Effect of short-term SSRI treatment on cognitive bias in generalised anxiety disorder.

RATIONALE: There is considerable evidence showing that individuals with generalised anxiety disorder (GAD) selectively process threat-related information, e.g. they have a bias to interpret ambiguous information in a threat-related manner. Cognitive theories of anxiety, which provide the basis of cognitive-behaviour therapy, propose that such processing biases play an important role in causing and maintaining anxiety. OBJECTIVES: Given that treatment with selective serotonin re-uptake inhibitors (SSRIs) appears to be effective for GAD, we examined whether it is successful in removing cognitive bias. METHODS: The clinical group included 19 patients with a diagnosis of GAD, and the control group consisted of a non-clinical sample of volunteers, matched for age, gender and years in education. The patients were assessed on measures of interpretative bias (homophone task), anxiety and depression before being prescribed an SSRI (paroxetine or citalopram). After 4 weeks, the cognitive task and mood measures were repeated in the patient group. RESULTS: Prior to treatment, the GAD group showed a significantly greater level of threat-related interpretive bias than controls. Following SSRI treatment, there were significant reductions in both interpretive bias and in anxiety levels in the GAD group. Furthermore, individuals who showed greater clinical improvement (e.g. reflected by reduced anxiety scores) showed a correspondingly greater reduction in their cognitive bias. CONCLUSION: The results suggest that SSRIs are effective in modifying both subjective anxiety levels and threat-related interpretive bias.

Profiles, co-morbidity and their relationship to treatment of 191 children with AD/HD and their families.

BACKGROUND: This study was set up to re-audit our use of a protocol for the assessment and treatment for children on psycho-stimulant medication within a community clinic for children with Attention Deficit/Hyperactive Disorder (AD/HD) and to examine the profile of children and their families referred to the clinic in order to consider their assessment and treatment needs. METHOD: A questionnaire based on results from previous studies was completed for 191 patients from a case note audit, and by questioning clinicians. Key areas examined were symptomatology and child and family variables, which included learning difficulties, medical problems, psychosocial factors and side-effects of medication. RESULTS: The protocol was used appropriately with the majority of children. Children with AD/HD referred to the clinic often presented with co-morbid psychopathology, e. g. conduct disorder, low self-esteem, and frequently experienced family and psychosocial difficulties. CONCLUSIONS: Protocols in clinics are useful as this should maintain good practice and allow on-going monitoring, but they need precise use. Also, as many children with AD/HD present with co-morbid psychopathology and complicated family dynamics to Child and Adolescent Mental Health Services, this will influence assessment and treatment needs and require increased resources.