Telephone interpersonal counseling treatment for frequent attenders to primary care: Development and piloting

Background: Frequent attenders in primary care (FAs) consume a disproportionate amount of healthcare resources and often have depression, anxiety, chronic health issues, and interpersonal problems. Despite extensive medical care, they remain dissatisfied with the care and report no improvement in quality of life. Objective: To pilot a Telephone-based Interpersonal Counseling intervention for Frequent Attenders (TIPC-FA) and assess its feasibility and efficacy in reducing symptoms and healthcare utilization. Method: Top 10% of primary care visitors were randomly assigned to TIPC-FA, Telephone Supportive Contact (Support), or Treatment as Usual (TAU). TIPC-FA and Support groups received six telephone sessions over twelve weeks, while the TAU group was interviewed twice. Multilevel regression tested for changes over time, considering patient and counselor variance. Results: TIPC-FA and Support groups demonstrated reduced depressive symptoms, and the TIPC-FA group showed decreased somatization and anxiety. The TIPC-FA group demonstrated a trend towards less healthcare utilization than the TAU group. Conclusion: This pilot study suggests that IPC via telephone outreach is a feasible approach to treating FAs, achieving a reduction in symptoms not seen in other groups. Promising reduction in healthcare utilization in the TIPC-FA group warrants further exploration in larger-scale trials

Social Phobia: Epidemiology and Cost of Illness

Social phobia is a prevalent and debilitating psychiatric disorder. It entails significant economic costs in the form of educational underachievement, increased financial dependency, decreased work productivity, social impairment and poorer quality of life. It is associated with increased prevalence of other psychiatric disorders including depression and alcohol dependence. Its onset is early and typically precedes onset of comorbid disorders. Despite its debilitating effects, social phobia is often unrecognised and is undertreated. The availability of efficacious pharmacological and psychotherapeutic treatments for social phobia makes it imperative to carefully consider the impact of this disorder and to consider the cost effectiveness of available treatments.Cost of illness, Pharmacoeconomics, Social phobia

Enriched rater training using Internet based technologies: a comparison to traditional rater training in a multi-site depression trial

Abstract Objective: The evaluation and training of raters who conduct efficacy evaluations in clinical trials is an important methodological variable that is often overlooked. Few rater training programs focus on teaching and assessing applied clinical skills, and even fewer have been empirically examined for efficacy. The goal of this study was to develop a comprehensive, standardized, interactive rater training program using new technologies, and to compare the relative effectiveness of this approach to ''traditional'' rater training in a multi-center clinical trial. Method: 12 sites from a 22 site multi-center study were randomly selected to participate (6 = traditional, 6 = enriched). Traditional training consisted of an overview of scoring conventions, watching and scoring videotapes with discussion, and observation of interviews in small groups with feedback. Enriched training consisted of an interactive web tutorial, and live, remote observation of trainees conducting interviews with real or standardized patients, via video-or teleconference. Outcome measures included a didactic exam on conceptual knowledge and blinded ratings of traineeÕs audiotaped interviews. Results: A significant difference was found between enriched and traditional training on pre-to-post training improvement on didactic knowledge, t(27) = 4.2, p < 0.0001. Enriched trainees clinical skills also improved significantly more than traditional trainees, t(56) = 2.1, p = 0.035. All trainees found the applied training helpful, and wanted similar web tutorials with other scales. Conclusions: Results support the efficacy of enriched rater training in improving both conceptual knowledge and applied skills. Remote technologies enhance training efforts, and make training accessible and cost-effective. Future rater training efforts should be subject to empirical evaluation, and include training on applied skills

Anxiety disorders and risk of self-reported ulcer: a 10-year longitudinal study among US adults

Objective: Previous epidemiologic studies have documented a link between anxiety disorders and ulcer among adults. Few studies have examined these associations over time and little is understood about the pathways underlying these relationships. Method: Data were drawn from n= 2101 adult participants in the Midlife Development in the United States I and II. Data on ulcer diagnoses were collected through self-report: among participants in the current sample, 38 reported ulcer at Waves 1 and 2 (prevalent ulcer), and 18 reported ulcer at Wave 2 but not at Wave 1 (incident ulcer). Panic attacks and generalized anxiety disorder at Wave 1 (1994) were examined in relation to prevalent (past 12 months) and incident ulcer approximately 10 years later at Wave 2 (2005). Results: Anxiety disorders at Wave 1 were associated with increased prevalence of ulcer [odds ratio (OR)=4.1, 95% confidence interval (CI)=2.0-8.4], increased risk of incident ulcer at Wave 2 (OR=4.1, 95% CI=1.4-11.7) and increased risk of treated ulcer at Wave 2 (OR=4.7, 95% CI=2.3-9.9) compared with those without anxiety. Conclusions: In this large population sample of adults, anxiety disorders were associated with an increased risk of ulcer over a 10-year period. These relationships do not appear to be explained by confounding or mediation by a wide range of factors. Future studies should address potential mechanisms underlying the relationship between anxiety and ulcer

Noncardiac Chest Pain and Psychopathology in Children and Adolescents

Objective: We sought to examine the prevalence of DSM-IV psychiatric disorders in children and adolescents with complaints of noncardiac chest pain (NCCP). Method: We assessed 27 youngsters (ages 8-17 years) referred to a pediatric cardiology practice with complaints of NCCP. Each child and a parent were interviewed using the Anxiety Disorders Interview Schedule for Children. Results: Sixteen youngsters (59%) were diagnosed with a current DSM-IV disorder. Fifteen (56%) had a current anxiety disorder, nine of whom were diagnosed with panic disorder. One participant was diagnosed with a depressive disorder. Conclusion: Results of this preliminary study suggest that DSM-IV anxiety disorders may be common in youngsters with NCCP. No evidence was found for high prevalence of depression in this sample. Larger controlled studies are needed to determine the prevalence and impact of psychopathology in youngsters with NCCP

Anxiety and Depressive Symptoms and Anxiety Sensitivity in Youngsters with Noncardiac Chest Pain and Benign Heart Murmurs

Objective: Chest pain in children and adolescents is rarely associated with cardiac disease. We sought to examine psychological symptoms in youngsters with medically unexplained chest pain. We hypothesized that children and adolescents with medically unexplained chest pain would have high rates of anxiety and depressive symptoms. Methods: We assessed 65 youngsters with noncardiac chest pain (NCCP) and 45 comparison youngsters with benign heart murmurs using self-report measures of anxiety and depressive symptoms and anxiety sensitivity. Results: Compared with the asymptomatic benign-murmur group, youngsters with NCCP had higher levels of some anxiety symptoms and anxiety sensitivity. Differences on depressive symptoms were not significant. Conclusions: Though preliminary, results suggest that youngsters with chest pain may experience increased levels of some psychological symptoms. Future studies of noncardiac chest pain in youngsters should include larger samples and comprehensive diagnostic assessments as well as long-term follow-up evaluations