320 results on '"Shear MK"'
Search Results
2. Psychotherapy for panic disorder
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Shear Mk
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Psychotherapist ,Panic disorder ,medicine.medical_treatment ,Panic ,Cognition ,medicine.disease ,Comorbidity ,Brief psychotherapy ,Cognitive behavioral therapy ,Psychiatry and Mental health ,medicine ,Cognitive therapy ,medicine.symptom ,Psychology ,Anxiety disorder ,Clinical psychology - Abstract
Panic disorder is a common and debilitating illness in which unexpected panic episodes are the core feature. Medication treatment is of proven efficacy in this disorder. Cognitive behavioral treatment is also effective and can be administered without medication with good results. This paper reviews the techniques and strategies used in cognitive behavioral treatment and outcome results from studies utilizing this approach. The efficacy of other psychotherapeutic approaches is less well established. However, we recently conducted a study comparing cognitive behavioral treatment to an emotion focused brief psychotherapy and found them to be equivalent. We describe the theoretical background and the strategies and techniques for this treatment, and review the results of the prospective comparison.
- Published
- 1995
3. Psychotherapeutic Issues in Long-Term Treatment of Anxiety Disorder Patients
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Shear Mk
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Long term treatment ,Psychotherapist ,media_common.quotation_subject ,Vulnerability ,medicine.disease ,Psychiatry and Mental health ,Long-term care ,Feeling ,Anti-Anxiety Agents ,medicine ,Anxiety ,medicine.symptom ,Psychology ,Life stress ,Anxiety disorder ,media_common - Abstract
Although there have been impressive advances in the treatment of anxiety disorders during the past few decades, these have focused almost exclusively on short-term relief of anxiety symptoms. During this period, accumulated data have suggested that short-term, symptom-focused treatment is not sufficient for many patients. It is likely that ancillary psychotherapy treatment will be needed to enhance the extent and durability of response, reduce vulnerability to life stress, and bolster feelings of self-efficacy and controllability. These treatments will draw on strategies and techniques from traditional psychotherapy, but will need to incorporate more focused goals and regular assessments.
- Published
- 1995
4. An empirical study of defense mechanisms in dysthymia
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Shear Mk, John C. Markowitz, Bloch Al, Andrew C. Leon, and Perry Jc
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Adult ,Male ,medicine.medical_specialty ,media_common.quotation_subject ,Pilot Projects ,Anger ,behavioral disciplines and activities ,Diagnosis, Differential ,Rating scale ,medicine ,Humans ,Projection ,Psychiatry ,Defense Mechanisms ,media_common ,Depressive Disorder ,Psychodynamic psychotherapy ,Aggression ,Acting out ,Panic disorder ,Panic ,medicine.disease ,Psychiatry and Mental health ,Acting Out ,Panic Disorder ,Female ,medicine.symptom ,Psychology ,Anxiety disorder - Abstract
OBJECTIVE The psychodynamic approach to understanding dysthymia has rarely been empirically tested. In this pilot study the Defense Mechanism Rating Scales were used to examine psychodynamic data from patients with dysthymia and patients with panic disorder in order to test the hypotheses that 1) dysthymic patients would be similar to panic patients in endorsing primarily lower-maturity defense mechanisms, 2) dysthymic patients would use a distinct pattern of defense mechanisms, different from that of panic patients, and 3) dysthymic patients would endorse more frequently than panic patients four individual defenses that tend to handle anger and low self-esteem poorly: devaluation, passive aggression, projection, and hypochondriasis. METHOD Twenty-two subjects meeting the DSM-III-R criteria for primary early-onset dysthymia and 22 subjects meeting the DSM-III-R criteria for primary panic disorder were interviewed on videotape and rated on the Defense Mechanism Rating Scales. RESULTS The dysthymic subjects scored significantly higher on narcissistic, disavowal, and action defense levels and on the four individual defenses of devaluation, projection, passive aggression, and hypochondriasis, as predicted, as well as on two additional defenses, acting out and projective identification. Both groups tended to use lower-maturity defense mechanisms. CONCLUSIONS The defense mechanism profile identified for dysthymia differs from that for panic disorder and supports particular psychodynamic hypotheses about chronic depression. It could be useful in devising treatment strategies and as a measure of treatment efficacy.
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- 1993
5. CROSS-CULTURAL VALIDITY OF THE STRUCTURED CLINICAL INTERVIEW FOR PANIC-AGORAPHOBIC SPECTRUM
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Frank, E, Shear, Mk, Rucci, P, Banti, S, Mauri, Mauro, Maser, Jd, Kupfer, Dj, Miniati, M, Fagiolini, A, and Cassano, GIOVANNI BATTISTA
- Published
- 2005
6. THE PANIC-AGORAPHOBIC SPECTRUM: DEVELOPMENT, DESCRIPTION AND CLINICAL SIGNIFICANCE
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Shear, Mk, Cassano, GIOVANNI BATTISTA, Frank, E., Rucci, P., Rotondo, A., and Fagiolini, A.
- Published
- 2002
7. Initial treatment engagement in a rural community mental health center
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Mike G, Shear Mk, Carol M. Anderson, and Catherine G. Greeno
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Male ,Rural Population ,medicine.medical_specialty ,Community Mental Health Centers ,Global Assessment of Functioning ,Severity of Illness Index ,Medical Records ,Appointments and Schedules ,Severity of illness ,medicine ,Initial treatment ,Humans ,Center (algebra and category theory) ,Psychiatry ,Rate of return ,Psychiatric Status Rating Scales ,business.industry ,Medical record ,Mental Disorders ,Patient Acceptance of Health Care ,Pennsylvania ,Mental health ,Psychiatry and Mental health ,Family medicine ,Scale (social sciences) ,Patient Compliance ,Female ,business - Abstract
The charts of patients who received an initial assessment at a rural mental health center were reviewed to identify patient, system, and clinical characteristics that predicted return to the center for at least one treatment visit in the following three months. Among 112 patients, the overall rate of return was 46 percent. Patients who were seen for assessment within one week of their initial request for services were significantly more likely to return, as were those who had lower scores on the Global Assessment of Functioning scale. Patients referred for assessment by agencies of social control were the least likely to return for treatment.
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- 1999
8. The Panic-Agoraphobic Spectrum
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Cassano, Gb, Frank, E, Maser, Jd, Shear, Mk, Rotondo, A, Mauri, Mauro, and Dell'Osso, Liliana
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- 1999
9. Consensus statement on panic disorder from the International Consensus Group on Depression and Anxiety
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Ballenger, JC, Lecrubier, Y, Nutt, DJ, Baldwin, DS, den Boer, JA, Kasper, S, and Shear, MK
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DOUBLE-BLIND ,UNITED-STATES ,IMIPRAMINE ,AGORAPHOBIA ,ALPRAZOLAM ,CLOMIPRAMINE ,PLACEBO-CONTROLLED TRIAL ,COMORBIDITY ,MULTICENTER TRIAL - Abstract
Objective: To provide primary care clinicians with a better understanding of management issues in panic disorder and guide clinical practice with recommendations for appropriate pharmacotherapy. Participants: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Four faculty invited by the chairman also participated: David S. Baldwin, Johan A. den Beer, Siegfried Kasper, and M. Katherine Shear. Evidence: The consensus statement is based on the 6 review papers that are published in this supplement and on the scientific literature relevant to these issues. Consensus Process: There were group meetings held during a 2-day period. On day 1, the group discussed each review paper and the chairman and discussant (Dr. Kasper) identified key issues for further debate. On day 2, the group discussed these key issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chairman and approved by all attendees. Conclusions: The consensus statement provides standard definitions for response and remission and identifies appropriate strategy for the management of panic disorder in a primary care setting. Serotonin selective reuptake inhibitors are recommended as drugs of first choice with a treatment period of 12 to 24 months. Pharmacotherapy should be discontinued slowly over a period of 4 to 6 months.
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- 1998
10. The panic-agoraphobic spectrum and cardiovascular disease
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Miniati, M, Mauri, Mauro, Dell'Osso, Liliana, Pini, Stefano, Mengali, F, Shear, Mk, Maser, Jd, Grochocinski, V, Frank, E, and Cassano, Gb
- Published
- 1998
11. Anxiety disorders in women: gender-related modulation of neurobiology and behavior
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Shear Mk
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Adult ,Serotonin ,Endocrinology, Diabetes and Metabolism ,media_common.quotation_subject ,Maternal hormones ,Behavioral neuroscience ,Endocrinology ,Sex Factors ,Physiology (medical) ,medicine ,Prevalence ,Personality ,Humans ,Social Behavior ,Progesterone ,media_common ,Social change ,Obstetrics and Gynecology ,Brain ,Gender related ,medicine.disease ,Anxiety Disorders ,Neurosecretory Systems ,Reproductive Medicine ,Anxiety ,Female ,medicine.symptom ,Psychology ,Psychosocial ,Anxiety disorder ,Clinical psychology - Abstract
The study of psychobiology of gender is in its infancy, but already there are emerging findings of interest to clinicians and researchers in the area of anxiety disorders. There is much work yet to be done, but findings provide initial support for hypotheses that ovarian and other gonadal and maternal hormones play important regulatory roles in determining behavior as well as neurotransmitter function in women. These regulatory effects clearly involve areas known to be important in the onset and maintenance of anxiety symptoms and anxiety disorders. It is important to note that although neurophysiologic mechanisms are definitely in need of study and attention, this should not occur at the expense of further psychosocial research in this area. Social changes in gender-role functioning may well produce important neurobiologic changes, and this may be the most effective and efficient way of producing such changes, which can ultimately reduce women's risk of anxiety disorders.
- Published
- 1997
12. Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders
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Herbert C. Schulberg, Shear Mk, Houck Pr, Charlotte Brown, and Madonia Mj
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Adult ,Male ,medicine.medical_specialty ,Generalized anxiety disorder ,Adolescent ,medicine.medical_treatment ,Comorbidity ,Nortriptyline ,Severity of Illness Index ,medicine ,Humans ,Psychiatry ,Depression (differential diagnoses) ,Psychiatric Status Rating Scales ,Depressive Disorder ,Primary Health Care ,Panic disorder ,Panic ,Middle Aged ,medicine.disease ,Anxiety Disorders ,Combined Modality Therapy ,Antidepressive Agents ,Psychotherapy ,Psychiatry and Mental health ,Treatment Outcome ,Interpersonal psychotherapy ,Anxiety ,Panic Disorder ,Female ,medicine.symptom ,Psychology ,Anxiety disorder - Abstract
Objective : Major depression occurs with generalized anxiety disorder and panic disorder in up to 60% of psychiatric and primary care patients. This comorbidity has been associated with greater severity of depression, poorer psychosocial functioning, and poorer treatment outcomes in psychiatric samples. This study examined the clinical outcomes for depressed primary care patients with and without a lifetime anxiety disorder. Method : A total of 157 primary care patients who met criteria for major depression were randomly assigned to standardized interpersonal psychotherapy or pharmacotherapy with nortriptyline and were assessed at baseline and at 4 and 8 months on severity of depression, psychosocial functioning, and health-related functioning. Results : Depressed patients with a comorbid anxiety disorder presented with significantly more psychopathology and tended to prematurely terminate treatment more frequently than patients with major depression alone. Both standardized depression-specific treatments were effective for depressed patients with and without a comorbid generalized anxiety disorder, although time to recovery was longer for the former. Patients with lifetime panic disorder showed poor recovery in response to psychotherapy or pharmacotherapy. Conclusions : Standardized psychotherapy and pharmacotherapy are effective for patients with major depression with and without a generalized anxiety disorder. However, the longer time to recovery for the former group and lack of response to these treatments by patients with lifetime panic disorder suggest that primary care physicians should carefully assess history of anxiety disorder among depressed patients so as to select a proper intervention.
- Published
- 1996
13. Factors in the etiology and pathogenesis of panic disorder: revisiting the attachment-separation paradigm
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Shear Mk
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Adult ,Male ,Psychotherapist ,Adolescent ,Models, Psychological ,Shame ,Models, Biological ,Pathogenesis ,Anxiety, Separation ,Medicine ,Animals ,Humans ,Family ,Interpersonal Relations ,Object Attachment ,Agoraphobia ,Defense Mechanisms ,Parenting ,business.industry ,Panic disorder ,Fear ,medicine.disease ,Psychiatry and Mental health ,Child, Preschool ,Etiology ,Anxiety ,Panic Disorder ,Female ,medicine.symptom ,business ,Stress, Psychological - Published
- 1996
14. Attrition in a multicenter clinical trial for panic disorder.
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White KS, Allen LB, Barlow DH, Gorman JM, Shear MK, Woods SW, White, Kamila S, Allen, Laura B, Barlow, David H, Gorman, Jack M, Shear, M Katherine, and Woods, Scott W
- Published
- 2010
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15. A multidimensional spectrum approach to post-traumatic stress disorder: comparison between the Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS) and the Self-Report instrument (TALS-SR)
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Dell'Osso L, Carmassi C, Rucci P, Conversano C, Shear MK, Calugi S, Maser JD, Endicott J, Fagiolini A, and Cassano GB
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- 2009
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16. The burden of late-life generalized anxiety disorder: effects on disability, health-related quality of life, and healthcare utilization.
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Porensky EK, Dew MA, Karp JF, Skidmore E, Rollman BL, Shear MK, Lenze EJ, Porensky, Emily K, Dew, Mary Amanda, Karp, Jordan F, Skidmore, Elizabeth, Rollman, Bruce L, Shear, M Katherine, and Lenze, Eric J
- Abstract
Objective: To describe the burden of Generalized Anxiety Disorder (GAD), a common anxiety disorder in older adults.Design: Cross-sectional.Setting: Late-life depression and anxiety research clinic in Pittsburgh, PA.Participants: One hundred sixty-four older adults with GAD and 42 healthy comparison participants with no lifetime history of psychiatric disorder were recruited from primary care and mental health settings as well as advertisements.Measurements: Participants were evaluated with the Late Life Function and Disability Index to assess disability, the MOS 36-Item Short Form Survey Instrument to assess health-related quality of life (HRQOL), and the Cornell Service Index to assess healthcare utilization.Results: Older adults with GAD were more disabled, had worse HRQOL, and had greater healthcare utilization, than nonanxious comparison participants, even in the absence of psychiatric comorbidity. After controlling for medical burden and depressive symptoms, higher severity of anxiety symptoms was associated with greater disability and poorer HRQOL in several domains. The greatest decrements in HRQOL and function were observed in measures assessing role functioning, including social function.Conclusion: This study, the largest ever of GAD in older adults, provides evidence of the significant burden of this disorder in late life. Given the high prevalence and chronicity of GAD in the elderly, these data provide a public health imperative for finding and implementing effective management strategies for this typically undiagnosed and untreated disorder. [ABSTRACT FROM AUTHOR]- Published
- 2009
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17. Escitalopram for older adults with generalized anxiety disorder: a randomized controlled trial.
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Lenze EJ, Rollman BL, Shear MK, Dew MA, Pollock BG, Ciliberti C, Costantino M, Snyder S, Shi P, Spitznagel E, Andreescu C, Butters MA, Reynolds CF 3rd, Lenze, Eric J, Rollman, Bruce L, Shear, M Katherine, Dew, Mary Amanda, Pollock, Bruce G, Ciliberti, Caroline, and Costantino, Michelle
- Abstract
Context: Generalized anxiety disorder (GAD) is one of the most common psychiatric disorders in older adults; however, few data exist to guide clinicians in efficacious and safe treatment. Selective serotonin reuptake inhibitors (SSRIs) are efficacious for younger adults with GAD, but benefits and risks may be different in older adults.Objective: To examine the efficacy, safety, and tolerability of the SSRI escitalopram in older adults with GAD.Design, Setting, and Participants: A randomized controlled trial in primary care practices and related specialty clinics in Pittsburgh, Pennsylvania, of 177 participants aged 60 years or older with a principal diagnosis of GAD randomized to receive either escitalopram or placebo and conducted between January 2005 and January 2008.Interventions: Twelve weeks of 10 to 20 mg/d of escitalopram (n = 85) or matching placebo (n = 92).Main Outcome Measures: Cumulative response defined by Clinical Global Impressions-Improvement score of much or very much improved; time to response; and anxiety and role functioning changes measured by the Clinical Global Impressions-Improvement scale, Hamilton Anxiety Rating Scale, Penn State Worry Questionnaire, Late-Life Function and Disability Instrument activity limitations subscale, and the role-emotional impairment and social function subscales of the Medical Outcome Survey 36-item Short Form.Results: In the primary analytic strategy in which participants (n = 33) were censored at the time of dropout, mean cumulative response rate for escitalopram was 69% (95% confidence interval [CI], 58%-80%) vs 51% (95% CI, 40%-62%) for placebo (P = .03). A conservative intention-to-treat analysis showed no difference in mean cumulative response rate between escitalopram and placebo (57%; 95% CI, 46%-67%; vs 45%; 95% CI, 35%-55%; P = .11). Participants treated with escitalopram showed greater improvement than with placebo in anxiety symptoms and role functioning (Clinical Global Impressions-Improvement scale: effect size, 0.93; 95% CI, 0.50-1.36; P < .001; Penn State Worry Questionnaire: 0.30; 95% CI, 0.23-0.48; P = .01; activity limitations: 0.32; 95% CI, 0.01-0.63; P = .04; and the role-emotional impairment and social function: 0.96; 95% CI, 0.03-1.90; P = .04). Adverse effects of escitalopram (P < .05 vs placebo) were fatigue or somnolence (35 patients [41.1%]), sleep disturbance (12 [14.1%]), and urinary symptoms (8 [9.4%]).Conclusions: Older adults with GAD randomized to escitalopram had a higher cumulative response rate for improvement vs placebo over 12 weeks; however, response rates were not significantly different using an intention-to-treat analysis. Further study is required to assess efficacy and safety over longer treatment durations.Trial Registration: clinicaltrials.gov Identifier: NCT00105586. [ABSTRACT FROM AUTHOR]- Published
- 2009
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18. Relapse following combined treatment discontinuation in a placebo-controlled trial for panic disorder.
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Raffa SD, Stoddard JA, White KS, Barlow DH, Gorman JM, Shear MK, Woods SW, Raffa, Susan D, Stoddard, Jill A, White, Kamila S, Barlow, David H, Gorman, Jack M, Shear, M Katherine, and Woods, Scott W
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- 2008
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19. A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder.
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Milrod B, Leon AC, Busch F, Rudden M, Schwalberg M, Clarkin J, Aronson A, Singer M, Turchin W, Klass ET, Graf E, Teres JJ, and Shear MK
- Abstract
OBJECTIVE: The purpose of this study was to determine the efficacy of panic-focused psychodynamic psychotherapy relative to applied relaxation training, a credible psychotherapy comparison condition. Des- pite the widespread clinical use of psychodynamic psychotherapies, randomized controlled clinical trials evaluating such psychotherapies for axis I disorders have lagged. To the authors' knowledge, this is the first efficacy randomized controlled clinical trial of panic-focused psychodynamic psychotherapy, a manualized psychoanalytical psychotherapy for patients with DSM-IV panic disorder. METHOD: This was a randomized controlled clinical trial of subjects with primary DSM-IV panic disorder. Participants were recruited over 5 years in the New York City metropolitan area. Subjects were 49 adults ages 18-55 with primary DSM-IV panic disorder. All subjects received assigned treatment, panic-focused psychodynamic psychotherapy or applied relaxation training in twice-weekly sessions for 12 weeks. The Panic Disorder Severity Scale, rated by blinded independent evaluators, was the primary outcome measure. RESULTS: Subjects in panic-focused psychodynamic psychotherapy had significantly greater reduction in severity of panic symptoms. Furthermore, those receiving panic-focused psychodynamic psychotherapy were significantly more likely to respond at treatment termination (73% versus 39%), using the Multicenter Panic Disorder Study response criteria. The secondary outcome, change in psychosocial functioning, mirrored these results. CONCLUSIONS: Despite the small cohort size of this trial, it has demonstrated preliminary efficacy of panic-focused psychodynamic psychotherapy for panic disorder. [ABSTRACT FROM AUTHOR]
- Published
- 2007
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20. Impact of maternal mental health status on child mental health treatment outcome.
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Rishel CW, Greeno CG, Marcus SC, Sales E, Shear MK, Swartz HA, and Anderson C
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This study examined the effect of maternal depression and anxiety on child treatment outcome. Psychiatric assessments were conducted on 180 mother-child pairs when the child entered treatment in a community mental health center and six months later. Children whose mothers were depressed or anxious were significantly more impaired than children of mentally healthy mothers at both time points. Both groups of children improved at approximately the same rate. The findings suggest that early mental health screening of children and their mothers may be important preventive practices. Addressing the mental health needs of mothers and children simultaneously may be an effective method of reducing their mental health problems. [ABSTRACT FROM AUTHOR]
- Published
- 2006
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21. The daily life of complicated grief patients -- what gets missed, what gets added?
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Monk TH, Houck PR, and Shear MK
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Many patients with complicated grief suffer severe symptoms for several years after the loss, interfering with daily life. We sought to determine which elements of a patient's daily routine were likely to be missed or added. Sixty-four patients completed a diary each evening for 2 weeks. The diary asked whether each of 13 daily life activities were done or missed on that day. Comparisons were made with 64 matched healthy control participants. Patients were significantly more likely than controls to miss contact with another person, breakfast, lunch, dinner, starting work, and going outside, and to add a nap and evening snack. [ABSTRACT FROM AUTHOR]
- Published
- 2006
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22. Optimal treatment of anxiety disorders.
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Shear MK
- Abstract
Both pharmacotherapy and cognitive-behavior therapy [CBT] can reduce the symptoms of anxiety disorders. Limited availability of specialists in CBT makes familiarity with the intricacies of pharmacotherapy a necessity. [ABSTRACT FROM AUTHOR]
- Published
- 2003
23. Cognitive-behavioral therapy, imipramine, or their combination for panic disorder: A randomized controlled trial.
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Barlow DH, Gorman JM, Shear MK, Woods SW, Barlow, D H, Gorman, J M, Shear, M K, and Woods, S W
- Abstract
Context: Panic disorder (PD) may be treated with drugs, psychosocial intervention, or both, but the relative and combined efficacies have not been evaluated in an unbiased fashion.Objective: To evaluate whether drug and psychosocial therapies for PD are each more effective than placebo, whether one treatment is more effective than the other, and whether combined therapy is more effective than either therapy alone.Design and Setting: Randomized, double-blind, placebo-controlled clinical trial conducted in 4 anxiety research clinics from May 1991 to April 1998.Patients: A total of 312 patients with PD were included in the analysis.Interventions: Patients were randomly assigned to receive imipramine, up to 300 mg/d, only (n=83); cognitive-behavioral therapy (CBT) only (n=77); placebo only (n=24); CBT plus imipramine (n=65); or CBT plus placebo (n=63). Patients were treated weekly for 3 months (acute phase); responders were then seen monthly for 6 months (maintenance phase) and then followed up for 6 months after treatment discontinuation.Main Outcome Measures: Treatment response based on the Panic Disorder Severity Scale (PDSS) and the Clinical Global Impression Scale (CGI) by treatment group.Results: Both imipramine and CBT were significantly superior to placebo for the acute treatment phase as assessed by the PDSS (response rates for the intent-to-treat [ITT] analysis, 45.8%, 48.7%, and 21.7%; P=.05 and P=.03, respectively), but were not significantly different for the CGI (48. 2%, 53.9%, and 37.5%, respectively). After 6 months of maintenance, imipramine and CBT were significantly more effective than placebo for both the PDSS (response rates, 37.8%, 39.5%, and 13.0%, respectively; P=.02 for both) and the CGI (37.8%, 42.1%, and 13.0%, respectively). Among responders, imipramine produced a response of higher quality. The acute response rate for the combined treatment was 60.3% for the PDSS and 64.1% for the CGI; neither was significantly different from the other groups. The 6-month maintenance response rate for combined therapy was 57.1% for the PDSS (P=.04 vs CBT alone and P=.03 vs imipramine alone) and 56.3% for the CGI (P=.03 vs imipramine alone), but not significantly better than CBT plus placebo in either analysis. Six months after treatment discontinuation, in the ITT analysis CGI response rates were 41.0% for CBT plus placebo, 31.9% for CBT alone, 19.7% for imipramine alone, 13% for placebo, and 26.3% for CBT combined with imipramine.Conclusions: Combining imipramine and CBT appeared to confer limited advantage acutely but more substantial advantage by the end of maintenance. Each treatment worked well immediately following treatment and during maintenance; CBT appeared durable in follow-up. JAMA. 2000;283:2529-2536 [ABSTRACT FROM AUTHOR]- Published
- 2000
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24. How well do you manage panic disorder?
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Starr C, Ballenger JC, Shear MK, and Spiegel DA
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Panic disorder makes life miserable for patients and family, and somatic symptoms often confound the diagnosis. But if you know the right questions to ask patients who may have this medical chameleon, you can swiftly direct them toward recovery. [ABSTRACT FROM AUTHOR]
- Published
- 1998
25. Morbidity of homebound versus inpatient elderly psychiatric patients.
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Pasternak R, Rosenweig A, Booth B, Fox A, Morycz R, Mulsant B, Sweet R, Zubenko GS, Reynolds CF III, Shear MK, Pasternak, R, Rosenweig, A, Booth, B, Fox, A, Morycz, R, Mulsant, B, Sweet, R, Zubenko, G S, Reynolds, C F 3rd, and Shear, M K
- Published
- 1998
26. The Effects of Maternal Deprivation and of Refeeding on the Blood Pressure of Infant Rats1
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Brunelli, Hofer Ma, and Shear Mk
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medicine.medical_specialty ,Maternal deprivation ,Cardiac rate ,business.industry ,Adrenergic ,Psychiatry and Mental health ,Endocrinology ,Blood pressure ,Internal medicine ,Heart rate ,medicine ,business ,Applied Psychology ,Tail cuff - Abstract
Blood pressure regulation was explored in infant rats 12-14 days of age during the 30-40% changes in cardiac rate that accompany nutrient (maternal) deprivation and refeeding at this age. Using specially modified tail cuff and intraarterial cannulation techniques, blood pressure was found to be maintained at stable levels (65-75 mm Hg) throughout these marked changes in pumping rate. The results suggest that adrenergic vasoconstrictor tone is controlled reciprocally with heart rate during a complex cardiovascular response to changes in nutrient levels at this early age. The possible role of such a mechanism in the development of "spontaneous" hypertension is discussed.
- Published
- 1983
27. Case 5: Psychotherapy on a clinical research unit: The interaction of therapy and research for a patient hospitalized on a research unit
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Shear Mk and Gilmore Mm
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Adult ,Clinical Trials as Topic ,medicine.medical_specialty ,Depression ,business.industry ,Public health ,Patient Advocacy ,Patient advocacy ,Unit (housing) ,Psychiatry and Mental health ,Clinical research ,medicine ,Humans ,Female ,Psychiatry ,business ,Hospital Units ,Depression (differential diagnoses) - Published
- 1979
28. Clinical presentation and treatment outcome of African Americans with complicated grief.
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Cruz M, Scott J, Houck P, Reynolds CF III, Frank E, Shear MK, Cruz, Mario, Scott, John, Houck, Patricia, Reynolds, Charles F 3rd, Frank, Ellen, and Shear, M Katherine
- Abstract
Objective: This study sought to examine whether ethnic differences occur in the presentation of patients with complicated grief or their treatment outcome.Methods: Analyses of a randomized controlled trial comparing a novel psychotherapy for complicated grief with interpersonal psychotherapy contrasted the clinical presentation, treatment alliance, and rates of treatment completion and response for 19 African Americans with complicated grief and 19 Caucasian Americans with complicated grief matched by sex, age, and baseline grief severity. Participants were randomly assigned to receive 16 sessions of either standard interpersonal psychotherapy or interpersonal psychotherapy enhanced with focused complicated grief components.Results: No differences were found in any clinical or treatment-related measure.Conclusions: African Americans and Caucasian Americans with complicated grief did not differ significantly in clinical presentation, treatment alliance, treatment completion, and outcome. The results suggest that standard treatment for complicated grief can be provided successfully for different racial and economic groups. [ABSTRACT FROM AUTHOR]- Published
- 2007
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29. A comparison of medication side effect reports by panic disorder patients with and without concomitant cognitive behavior therapy.
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Marcus SM, Gorman J, Shear MK, Lewin D, Martinez J, Ray S, Goetz R, Mosovich S, Gorman L, Barlow D, and Woods S
- Abstract
OBJECTIVE: The authors assessed whether adding cognitive behavior therapy (CBT) to imipramine for patients with panic disorder decreased the severity of side effects and dropouts from side effects. METHOD: Data were analyzed for 172 panic disorder patients who were randomly assigned to receive imipramine alone, imipramine plus CBT, or placebo. Mixed-effects models were used to assess longitudinal differences among the treatment groups with respect to side effect burden and dropout rates during the acute, maintenance, and follow-up phases of treatment. RESULTS: Patients treated with imipramine plus CBT experienced less severe fatigue/weakness, dry mouth, and sweating and had a lower rate of dropout due to side effects compared with those treated with imipramine only. CONCLUSIONS: The addition of CBT to medication treatment with imipramine was associated with less severe side effects and fewer dropouts due to perceived side effects than treatment with imipramine alone. [ABSTRACT FROM AUTHOR]
- Published
- 2007
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30. Cardiac rate and rhythm in panic patients
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Shear Mk, Harshfield G, Allen Frances, Polan Jj, R.B. Devereux, Paul Kligfield, Thomas G. Pickering, and J. John Mann
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Adult ,Male ,medicine.medical_specialty ,Cardiac Complexes, Premature ,Adolescent ,behavioral disciplines and activities ,Asymptomatic ,Electrocardiography ,Rhythm ,Heart Rate ,Internal medicine ,mental disorders ,Heart rate ,medicine ,Humans ,cardiovascular diseases ,Psychiatry ,Agoraphobia ,Monitoring, Physiologic ,Panic disorder ,Panic ,Arrhythmias, Cardiac ,Heart ,Fear ,Middle Aged ,medicine.disease ,Anxiety Disorders ,humanities ,Psychiatry and Mental health ,Ambulatory ,cardiovascular system ,Cardiology ,Anxiety ,Female ,medicine.symptom ,Psychology - Abstract
This study assessed cardiac rate and rhythm by ambulatory monitoring in 23 patients with panic disorder or agoraphobia with panic attacks. The patients had a higher than normal mean daily density of ventricular premature complexes (VPCs), but complex ventricular arrhythmias were uncommon. Heart rate was greater during panic intervals than during asymptomatic periods. The prevalence of arrhythmias within symptomatic intervals was similar during panic, partial panic, and anxiety and was significantly higher than during asymptomatic intervals. However, most panic episodes had no arrhythmias, and arrhythmias during panic intervals were simple VPCs.
- Published
- 1987
31. Low prevalence of mitral valve prolapse in patients with panic disorder
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R.B. Devereux, Randi Kramer-Fox, J. John Mann, Shear Mk, and Allen Frances
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Adult ,Male ,medicine.medical_specialty ,Heart disease ,Population ,Mitral valve ,Internal medicine ,medicine ,Mitral valve prolapse ,Humans ,In patient ,education ,Agoraphobia ,education.field_of_study ,Mitral Valve Prolapse ,Panic disorder ,Panic ,Fear ,medicine.disease ,Anxiety Disorders ,Surgery ,Psychiatry and Mental health ,medicine.anatomical_structure ,Cardiology ,Anxiety ,Female ,New York City ,medicine.symptom ,Psychology - Abstract
In 25 patients with panic attacks the prevalence of mitral valve prolapse was 8%, close to that in the general population. The higher rates in previous reports may be due to differences in prolapse criteria, sampling techniques, or the samples' sex ratios.
- Published
- 1984
32. Suicide Associated with Akathisia and Depot Fluphenazine Treatment
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Weiden P, Allen Frances, and Shear Mk
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Adult ,Male ,Fluphenazine ,Dyskinesia, Drug-Induced ,medicine.medical_specialty ,Psychomotor agitation ,Side effect ,Poor compliance ,Akathisia ,medicine ,Humans ,Pharmacology (medical) ,Psychiatry ,Psychomotor Agitation ,medicine.disease ,Suicide ,Psychiatry and Mental health ,Schizophrenia ,Etiology ,Schizophrenic Psychology ,medicine.symptom ,Psychology ,Akathisia, Drug-Induced ,medicine.drug ,Clinical psychology - Abstract
AKATHISIA is a common and distressing side effect of neuroleptic medication that can he difficult to recognize and treat,1 Several previous reports mention maladaptive behavioral consequences, such as poor compliance with prescribed medication2 and aggressive or self-destructive outbursts2–3 We are
- Published
- 1983
33. Predictors of response among patients with panic disorder treated with medications in a naturalistic follow-up: The role of adult separation anxiety.
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Miniati M, Calugi S, Rucci P, Shear MK, Benvenuti A, Santoro D, Mauri M, and Cassano GB
- Published
- 2012
34. A contemporary protocol to assist primary care physicians in the treatment of panic and generalized anxiety disorders.
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Rollman BL, Belnap BH, Reynolds CF, Schulberg HC, and Shear MK
- Published
- 2003
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35. Predictors of response among patients with panic disorder treated with medications in a naturalistic follow-up: the role of adult separation anxiety
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A. Benvenuti, Giovanni B. Cassano, Paola Rucci, Mauro Mauri, Mario Miniati, S. Calugi, Domenico Santoro, M. K. Shear, Miniati M., Calugi S., Rucci P., Shear MK., Benvenuti A., Santoro D., Mauri M., and Cassano GB.
- Subjects
Adult ,Male ,medicine.medical_specialty ,Internal medicine ,Anxiety, Separation ,medicine ,Humans ,Bipolar disorder ,panic disorder ,Agoraphobia ,Depression (differential diagnoses) ,TREATMENT RESPONSE ,Cognitive Behavioral Therapy ,Panic disorder ,Remission Induction ,Panic ,Panic Disorder Severity Scale ,Middle Aged ,medicine.disease ,Prognosis ,DEPRESSION ,Comorbidity ,Psychiatry and Mental health ,Clinical Psychology ,Logistic Models ,Treatment Outcome ,Anxiety ,Female ,medicine.symptom ,Psychology ,Clinical psychology ,Psychopathology ,Follow-Up Studies - Abstract
Background Efficacy of treatments for panic disorder is well established, but not all patients respond. Adult separation anxiety has been found to predict poorer response to CBT, but its effect on response to medication has not been previously explored. Study aim The aim of this study is to investigate if panic–agoraphobic spectrum factors, including ‘separation anxiety’ factor predict treatment outcome in patients with panic disorder. Study sample Participants who met criteria for PD (n = 57) completed baseline assessment and 12 months follow-up. Patients were administered the Panic Agoraphobic Spectrum Self-Report (PAS-SR, Lifetime and Last-Month Versions), and the Panic Disorder Severity Scale (PDSS). We examined patients who met the following criteria at baseline: 1) PDSS total score > 7; 2) no current Axis I comorbidity with major depression; 3) no lifetime or current bipolar disorder. All patients were treated with evidence-based psychopharmacological treatment for panic disorder during the 12-month observation period. Results Twenty eight patients (48.1%) achieved remission during the follow-up period. In a logistic regression model, controlling for baseline severity, gender and age, only the last-month PAS-SR ‘separation anxiety’ factor was associated with a lower likelihood of remission. Conclusions Signs and symptoms of separation anxiety in adulthood, as assessed with the PAS-SR Last Month version, are predictors of poor treatment outcome in patients with PD. We submit that the assessment of panic–agoraphobic spectrum features, including adult separation anxiety, should become routine of clinical assessment of patients with PD. It is likely that a better psychopathological characterization of patients may inform treatment selection, and result in better treatment outcome.
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- 2012
36. Validity and reliability of the Structured Clinical Interview for the Trauma and Loss Spectrum (SCI-TALS)
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Claudia Carmassi, Jack D. Maser, Giovanni B. Cassano, Nannina Sarno, Ciro Conversano, M. Katherine Shear, Paola Rucci, Ellen Frank, Liliana Lorettu, Antonio Ciapparelli, Liliana Dell'Osso, Jean Endicott, A. Carlo Altamura, Marina Carlini, Francesco Perris, Bernardo Carpiniello, Dell'osso L., Shear MK., Carmassi C., Rucci P., Maser JD., Frank E., Endicott J., Lorettu L., Altamura CA., Carpiniello B., Perris F., Conversano C., Ciapparelli A., Carlini M., Sarno N., and Cassano GB.
- Subjects
medicine.medical_specialty ,Epidemiology ,media_common.quotation_subject ,Adjustment disorders ,Structured Clinical Interview for DSM-IV Dissociative Disorders--Validity ,Validity ,Medical sciences ,Grief--Psychological aspects ,Mental health--Study and teaching ,medicine ,Psychiatry--Research ,MED/25 Psichiatria ,Big Five personality traits ,Psychiatry ,TRAUMA ,media_common ,Post-traumatic stress disorder ,Research ,FOS: Clinical medicine ,IN-DEPTH INTERVIEWS ,Discriminant validity ,Neurosciences ,medicine.disease ,Mental health ,Complicated grief ,Acute Stress Disorder ,Psychiatry and Mental health ,Grief ,Psychology ,Clinical psychology - Abstract
Background. DSM-IV identifies three stress response disorders (acute stress Disorder (ASD), post-traumatic stress Disorder (PTSD) and adjustment disorders (AD)) that derive from specific life events. An additional condition of complicated grief (CG), well described in the literature, is triggered by bereavement. This paper reports on the reliability and validity of the Structured Clinical Interview for Trauma and Loss Spectrum (SCI-TALS) developed to assess the spectrum of stress response. The instrument is based on a spectrum model that emphasizes soft signs, low-grade symptoms, subthreshold syndromes, as well as temperamental and personality traits comprising clinical and subsyndromal manifestations. Methods. Study participants, enrolled at 6 Italian Departments of Psychiatry located at six sites, included consecutive patients with PTSD, 44 with CG and a comparative group of 48 unselected controls. Results. We showed good reliability and validity of the SCI-TALS. Domain scores were significantly higher in participants with PTSD or CG compared to controls. There were high correlations between specific SCI-TALS domains and corresponding scores on established measures of similar constructs. Participants endorsing grief and loss events reported similar scores on all instruments, except those with CG who scored significantly higher on the domain of grief reactions. Conclusion. These findings provide strong support for the internal consistency, the discriminant validity and the reliability of the SCI-TALS. These results also support the existence of a specific grief-related condition and the proposal that different forms of stress response have similar manifestations.
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- 2008
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37. A case report to understand the use of an evidence-based approach of prolonged grief therapy in Chinese culture.
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Xu X, Skritskaya NA, Zhou N, Wen J, Shi G, and Shear MK
- Abstract
Prolonged grief disorder (PGD) is a new diagnosis that may cause significant functional impairment. Prolonged grief therapy (PGT) is a manualized 16-session intervention, whose efficacy has been demonstrated in studies primarily from Western cultures. The current report aimed to present a case to illustrate the use of PGT in Chinese culture. The client was a bereaved adult suffering from PGD after the death of her mother ten years ago. Additionally, she lost her father three months ago. Questionnaires were completed before and after treatment. In-depth interview was conducted at a 3-month follow-up. The client's scores for grief, functional impairment, grief-related beliefs and avoidance, depression and insomnia all decreased substantially after treatment. The follow-up feedbacks indicated that the beneficial effects of PGT persisted in the client's life. This case report provides preliminary evidence that bereaved people in China could benefit greatly from PGT, with minimal cultural adaptation.
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- 2024
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38. Neurobiology and treatment advances for prolonged grief disorder.
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Donaldson ZR and Shear MK
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- Humans, Neurobiology, Time Factors, Grief, Prolonged Grief Disorder, Cognitive Behavioral Therapy
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- 2024
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39. Bereavement, Memorial Attendance, and Mental Health During the COVID-19 Pandemic: Longitudinal Results from the Nurses' Health Study.
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Denckla CA, Hahn J, Cowden RG, Ho S, Gao K, Espinosa Dice AL, Jha SC, Kang JH, and Shear MK
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- Female, Humans, Aged, Mental Health, Pandemics, COVID-19, Bereavement, Nurses
- Abstract
Background: Mortality increased during the COVID-19 pandemic. Many bereaved individuals were not able to gather to memorialize their loved ones, yet it is unknown if this contributed to worsening mental health., Objective: Examine the association of bereavement in the early part of the COVID-19 pandemic with subsequent psychological distress and the role of memorial attendance in reducing psychological distress among the bereaved., Design, Settings, Subjects: In May 2020, 39,564 older females from the Nurses' Health Study II enrolled in a longitudinal COVID-19 substudy (mean
age = 65.2 years, SD = 4.5)., Methods: Linear regression analyses estimated associations of bereavement reported between March and October, 2020 with subsequent psychological distress between January and October 2021, adjusting for sociodemographic and prepandemic depression symptoms. Secondary models examined associations between memorial attendance and psychological distress., Results: Bereavement during the early part of the COVID-19 pandemic was associated with higher psychological distress (adjusted β = 0.21, 95% CI: 0.15, 0.26) assessed over the next year. Among the bereaved, memorial attendance was associated with lower psychological distress (in-person: adjusted β = -0.41, 95% CI: -0.53, -0.29; online: adjusted β = -0.24, 95% CI: -0.46, --0.02)., Conclusion: Attending memorials was associated with lower subsequent psychological distress among bereaved older females., (Copyright © 2023 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)- Published
- 2023
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40. A Web-Based Therapist Training Tutorial on Prolonged Grief Disorder Therapy: Pre-Post Assessment Study.
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Kobak K, Shear MK, Skritskaya NA, Bloom C, and Bottex G
- Abstract
Background: Prolonged grief disorder (PGD) is a newly recognized mental disorder characterized by pervasive intense grief that persists longer than cultural or social expectations and interferes with functioning. The COVID-19 epidemic has resulted in increased rates of PGD, and few clinicians feel confident in treating this condition. PGD therapy (PGDT) is a simple, short-term, and evidence-based treatment developed in tandem with the validation of the PGD diagnosis. To facilitate the dissemination of PGDT training, we developed a web-based therapist tutorial that includes didactic training on PGDT concepts and principles as well as web-based multimedia patient scenarios and examples of clinical implementation of PGDT., Objective: We aimed to evaluate user satisfaction with the tutorial and whether the tutorial increased trainees' knowledge of PGDT principles and procedures. Moreover, we included a small number of pilot questions to evaluate the PGDT-related clinical skills., Methods: This study evaluated tutorial learning using a pre- and poststudy design. Participants were recruited from professional organization mailing lists, announcements to graduates of the Columbia School of Social Work, and through word of mouth. After signing consent, participants completed a brief demographic survey, a 55-item multiple-choice prestudy test on the concepts and principles of PGD and PGDT covered in the tutorial, and a 4-item pilot web-based prestudy test to gauge PGD clinical implementation skills. The link to the course content was then activated, and participants were given 8 weeks to complete the 11-module tutorial containing information, web-based exercises, simulated patient and video examples, and self-tests., Results: Overall, 406 clinicians signed consent, and 236 (58.1%) started the tutorial. Of these, 83.1% (196/236) completed all 11 modules. Trainee scores on our PDGT assessment improved substantially from pretraining to the postmodule assessment, with the total number of correct answers increasing from a mean of 29 (SD 5.5; 52.7% correct) to 36.7 (SD 5.2; 66.7% correct; t
195 =18.93; P<.001). In addition, the trainee's implementation scores on 4 clinical vignettes increased from 2.6 (SD 0.7) correct out of 4 to 3.1 (SD 0.4) out of 4 (t188 =7.02; P<.001). Effect sizes (Cohen d) were 1.44 (95% CI 1.23-1.65) for PDGT assessment and 1.06 (95% CI 0.84-1.29) for implementation. Trainees found the tutorial interesting, enjoyable, clearly presented, and useful for professional development. They endorsed a mean score of 3.7 (SD 0.47) on a 1 to 4 scale of agreement with recommending the course to others and feeling satisfied with the tutorial, and a mean of 3.3 (SD 0.57) with feeling able to apply the skills with clients., Conclusions: This pilot study provides support for the usefulness of this web-based training for teaching clinicians how to administer PGDT. The addition of patient scenarios for clinical implementation strategies holds promise for increasing the effectiveness of PGDT training and other evidence-based treatments., Trial Registration: ClinicalTrials.gov NCT05121792; https://www.clinicaltrials.gov/ct2/show/NCT05121792., (©Kenneth Kobak, M Katherine Shear, Natalia A Skritskaya, Colleen Bloom, Gaelle Bottex. Originally published in JMIR Medical Education (https://mededu.jmir.org), 27.03.2023.)- Published
- 2023
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41. Social Determinants Associated With Exposure to Childhood Parental Bereavement and Subsequent Risk for Psychiatric Disorders.
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Denckla CA, Averkamp NM, Slopen N, Espinosa Dice AL, Williams D, Shear MK, and Koenen KC
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- Adolescent, Humans, Female, Male, Cross-Sectional Studies, Social Determinants of Health, Retrospective Studies, Parents, Mental Disorders epidemiology, Mental Disorders psychology, Bereavement, Parental Death
- Abstract
Importance: Prevalence of childhood parental death varies by race and ethnicity and socioeconomic status, yet whether similar variation persists in the association with lifetime psychiatric disorder is unknown., Objective: To assess whether race and ethnicity and parental educational attainment are associated with the risk of death of a parent; to determine whether the risk for lifetime psychiatric disorder associated with death of a parent was moderated by race and ethnicity and highest parental educational attainment; and to examine a potential intersection of race and ethnicity with parental educational attainment in the risk of lifetime psychiatric disorder associated with death of a parent., Design, Setting, and Participants: This retrospective cohort study used data from the National Comorbidity Study: Adolescent Supplement (NCS-A), 2001 to 2004. Participants included youth aged 13 to 18 years, restricted to Black, Hispanic, and White youth due to power limitations. Data were analyzed from February 26, 2021, to April 21, 2022., Exposure: Death of a parent during childhood., Main Outcomes and Measures: The primary study outcome was any lifetime Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) psychiatric disorder, assess via assessed via structured clinical interviews., Results: Among 9501 youth (mean [SD] age, 15.2 [1.5] years; 50.9% female), including 511 youth who had experienced parental death and 8990 youth who had not, the cumulative hazard of parental death by age 18 years was approximately doubled for Hispanic (10.1%; 95% CI, 6.9%-14.7%) and Black (14.0%; 95% CI, 10.6%-18.4%) youth compared with White youth (6.0%; 95% CI, 4.7%-7.8%). Similar patterns were noted by parental educational attainment: the cumulative hazard of parental death for youth of parents with less educational attainment was nearly double (10.1%; 95% CI, 8.1%-12.6%) compared with youth of parents with more education (6.6%; 95% CI, 5.2%-8.4%). Death of a parent was positively and significantly associated with risk of any lifetime psychiatric disorder (aOR, 1.34; 95% CI, 1.03-1.75) compared with youth who had not experienced death of a parent. However, this association was not moderated by race and ethnicity (aOR, 1.05; 95% CI, 0.58-1.92) or parental educational attainment (aOR, 1.19; 95%, 0.70-2.04), although power analyses suggest that larger sample sizes are needed., Conclusions and Relevance: In this cross-sectional study, Black and Hispanic youth experienced elevated parental death compared with White youth, yet the risk for any lifetime psychiatric disorder after parental death was not significantly moderated by race and ethnicity or parental education. Both individual- and population-level interventions may be needed to address the increased risk of psychiatric disorders, although additional studies with larger sample sizes are needed.
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- 2022
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42. The efficacy of complicated grief therapy for DSM-5-TR prolonged grief disorder.
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Mauro C, Tumasian RA 3rd, Skritskaya N, Gacheru M, Zisook S, Simon N, Reynolds CF 3rd, and Shear MK
- Published
- 2022
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43. Prolonged Grief Disorder Diagnostic Criteria-Helping Those With Maladaptive Grief Responses.
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Prigerson HG, Shear MK, and Reynolds CF 3rd
- Subjects
- Grief, Humans, Bereavement, Prolonged Grief Disorder
- Published
- 2022
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44. Grief-related beliefs in shidu parents with and without prolonged grief disorder: Psychometric properties of a Chinese version of the Typical Beliefs Questionnaire.
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Xu X, Wen J, Skritskaya NA, Zou X, Mauro C, Wang J, and Shear MK
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- Child, China, Grief, Humans, Parents, Psychometrics, Surveys and Questionnaires, Bereavement, Prolonged Grief Disorder
- Abstract
The Typical Beliefs Questionnaire (TBQ) assesses common grief-related cognitions, which demonstrated satisfactory psychometric properties in a treatment-seeking sample with prolonged grief disorder (PGD). Chinese shidu parents (bereaved parents over the age of 49 who have lost their only child) are at a high risk of PGD. The current study aimed to examine psychometric properties of the Chinese version of the TBQ (TBQ-C) in a community sample of shidu parents with and without PGD, to compare this to the original validation clinical sample in the United States bereaved of any close relationship and to consider its use as a clinical tool. We examined the rate of positive endorsement, factor structure, internal consistency and validity of the TBQ-C in 310 community-based shidu parents (including 102 who met the criteria for PGD). Results showed that the rate of positive endorsement for each item ranged from 7.2% to 48.6% among non-PGD participants and from 20.6% to 92.2% among PGD participants. Confirmatory factor analysis indicated that the original five-factor structure fit both the non-PGD and PGD shidu parents. The TBQ-C showed acceptable internal consistency and satisfactory convergent and concurrent validity in both groups. It had good discriminant validity and can be helpful in distinguishing shidu parents with and without PGD. The TBQ-C can be used to investigate common grief-related beliefs that may be problematic for both shidu parents with and without PGD., (© 2021 John Wiley & Sons, Ltd.)
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- 2022
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45. Change in avoidance and negative grief-related cognitions mediates treatment outcome in older adults with prolonged grief disorder.
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Lechner-Meichsner F, Mauro C, Skritskaya NA, and Shear MK
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- Aged, Cognition, Humans, Treatment Outcome, Grief, Prolonged Grief Disorder
- Abstract
Objective: The present study investigated the role of the two theoretically derived mediators in the treatment of Prolonged Grief Disorder (PGD). Mediators were changes in avoidance and maladaptive cognitions. An additional hypothesis tested whether these candidate mediators are specific to CBT-based Complicated Grief Treatment (CGT) compared to Interpersonal Therapy (IPT). Method: We performed secondary analyses with assessment completers ( n = 131) from a randomized-controlled trial with older adults with PGD. Patients received 16 sessions of CGT or IPT. Outcomes were treatment response and reductions in grief symptoms and grief-related related impairment. Results: Reductions in avoidance between baseline and week 16 mediated reductions in grief symptoms and grief-related impairment. Reductions in maladaptive grief-related cognitions over the same period mediated treatment response, reductions in grief symptoms and grief-related impairment. There were no significant treatment-mediator interactions. We could not establish that mediators changed before the outcomes. Conclusion: Results are consistent with theoretical models of PGD, including the CGT treatment model. Despite different therapeutic procedures, we found no significant interaction effect, but CGT produced larger effects. Future research needs to establish a timeline of change through the use of multiple measurements of mediators and outcomes. Trial registration: ClinicalTrials.gov identifier: NCT01244295.
- Published
- 2022
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46. Grief and the COVID-19 Pandemic in Older Adults.
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Goveas JS and Shear MK
- Abstract
(Appeared originally in Am J Geriatr Psychiatry 2020; 28:10 1119-1125)., (Copyright © 2021 by the American Psychiatric Association.)
- Published
- 2021
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47. Posttraumatic Distress Symptoms and Their Response to Treatment in Adults With Prolonged Grief Disorder.
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Na PJ, Adhikari S, Szuhany KL, Chen AZ, Suzuki RR, Malgaroli M, Robinaugh DJ, Bui E, Mauro C, Skritskaya NA, Lebowitz BD, Zisook S, Reynolds CF 3rd, Shear MK, and Simon NM
- Subjects
- Adult, Aged, Behavioral Symptoms drug therapy, Citalopram administration & dosage, Combined Modality Therapy, Female, Humans, Longitudinal Studies, Male, Middle Aged, Selective Serotonin Reuptake Inhibitors administration & dosage, Stress Disorders, Post-Traumatic drug therapy, Syndrome, Behavioral Symptoms therapy, Citalopram pharmacology, Grief, Outcome Assessment, Health Care, Psychotherapy, Selective Serotonin Reuptake Inhibitors pharmacology, Stress Disorders, Post-Traumatic therapy
- Abstract
Objective: Posttraumatic stress disorder and prolonged grief disorder (PGD) arise following major life stressors and may share some overlapping symptomatology. This study aimed to examine the presence and response to treatment of posttraumatic stress symptoms (PTSS) in bereaved adults with a primary diagnosis of PGD., Methods: A randomized controlled trial of 395 adults with PGD (defined as an Inventory of Complicated Grief score ≥ 30 plus confirmation on structured clinical interview) randomly assigned participants to either complicated grief treatment (CGT) with citalopram, CGT plus placebo, citalopram, or placebo between March 2010 and September 2014. This secondary analysis examined the presence of PTSS (per the Davidson Trauma Scale) at baseline and change in PTSS with treatment using longitudinal mixed-effects regression and examined the role of violent compared to nonviolent deaths (loss type)., Results: High levels of PTSS were present at baseline, regardless of loss type, and were associated with increased functional impairment (P < .001). CGT with placebo demonstrated efficacy for PTSS compared to placebo in both threshold (OR = 2.71; 95% CI, 1.13-6.52; P = .026) and continuous (P < .001; effect size d = 0.47) analyses, and analyses were suggestive of a greater effect for CGT plus citalopram compared to citalopram alone (threshold analysis: OR = 2.84; 95% CI, 1.20-6.70; P = .017; continuous analysis: P = .053; d = 0.25). In contrast, citalopram did not differ from placebo, and CGT plus citalopram did not differ from CGT plus placebo., Conclusions: Bereavement-related PTSS are common in bereaved adults with PGD in the context of both violent and nonviolent death and are associated with poorer functioning. CGT shows efficacy for PTSS, while the antidepressant citalopram does not., Trial Registration: : ClinicalTrials.gov identifier: NCT01179568., (© Copyright 2021 Physicians Postgraduate Press, Inc.)
- Published
- 2021
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48. Grief and the COVID-19 Pandemic in Older Adults.
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Goveas JS and Shear MK
- Subjects
- Aged, Bereavement, Betacoronavirus, COVID-19, Humans, Pandemics, SARS-CoV-2, Ceremonial Behavior, Coronavirus Infections epidemiology, Grief, Pneumonia, Viral epidemiology, Terminal Care
- Abstract
In few periods in human history have bereavement and grief been on so many people's minds as they are today. As the coronavirus disease 2019 (COVID-19) ravages the world, we have seen many perish in a short time. Many have died alone because of requirements for physical distancing. Even more will succumb as COVID-19 continues to spread. Moreover, deaths from other causes, numbering over 50 million annually, are also happening amid physical distancing and other COVID-19-related challenges. The pandemic is affecting the way terminally ill patients are being cared for, when and how people are dying of other causes, and how bodies are being handled and bereavement rituals performed. The bereaved are required to grieve without the support of usual social and cultural rituals. Grieving is further encumbered by cascading life stressors deriving from policies needed to mitigate the pandemic. Though we are often heartened by human resilience in response to death and other hardships, for some, the burden of this pandemic will be too much. Among other mental health problems, we will likely see an increase in prolonged grief disorder. In this commentary, we review the new diagnosis of prolonged grief disorder and outline why we might anticipate increased rates of this condition on the heels of COVID-19, especially among older persons. The authors suggest ways that might mitigate this emerging problem., (Copyright © 2020 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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49. Grief Before and After Bereavement in the Elderly: An Approach to Care.
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Meichsner F, O'Connor M, Skritskaya N, and Shear MK
- Subjects
- Adaptation, Psychological, Aged, Humans, Mental Disorders psychology, Risk Factors, Bereavement, Cognitive Behavioral Therapy, Grief, Mental Disorders therapy
- Abstract
Grief is the natural response to the death of a loved one and is encountered frequently in clinical practice with the elderly; it can also precede the death. Knowledge about four distinct forms of grief can aid clinicians with the conceptualization of grief, and the assessment and care of grievers. First, predeath grief is experienced by many caregivers of terminally ill patients. Second, acute grief arises immediately after the death of a loved one; and third, this normally evolves to a permanent state of integrated grief after a process of adaptation. Finally, failure of adaptation results in Prolonged Grief Disorder (PGD) which has been recently included in ICD-11. The hallmark feature of PGD is intense longing for the deceased or persistent preoccupation with the deceased that lasts longer than 6 months after the death. Validated instruments are available to assist practitioners with assessment of predeath grief and screening for PGD, thereby enabling identification of patients in need of additional support. Increased risks of morbidity and mortality following bereavement are important health issues for clinicians to be aware of. All grievers can benefit from support focused on understanding their grief, managing emotional pain, thinking about the future, strengthening their relationships, telling the story of the death, learning to live with reminders of the deceased, and connecting with memories. A short-term evidence-based intervention for PGD is based upon these seven themes and is efficacious in the elderly. Caregivers of the terminally ill benefit from psychological support that validates and normalizes their grief experiences and helps them recognize and accept their losses., (Copyright © 2020 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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50. Optimizing the clinical utility of four proposed criteria for a persistent and impairing grief disorder by emphasizing core, rather than associated symptoms.
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Cozza SJ, Shear MK, Reynolds CF, Fisher JE, Zhou J, Maercker A, Simon N, Mauro C, Skritskaya N, Zisook S, Lebowitz B, Bloom CG, Fullerton CS, and Ursano RJ
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Death, Diagnostic and Statistical Manual of Mental Disorders, Family psychology, Grief, International Classification of Diseases, Military Personnel psychology
- Abstract
Background: Distinguishing a disorder of persistent and impairing grief from normative grief allows clinicians to identify this often undetected and disabling condition. As four diagnostic criteria sets for a grief disorder have been proposed, their similarities and differences need to be elucidated., Methods: Participants were family members bereaved by US military service death (N = 1732). We conducted analyses to assess the accuracy of each criteria set in identifying threshold cases (participants who endorsed baseline Inventory of Complicated Grief ⩾30 and Work and Social Adjustment Scale ⩾20) and excluding those below this threshold. We also calculated agreement among criteria sets by varying numbers of required associated symptoms., Results: All four criteria sets accurately excluded participants below our identified clinical threshold (i.e. correctly excluding 86-96% of those subthreshold), but they varied in identification of threshold cases (i.e. correctly identifying 47-82%). When the number of associated symptoms was held constant, criteria sets performed similarly. Accurate case identification was optimized when one or two associated symptoms were required. When employing optimized symptom numbers, pairwise agreements among criteria became correspondingly 'very good' (κ = 0.86-0.96)., Conclusions: The four proposed criteria sets describe a similar condition of persistent and impairing grief, but differ primarily in criteria restrictiveness. Diagnostic guidance for prolonged grief disorder in International Classification of Diseases, 11th Edition (ICD-11) functions well, whereas the criteria put forth in Section III of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are unnecessarily restrictive.
- Published
- 2020
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