Background: Cognitive-behavioral group therapy (CBGT) and serotonin reuptake inhibitors have proven efficacy in reducing symptoms of obsessive-compulsive disorder (OCD). There is no consensus about which of these forms of treatment is more effective. This study was conducted to evaluate the efficacy of CBGT as compared to that of sertraline in reducing OCD symptoms. Method: Fifty-six outpatients with an OCD diagnosis, according to DSM-IV criteria, participated in the randomized clinical trial: 28 took 100 mg/day of sertraline and 28 underwent CBGT for 12 weeks. Efficacy of treatments was rated according to the reduction in scores on the Yale-Brown Obsessive Compulsive Scale (YBOCS) and the Clinical Global Impressions-Severity of Illness scale. The trial was performed in 4 successive periods from March 2002 to December 2003. Results: Both treatments were effective, although patients treated with CBGT obtained a mean YBOCS reduction of symptoms of 44%, while those treated with sertraline obtained only a 28% reduction (p = .033). Cognitive-behavioral group therapy was also significantly more effective in reducing the intensity of compulsions (p = .030). Further, 8 patients (32%) treated with CBGT presented a complete remission of OCD symptoms (YBOCS score ≤ 8) as compared to only 1 patient (4%) among those who received sertraline (p = .023). Conclusion: Cognitive-behavioral group therapy and sertraline have shown to be effective in reducing OCD symptoms. Nevertheless, the rate of symptom reduction, intensity reduction of compulsions, and percentage of patients who obtained full remission were significantly higher in patients treated with CBGT.

Background: In Brazil, treatment of panic disorder is most frequently initiated with pharmacotherapy, but only half of the patients can be expected to be panic free after medication. Studies have suggested that individual or group cognitive-behavior therapy (CBT) is an effective treatment strategy for panic patients who have failed to respond to pharmacotherapy. Methods: Thirty-two patients diagnosed with panic disorder with agoraphobia having residual symptoms despite being on an adequate dose of medication were treated with 12 weeks of group CBT. The outcome was evaluated for panic frequency and severity, generalized anxiety, and global severity. Comorbid conditions, a childhood history of anxiety, and defense mechanism styles were assessed as potential predictors of treatment response. Results: Twenty-nine patients completed the 12-week protocol. Treatment was associated with significant reductions in symptom severity on all outcome measures (p < 0.001). Patients with depression had a poorer outcome of the treatment (p = 0.01) as did patients using more neurotic (p = 0.002) and immature defenses (p = 0.05). Conclusion: Consistent with previous reports, we found that CBT was effective for our sample of treatment-resistant patients. Among these patients, depression as well as neurotic defense style was associated with a poorer outcome. The use of CBT in Brazil for treatment-resistant and other panic patients is encouraged.

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The aim of this cross-sectional community-based study was to examine the sensitivity and specificity of the Screen for Child Anxiety Related Emotional Disorders (SCARED) to the diagnosis of anxiety disorders (AD). Participants were 119 students aged 9-18. Psychiatric diagnoses were assessed by a psychiatrist throughout a structural clinical interview (K-SADS-PL). Forty-four participants had positive diagnosis for at least one AD. The total score of the SCARED significantly differentiated anxious from non-anxious children with an optimal cutoff point of 22 (sensitivity = 81.8 %; specificity = 52.0 %). SCARED subscales of social phobia and separation anxiety disorder, but not generalized anxiety disorder, revealed better discrimination proprieties than total scores to screen for that specific disorder (p < .05). Both total and specific SCARED scores presented moderate sensitivity and specificity for detecting AD in a community sample. Investigators interested in screening for specific AD, rather than the group of AD, may benefit from using the specific subscales.

Do defense mechanisms vary according to the psychiatric disorder? Os mecanismos de defesa se modificam de acordo com o transtorno psiquiátrico?A b s t r a c t Objective: The aim of this study was to evaluate the defense mechanisms used by depressive and anxious patients without comorbidities compared to those used by controls and to determine whether these patterns differ between diagnoses. Method:The sample was composed of 167 psychiatric patients and 36 controls that were evaluated using the Defense Style Questionnaire 40. All subjects were evaluated through a clinical interview, and each evaluation was confirmed through the application of the Mini International Neuropsychiatric Interview, a structured psychiatric interview. We used ANOVA and discriminant analysis to assess differences between groups. Results: Neurotic defense mechanisms discriminated controls from all patients except those with social anxiety. Immature defense mechanisms differentiated controls from all patients, as well as distinguished depressive patients from panic disorder and obsessive disorder patients. The discriminant analysis indicated that depressive patients are characterized by projection, panic disorder patients by sublimation and obsessive-compulsive patients by acting out. Conclusions: Depressive and anxious patients differ from other individuals in their use of defense mechanisms, and each diagnosis has a particular pattern. These findings could lead to the development of specific psychotherapeutic interventions. Keywords: Mental disorders; Defense mechanisms; Questionnaires; Personality tests; DepressionResumo Objetivo: O objetivo do estudo é avaliar o uso dos mecanismos de defesa utilizados por pacientes deprimidos e ansiosos sem comorbidades comparados com aqueles utilizados por pacientes-controle e se esses padrões de defesa podem ser diferenciados entre os diagnósticos. Método: 167 pacientes psiquiátricos e 36 controles foram avaliados pelo Defense Style Questionnaire 40. Todos os indivíduos foram avaliados por uma entrevista clínica que foi confirmada pelo Mini International Neuropsychiatric Interview, uma entrevista psiquiátrica estruturada. Para detectar diferenças entre os grupos, os dados foram submetidos à análise discriminante e ANOVA. Resultados: As defesas neuróticas discriminam os controles de todos pacientes, exceto dos pacientes com ansiedade social. As defesas imaturas diferenciam os controles de todos pacientes, além de discriminar os pacientes deprimidos dos pacientes com transtorno do pânico e obsessivo. A análise discriminante indica que a projeção diferencia pacientes deprimidos, sublimação diferencia pacientes com transtorno do pânico, e acting-out diferencia pacientes obsessivos-compulsivos. Conclusões: Os pacientes diferem dos controles no uso dos mecanismos de defesa, e cada patologia tem seu padrão particular. Esses achados podem permitir o desenvolvimento de intervenções específicas no tratamento psicoterápico.

Social anxiety disorder (SAD) is a highly prevalent and disabling disorder in children and adolescents. This study was designed to evaluate the efficacy and safety of a highly potent and selective serotonin reuptake inhibitor, escitalopram, in the treatment of SAD in children and adolescents. Twenty outpatients with a primary diagnosis of SAD were treated in a 12-week open trial with escitalopram. The primary outcome variable was the change from baseline to end point in Clinical Global Impression-Improvement scale (CGI-I). Secondary efficacy measures included the CGI-Severity scale (CGI-S), the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Screen for Child and Anxiety Related Emotional Disorders (SCARED)-Child and Parent version, and The Youth Quality of Life Instrument-Research Version (Y-QOL-R). On the CGI-I scale, 13 of 20 patients (65%) had a score < or =2, meaning response to treatment. All symptomatic and quality of life measures showed improvements from baseline to week 12, with large effect sizes ranging from 0.9 to 1.9 (all p < 0.001). Escitalopram was generally well-tolerated. These results suggest that escitalopram may be an effective and safe treatment for pediatric SAD. Future double-blind, placebo-controlled, randomized clinical trials are warranted.