support the idea that they are indicative of an underlying stereotypic disorder, and we therefore explored their frequency in people with hair-pulling...

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..A randomized, double-blind, placebo-controlled trial was designed to assess the efficacy of agomelatine in generalized anxiety disorder (GAD)...

..In recent years, however, similar assessments and treatments have been utilized across the world...

..First-line antidepressants, including the selective serotonin reuptake inhibitors (SSRIs) and serotonin noradrenaline reuptake inhibitors (SNRIs), may have different effects on sleep...

..For these reasons, we propose specific diagnostic criteria that will allow for consistent identification and assist in further study of this behavior...

..However, further research is necessary to determine whether impulsivity should be conceptualized as lying on a spectrum with compulsivity or as a dimension that is orthogonal to compulsivity...

..These data support a role for the dopaminergic system, which may be relevant to the development of early-onset OCD...

..Sufficient and significant differences between these disorders support the view that they are independent entities. Shared abnormalities in the 5HT1A receptor function, for example, may help explain some of the comorbidity...

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..Further research is needed to determine whether broadening the current diagnostic criteria results in a more valid characterization of GAD...

..This study examines the prevalence, age of onset and sociodemographic correlates of suicide ideation, planning, and attempts among South Africans...

..However, such algorithms run the risk of oversimplifying complex clinical realities, and are only as good as the data on which they rest. In this article, an algorithm for the pharmacotherapy of anxiety disorders is presented...

..This paper examines data from a fixed-dose trial of escitalopram versus paroxetine, in order to determine the differential effects of these agents on symptom dimensions in social anxiety disorder (SAD)...

..There is, however, little published data on adherence in the South African context. In this pilot study we explore the possible benefits of a consumer psychoeducation program...

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..CONCLUSION: These data demonstrate that paroxetine is a reasonable choice of treatment in a broad spectrum of patients with social anxiety disorder. An optimal trial of medication should continue beyond 8 weeks...

..These results demonstrate that escitalopram is effective for long-term treatment and relapse prevention in OCD...

..That raised 5HT activity may mediate hippocampal 5HT(1A) receptor changes evoked by stress suggests a bidirectional role for 5HT in the development of PTSD...

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..Quetiapine is generally well tolerated and previous open-label data has produced mixed results in OCD and additional controlled data is needed...

..More generally, HIV care and treatment services represent an important venue to identify and manage individuals with common mental disorders in resource-limited settings...

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