Social Phobia - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

SOCIAL PHOBIA A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Social Phobia: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84219-1 1. Social Phobia-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on social phobia. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON SOCIAL PHOBIA ........................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Social Phobia ................................................................................. 5 E-Journals: PubMed Central ....................................................................................................... 31 The National Library of Medicine: PubMed ................................................................................ 32 CHAPTER 2. NUTRITION AND SOCIAL PHOBIA............................................................................... 75 Overview...................................................................................................................................... 75 Finding Nutrition Studies on Social Phobia................................................................................ 75 Federal Resources on Nutrition ................................................................................................... 77 Additional Web Resources ........................................................................................................... 77 CHAPTER 3. ALTERNATIVE MEDICINE AND SOCIAL PHOBIA ........................................................ 79 Overview...................................................................................................................................... 79 National Center for Complementary and Alternative Medicine.................................................. 79 Additional Web Resources ........................................................................................................... 83 General References ....................................................................................................................... 83 CHAPTER 4. DISSERTATIONS ON SOCIAL PHOBIA .......................................................................... 85 Overview...................................................................................................................................... 85 Dissertations on Social Phobia..................................................................................................... 85 Keeping Current .......................................................................................................................... 86 CHAPTER 5. CLINICAL TRIALS AND SOCIAL PHOBIA ..................................................................... 87 Overview...................................................................................................................................... 87 Recent Trials on Social Phobia..................................................................................................... 87 Keeping Current on Clinical Trials ............................................................................................. 89 CHAPTER 6. PATENTS ON SOCIAL PHOBIA ..................................................................................... 91 Overview...................................................................................................................................... 91 Patents on Social Phobia .............................................................................................................. 91 Patent Applications on Social Phobia .......................................................................................... 96 Keeping Current ........................................................................................................................ 100 CHAPTER 7. BOOKS ON SOCIAL PHOBIA ....................................................................................... 101 Overview.................................................................................................................................... 101 Book Summaries: Online Booksellers......................................................................................... 101 Chapters on Social Phobia.......................................................................................................... 102 CHAPTER 8. PERIODICALS AND NEWS ON SOCIAL PHOBIA ......................................................... 105 Overview.................................................................................................................................... 105 News Services and Press Releases.............................................................................................. 105 Academic Periodicals covering Social Phobia ............................................................................ 107 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 109 Overview.................................................................................................................................... 109 U.S. Pharmacopeia..................................................................................................................... 109 Commercial Databases ............................................................................................................... 110 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 113 Overview.................................................................................................................................... 113 NIH Guidelines.......................................................................................................................... 113 NIH Databases........................................................................................................................... 115 Other Commercial Databases..................................................................................................... 117 APPENDIX B. PATIENT RESOURCES ............................................................................................... 119 Overview.................................................................................................................................... 119 Patient Guideline Sources.......................................................................................................... 119 Finding Associations.................................................................................................................. 123

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APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 125 Overview.................................................................................................................................... 125 Preparation................................................................................................................................. 125 Finding a Local Medical Library................................................................................................ 125 Medical Libraries in the U.S. and Canada ................................................................................. 125 ONLINE GLOSSARIES................................................................................................................ 131 Online Dictionary Directories ................................................................................................... 132 SOCIAL PHOBIA DICTIONARY .............................................................................................. 133 INDEX .............................................................................................................................................. 171

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with social phobia is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about social phobia, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to social phobia, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on social phobia. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to social phobia, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on social phobia. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON SOCIAL PHOBIA Overview In this chapter, we will show you how to locate peer-reviewed references and studies on social phobia.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and social phobia, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “social phobia” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Anxiety and the Irritable Bowel Syndrome: Psychiatric, Medical, or Both? Source: Journal of Clinical Psychiatry. 58(supplement 3): 51-61. 1997. Contact: Available from Physicians Postgraduate Press, Inc. P.O. Box 752870, Memphis, TN 38175-2870. Summary: The association between the irritable bowel syndrome (IBS) and psychiatric disorders is well-known to most clinicians, but the nature of the relationship is far from clear. There is an increased prevalence of psychiatric illness in IBS patients and an increase in IBS in psychiatric patients. Whether this association exists outside of treatment-seeking populations (i.e., in people with IBS who do not seek treatment) has not been well investigated. This article selectively reviews the existing literature regarding the association of IBS and psychiatric illness in both patient and nonpatient

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samples. The author presents a model of the brain-gut interaction, and offers a discussion of the practical implications of this model for treating individuals with IBS. The author considers patients with IBS and general anxiety disorder (GAD), panic disorder, posttraumatic stress disorder (PTSD), social phobia, and mood disorders. The treatment model suggests that, even in patients without psychiatric disorders, neuroactive medications may be a useful tool in improving functioning in individuals whose functional GI disorders have not responded to standard, conservative measures. Appended to the article is a discussion between three physicians on the concepts presented. 2 figures. 2 tables. 51 references. (AA-M). •

Fourteen-Year Follow-Up of Speech/Language-Impaired and Control Children: Psychiatric Outcome Source: Journal of the American Academy of Child and Adolescent Psychiatry. 40(1): 7582. January 2001. Contact: Available from Lippincott Williams and Wilkins. Subscription Department, P.O. Box 350, Hagerstown, MD 21740-0350. (800) 638-3030. Website: www.aacap.org/journal/journal.htm. Summary: This article reports on a study undertaken to examine the association between early childhood speech and language disorders and young adult psychiatric disorders. In a longitudinal community study conducted in Ontario, Canada, interviewers administered structured psychiatric interviews to age 19 participants who were originally identified as speech impaired only, language impaired, or non-impaired at age 5. The first stage of the study took place in 1982 when participants were 5 years old, and the latest stage of the study took place between 1995 and 1997 when participants had a mean age of 19 years. This article examines the association between early childhood speech language status and young adult psychiatric outcome. The results showed that children with early language impairment had significantly higher rates of anxiety disorder in young adulthood compared with non-impaired children. The majority of participants with anxiety disorders had a diagnosis of social phobia. Trends were found toward associations between language impairment and overall and antisocial personality disorder rates. Males from the language impaired group had significantly higher rates of antisocial personality disorder compared with males from the control group. Age of onset and comorbidity did not differ by speech language status. The majority of participants with a disorder had more than one disorder. These results support the association between early childhood speech and language functioning and young adult psychiatric disorder over a 14 year period. This association underscores the importance of effective and early interventions. 1 figure. 3 tables. 36 references.

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Psychodermatology: The Mind and Skin Connection Source: American Family Physician. 64(11): 1873-1878. December 1, 2001. Contact: Available from American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672. (800) 274-2237 or (913) 906-6000. E-mail: [email protected]. Website: www.aafp.org. Summary: This journal article provides health professionals with information on the classification and management of psychodermatologic disorders. A psychodermatologic disorder is a condition that involves an interaction between the mind and the skin. Psychodermatologic disorders can be broadly classified into psychophysiologic disorders, primary psychiatric disorders, and secondary psychiatric disorders.

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Psychophysiologic disorders, such as psoriasis and eczema, are conditions that are frequently precipitated or exacerbated by emotional stress. Stress management classes, relaxation techniques, music, or exercise may benefit patients whose skin condition is precipitated or exacerbated by stress. Drug therapy with antianxiety medication may also be helpful. Primary psychiatric disorders involve conditions that result in self induced cutaneous manifestations, such as trichotillomania and delusions of parasitosis. Trichotillomania is a condition in which a person pulls out his or her own hair. A skin biopsy can be helpful in determining the diagnosis because the hair root undergoes a unique change called trichomalacia. Drugs used in the treatment of obsessive compulsive disorder can be helpful in the pharmacologic management of trichotillomania. Patients with delusions of parasitosis believe that their bodies are infested by some type of organism. The treatment for this condition is an antipsychotic medication called pimozide. The terms neurotic excoriations and psychologic excoriations are used when patients self inflict excoriations with their fingernails. Factitial dermatitis generally refers to a condition in which the patient uses something more elaborate than the fingernails to damage his or her skin. Tricyclic antidepressants may be used to treat these primary psychiatric disorders. Secondary psychiatric disorders are associated with disfiguring skin disorders. This disfigurement results in psychiatric problems, such as decreased self esteem, depression, or social phobia. 6 figures, 3 tables, and 21 references. (AA-M).

Federally Funded Research on Social Phobia The U.S. Government supports a variety of research studies relating to social phobia. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to social phobia. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore social phobia. The following is typical of the type of information found when searching the CRISP database for social phobia: •

Project Title: ALCOHOLISM: GENETIC EPIDEMIOLOGIC TWIN STUDY Principal Investigator & Institution: Heath, Andrew C.; Director, Missouri Alcoholism Research c; Psychiatry; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-MAR-1994; Project End 31-MAR-2005 Summary: This resubmission seeks continued funding for the Missouri Adolescent Female Twin Study (MOAFTS), a prospective genetic-epidemiologic survey of alcohol

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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use and abuse/dependence and co-morbid psychopathology in adolescent and young adult women. During the first five years of the project, using a cohort-sequential sampling design, cohorts of 13.5, 15.5, 17.5 and 19.5 year-old twins have been ascertained from birth records over a 2-year period, with continued recruitment of new cohorts of 13 year-olds and 11 year-olds. The twins, together with at least one parent information, have been assessed using telephone diagnostic interviews (N-1730 pairs, including 249 minority pairs; N=3651 parents), with brief 1-year follow up interventions and self-report questionnaire assessments of twin pairs (N=1378 pairs to date) and 2year follow-up interview assessments of twin pairs (N=477 pairs to date) and a parent informant (N=796 parents to date) still in progress. Detailed assessments of history of psychopathology (childhood inattention and hyperactivity, suicidality, lifetime histories of DSM-IV oppositional defiant and conduct disorders, major depression, social phobia and panic disorder) and alcohol and other substance use disorders (DSM-V alcohol dependence or abuse, nicotine dependence, illicit drug abuse/dependence), as well as other behavioral and environmental risk- factors (including parental psychopathology and perceived peer and sibling behaviors) have been made. In this competing continuation, we seek to continue detailed telephone diagnostic interview assessments with twin cohorts at ages 175, 19.5, 21.5, 23.5, and 25.5, as well as repeat assessments of mothers of 19-year olds, plus assessment of those fathers who have not previously been interviewed. Following these twin pairs through their period of highest risk for onse5t of alcohol dependence will provide a powerful basis for identifying mediators and riskmodifiers of genetic and environmental influences on alcohol dependence and harmful alcohol use in young women (see heuristic models in Figures a1 and bla- blc), including effects of partner influences and influences of peers at college or work, occupation and work environment and transitions to adult roles (full-time employment, marriage, parenthood) on drinking behavior and problems. It will provide preliminary data on genetic and environmental predictors of course and remission versus persistence on alcohol problems, issues that can be addressed with greatest power when the youngest cohorts are followed up in a proposal as they reach their mid to late 20s. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ANATOMY OF THE PRIMATE AMYGDALOID COMPLEX Principal Investigator & Institution: Amaral, David G.; Professor; Psychiatry; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 95616 Timing: Fiscal Year 2002; Project Start 01-SEP-1986; Project End 30-JUN-2005 Summary: (adapted from applicant's abstract): The amygdala is a complex medial temporal lobe structure that has been implicated in the mediation of emotion and social behavior. Pathology of the amygdala has been associated with psychiatric conditions including anxiety, panic disorder and social phobia. Social impairment, the core deficit in autism, may also involve dysfunction of the amygdala. The overarching goal of this program of functional neuroanatomical research has been to establish the major intrinsic and extrinsic connections as well as the chemical neuroanatomy of the macaque monkey amygdaloid complex. This information goes some way in defining the neural circuitry mediating social cognition and provides targets for pharmacological modulation of amygdala-based psychopathology. During the current funding period, we have identified virtually all of the cortical inputs to the amygdala. We have also identified new intrinsic connections as we mapped the intra-amygdaloid pathways of the lateral, basal and accessory basal nuclei. We have also conducted detailed immunohistochemical and in situ hybridization studies of the GABA system. In this application we propose to extend our studies of the mature amygdala and to begin

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research on the developing primate amygdala. We will also initiate studies of the human amygdala both in normal and autistic brains. In the mature monkey brain, we will use electron microscopy to examine the synaptic organization of amygdaloid projections to the neocortex. We will determine whether these projections terminate on principal neurons, interneurons or both. In the neonatal macaque monkey, we will use neural tract tracing techniques to examine the development of amygdaloid projections to the neocortex and neocortical projections to the amygdala. Our goal will be to determine when these connections are established in an adult fashion and how much reorganization occurs during the neonatal period. We will also investigate the distribution of serotonergic innervation of the mature and developing amygdala. Serotonin has been implicated in modulating social function, particularly aggression, but little is known concerning its normal distribution or development in the amygdala. For the first time, we will extend our observation in the monkey to the human amygdala. We hypothesize that the amygdala is dysfunctional in autism and we will attempt to determine whether a neuroanatomical/neurochemical abnormality can be established. We will conduct quantitative, stereological studies on the volume and cell number of the amygdala and its component nuclei and search for pathology of the GABA system, which may be particularly altered in the 30 percent of autistics who also have epilepsy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BASAL GANGLIA AND 5-HT IN RITUALISTIC SOCIAL DISPLAYS Principal Investigator & Institution: Baxter, Lewis R.; Professor; Psychiatry & Behav Neurobiol; University of Alabama at Birmingham Uab Station Birmingham, Al 35294 Timing: Fiscal Year 2002; Project Start 27-SEP-2001; Project End 02-SEP-2002 Summary: (provided by applicant): Ritualistic displays of social/territorial status are important regulators of intra-species interactions, reducing costs of competition for both individuals, and the group. Such ritualistic behaviors have similar forms across a wide range of land vertebrates (anmiotes). When the brain mechanisms mediating them dysfunction in man, the result may be certain psychopathologies, such as those characteristic of obsessive compulsive disorder (OCD), Tourette's disorder (GTS), social phobia, and some mood disorders. Functional neuroimaging studies by the Principal Investigator and others suggest that cortico/limbic-basal ganglionic-thalamic (=BG) systems mediate symptoms seen in OCD and related depressions. Work with Anolis lizards suggest that amniote- generic dorsolateral (DL) vs. ventro-medial (VM) BG systems mediate generic dominant vs. submissive social displays, respectively. This work has also demonstrated an acute role for serotomn (5-HT) in determining whether dominant or submissive behaviors are expressed in a given context, and strongly suggest that Anolis 5-HTIB receptors determines the differential 5-HT flux related to dominant vs. submissive behavior. Our human and lizard findings together have lead to a thesis that BG systems are organized as cross-inhibitory DL vs. VM subsystems that interact to bias behavior toward generic dominant vs. submissive behavioral routines. When DL/VM BQ subsystem interactions dysfunction in humans, the result may be fixed, context-inappropriate behaviors, as seen in OCD/depressions (submissive/ defeat), thus explaining the human PET findings. Conversely, aggressive states with stereotypic displays of dominance behavior (e.g., mania ,QTS), might have reciprocal BG system dysfunctions. Thus, a fuller understanding of how BQ systems interact and are regulated by 5-HT functions to mediate social/territorial display behaviors in an appropriate, easily manipulated model system is of value. By using pharmacological challenges, in vivo functional autoradiography, and in situ hybridization, we propose to

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elucidate the proximate BG mechanisms by which male Anolis lizards are vectored to display dominant vs. subordinate social/territorial behavioral routines, and how these behaviors and their mediating brain functions are switched between these poles of status as a result of social/conflict experience. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: BRAIN IMAGING IN PANIC DISORDER AT HIGH-FIELD Principal Investigator & Institution: Friedman, Seth D.; Radiology; University of Washington Grant & Contract Services Seattle, Wa 98105 Timing: Fiscal Year 2004; Project Start 01-DEC-2003; Project End 30-NOV-2008 Summary: (provided by applicant): This five-year career development proposal will establish Dr. Seth D. Fdedman as an independent researcher who can develop, apply, and integrate rapid high-field multinuclear magnetic resonance spectroscopy (MRS) and peripheral physiological monitoring to study biological regulation in anxiety disorders. Towards this aim, a detailed curriculum of physics, digital signal processing, physiology, and statistical methods will be undertaken. Regular training visits to centers with critical expertise are also planned to facilitate technical and clinical skill development. The studies associated with this training experience will be conducted in three phases: (1) technical development and characterization of hyperventilation (HV) response in healthy control subjects, (2) clinical investigation of HV dysregulation in panic disorder subjects compared to healthy controls and social phobia subjects, and (3) pilot work focused on alternative challenges. In PD, a number of peripheral alterations are found at rest (increased sighing, low pCO2, and respiratory variability) and in response to HV, with delayed recovery of end-tidal pCO2 commonly demonstrated. Importantly, anxiety level per se is not sufficient to produce this delayed recovery, since SP subjects, who will be used as anxious controls in the proposed studies, do not demonstrated altered pCO2 recovery following HV. Central nervous system alterations of lactate production are also demonstrated in response to HV challenge in PD, a response suggested to be in excess of the observed metabolic alkalosis. By integrating time-resolved central and peripheral nervous system measures of physiological regulation, the components of altered physiology in PD will be elucidated. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CD-ROM CHILD ANXIETY TREATMENT Principal Investigator & Institution: Harris, M S.; Workbook Publishing, Inc. 208 Llanfair Rd Ardmore, Pa 19003 Timing: Fiscal Year 2003; Project Start 14-MAR-2003; Project End 29-FEB-2004 Summary: (provided by applicant): This study will examine the feasibility and initial efficacy of a CD-ROM version of a cognitive-behavioral therapy (CBT) for anxiety disorders in youth. Anxiety disorders (Generalized Anxiety Disorder; Social Phobia; Separation Anxiety Disorder) are among the most prevalent psychopathological problems in youth and, if untreated, are said to be chronic in nature and to cause significant social and educational impairment. Recent empirical work based on randomized clinical trials suggests that various forms of CBT (e.g., individual, family, group) can be effective in reducing the presence of these very same anxiety disorders. Although studies have found a person-to-person therapeutic approach to be effective, anxious youth often do not seek help. The very nature of anxiety in youth includes a worrisome and perfectionist style and a self presentation that there isn't a problem. Therefore, many anxious youth do not seek or receive needed intervention. The use of a

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CD-ROM version of the CBT could increase, by significant magnitude, the number of anxious youth for whom a CBT treatment would become available. Further, for the more than 40 million Americans who have no health insurance, or inadequate insurance, a more accessible and affordable treatment modality is needed. Researchers agree that an examination of the viability of cost-effective therapy approaches is critical. The primary goal of this Phase I project is to develop a 14-session CD-ROM version of the CBT and to examine its efficacy by comparing pre-post treatment to pre-post waitlist. A final total of 12 participants, ages 8-13 years, will have been assessed via a structured diagnostic interview (by a reliable independent evaluator) and self-report measures to determine the presence of an anxiety disorder and to evaluate changes before and after waitlist and before and after treatment (and at a 3-month follow-up after treatment completion). Successful completion of this Phase I project will enable a Phase II randomized clinical trial to evaluate the CD-ROM treatment versus the application of CBT in the customary one-to-one context. The long-term goals are to develop an effective and affordable CD-ROM version of CBT for anxious youth for use on PC-based (and Mac) systems that are available to a wide range of youth, educators, and therapists. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHILD /ADOLESCENT ANXIETY MULTIMODAL TREATMENT STUDY Principal Investigator & Institution: Albano, Anne Marie.; Recanati Family Assistant Professor of p; Anesthesiology; New York University School of Medicine 550 1St Ave New York, Ny 10016 Timing: Fiscal Year 2002; Project Start 20-SEP-2002; Project End 31-MAY-2006 Summary: (provided by applicant): With point prevalence estimates ranging from 12 percent to 20 percent, anxiety disorders are among the most common conditions affecting children and adolescents. The three most commonly impairing childhoodonset anxiety disorders are separation anxiety disorder, social phobia and generalized anxiety disorder. As a group, these disorders routinely co-occur and cause clinically significant distress and impairment affecting school, social, and family functioning. Left untreated, these disorders leave children at risk for anxiety disorders, major depression and, in some cases, substance abuse extending into late adolescence and adulthood. Hence, effective treatments for childhood-onset anxiety disorders promise to alleviate and perhaps to prevent long-term morbidity and even mortality. In randomized controlled trials, we have shown that two monotherapies, cognitive-behavioral therapy (CBT) and the selective serotonin reuptake inhibitor (SSRI), fluvoxamine (FLV), are effective treatments for separation anxiety, social phobia, and generalized anxiety disorders in children and adolescents. Even though the monotherapies are effective a substantial number of patients remain symptomatic following treatment and, might have benefited from combined treatment. There are as yet no systematic, controlled studies comparing CBT and an SSRI, alone or in combination, against a control condition in the same patient population. This revised application proposes a four-year, six site, randomized controlled efficacy trial comparing cognitive-behavioral (CBT) and pharmacological treatment for youth ages 7 to 16 years with anxiety disorders. Phase 1 is a 12-week, random assignment acute efficacy study comparing CBT, FLV, their combination (n=90, each condition), and pill placebo control (n=48) in 318 (53/site) youth with DSM-IV primary diagnoses of separation anxiety, social phobia, and/or generalized anxiety disorder. Phase II involves a 6-month treatment maintenance period for Phase I responders. All subjects regardless of response status will be evaluated at all scheduled assessment points. In addition to comprehensive parent, child, clinician, and

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teacher reports, the primary outcome variables will be assessed by blind independent evaluators. Manualized intervention and assessment protocols plus state-of-the-art quality assurance and adverse event monitoring procedures insure uniform cross-site administration of the study protocol. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHILD AND ADOLESCENT ANXIETY MULTISITE STUDY (CAMS) Principal Investigator & Institution: March, John S.; Associate Professor; Psychiatry; Duke University Durham, Nc 27706 Timing: Fiscal Year 2002; Project Start 21-SEP-2002; Project End 31-MAY-2006 Summary: (provided by applicant): With point prevalence estimates ranging from 12 percent to 20 percent, anxiety disorders are among the most common conditions affecting children and adolescents. The three most commonly impairing childhoodonset anxiety disorders are separation anxiety disorder, social phobia and generalized anxiety disorder. As a group, these disorders routinely co-occur and cause clinically significant distress and impairment affecting school, social, and family functioning. Left untreated, these disorders leave children at risk for anxiety disorders, major depression and, in some cases, substance abuse extending into late adolescence and adulthood. Hence, effective treatments for childhood-onset anxiety disorders promise to alleviate and perhaps to prevent long-term morbidity and even mortality. In randomized controlled trials, we have shown that two monotherapies, cognitive-behavioral therapy (CBT) and the selective serotonin reuptake inhibitor (SSRI), fluvoxamine (FLV), are effective treatments for separation anxiety, social phobia, and generalized anxiety disorders in children and adolescents. Even though the monotherapies are effective a substantial number of patients remain symptomatic following treatment and, might have benefited from combined treatment. There are as yet no systematic, controlled studies comparing CBT and an SSRI, alone or in combination, against a control condition in the same patient population. This revised application proposes a four-year, six site, randomized controlled efficacy trial comparing cognitive-behavioral (CBT) and pharmacological treatment for youth ages 7 to 16 years with anxiety disorders. Phase 1 is a 12-week, random assignment acute efficacy study comparing CBT, FLV, their combination (n=90, each condition), and pill placebo control (n=48) in 318 (53/site) youth with DSM-IV primary diagnoses of separation anxiety, social phobia, and/or generalized anxiety disorder. Phase II involves a 6-month treatment maintenance period for Phase I responders. All subjects regardless of response status will be evaluated at all scheduled assessment points. In addition to comprehensive parent, child, clinician, and teacher reports, the primary outcome variables will be assessed by blind independent evaluators. Manualized intervention and assessment protocols plus state-of-the-art quality assurance and adverse event monitoring procedures insure uniform cross-site administration of the study protocol. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: CHILD/ADOLESCENT ANXIETY MULTIMODAL TREATMENT STUDY Principal Investigator & Institution: Birmaher, Boris; Associate Professor; Psychiatry; University of Pittsburgh at Pittsburgh 350 Thackeray Hall Pittsburgh, Pa 15260 Timing: Fiscal Year 2002; Project Start 18-SEP-2002; Project End 31-MAY-2006 Summary: (provided by applicant): With point prevalence estimates ranging from 12 percent to 20 percent, anxiety disorders are among the most common conditions

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affecting children and adolescents. The three most commonly impairing childhoodonset anxiety disorders are separation anxiety disorder, social phobia and generalized anxiety disorder. As a group, these disorders routinely co-occur and cause clinically significant distress and impairment affecting school, social, and family functioning. Left untreated, these disorders leave children at risk for anxiety disorders, major depression and, in some cases, substance abuse extending into late adolescence and adulthood. Hence, effective treatments for childhood-onset anxiety disorders promise to alleviate and perhaps to prevent long-term morbidity and even mortality. In randomized controlled trials, we have shown that two monotherapies, cognitive-behavioral therapy (CBT) and the selective serotonin reuptake inhibitor (SSRI), fluvoxamine (FLV), are effective treatments for separation anxiety, social phobia, and generalized anxiety disorders in children and adolescents. Even though the monotherapies are effective a substantial number of patients remain symptomatic following treatment and, might have benefited from combined treatment. There are as yet no systematic, controlled studies comparing CBT and an SSRI, alone or in combination, against a control condition in the same patient population. This revised application proposes a four-year, six site, randomized controlled efficacy trial comparing cognitive-behavioral (CBT) and pharmacological treatment for youth ages 7 to 16 years with anxiety disorders. Phase 1 is a 12-week, random assignment acute efficacy study comparing CBT, FLV, their combination (n=90, each condition), and pill placebo control (n=48) in 318 (53/site) youth with DSM-IV primary diagnoses of separation anxiety, social phobia, and/or generalized anxiety disorder. Phase II involves a 6-month treatment maintenance period for Phase I responders. All subjects regardless of response status will be evaluated at all scheduled assessment points. In addition to comprehensive parent, child, clinician, and teacher reports, the primary outcome variables will be assessed by blind independent evaluators. Manualized intervention and assessment protocols plus state-of-the-art quality assurance and adverse event monitoring procedures insure uniform cross-site administration of the study protocol. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHILDHOOD SOCIAL PHOBIA: LONG-TERM FOLLOW-UP Principal Investigator & Institution: Beidel, Deborah C.; Professor; Psychology; University of Maryland College Pk Campus College Park, Md 20742 Timing: Fiscal Year 2002; Project Start 01-JAN-2000; Project End 31-DEC-2004 Summary: Social phobia affects approximately 3-5 percent of children, and the prevalence rises as age increases. Youth with social phobia have significant fear of public speaking, reading or writing in public, going to parties, interacting with authority figures, using public restrooms and interacting in informal social gatherings. Clinical correlates include headaches or stomach aches, panic attacks, crying, avoidance, general anxiety, dysphoria, a sense of loneliness, and a very restricted range of social relationships. In extreme cases, school refusal or other behavioral problems may result. These children are deficient in the social skills necessary for normal social development. The disorder is chronic and onset prior to age 11 predicts non- recovery in adulthood. Also, other disorders frequently occur concurrently, most often generalized anxiety disorder, separation anxiety disorder and specific phobia. Recent findings indicate that a new psychosocial treatment (Social Effectiveness Therapy for Children; SET-C) is efficacious for children ages 8-12, resulting in reduction in emotional distress and improvement in social functioning, and the treatment effects have been maintained for up to 6 months. However, the long-term effects of this treatment, or any other treatment, for childhood social phobia are unknown. The study proposed in this application is

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Social Phobia

designed to extend the followup period for those children who were successfully treated with SET-C in our current study (MH53703). The study is designed to extend the followup period for these children to 5 years posttreatment. Assessments will include diagnostic interviews, self-report inventories, parental and clinician ratings, behavioral assessments of social skill, and daily diaries. This followup study will provide the longest followup to date for children treated for childhood social phobia. The assessment strategy is designed to allow for the determination of the durability of treatment, determination of risk factors for relapse or the development of other disorders, gauge academic, social, and emotional functioning. Data from this study will be particularly useful because the followup period will cover the children during the age of highest risk for social phobia (15-18 years). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CLINICAL STUDIES OF HUMAN ANXIETY DISORDERS Principal Investigator & Institution: Weissman, Myrna M.; Professor; Columbia Univ New York Morningside 1210 Amsterdam Ave, Mc 2205 New York, Ny 10027 Timing: Fiscal Year 2003; Project Start 01-JAN-2003; Project End 31-DEC-2006 Summary: (provided by applicant): The overall aim of the Program Project Grant (PPG) is to understand the genetic basis for fear, anxiety and anxiety disorders in humans by identifying variant forms of genes that may contribute to pathological anxiety states. The underlying idea is that both learned and innate fear are tractable targets for genetic analyses in mice and humans. To accomplish this portion of the PPG dealing with human anxiety disorders Project 4 will provide well-characterized clinical samples and DNA from subjects with selected anxiety disorders (panic disorder, social anxiety disorder, and controls). Dimensional assessments of anxiety related temperaments, which cut across all clinical groups will provide another method for sample stratification. The clinical disorders have been selected where there is indication of heritability from family and/or twin studies; the clinical phenotypes are well defined and there is suggestive evidence for a relationship with fear conditioning and/or its neurobiological substrate and where hypotheses about candidate genes based on marker, treatment or pathophysiologic studies can be developed. To maximize the likelihood that we are selecting cases with genetic etiology, we will select cases from families with multiple affected individuals. The dimensional assessments have been selected because of prior promising associations with specific polymorphisms related to anxiety and evidence for heritability. Since issues of design and control groups have not been resolved, we will use both family based "triads" (probands and two biological parents) and population controls (matched for ethnicity). The central hypothesis is that there are similarities in fear conditioning circuitry between animal models and human and that genes involved in the pathways associated with fear conditioning or innate fear may be involved in the development of human anxiety disorders, particularly panic disorder, social anxiety disorder (social phobias), and/or neuroticism or anxiety sensitivity. The specific aims of this project are: identification, clinical characterization and DNA extraction of subjects with panic disorder (N= 150); social anxiety disorder (social phobia) (N=150); selected to be at high genetic risk for anxiety disorders; non ill matched controls also assessed on quantitative trait dimension (N=150). We will also collect bloods from the biological parents of the panic and social anxiety disorder probands. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COGENT TO SUPPORT CLINICAL RESEARCH AT STANFORD Principal Investigator & Institution: Schatzberg, Alan F.; Professor and Chair; Psychiatry and Behavioral Sci; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2002; Project Start 01-SEP-2000; Project End 31-AUG-2004 Summary: (Adapted from the Applicants Abstracts): This is an application for four years of CoGent funding to support 7 NIMH-funded R01's led by six PI's in the Departments of Psychiatry and Behavioral Sciences of Psychology at Stanford University. The R01's focus on a number of disorders - major depression with and without psychotic features, obsessive compulsive disorder, post-traumatic stress disorder, fragile X and other neurogenetic syndromes, and schizophrenia. This CoGent will increase the efficiency of the approved research of each of the studies, expand their scope, and allow for significant cross study collaborations. It consists of 3 cores - Recruitment, Statistics and Data Management, and Neuroimaging. The Recruitment Core will be located across three sites (two in Palo Alto and one in San Francisco) to increase recruitment of subjects. The San Francisco site will provide greater numbers of ethnic minority subjects for the Base Grants. The Core will facilitate subjects participating in more than one study. The Statistic and Data Management Core will assist in developing methods that can be used across studies for accessing longitudinal course and outcome (e.g. random regression models), response in randomized clinical trials (e.g. Reciever Operating Characteristics Curve Methodology), and the relative contributions of multiple risk factors. The Neuroimaging Core will offer prestudy exposure to a simulator and provide for additional scan time. A major feature of this CoGent is the application of fMRI across different populations being studied in the Base Grants. Several of the studies already use fMRI to study affect and cognition in specific disorders - e.g., schizophrenia, nonpsychotic and psychotic major depression, social phobia, fragile X, etc. The CoGent will permit utilization of standard fMRI experiments in these patient groups that will allow comparisons to be made across projects - e.g., hallucinating schizophrenic patients with hallucinating psychotic depressives. In two studies, the use of fMRI will significantly enhance the research design by exploring the specific effects of treatment on brain function. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: COGNITIVE BEHAVIORAL TREATMENT OF SOCIAL PHOBIA

AND

PHARMACOLOGICAL

Principal Investigator & Institution: Heimberg, Richard G.; Temple University 406 Usb, 083-45 Philadelphia, Pa 19122 Timing: Fiscal Year 2002 Summary: The primary objective of this study is the continued evaluation of cognitivebehavioral group therapy and the monoamine oxidase inhibitor phenelzine as treatments for the anxiety disorder social phobia. In this study, we examine a number of additional questions, e g:(1)is there utility to combining cognitive behavioral therapy with phenelzine pharmacotherapy; (2) does cognitive behavioral treatment produce greater effects if administered for a longer period of time. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COGNITIVE TRAINING FOR SOCIAL ANXIETY Principal Investigator & Institution: Huppert, Jonathan D.; Assistant Professor of Psychology in Psy; Psychiatry; University of Pennsylvania 3451 Walnut Street Philadelphia, Pa 19104

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Timing: Fiscal Year 2003; Project Start 11-JUN-2003; Project End 31-MAY-2007 Summary: (provided by applicant): This application proposes Jonathan D. Huppert, Ph.D. for a K23 Mentored Patient Oriented Research Career Development Award at the University of Pennsylvania. The overarching goal of this award is for the applicant to acquire expertise in information processing/cognitive science of anxiety disorders and to translate this knowledge to the treatment of anxiety disorders through an independent program of research funded by NIH. The four-year program discussed in this proposal is designed to accomplish this goal by through five aims: 1) to solidify his foundation in cognitive science and advanced research methods; 2) to establish a research program on cognitive training of social anxiety that will integrate cognitive science and clinical outcome research; 3) to write and publish empirical and theoretical papers about such an integration; 4) to create collaborative relationships with clinical and cognitive science faculty at the University of Pennsylvania as well as other experts in the field; and 5) to prepare for further funding for this programmatic line of research. These aims will be accomplished through a structured four-part plan: 1) to receive further formal instruction in cognitive science, advanced research design, and bioethics; 2) to obtain training and mentoring by a senior scientist experienced in this area (Edna B. Foa, Ph.D.) as well by a collaborator (Andrew M. Mathews, Ph.D.) and consultants (Colin M. MacLeod, Ph.D., Richard G. Heimberg, Ph.D., David M. Clark, Ph.D., and Xin Tu, Ph.D.); 3) to coordinate ongoing clinical research trials at the Center for the Treatment and Study of Anxiety; 4) to design and execute an original program of research. A series of studies examining the factors involved in the modification of interpretation and attentional biases in social anxiety will be conducted. The goal of these investigations is to create a cognitive training program that directly addresses the core biases involved in causing and maintaining social anxiety. First, a new measure of interpretation bias will be developed using contextual priming in order to have a measure that is less likely to be confounded by repeated administration. Simultaneously, the nature of attentional bias in social anxiety will be clarified in order to bring some resolution to conflicting findings in the literature. Then, potential for modifying interpretation bias will be examined. In parallel, parameters related to modifying attentional bias in social anxiety will be examined. In addition, the relationship between cognitive biases and cognitive-behavioral therapy outcome in patients diagnosed with social phobia will be evaluated. Based on these findings, a cognitive training program for social phobia will be developed and will be further evaluated in future research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: COMPUTER BASED EXPOSURE THERAPY FOR SOCIAL ANXIETY Principal Investigator & Institution: Anderson, Page L.; Phd; Virtually Better, Inc. 2450 Lawrenceville Hwy, Ste 101 Decatur, Ga 300333226 Timing: Fiscal Year 2002; Project Start 20-MAR-2002; Project End 31-MAR-2004 Summary: (provided by applicant) This study will develop and test the feasibility of using virtual reality technology as a part of a computer-based exposure (CBE) self-help program to address public speaking fears. Public speaking anxiety is the most common fear among individuals, affecting up to 57 percent of the general population. Although cognitive-behavioral therapy is an effective treatment for social anxiety, many individuals do not seek treatment. Self-help programs are one popular alternative to psychiatric treatment. Primary goals of Phase I include are to develop a virtual environment for public speaking anxiety that can be used as a part of a CBE self-help program and to determine the effectiveness of CBE as compared to pre-treatment

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baseline. Ten participants who meet criteria for social phobia with a prominent fear of public speaking will be assessed using standardized measures prior to and following CBE and again at three-month follow-up. Phase II will test the relative efficacy of CBE and a cognitive-behavioral self-help manual for social anxiety versus a waitlist. The long-term objectives include the development of an effective and affordable self-help program utilizing virtual reality, leading to direct commercial access for anxiety sufferers to help them help themselves. PROPOSED COMMERCIAL APPLICATION: The commercial applications include: (1) the sale of PC-based self-help program to individuals suffering with social anxiety, (2) the utilization of the program by therapists as an adjunct to treatment, (3) the training of researchers and therapists in using this technology in therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DOPAMINE FUNCTION IN SOCIAL PHOBIA & RELATED CONDITIONS Principal Investigator & Institution: Schneier, Franklin R.; Associate Professor; Psychiatry; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 06-SEP-2002; Project End 31-AUG-2007 Summary: (provided by applicant): The overall goal of this proposal is to support the continuing development of the applicant as a scientist studying generalized social phobia (GSP) (also known as generalized social anxiety disorder), related traits, behaviors and disorders. The applicant will develop his capacity to utilize brain imaging methods in close collaboration with imaging experts, in order to assess brain function associated with these conditions. Training goalsfocus on increasing the applicant's understanding of single photon computerized tomography (SPECT) and positron emission tomography (PET) techniques and dopamine (DA) neurociruitry. A research goal is to integrate multiple imaging findings in GSP and related conditions, toward testing models of DA neurocircuitry. This program builds on recent findings of low DAD2 receptor and DA transporter binding in GSP and the related trait of detachment. The applicant will further characterize DA system dysfunction in collaboration with N.Y. State Psychiatric Institute's Functional Brain Mapping Division, directed by Dr. Marc Laruelle. The applicant will use PET and SPECT to study the relationship of D2 receptors, DA transporters, and DA release in patients with GSP (specific aim 1). Main hypotheses are that striatal D2 receptor and DA transporter binding will be low, and DA release will be blunted. Specific aim 2 will test whether DA system findings in GSP represent a trait or a state finding that changes with treatment. Hypotheses are that low D2 binding at baseline and change in D2 binding during treatment will be associated with symptomatic improvement during treatment Specficity offindings to GSP will be studied by assessing D2 receptor binding and amphetamine-induced DA release in patients with major depressive disorder with atypical features, which like GSP is characterized by interpersonal sensitivity, (specific aim 3). Specific aim 4 will study associations of biologically salient traits of detachment, submissive behavior, capacity for social reward, and social memory with GSP and DA function. Long-term goals include integration of phenomenology related to GSP with imaging measures, treatment outcome, animal findings, and genetics. Better understanding of the neurocircuitry associated with GSP holds promise for improving diagnosis and treatment strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DYSFUNCTION OF AFFECTIVE CIRCUITRY IN AUTISM Principal Investigator & Institution: Davidson, Richard J.; Vilas Professor; University of Wisconsin Centers 149 N Frances St Madison, Wi 53703 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2008 Summary: The broad goal of this project is to examine the brain circuitry underling emotion in autistic and comparison subjects. In response to previous reviews, we now restrict data collect to the Wisconsin site. All studies will involve functional magnetic resonance imaging (fMRI) during tasks designed to probe different aspects of affective function. In addition, all studies will also use eye tracking in the scanner to ascertain precisely where subjects are fixating during stimulus presentation since some of the extant neuroimaging data in autistic subjects are assumed to be a function of the fact that autistic subjects are exhibiting gaze aversion and not foveating the stimuli to the same degree as controls. Since the last submission, we have collected pilot data on 8 participants with autism and 10 controls illustrating our capability for measuring gaze patterns in the scanner, recording electrodermal activity in the scanner and successfully collecting fMRI data. In each of the proposed studies, analyses will be conducted on all trials, as well as restricted to only those trials during which subjects are fixating on the stimuli. Aim 1 is to test the hypothesis that when fixating on social stimuli (e.g., faces) autistic subjects will show increased activation in the amygdala and increased electrodermal activity. Aim 2 will test the hypothesis that autistic subjects will show more fixation to non-social positive stimuli while controls will show more fixation to social positive stimuli. In circuitry associated with positive affective responding such as the ventral striatum, we predict that autistic subjects will show the greatest activation in response to ideographic non-social stimuli while controls will show the greatest activation to ideographic social stimuli. We predict that autistic subjects will show greater activation in the amygdala and other regions associated with negative affect in response to social vs non-social stimuli while controls will not show amygdala activation in this contrast. Aim 3 will use a task that involves the presentation of congruent and incongruent faces and voices. We predict that autistic subjects will show less activation in the anterior cingulate cortex in response to the incongruent conditions compared with the congruent conditions relative to controls. We will also test a sample of children with social phobia to use a second comparison group to ascertain the extent to which the deficits observed for autistic subjects are specific to this population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: EARLY INTERVENTIONS FOR ANXIOUS CHILDREN Principal Investigator & Institution: Bernstein, Gail A.; Associate Professor; Psychiatry; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2003; Project Start 01-DEC-2002; Project End 30-NOV-2005 Summary: (provided by applicant): This R21 application is in response to Program Announcement #PA-99-134 Exploratory/Development Grants for Mental Health Intervention Research. This project focuses on early identification of anxious children and pilot testing of school-based group interventions for anxious youth. Anxiety disorders are among the most prevalent psychiatric disorders in children. These disorders are strongly associated with risk for later developing mood disorders and other psychiatric disorders, academic failure, substance abuse problems, and other significant health problems. Up to 10-15% of the general youth population has an anxiety disorder. Anxiety disorders are associated with functional impairment and substantial morbidity. Longitudinal studies have demonstrated that untreated anxiety

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disorders in children may continue for years. For all these reasons, early identification and intervention are critical for preventing anxiety disorders and returning anxious children to the normal developmental trajectory. This R21 will employ a multiple gating procedure to identify children (ages 7-11) with features or diagnoses of separation anxiety disorder, generalized anxiety disorder, or social phobia. Schools will be randomly assigned to one of three conditions: (1) group cognitive-behavioral therapy (CBT) for children, (2) group CBT for children plus parent training, or (3) treatment as usual. Treatment as usual will consist of whatever the school would normally recommend for a child identified as anxious. Active treatments will utilize the FRIENDS Manual and will be provided at school. The FRIENDS manual will be expanded to provide a more intensive parent training component (i.e., parental anxiety management, understanding the child's anxiety in the family context, contracting and contingency management). All children will be followed prospectively with assessments at 3 months and 6 months post-treatment. Outcome measures will evaluate symptom severity, level of functioning, remission of baseline anxiety disorders, and incidence of new anxiety disorders. Data from this study will guide a large-scale school-based investigation of group interventions for anxious youth. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ETIOLOGICAL FACTORS IN ADOLESCENT SOCIAL PHOBIA Principal Investigator & Institution: Inderbitzen-Nolan, Heidi M.; Associate Professor; Psychology; University of Nebraska Lincoln Lincoln, Ne 685880430 Timing: Fiscal Year 2002; Project Start 01-JUN-2000; Project End 31-MAY-2005 Summary: Mental health professionals have only recently begun to appreciate the staggering prevalence of child and adolescent psychopathology. One particular anxiety disorder that has received limited research attention and, yet, has significant consequences for youth is social phobia. Although research in the area of social phobia in youth is very limited, there has been a plethora of research examining this disorder in adults over the last several years. Theories concerned with the etiology and maintenance of this disorder have often focused on behavioral, cognitive and physiological factors. Although all three of these factors (behavior, cognitions, and physiological arousal) have been found to be related to social phobia in adults, there has been extremely limited research looking at whether these same three factors are related to social phobia in youth. Thus, the purpose of the present study is to examine the role that behaviors, cognitions, and physiological arousal play in social phobia in adolescents. Participants will be approximately 450 youth, 13 to 17 years of age and their parents. Participants will be recruited through flyers mailed to the homes of parents with youth enrolled in the public schools between the ages of 13 and 17. It is expected that approximately 225300 of the youth will be classified into one of three groups (social phobic, socially anxious, and normal controls) using information gathered from diagnostic interviews and questionnaires. Youth in the three different groups will be compared with regard to their performance on several cognitive tasks (i.e, Stroop task and several memory tasks), physiological arousal (i.e., cortisol levels, heart rate, blood pressure, and body temperature), and behavioral skills during two behavioral role-plays (i.e., an contribute to the overall body of literature on social phobia, will extend the research investigating social phobia in adolescents, and will suggest important avenues for the development of effective treatment programs for youth with social phobia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: FAMILY INTERACTION AND SOCIAL ANXIETY IN CHILDREN Principal Investigator & Institution: Morris, Tracy L.; Associate Professor; Psychology; West Virginia University P. O. Box 6845 Morgantown, Wv 265066845 Timing: Fiscal Year 2002; Project Start 23-AUG-2001; Project End 31-JUL-2003 Summary: (provided by applicant): Understanding of the clinical manifestations of social anxiety in adult populations has increased dramatically in recent years. However, empirical data on the etiology and course of social anxiety in children is quite limited. Empirical investigation of potential pathways leading to the development of social anxiety will assist in the identification of children at risk for social phobia and may enhance efforts toward the development of early intervention or prevention programs. The primary aim of the study is the identification of differential styles of parent-child interaction associated with social anxiety, generalized anxiety, and depression. Participants will be recruited from siblings of participants in an ongoing longitudinal investigation being conducted by the principal investigator. Ninety-six children (aged 912) and their parents will serve as the sample for the proposed investigation. Participants will complete questionnaire symptom report measures, a diagnostic interview, and will participate in a series of laboratory tasks. The first task is actually an unstructured observation in which family members are left alone in a room for 5 minutes. Behavior will be videotaped and later coded for frequency of anxious verbalizations (e.g., comments about being observed, worry about performance). For the second task, families will discuss three hypothetical social scenarios (e.g., try-outs for the school play coming up next week)). Responses to scenarios will be coded for interpretation (threat v. no threat); proposed action of child (prosocial, avoidant, aggressive) and parents' support of child's proposed action. For the final task, children and their parents will work together to create two origami figures. Interactions will be videotaped for later coding. Coded interaction behaviors include such actions as praise, criticism, physical takeover, etc. Behaviors will be coded in 10-second intervals. Data will be analyzed primarily through a series of multiple regression procedures. Higher rates of anxious verbalizations during the unstructured observation are expected to be associated with higher levels of self-reported social anxiety. With respect to questionnaire data, parental encouragement of isolation is expected to emerge as the primary predictor of social anxiety, but not a significant predictor of general anxiety or depression. For the scenario discussion data, interpretation of threat is expected to be the primary predictor of child social anxiety, moderated by parental support. The origami interaction task data, will be analyzed with respect to whether aversive parenting strategies have any unique association with specific child symptoms or are merely associated with general negative outcome. For all analyses, potential interactions between parent- and child-gender will be explored. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: GENETIC ALCOHOLISM

EPIDEMIOLOGY

OF

SOCIAL

PHOBIA

AND

Principal Investigator & Institution: Nelson, Elliot C.; Assistant Professor; Psychiatry; Washington University Lindell and Skinker Blvd St. Louis, Mo 63130 Timing: Fiscal Year 2002; Project Start 01-AUG-1999; Project End 31-JUL-2004 Summary: This proposal is for a NIAAA Mentored Clinical Scientist Development Award (KO8) to foster the development of Dr. Elliot Nelson's career by supporting his work with Dr. Andrew Heath and Dr. Richard Todd. The award will enable the candidate to explore the relationship of alcohol dependence and social phobia,

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controlling for comorbid major depressive disorder (MDD). The candidate's career development will include a program of formal coursework and independent tutorials focusing on biostatistics, genetic epidemiology, research methodology (including the mediation of alcohol dependence and dangerous behavior risks), and behavioral and quantitative genetics. The skills acquired will be applied to both the analysis of existing data and to an independent research project designed to provide a better understanding of the mediation of shared risk. The preliminary data from adolescent female twins suggests that comorbid alcohol dependence is likely to be seen at increased rates in individuals with social phobia and that these subjects are also at increased risk for dangerous behaviors such as having unprotected sex, suicidal ideation, suicide plans, and suicide attempts. The goals of the proposal are to collect two waves of data on l00 control pairs and l00 pairs where at least one twin has a history of social phobia. We will use these data, plus existing data-sets, to address the following Specific Aims: l) To characterize prospectively the profile of comorbid illness observed in individuals with social phobia; 2) To determine prospectively the risk for alcohol dependence and harmful alcohol use given a primary diagnosis of social phobia; 3) To use multivariate twin analysis to characterize the relative contributions of disorder-specific and shared genetic and environmental risk factors for social phobia, alcohol dependence, and MDD; 4) To examine whether a variety of dangerous behaviors are seen more frequently in individuals with social phobia, and determine their association with the development of alcohol problems; 5) To examine the routes by which the shared risks appear to be mediated (including both risks of comorbid illness and dangerous behaviors). Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GENETIC STUDIES OF CHILDREN/ADOLESCENTS WITH ANXIETY DIS Principal Investigator & Institution: Labellarte, Michael; Johns Hopkins University 3400 N Charles St Baltimore, Md 21218 Timing: Fiscal Year 2002 Summary: Anxiety disorders are relatively frequent in the pediatric population and are responsible for significant morbidity. We are currently conducting a clinical trial of fluvoxamine treatment of childhood and adolescent-onset anxiety disorders, specifically separation anxiety disorder, generalized anxiety disorder, and social phobia. This study is an opportunity to utilize a molecular genetic research design to study the genetics of anxiety in a pediatric population. This proposed study will examine three primary associations: 1) the presence of childhood-onset anxiety disorders and serotonin (5HT) related candidate genes, 2) temperament and 5HT related genes, and 3) response of childhood anxiety to treatment with fluvoxamine and 5HT related genes. Identification of specific genetic factors may lead to advanced prevantative and treatment strategies. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: HARVARD BROWN ANXIETY RESEARCH PROJECT Principal Investigator & Institution: Keller, Martin B.; Professor; Psychiatry and Human Behavior; Brown University Providence, Ri 02912 Timing: Fiscal Year 2002; Project Start 01-APR-1995; Project End 30-NOV-2003 Summary: We propose to continue the Harvard/Brown Anxiety Research Program (HARP), a unique, naturalistic, prospective, multicenter study of 478 currently active subjects with anxiety disorders, for an additional 4 years of follow-up. This will enable

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Social Phobia

us to create a complete master file with a minimum of 11 years of follow-up data on all active subjects and to incorporate new assessments and data analysis methods in order to address important unanswered questions and develop a comprehensive picture of the longitudinal course and outcome of 3 common anxiety disorders: panic disorder with and without a agoraphobia, generalized anxiety disorder, and social phobia. Our specific aims are to 1) comprehensively map patterns of course for the 3 anxiety disorders; 2) examine predictors/mediating variables, such as stressful life events, depression, substance abuse, and personality disorders, associated with the course of anxiety disorders; describe medication received and investigate the mediating effect of medication on course; 4) assess the relationship between psychosocial functioning and anxiety; symptom severity; and 5) examine the utility of a dimensional approach (i.e., anxiety - and mood-related traits) in characterizing the nature and course of the anxiety disorders and comorbid depressive disorders. Subjects will be evaluated at 6 month intervals with instruments that obtain detailed information on symptom status and severity, diagnostic status, treatment received, psychosocial functioning, and other domains. Since our earlier submission we have added new assessments that measure stressful life events, underlying mood- and anxiety-related traits, and symptom severity independent of diagnosis and functioning; we have also incorporated new data analysis methods in order to answer important questions about the anxiety disorders. To have sufficient statistical power to test our hypotheses, 4 more years of prospective observation are needed. The HARP data set is unique in its large number of subjects, comprehensiveness of assessment, and length of prospective follow-up. This proposal will allow us to more completely investigate the aims and hypotheses of the previously funded grant and to add new, previously unexplored aims and hypotheses generated by findings from HARP and other investigators during the past 4 years. Continuation of HARP is expected to shed new light on clinically and theoretically important, innovative questions about a group of common and impairing disorders which have not been adequately addressed by previous research. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMPLICIT AND EXPLICIT MEMORY FOR FACES IN SOCIAL PHOBIA Principal Investigator & Institution: Coles, Meredith E.; Psychology; Temple University 406 Usb, 083-45 Philadelphia, Pa 19122 Timing: Fiscal Year 2002; Project Start 01-JUL-2002 Summary: The study proposed herein seeks to examine implicit and explicit memory biases for critical faces in individuals with social phobia (SP). A solid understanding of the psychopathology of SP is essential as this syndrome is one of the most common and debilitating of all psychiatric diagnoses. One promising route to furthering our understanding of the psychopathology of SP is to employ the methods of experimental psychopathology to examine possible biases in information-processing. Biases may occur at automatic stages of processing, beyond conscious awareness, prohibiting the use of introspective self-report methods, making the methods of experimental psychopathology particularly useful. Memory biases may play a particularly important role as intrusive memories are a common symptom of several anxiety disorders. However, while much knowledge has been gained from examining memory biases in SP in previous studies, limitations of the existing literature make firm conclusions difficult. The study proposed herein seeks to address previous limitations in an effort to further our understanding of the role of implicit and explicit memory biases in SP. Specifically, the proposed study will use a modified visual analogue version of Jacoby, Allan,

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Collins, and Larwill's (1988) white noise judgement paradigm. In this study, critical and neutral faces will be presented to individuals with social phobia (SPs) and non-anxious controls (NACs). Two separate memory tests will be employed, with one assessing implicit memory biases and the other assessing explicit memory biases, for critical faces in individuals with SP as compared to NACs. Further, the two groups will also be compared on immediate rote recall to rule-out this factor as a possible explanation for group differences in memories for emotional stimuli. Findings from this study will be utilized to inform existing models of the psychopathology underlying SP and explore possible refinements in existing treatment interventions. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INFORMATION PROCESSING BIASES IN DEPRESSION Principal Investigator & Institution: Gotlib, Ian H.; Professor; Psychology; Stanford University Stanford, Ca 94305 Timing: Fiscal Year 2002; Project Start 01-JAN-1999; Project End 30-JUN-2004 Summary: Depression is among the most prevalent of all psychiatric disorders, accounting for over 20 percent of economic costs for all mental illness. A great deal of theoretical attention has focused on the possibility that negative thinking might represent not only a feature of depression, but a vulnerability factor for this disorder as well. A recent influential research paradigm has operationalized depressotypic cognitions in terms of selective attention to, and memory for, negative emotional stimuli. The overall goal of the proposed investigations is to utilize this paradigm to investigate the role of cognitive biases in onset and course of depression, and to examine neurobiological foundations of cognitive biases in depression. Specific aims include (1) examining the utility of cognitive biases to predict the course of depressive symptoms and diagnostic status over a two-year period; (2) localizing the neurobiological underpinnings of these biases; and (3) examining the breadth of these biases and their specificity to depression. To achieve these aims, standardized cognitive informationprocessing tasks will be used to identify 30 "high-bias" and 30 "low- bias" depressed patients in psychiatric outpatient clinics. The nature and breadth of these biases in the depressed patients will be compared to cognitive biases among 30 patients diagnoses with generalized anxiety disorder, 30 patients diagnosed with social phobia, and 30 non-patient controls. Each depressed patient will be followed for one year, and the degree of cognitive biases will be reassessed when the patient achieves clinical remission. Hypotheses concerning the neurobiological underpinnings of depressotypic cognitive biases will be tested by conducting functional magnetic resonance imaging (MRI) of depressed (and later, remitted) patients while they are performing informationprocessing tasks. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: INTERPERSONAL PSYCHOTHERAPY FOR SOCIAL PHOBIA Principal Investigator & Institution: Lipsitz, Joshua D.; Anatomy and Cell Biology; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 01-AUG-1998; Project End 31-JUL-2004 Summary: (Applicant's abstract): Social phobia is a common and debilitating disorder. Because established treatments are effective for many but not all social phobia patients, research into alternative treatments in needed. In response to this need, this Mentored Clinical Scientist Development Award proposal pursues two distinct, yet interdependent goals. The first is to develop the principal investigator's ability to

22

Social Phobia

conduct independent research in the psychosocial treatments of anxiety disorders. Second, the proposed research tests the efficacy of interpersonal psychotherapy (IPT) for social phobia and expands on this question through additional projects. The training program will integrate: 1) course work in research design, statistics, and the ethical conduct of research, 2) intensive tutorials and ongoing training in specific psychotherapy approaches, 3) supervision by the primary mentor in carrying out the research plan, and 4) supervision from specialized preceptors in various aspects of research with IPT and psychotherapy research for the anxiety disorders. The planned research expands on promising preliminary results with interpersonal psychotherapy for social phobia through three projects. The primary project is a controlled clinical trial with randomized assignment to interpersonal psychotherapy for social phobia (IPT-SP) or a credible psychotherapy control. Comprehensive assessment will be conducted periodically during treatment and at 6 and 12 months following treatment. In a second project, IPT-SP will be modified for treatment of groups, and this treatment will be piloted in a group of social phobia patients. In a third project, available narrative summaries from 120 panic disorder patients will be analyzed to explore the relevance of IPT for panic disorder. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: LATENT APPLICATION

STRUCTURE

OF

ANXIETY--EVALUATION

AND

Principal Investigator & Institution: Ruscio, Ayelet M.; Psychology; Pennsylvania State University-Univ Park 201 Old Main University Park, Pa 16802 Timing: Fiscal Year 2002; Project Start 01-APR-2002 Summary: The proposed research program aims to begin to test whether anxiety is categorical or dimensional in nature. In years 1 and 2 of the research program, a series of investigations will empirically evaluate the structural nature of three anxiety disorders: generalized anxiety disorder, posttraumatic stress disorder, and social phobia. Each disorder will he examined in large clinical and analogue samples using sophisticated taxometric procedures designed to test latent structures. Follow-up analyses will inspect the overlap between the three disorders to increase understanding of their frequent comorbidity. In years 3 and 4, a therapy outcome investigation will assess the efficacy of a classification scheme (either categorical or dimensional) derived from taxometric analysis of generalized anxiety disorder. The investigation will compare this classification scheme to traditional DSM-IV diagnosis on the relative ability to predict prognosis, treatment response, and functional outcome following a brief clinical intervention for chronic worry. Results of the proposed research are expected to enhance scientific understanding of the nature of anxiety, with important implications for the conceptualization, assessment, investigation, and treatment of the anxiety disorders. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MENTORING AND CAREER DEVELOPMENT IN ALCOHOL RESEARCH Principal Investigator & Institution: Randall, Carrie L.; Professor; Psychiatry and Behavioral Scis; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425 Timing: Fiscal Year 2002; Project Start 20-SEP-2001; Project End 31-AUG-2006 Summary: (provided by applicant): This proposal is submitted to request support for Carrie Randall, Ph.D. in her continued efforts to mentor clinical investigators and to

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conduct patient-oriented research. Her main interest is in comorbidity research, specifically alcoholism and social anxiety disorder (aka social phobia). She has served as PI on two funded research projects related to alcoholism and social anxiety disorder, including Alcohol and Social Phobia: Treatment of Dual-Diagnosis (NIAAA), and A Double-Blind, Placebo-Controlled Trial of Paroxetine Treatment of Comorbid Social Anxiety and Alcoholism (Smith kline Beechain). Besides her reputation as a quality researcher and her strong track record of funding in both basic science and clinical research, the candidate has an excellent record of mentorship. She has served as training director for NIAAA- and NIDA-funded training grants and has mentored over 20 basic science and clinical investigators who have continued in alcohol research. Her immediate goals are to continue to mentor junior investigators, and to acquire new skills to assist her in continuing her own patient-oriented research. Toward this end, she will submit an R01 for a clinical trial on the treatment of alcoholics with social anxiety disorder and will acquire skills and knowledge in expectancy and human laboratory research (as these relate to alcohol use and social anxiety). Her long-term goal is to continue to develop a unique expertise in the area of comorbidity of alcohol and anxiety disorders through the opportunities afforded by this award. This expertise better enables her to mentor junior clinical researchers in conducting patient-oriented alcohol research in the future. The award is needed to provide the candidate with the time required to meet these goals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: CHILDREN

PSYCHOBIOLOGY

AND

TEMPERAMENT

IN

HIGH

RISK

Principal Investigator & Institution: Fairbanks, Janet M.; Psychiatry; Columbia University Health Sciences New York, Ny 10032 Timing: Fiscal Year 2002; Project Start 01-MAY-1998; Project End 31-OCT-2003 Summary: (Adapted from applicant's abstract): This application for a Mentored Clinical Scientist Development Award has the long-term objective of developing the applicant's ability to conduct independent research in developmental psychopathology, specifically, temperamental risk factors and their biological correlates in children at risk for anxiety disorders. Rachel Klein, Ph.D., primary sponsor, will oversee training of the applicant in methodology, assessment and data interpretation. Jack Gorman, M.D. will supervise biological studies, and physiology training. Training will be accomplished by means of: 1) supervision with experienced researchers, 2) internships in cardiac physiology, respiratory physiology, and brain function, 3) formal instruction in statistics, and 40 implementation of the research project. Course work will provide the necessary background in biostatistics and epidemiology to conduct data analyses. Training in data collection processing and analysis will be obtained through carrying out the Research Plan. The purpose of the research is to further understanding of the developmental psychopathology of anxiety disorders through the study of early temperament. The goal is to conduct an in-depth examination of behaviorally inhibited temperament and its biological correlates in at-risk children. Specific aims are to examine the relationship between behavioral inhibition and 1) parental anxiety disorders, and 2) physiological function exploring the influence of parental diagnosis on these relationships. These aims will be addressed through a top-down, high-risk study of 3-5 year old offspring of adults with lifetime panic disorder, social phobia, or major depression, and offspring of normals. Behavioral inhibition will be qualified through direct observational protocols blind to parent diagnosis. Biological procedures examine autonomic dysregulation of cardiac function and skin temperature, asymmetries of brain electrical activation and

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Social Phobia

skin temperature. HPA Axis, and respiratory function. Measures of autonomic function include: 1) heart rate (HR), 2) heart rate variability (HRV) and spectral analysis of HRF, 3) acceleration of HR, 4) blood pressure, and 5) skin temperature. Techniques of quantitative EEG measure brain activational asymmetry. Salivary cortisol measures HPA Axis dysregulation. Measures of respiratory function include end-tidal carbon dioxide, respiratory rate, tidal volume, and minute ventilation. These have been implicated in behavioral inhibition and anxiety disorders. The study of risk factors has important implications for early identification and ultimately prevention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PURIFIED SEROTONIN RECEPTORS FOR STRUCTURAL STUDIES Principal Investigator & Institution: Salom, David; Novasite Pharmaceuticals, Inc. 11095 Flintkote Ave San Diego, Ca 921211214 Timing: Fiscal Year 2003; Project Start 01-AUG-2003; Project End 31-JAN-2004 Summary: (provided by applicant): Serotonin (5-HT) is a neurotransmitter that has been implicated in the aetiology of numerous Mental Health disorders, including depression, anxiety, social phobia, schizophrenia, obsessive-compulsive and panic disorders, migraine, and eating disorders. There are 12 5-HT receptor subtypes with similar recognition properties yet widely divergent physiological roles that belong to the same family of G Protein Coupled Receptors (GPCRs), hindering the discovery of subtypeselective drugs. Knowledge of the 3-dimensional structure of these receptors would enable the design of selective drugs. However, solving the structure at atomic resolution of membrane proteins such as GPCRs has been hampered by the difficulty to purify sufficient amounts of homogeneous and functional protein. Here, it is proposed a novel, proprietary expression system combined with a purification method to generate large amounts of high quality purified receptor, which could solve the bottleneck for structural elucidation of these important drug targets. In Phase I, the feasibility of the proposed approach will be tested for all the 12 human 5-HT GPCRs. In Phase II, this approach will be developed resulting in purified homogenous protein for each human 5- HT receptor subtype. This high quality purified material will be a highly valuable product enabling structural elucidation of these receptors. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: QUALITY IMPROVEMENT OF SCHOOL MENTAL HEALTH SERVICES Principal Investigator & Institution: Kataoka Endo, Sheryl K.; Psychiatry & Biobehav Sciences; University of California Los Angeles 10920 Wilshire Blvd., Suite 1200 Los Angeles, Ca 90024 Timing: Fiscal Year 2004; Project Start 01-DEC-2003; Project End 30-NOV-2008 Summary: (provided by applicant): This is a request for a Mentored-Clinical Scientist Development Award. The candidate is a child psychiatrist whose long-term career goal is to improve the quality of mental health services delivered in schools, using a quality improvement framework. The candidate's more immediate career goal is to become an independent investigator who partners with the school community to improve the treatment of anxiety disorders (separation anxiety, social phobia, and generalized anxiety disorder) for students receiving school counseling services through Special Education. To accomplish these goals, the candidate's career development plan will consist of the following: 1) Coursework in qualitative methods, special education, quality of care, cultural issues in assessment and treatment, and advanced quantitative

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25

analysis; 2) In-depth supervision in quality improvement methods; in mixed methods approaches; in development of school interventions that take into account the school ecology and working with multicultural communities. The research plan will use a quality improvement framework for exploring how to make changes within school services from the perspective of multiple stakeholders. The specific aims are to: 1) To critically evaluate and adapt evidence-based reviews, practice parameters, and a standardized CBT intervention for childhood anxiety disorders, for use in schools; 2)To describe the current mental health services provided to students in special education; and 3) To develop a protocol for delivering services for special education students who have anxiety disorders and to pilot this program for feasibility and acceptability. This project will provide pilot data for an R01 application to evaluate the effectiveness of this program on a larger population of students in special education. The overall goal of this career development award is for Sheryl Kataoka to develop expertise and research skills in order to independently pursue a research career focused on developing and applying a quality improvement model to improving mental health services in schools, especially targeting ethnic minority youth. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: REAL-TIME CLASSIFICATION

FMRI

AT

HIGH

FIELD

/

AUTOMATIC

Principal Investigator & Institution: Posse, Stefan; Assistant Professor; Psychiatry & Behav Neuroscis; Wayne State University 656 W. Kirby Detroit, Mi 48202 Timing: Fiscal Year 2003; Project Start 30-SEP-2003; Project End 31-AUG-2006 Summary: (provided by applicant): This proposal, Interactive Real-time fMRI at High Field with Automatic Classification of Activation Patterns is submitted in response to RFA EB-03-007. The objective of this application is to further develop highly sensitive multi-echo pulse sequences with parallel imaging data acquisition and compensation of susceptibility artifacts at high magnetic field (4 Tesla), and to design real-time data analysis methods that allow automatic classification of brain activation patterns in terms of underlying cognitive processes. Feasibility of this methodology has already been shown in pilot studies at 1.5 and 4 Tesla. A secondary goal is to validate this methodology with interactive experimental paradigms by characterizing neural correlates of cognitive and emotional processes in individual subjects. This novel realtime fMRI methodology is applicable to a wide range of neuroscience research and to a variety of neuro-psychiatric conditions in which pathology of the amygdala is implicated, such as unipolar and bipolar depression, anxiety, schizophrenia, psychopathy and social phobia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SOCIAL PHOBIA: ASSESSMENT AND TREATMENT OF SOCIAL SKILL Principal Investigator & Institution: Turner, Samuel M.; Professor; Psychology; University of Maryland College Pk Campus College Park, Md 20742 Timing: Fiscal Year 2003; Project Start 01-DEC-2002; Project End 30-NOV-2006 Summary: (provided by applicant): Data from the National Comorbidity Study revealed the lifetime prevalence of social phobia to be 13% and the 6-month prevalence to be 8%. These figures indicate that social phobia is the most common anxiety disorder and one of the most common emotional disorders in the general population (second only to substance abuse). Social phobia has an early onset and appears to follow a chronic and

26

Social Phobia

unremitting course. Social phobics suffer severe emotional distress, social avoidance, increased use of alcohol and other drugs, increased suicidal ideation and attempts, incomplete educational attainment, and social, educational and occupational maladjustment (including lost productivity). A prominent gap in understanding the psychopathology of social phobia is whether the disorder is characterized by deficits in social skills. Extant data have provided mixed findings, but the weight of the clinical evidence is that social phobics are deficient in social skills but the exact skill deficits remain to be elucidated. Whether or not social phobics are deficient in social skill has implications for how psychosocial treatment is carried out. Conceptually, there are two studies proposed in this application. The first study is designed to determine if social phobics manifest social skills deficits, explicate the nature of the deficiencies, and determine if the generalized are more deficient than the non-generalized (specific subtype). A normal comparison group will be included in order to allow for a comparison of social skills in social phobics to those of normals. Also, including the normal group will allow for the generation of norms to which the social skills of social phobics in future studies can be compared. The second study is designed to determine if skill deficits in generalized social phobics can be improved, and whether improvements in social skills are associated with improvements in overall social functioning Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ST. JOHN'S WORT VS PLACEBO IN SOCIAL PHOBIA Principal Investigator & Institution: Kobak, Kenneth A.; Senior Research Scientist; Dean Fdn for Health, Research & Educatn Research and Education Middleton, Wi 53562 Timing: Fiscal Year 2002; Project Start 17-SEP-2001; Project End 31-AUG-2004 Summary: (provided by applicant): Social Phobia is a prevalent and debilitating condition, with a lifetime prevalence rate to be 13.3 percent. Socially phobic patients have been found to be functionally impaired in the areas of education, employment and social relationships, to have poorer quality of life, and increased suicidal ideation and psychiatric comorbidity. Double-blind studies have found benzodiazepines, selective and non-selective MAOI inhibitors, several SSRIs, and the anticonvulsants pregabalin and gabapentin to be effective. However, side effects with these compounds suggests the need for better tolerated compounds, e.g., in the paroxetine multi-center trial (the only drug with an FDA approved indication), 27 percent reported somnolence, 26 percent nausea, and 37 percent of males reported delayed ejaculation; 34 percent of patients discontinued the trial early. There has been considerable worldwide interest in St. John's Wort (SJW) (Hypericum perforatum) as a treatment of mild to moderate depression. There have been 23 randomized trials suggesting SJW is more effective than placebo for the treatment of outpatients with mild to moderate depression. SJW is very well tolerated with mild side effects observed in only 2.5 percent of cases in a large (3250 patients) drug monitoring study. Pharmacokinetic studies have found Hypericum to have affinity for serotonin, dopamine and GABA alpha and GABA beta receptors, each of which have been implicated in social phobia, thus there is a suggestion that SJW may be effective for this disorder. This will be a 12-week, double blind, placebo-controlled trial, designed to generate effect size data that will be used to determine sample size needed to power a definitive study. Forty patients will be randomized to either SJW (LI 160) or matching placebo. This will be a flexible-dose design, starting at 300 mg tid to a maximum of 1800 mg total per day. An intent-to-treat analysis will be employed. Subjects will be evaluated weekly for two weeks, then bi-weekly thereafter. The primary outcome measure will be the change from baseline to endpoint on the Liebowitz Social Anxiety Scale.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: STRUCTURE AND ASSESSMENT OF SYMPTOMS OF DEPRESSION Principal Investigator & Institution: Watson, David B.; Professor; Psychology; University of Iowa Iowa City, Ia 52242 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-APR-2008 Summary: (provided by applicant): Many of the most frequently used depression instruments were created more than 40 years ago, without the benefit of rigorous psychometric development and testing. Most of these measures were designed to provide only a single overall index of depression, so that they do not yield reliable and valid subscales assessing specific types of depressive symptoms. Furthermore, progress in this area is hampered by our limited understanding of the internal structure of depressive symptoms. The proposed work will result in a multi-dimensional measure of depression that will include a wide range of depression symptoms, as well as symptoms of related anxiety disorders such as generalized anxiety disorder, social phobia, and panic disorder. The scales comprising the final measure will be suitable for use in clinical outcome research as well as other studies of the etiology and consequences of depression. The process will begin with the creation of a comprehensive item pool; our review of the literature indicates that this pool should multiple groups of items assessing prominent symptoms of depression, another group of items measuring positive emotionality, and several clusters of anxiety-related items. These items will undergo extensive testing with diverse samples of both clinical and non-clinical adult populations. The goal of the initial phases of the proposed research is to determine the factor structure of depression and related symptoms so that appropriate subscales are modeled in the final measure. Further studies will assess the construct validity of the resulting factor-based measures through analyses of their (a) sensitivity to change and (b) convergence with other self-report and clinician-rated measures of depression and anxiety. The next group of proposed studies will use advanced psychometric methods (including confirmatory factor analysis and item response theory) to assess the suitability of the measure--at both the subscale and item level--in different populations (e.g., adolescents, pregnant and postpartum women, and older adults) and to modify the instrument as necessary for use with these populations. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: THERAPY SPECIFICITY AND MEDIATION IN FAMILY & GROUP CBT Principal Investigator & Institution: Silverman, Wendy K.; Professor; Psychology; Florida International University Division of Sponsored Research and Training Miami, Fl 33199 Timing: Fiscal Year 2002; Project Start 09-JUL-2002; Project End 30-JUN-2007 Summary: Considerable evidence has now accumulated demonstrating the efficacy of Individual Child Cognitive Behavior Therapy for reducing anxiety disorders in children. In growing recognition that the child's context affects the development, course, and outcome of childhood psychopathology and functional status, recent clinical research efforts have been directed toward evaluating whether cognitive behavior therapy when used with anxious children also is efficacious when particular contexts (i.e., family/parents, group/peer) are incorporated in the treatment program. As a result, there now exists considerable empirical evidence that childhood anxiety disorders also can be reduced in cognitive behavioral treatment programs that incorporate

28

Social Phobia

family/parents and peer/group contexts and target specific domains/content areas relevant to these contexts. Despite the above, there have been no studies that have directly evaluated whether family/parents and peer/group interventions that target specific domains/variables and content areas relevant to that respective intervention context actually produce specific effects on these domains/variables and, more importantly, whether changes produced on these variables mediate treatment response. Consequently, claims regarding the importance of incorporating (or not incorporating) family/parents and peer/groups and targeting respective variables relevant to each context in order to produce child treatment response are based more on speculation than on empirical data. Investigating whether incorporating family/parents or peer/group contexts and targeting specific domains/variables and content areas relevant to these respective contexts, and whether changes on these variables mediate treatment response in two cognitive behavioral treatments that each represent these distinct contexts (i.e., family/parents and peer/group) among children with anxiety disorders, thus comprise the specific aims of this project. The study targets the same DSM-IV anxiety disorders targeted in previous clinical trials and that are most common in children: social phobia, generalized anxiety disorder, and separation anxiety disorder. Using a controlled clinical trial design, 252 children (ages 8-14 years) and their parents will be admitted to treatment over the five years of the study, yielding an estimated 216 treatment completers at post-test and 180 at one year follow- up. Children and their parents will be randomly assigned to one of two treatment conditions: Family/Parents Cognitive Behavior Therapy (FCBT) and Peer/Group Cognitive Behavior Therapy (GCBT). All participants will be assessed at pretreatment, posttest, and one-year followup. Two sets of hypotheses will be tested. Because each condition represents a distinct treatment context (family/parents and peer/group) that targets the same two domains (skills and relationships) but in two different content areas within each domain (i.e., parenting skills and parent-child relationships in FCBT versus child social skills and peer-child relationships in GCBT), the first set of hypotheses is designed to establish empirically whether there are in fact treatment specific effects. Thus, the first set of hypotheses to be tested is that FCBT will produce significantly greater specific effects on parenting skills and parent-child relationships than on child social skills and peer-child relationships. GCBT, on the other hand, will produce significantly greater specific effects on child social skills and peer-child relationships than on parenting skills and parent-child relationships. The second and more theoretically and practically significant set of hypotheses will test whether or not it is the changes that are produced on these variables that mediate treatment response. Thus, the second set of hypotheses to be tested is that parenting skills, parent-child relationships, child social skills and/or peer-child relationships will be significant mediators of treatment response, i.e., anxiety reduction. To test the study's mediational models and to fully examine specificity effects, a multi-analytic approach that includes structural equational modeling and other complex data analytic strategies (e.g., growth curve modeling) will be used. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TRAINING IN COMORBIDITY OF ALCOHOLISM AND MENTAL ILLNESS Principal Investigator & Institution: Book, Sarah W.; Psychiatry and Behavioral Scis; Medical University of South Carolina 171 Ashley Ave Charleston, Sc 29425 Timing: Fiscal Year 2003; Project Start 29-SEP-2003; Project End 31-AUG-2008 Summary: (provided by applicant): This application is designed to provide the candidate, Dr. Sarah Book, with skills and expertise in the treatment of alcoholism and

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co-occurring psychiatric disorders (psychiatric comorbidity), in general, and cooccurring alcoholism and social phobia, in particular. Psychiatric comorbidity is an area of recent interest to NIAAA, and one where well trained psychiatric researchers are needed. Perhaps more than 60% of individuals with alcoholism suffer from psychiatric comorbidity. This population is more likely to seek alcoholism treatment, their alcohol problems are more severe, and their outcomes tend to be more complicated and less favorable than for those without psychiatric comorbidity. In the past decade, there has been interest in using psychiatric comorbidity to sub-group alcoholics for treatment matching. The anxiety area has received considerably less attention than depression comorbidity, and more research is needed. Dr. Book's goal is to be a clinical-scientist with unique expertise in the treatment of alcoholism and anxiety disorder comorbidity. She desires K23 training to permit the development of a research program to enable her to conduct research, treat patients, and educate future medical professionals about the challenges faced in treating alcoholic individuals with comorbidity. The proposed research integrates her skills developed in clinical treatment of anxiety disorders with more recently acquired ones in treatment of alcohol dependence as inpatient attending in the Center for Drug and Alcohol Programs. The training plan identifies areas to be developed, including mastery of the literature, delivery of cognitive behavioral therapy for alcohol treatment, and exploration of gender differences in alcohol use disorders and psychiatric comorbidity. She will refine skills in critical reasoning, and develop skills in quantitative methods and grant writing. This award will allow Dr. Book protected time from her extensive clinical, education, and administrative responsibilities as an inpatient attending to further develop her research skills. Her ultimate goal is to become an independent clinical researcher, while still treating patients and providing didactic substance abuse education to future generations of medical professionals. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT OF CHILD ANXIETY IN NONPSYCHIATRIC SETTINGS Principal Investigator & Institution: Masia, Carrie L.; Psychiatry; New York University School of Medicine 550 1St Ave New York, Ny 10016 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 30-APR-2007 Description (provided by applicant): Anxiety disorders in youth are highly prevalent and associated with long-term negative consequences (e.g., depression, substance use). Yet, these disorders often go unidentified and untreated. The purpose of this application is to address this problem by developing skills to implement and evaluate early detection and intervention programs for child anxiety disorders in nonpsychiatric settings, including schools and pediatric medical settings. To accomplish these goals, a career development plan has been designed to: (1) obtain training in efficacy and effectiveness research methods, (2) adapt empirically-supported assessments and treatments for school and medical settings, (3) learn about the barriers to screening and intervention for anxiety disorders in these environments, and (4) receive training in statistical methods applied to naturalistic assessment, longitudinal data, and evaluation of clinical trials. Training will be provided via formal coursework, supervision and consultation with a panel of experts, and a research plan that complements the career development activities outlined in this application. The proposed research project will evaluate the relative efficacy of a manualized school-based cognitive-behavioral intervention to an attention control condition for adolescents with social anxiety disorder in a 2 (intervention condition) by 3 (pre-intervention, post-intervention, followup) mixed model factorial design with random assignment to condition and repeated

30

Social Phobia

measures on the second factor. It is expected that school-based cognitive-behavioral intervention will lead to significantly greater reduction of social phobia symptoms and greater improvement in general functioning than a non-specific intervention, and that these relative advantages will persist over time. Findings from this study will be used to inform the Candidate's application for an RO1 to conduct a full-scale study, and to guide the development of intervention programs in pediatric clinics. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT MODERATORS

OF

SOCIAL

PHOBIA--MEDIATORS

AND

Principal Investigator & Institution: Hofmann, Stefan G.; Psychology; Boston University Charles River Campus 881 Commonwealth Avenue Boston, Ma 02215 Timing: Fiscal Year 2002; Project Start 01-MAY-1998; Project End 28-FEB-2003 Summary: (Applicant's abstract): Social phobia is a very prevalent and debilitating disorder with public speaking anxiety being the most common tear among socially phobic individuals. Although there are a number of effective psychosocial treatments for social phobia (e.g., cognitive-behavioral treatments and exposure therapy) very little is known about the underlying mechanism of therapeutic change (i.e., the mediators of change), and the variables that are predictive. of treatment outcome (i.e., the moderators of change). Furthermore; it is unclear why treating individuals for their public speaking anxiety can generalize to other untreated social fears. The primary goal of the present study is to identify the mediators and moderators of change in the treatment of social phobia, and, in so doing suggest a common mechanism of action for all brief psychosocial interventions. Perceived self-efficacy of social behavior, negative cognitive appraisal (estimated social costs), and perceived emotional control will be considered as potential mediators; avoidant personality disorder and the generalized subtype of social phobia will be considered as potential predictors for poor treatment outcome. Individuals meetings criteria for social phobia with significant fear of public speaking will be randomly assigned to either a comprehensive cognitive-behavioral treatment for social phobia (n=43), a performance-based exposure treatment for public speaking anxiety without cognitive intervention (n=43), or a waitlist control group (n=43). Clinician ratings, behavioral tests, cognitive assessments, subjective ratings, and physiological measures will be employed to determine the degree of therapeutic gains in various social phobia domains. The main hypothesis is that perceived emotional control will mediate treatment outcome and generality of effectiveness independent of the specific treatment condition. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: VENTILATORY PHYSIOLOGY IN CHILDREN AT RISK FOR ANXIETY Principal Investigator & Institution: Klein, Rachel G.; Professor; Psychiatry; New York University School of Medicine 550 1St Ave New York, Ny 10016 Timing: Fiscal Year 2002; Project Start 28-SEP-1999; Project End 31-MAY-2004 Summary: The proposed investigation addresses the biology of risk for anxiety disorders. It derives from important parallel scientific concerns regarding the association between adult and child anxiety disorders, coupled with concerns regarding the mechanisms which underlie this association. The study specifically evolves from findings that link childhood separation anxiety disorder (SAD) and adult panic disorder (PD). These findings include: family studies noting elevated rates of SAD in offspring of

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adults with PD; longitudinal studies linking childhood SAD to adult PD; and biological studies finding CO2-hypersensitivity in children with SAD. CO2-hypersensitivity is also found in both adults with PD and non-ill adult relatives of patients with PD. Taken together, these findings point to the existence of a latent vulnerability to PD reflected in the respiratory system. We propose to examine respiratory function in children at high risk for panic disorder. Major hypotheses are that at risk children, compared to controls, exhibit more variable respiration and hypersensitivity to CO2 exposure as manifested by greater symptomatic and physiologic responses to the inhalation of 5 percent of CO2. We hypothesize that such abnormalities will occur among offspring even in the absence of an anxiety disorder. Aims are addressed through the study of ventilatory measures in offspring, ages nine-to-17, of adults with PD, as compared to offspring of adults with a) social phobia but not panic disorder, b) major depression but neither panic disorder nor social phobia, and c) no mental disorder. A total of nearly 350 children and their parents have been systematically assessed in an ongoing diagnostic study of children at highrisk for anxiety. In the proposed work, diagnosis will be updated with separate interviewers for each family member. Children will undergo a CO2 inhalation procedure in their home with a validated apparatus. Outcome measures consist of: i) pre-experimental respiratory variability, as well as ii) the symptomatic, and iii) physiological response to CO2. A series of studies conducted by the investigative team finds that these factors distinguish adults with PD and children with SAD from relevant contrast groups. Respiratory variables will be rated blind to parental and child diagnosis. The inclusion of offspring from pathological comparison groups, together with offspring of normals, provides a rigorous test of hypothesized diagnostic specificity in the relationship between respiratory factors and anxiety in both children and adults. The proposed study follows naturally from the investigative team's prior work and capitalizes on the availability of a well-characterized sample. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “social phobia” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for social phobia in the PubMed Central database: •

Comorbid Major Depression and Social Phobia. by Douglas S.; 2001 Aug; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=181185

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Extreme Fear, Shyness, and Social Phobia: Origins, Biological Mechanisms and Clinical Outcomes. by Schwartzman AE.; 2002 Jan; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=149798

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Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print.

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The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with social phobia, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “social phobia” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for social phobia (hyperlinks lead to article summaries): •

A comparison of the efficacy of clonazepam and cognitive-behavioral group therapy for the treatment of social phobia. Author(s): Otto MW, Pollack MH, Gould RA, Worthington JJ 3rd, McArdle ET, Rosenbaum JF. Source: Journal of Anxiety Disorders. 2000 July-August; 14(4): 345-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11043885&dopt=Abstract

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A composite measure to determine improvement following treatment for social phobia: the Index of Social Phobia Improvement. Author(s): Turner SM, Beidel DC, Wolff PL. Source: Behaviour Research and Therapy. 1994 May; 32(4): 471-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8192646&dopt=Abstract

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A direct-interview family study of generalized social phobia. Author(s): Stein MB, Chartier MJ, Hazen AL, Kozak MV, Tancer ME, Lander S, Furer P, Chubaty D, Walker JR. Source: The American Journal of Psychiatry. 1998 January; 155(1): 90-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9433344&dopt=Abstract

6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A double-blind placebo-controlled trial of paroxetine in the management of social phobia (social anxiety disorder) in South Africa. Author(s): Stein DJ, Berk M, Els C, Emsley RA, Gittelson L, Wilson D, Oakes R, Hunter B. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1999 April; 89(4): 402-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10341825&dopt=Abstract

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A multicomponent behavioral treatment for social phobia: social effectiveness therapy. Author(s): Turner SM, Beidel DC, Cooley MR, Woody SR, Messer SC. Source: Behaviour Research and Therapy. 1994 May; 32(4): 381-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8192637&dopt=Abstract

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A preliminary study of baclofen-induced growth hormone release in generalised social phobia. Author(s): Condren RM, Lucey JV, Thakore JH. Source: Human Psychopharmacology. 2003 March; 18(2): 125-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12590406&dopt=Abstract

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A preliminary study of buspirone stimulated prolactin release in generalised social phobia: evidence for enhanced serotonergic responsivity? Author(s): Condren RM, Dinan TG, Thakore JH. Source: European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology. 2002 August; 12(4): 349-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12126875&dopt=Abstract

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A preliminary study of dopamine-mediated prolactin inhibition in generalised social phobia. Author(s): Condren RM, Sharifi N, Thakore JH. Source: Psychiatry Research. 2002 August 5; 111(1): 87-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12140123&dopt=Abstract

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A prospective follow-along study of the course of social phobia. Author(s): Reich J, Goldenberg I, Vasile R, Goisman R, Keller M. Source: Psychiatry Research. 1994 December; 54(3): 249-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7792329&dopt=Abstract

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A prospective, follow-along study of the course of social phobia: II. Testing for basic predictors of course. Author(s): Reich J, Goldenberg I, Goisman R, Vasile R, Keller M. Source: The Journal of Nervous and Mental Disease. 1994 May; 182(5): 297-301. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10678312&dopt=Abstract

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A review of 19 double-blind placebo-controlled studies in social anxiety disorder (social phobia). Author(s): Versiani M. Source: World J Biol Psychiatry. 2000 January; 1(1): 27-33. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12607230&dopt=Abstract

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A review of social phobia. Author(s): Rapaport MH, Paniccia G, Judd LL. Source: Psychopharmacology Bulletin. 1995; 31(1): 125-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7675976&dopt=Abstract

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Adherence during sessions and homework in cognitive-behavioral group treatment of social phobia. Author(s): Edelman RE, Chambless DL. Source: Behaviour Research and Therapy. 1995 June; 33(5): 573-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7598680&dopt=Abstract

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Advances in behavioral-cognitive therapy of social phobia. Author(s): Marks IM. Source: The Journal of Clinical Psychiatry. 1995; 56 Suppl 5: 25-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7782273&dopt=Abstract

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Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Author(s): Magee WJ, Eaton WW, Wittchen HU, McGonagle KA, Kessler RC. Source: Archives of General Psychiatry. 1996 February; 53(2): 159-68. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8629891&dopt=Abstract

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Alcoholics with and without social phobia: a comparison of substance use and psychiatric variables. Author(s): Thomas SE, Thevos AK, Randall CL. Source: J Stud Alcohol. 1999 July; 60(4): 472-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10463803&dopt=Abstract

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Alexithymia in panic disorder and social phobia. Author(s): Cox BJ, Swinson RP, Shulman ID, Bourdeau D. Source: Comprehensive Psychiatry. 1995 May-June; 36(3): 195-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7648842&dopt=Abstract

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An eight-year longitudinal comparison of clinical course and characteristics of social phobia among men and women. Author(s): Yonkers KA, Dyck IR, Keller MB. Source: Psychiatric Services (Washington, D.C.). 2001 May; 52(5): 637-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11331798&dopt=Abstract

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An empirical approach to subtype identification in individuals with social phobia. Author(s): Eng W, Heimberg RG, Coles ME, Schneier FR, Liebowitz MR. Source: Psychological Medicine. 2000 November; 30(6): 1345-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11097075&dopt=Abstract

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An open clinical trial of reboxetine in the treatment of social phobia. Author(s): Atmaca M, Tezcan E, Kuloglu M. Source: Journal of Clinical Psychopharmacology. 2003 August; 23(4): 417-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12920422&dopt=Abstract

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Antecedents of the risk of recovery from DSM-III-R social phobia. Author(s): DeWit DJ, Ogborne A, Offord DR, MacDonald K. Source: Psychological Medicine. 1999 May; 29(3): 569-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10405078&dopt=Abstract

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Anxiety and growth disturbance: is there a connection? A review of biological studies in social phobia. Author(s): Uhde TW. Source: The Journal of Clinical Psychiatry. 1994 June; 55 Suppl: 17-27. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8077162&dopt=Abstract

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Anxiety sensitivity in social phobia: comparison between social phobics with and without panic attacks. Author(s): Scott EL, Heimberg RG, Jack MS. Source: Depression and Anxiety. 2000; 12(4): 189-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11195754&dopt=Abstract

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Anxiety symptoms in panic disorder and social phobia: support for suffocation theory of panic? Author(s): Hazen AL, Stein MB, Walker JR. Source: Anxiety. 1996; 2(2): 102-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9160610&dopt=Abstract

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Assessment and diagnosis of social phobia in the clinic and the community. Author(s): Heimberg RG. Source: Psychological Medicine. 2003 May; 33(4): 583-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785460&dopt=Abstract

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Assessment and treatment of social phobia. Author(s): Antony MM. Source: Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie. 1997 October; 42(8): 826-34. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9356770&dopt=Abstract

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Autism, affective disorders, and social phobia. Author(s): Smalley SL, McCracken J, Tanguay P. Source: American Journal of Medical Genetics. 1995 February 27; 60(1): 19-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7485230&dopt=Abstract

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Autonomic responsivity in generalized social phobia. Author(s): Stein MB, Asmundson GJ, Chartier M. Source: Journal of Affective Disorders. 1994 July; 31(3): 211-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7963074&dopt=Abstract

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Avoidant personality disorder, generalized social phobia, and shyness: putting the personality back into personality disorders. Author(s): Rettew DC. Source: Harvard Review of Psychiatry. 2000 December; 8(6): 283-97. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11133823&dopt=Abstract

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Avoidant personality in social phobia and panic-agoraphobic disorder: a comparison. Author(s): Perugi G, Nassini S, Socci C, Lenzi M, Toni C, Simonini E, Akiskal HS. Source: Journal of Affective Disorders. 1999 August; 54(3): 277-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10467971&dopt=Abstract

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Behavioral assessment and treatment of social phobia. An evaluative review. Author(s): Donohue BC, Van Hasselt VB, Hersen M. Source: Behavior Modification. 1994 July; 18(3): 262-88. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8037649&dopt=Abstract

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Behavioral assessment of social performance: a rating system for social phobia. Author(s): Fydrich T, Chambless DL, Perry KJ, Buergener F, Beazley MB. Source: Behaviour Research and Therapy. 1998 October; 36(10): 995-1010. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9714949&dopt=Abstract

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Behavioral inhibition in children: a possible precursor to panic disorder or social phobia. Author(s): Rosenbaum JF, Biederman J, Hirshfeld DR, Bolduc EA, Chaloff J. Source: The Journal of Clinical Psychiatry. 1991 November; 52 Suppl: 5-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1757458&dopt=Abstract

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Behavioral treatment of childhood social phobia. Author(s): Beidel DC, Turner SM, Morris TL. Source: Journal of Consulting and Clinical Psychology. 2000 December; 68(6): 1072-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11142541&dopt=Abstract

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Behavioral treatment of psychogenic vomiting in the context of social phobia. Author(s): Stravynski A. Source: The Journal of Nervous and Mental Disease. 1983 July; 171(7): 448-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6864204&dopt=Abstract

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Behavioral treatment of social phobia. Author(s): Marks I. Source: Psychopharmacology Bulletin. 1985; 21(3): 615-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=4034878&dopt=Abstract

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Behavioural inhibition and symptoms of anxiety and depression: is there a specific relationship with social phobia? Author(s): Neal JA, Edelmann RJ, Glachan M. Source: The British Journal of Clinical Psychology / the British Psychological Society. 2002 November; 41(Pt 4): 361-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12437791&dopt=Abstract

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Benzodiazepines and anticonvulsants for social phobia (social anxiety disorder). Author(s): Jefferson JW. Source: The Journal of Clinical Psychiatry. 2001; 62 Suppl 1: 50-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11206035&dopt=Abstract

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Biological characterization of social phobia. Author(s): Miner CM, Davidson JR. Source: European Archives of Psychiatry and Clinical Neuroscience. 1995; 244(6): 304-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7772613&dopt=Abstract

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Bipolar II and unipolar comorbidity in 153 outpatients with social phobia. Author(s): Perugi G, Frare F, Toni C, Mata B, Akiskal HS. Source: Comprehensive Psychiatry. 2001 September-October; 42(5): 375-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11559864&dopt=Abstract

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Blushing and physiological arousability in social phobia. Author(s): Gerlach AL, Wilhelm FH, Gruber K, Roth WT. Source: Journal of Abnormal Psychology. 2001 May; 110(2): 247-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11358019&dopt=Abstract

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Blushing and social phobia: a neuroethological speculation. Author(s): Stein DJ, Bouwer C. Source: Medical Hypotheses. 1997 July; 49(1): 101-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9247916&dopt=Abstract

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Brain circuits involved in emotional learning in antisocial behavior and social phobia in humans. Author(s): Veit R, Flor H, Erb M, Hermann C, Lotze M, Grodd W, Birbaumer N. Source: Neuroscience Letters. 2002 August 16; 328(3): 233-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12147314&dopt=Abstract

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Brain fluoxetine measurements using fluorine magnetic resonance spectroscopy in patients with social phobia. Author(s): Miner CM, Davidson JR, Potts NL, Tupler LA, Charles HC, Krishnan KR. Source: Biological Psychiatry. 1995 November 15; 38(10): 696-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8555383&dopt=Abstract

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Brief cognitive therapy for social phobia: a case series. Author(s): Wells A, Papageorgiou C. Source: Behaviour Research and Therapy. 2001 June; 39(6): 713-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11400714&dopt=Abstract

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Bringing up bashful baby. Developmental pathways to social phobia. Author(s): Stein MB, Chavira DA, Jang KL. Source: The Psychiatric Clinics of North America. 2001 December; 24(4): 661-75. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11723626&dopt=Abstract

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Brofaromine for social phobia: a multicenter, placebo-controlled, double-blind study. Author(s): Lott M, Greist JH, Jefferson JW, Kobak KA, Katzelnick DJ, Katz RJ, Schaettle SC. Source: Journal of Clinical Psychopharmacology. 1997 August; 17(4): 255-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9241003&dopt=Abstract

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Bupropion-SR in treatment of social phobia. Author(s): Emmanuel NP, Brawman-Mintzer O, Morton WA, Book SW, Johnson MR, Lorberbaum JP, Ballenger JC, Lydiard RB. Source: Depression and Anxiety. 2000; 12(2): 111-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11091936&dopt=Abstract

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Buspirone augmentation of selective serotonin reuptake inhibitors (SSRIs) in social phobia. Author(s): Van Ameringen M, Mancini C, Wilson C. Source: Journal of Affective Disorders. 1996 July 8; 39(2): 115-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8827420&dopt=Abstract

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Buspirone in social phobia. Author(s): Schneier FR, Saoud JB, Campeas R, Fallon BA, Hollander E, Coplan J, Liebowitz MR. Source: Journal of Clinical Psychopharmacology. 1993 August; 13(4): 251-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8376612&dopt=Abstract

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Buspirone use in an adolescent with social phobia and mixed personality disorder (cluster A type). Author(s): Zwier KJ, Rao U. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 1994 September; 33(7): 1007-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7961339&dopt=Abstract

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Cerebral blood flow during anticipation of public speaking in social phobia: a PET study. Author(s): Tillfors M, Furmark T, Marteinsdottir I, Fredrikson M. Source: Biological Psychiatry. 2002 December 1; 52(11): 1113-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12460694&dopt=Abstract

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Cerebral blood flow in subjects with social phobia during stressful speaking tasks: a PET study. Author(s): Tillfors M, Furmark T, Marteinsdottir I, Fischer H, Pissiota A, Langstrom B, Fredrikson M. Source: The American Journal of Psychiatry. 2001 August; 158(8): 1220-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11481154&dopt=Abstract

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Characteristics of patients with social phobia and their treatment in specialized clinics for anxiety disorders in the Netherlands. Author(s): Dingemans AE, van Vliet IM, Couvee J, Westenberg HG. Source: Journal of Affective Disorders. 2001 July; 65(2): 123-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11356235&dopt=Abstract

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Characteristics of social phobia among persons with essential tremor. Author(s): Schneier FR, Barnes LF, Albert SM, Louis ED. Source: The Journal of Clinical Psychiatry. 2001 May; 62(5): 367-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11411820&dopt=Abstract

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Childhood history of anxiety disorders among adults with social phobia: rates, correlates, and comparisons with patients with panic disorder. Author(s): Otto MW, Pollack MH, Maki KM, Gould RA, Worthington JJ 3rd, Smoller JW, Rosenbaum JF. Source: Depression and Anxiety. 2001; 14(4): 209-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11754127&dopt=Abstract

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Chronicity, relapse, and illness--course of panic disorder, social phobia, and generalized anxiety disorder: findings in men and women from 8 years of follow-up. Author(s): Yonkers KA, Bruce SE, Dyck IR, Keller MB. Source: Depression and Anxiety. 2003; 17(3): 173-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12768651&dopt=Abstract

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Citalopram for social phobia: a clinical case series. Author(s): Simon NM, Sharma SG, Worthington JJ, Marzol PC, Pollack MH. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2001 October; 25(7): 1469-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11513360&dopt=Abstract

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Citalopram in social phobia. Author(s): Kosieradzki PH. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2001 October; 40(10): 1126-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11589525&dopt=Abstract

•

Clinical distinctions between selective mutism and social phobia: an investigation of childhood psychopathology. Author(s): Yeganeh R, Beidel DC, Turner SM, Pina AA, Silverman WK. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 2003 September; 42(9): 1069-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12960706&dopt=Abstract

•

Cognitive aspects of social phobia: a review of theories and experimental research. Author(s): Musa CZ, Lepine JP. Source: European Psychiatry : the Journal of the Association of European Psychiatrists. 2000 February; 15(1): 59-66. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10713803&dopt=Abstract

Studies

41

•

Cognitive therapy for social phobia: individual versus group treatment. Author(s): Stangier U, Heidenreich T, Peitz M, Lauterbach W, Clark DM. Source: Behaviour Research and Therapy. 2003 September; 41(9): 991-1007. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12914803&dopt=Abstract

•

Cognitive therapy versus fluoxetine in generalized social phobia: a randomized placebo-controlled trial. Author(s): Clark DM, Ehlers A, McManus F, Hackmann A, Fennell M, Campbell H, Flower T, Davenport C, Louis B. Source: Journal of Consulting and Clinical Psychology. 2003 December; 71(6): 1058-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14622081&dopt=Abstract

•

Cognitive-behavioral group treatment for social phobia in adolescents. A preliminary study. Author(s): Albano AM, Marten PA, Holt CS, Heimberg RG, Barlow DH. Source: The Journal of Nervous and Mental Disease. 1995 October; 183(10): 649-56. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7561811&dopt=Abstract

•

Cognitive-behavioral treatment of social phobia: new advances. Author(s): Huppert JD, Roth DA, Foa EB. Source: Current Psychiatry Reports. 2003 August; 5(4): 289-96. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12857532&dopt=Abstract

•

Common changes in cerebral blood flow in patients with social phobia treated with citalopram or cognitive-behavioral therapy. Author(s): Furmark T, Tillfors M, Marteinsdottir I, Fischer H, Pissiota A, Langstrom B, Fredrikson M. Source: Archives of General Psychiatry. 2002 May; 59(5): 425-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11982446&dopt=Abstract

•

Comorbid generalized anxiety disorder in primary social phobia: symptom severity, functional impairment, and treatment response. Author(s): Mennin DS, Heimberg RG, Jack MS. Source: Journal of Anxiety Disorders. 2000 July-August; 14(4): 325-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11043884&dopt=Abstract

•

Convergent, discriminant, and criterion-related validity of the Social Phobia and Anxiety Inventory. Author(s): Rodebaugh TL, Chambless DL, Terrill DR, Floyd M, Uhde T. Source: Depression and Anxiety. 2000; 11(1): 10-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10723630&dopt=Abstract

42

Social Phobia

•

Core symptom pattern of social phobia. Author(s): Fahlen T. Source: Depression and Anxiety. 1996-97; 4(5): 223-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9167788&dopt=Abstract

•

Current status of psychotherapeutic interventions for social phobia. Author(s): Heimberg RG. Source: The Journal of Clinical Psychiatry. 2001; 62 Suppl 1: 36-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11206032&dopt=Abstract

•

Current trends in the understanding and treatment of social phobia in youth. Author(s): Velting ON, Albano AM. Source: Journal of Child Psychology and Psychiatry, and Allied Disciplines. 2001 January; 42(1): 127-40. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11205621&dopt=Abstract

•

Definition of a VR-based protocol to treat social phobia. Author(s): Roy S, Klinger E, Legeron P, Lauer F, Chemin I, Nugues P. Source: Cyberpsychology & Behavior : the Impact of the Internet, Multimedia and Virtual Reality on Behavior and Society. 2003 August; 6(4): 411-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14511454&dopt=Abstract

•

Delineating social phobia. Author(s): Liebowitz MR. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1987 May; 150: 718-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3651717&dopt=Abstract

•

Delineating social phobia. Author(s): Solyom L, Ledwidge B, Solyom C. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1986 October; 149: 464-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3814930&dopt=Abstract

•

Delineation of social phobia in Saudia Arabians. Author(s): Chaleby KS, Raslan A. Source: Social Psychiatry and Psychiatric Epidemiology. 1990 November; 25(6): 324-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2291136&dopt=Abstract

Studies

43

•

Detachment and generalized social phobia. Author(s): Schneier F, Liebowitz M, Laruelle M. Source: The American Journal of Psychiatry. 2001 February; 158(2): 327-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11156831&dopt=Abstract

•

Diagnostic anomalies in social phobia. Author(s): Tyrer P. Source: International Clinical Psychopharmacology. 1996 June; 11 Suppl 3: 29-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8923107&dopt=Abstract

•

Diagnostic patterns of social phobia. Comparison in Tokyo and Hawaii. Author(s): Tseng WS, Asai M, Kitanishi K, McLaughlin DG, Kyomen H. Source: The Journal of Nervous and Mental Disease. 1992 June; 180(6): 380-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1593272&dopt=Abstract

•

Disability and quality of life in pure and comorbid social phobia. Findings from a controlled study. Author(s): Wittchen HU, Fuetsch M, Sonntag H, Muller N, Liebowitz M. Source: European Psychiatry : the Journal of the Association of European Psychiatrists. 2000 February; 15(1): 46-58. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10713802&dopt=Abstract

•

Disability and quality of life in pure and comorbid social phobia--findings from a controlled study. Author(s): Wittchen HU, Fuetsch M, Sonntag H, Muller N, Liebowitz M. Source: European Psychiatry : the Journal of the Association of European Psychiatrists. 1999 June; 14(3): 118-31. Erratum In: Eur Psychiatry 1999 September; 14(5): Following 298. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10572336&dopt=Abstract

•

Disability and quality of life in social phobia: epidemiologic findings. Author(s): Stein MB, Kean YM. Source: The American Journal of Psychiatry. 2000 October; 157(10): 1606-13. Erratum In: Am J Psychiatry 2000 December; 157(12): 2075. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11007714&dopt=Abstract

•

Discontinuation of clonazepam in the treatment of social phobia. Author(s): Connor KM, Davidson JR, Potts NL, Tupler LA, Miner CM, Malik ML, Book SW, Colket JT, Ferrell F. Source: Journal of Clinical Psychopharmacology. 1998 October; 18(5): 373-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9790154&dopt=Abstract

44

Social Phobia

•

Discriminant validity of the Social Phobia and Anxiety Inventory (SPAI), the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS). Author(s): Peters L. Source: Behaviour Research and Therapy. 2000 September; 38(9): 943-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10957828&dopt=Abstract

•

Dismantling cognitive-behavioral group therapy for social phobia. Author(s): Hope DA, Heimberg RG, Bruch MA. Source: Behaviour Research and Therapy. 1995 July; 33(6): 637-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7654156&dopt=Abstract

•

Distinguishing panic disorder and agoraphobia from social phobia. Author(s): Page AC. Source: The Journal of Nervous and Mental Disease. 1994 November; 182(11): 611-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7964668&dopt=Abstract

•

Does reducing safety behaviours improve treatment response in patients with social phobia? Author(s): Morgan H, Raffle C. Source: The Australian and New Zealand Journal of Psychiatry. 1999 August; 33(4): 50310. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10483844&dopt=Abstract

•

Dopamine reuptake site densities in patients with social phobia. Author(s): Tiihonen J, Kuikka J, Bergstrom K, Lepola U, Koponen H, Leinonen E. Source: The American Journal of Psychiatry. 1997 February; 154(2): 239-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9016274&dopt=Abstract

•

Dopamine system genes not linked to social phobia. Author(s): Kennedy JL, Neves-Pereira M, King N, Lizak MV, Basile VS, Chartier MJ, Stein MB. Source: Psychiatric Genetics. 2001 December; 11(4): 213-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11807412&dopt=Abstract

•

Drug treatment of social phobia. Author(s): Gorman JM, Gorman LK. Source: Journal of Affective Disorders. 1987 September-October; 13(2): 183-92. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2890679&dopt=Abstract

Studies

45

•

DSM-III-R subtypes of social phobia. Comparison of generalized social phobics and public speaking phobics. Author(s): Heimberg RG, Hope DA, Dodge CS, Becker RE. Source: The Journal of Nervous and Mental Disease. 1990 March; 178(3): 172-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2307969&dopt=Abstract

•

Dysfunctional cognitions in children with social phobia, separation anxiety disorder, and generalized anxiety disorder. Author(s): Bogels SM, Zigterman D. Source: Journal of Abnormal Child Psychology. 2000 April; 28(2): 205-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10834771&dopt=Abstract

•

Eating disorders and social phobia. Author(s): Brewerton TD, Lydiard RB, Ballenger JC, Herzog DB. Source: Archives of General Psychiatry. 1993 January; 50(1): 70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8481194&dopt=Abstract

•

Effects of focus of attention on anxiety levels and social performance of individuals with social phobia. Author(s): Woody SR. Source: Journal of Abnormal Psychology. 1996 February; 105(1): 61-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8666712&dopt=Abstract

•

Effects of stress and social phobia on medical students' specialty choices. Author(s): Onady AA, Rodenhauser P, Markert RJ. Source: J Med Educ. 1988 March; 63(3): 162-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3346891&dopt=Abstract

•

Effects of the 5-HT3 antagonist, ondansetron, on the behavioral and physiological effects of pentagastrin in patients with panic disorder and social phobia. Author(s): McCann UD, Morgan CM, Geraci M, Slate SO, Murphy DL, Post RM. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 1997 December; 17(6): 360-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9397424&dopt=Abstract

•

Effects of varying levels of anxiety within social situations: relationship to memory perspective and attributions in social phobia. Author(s): Coles ME, Turk CL, Heimberg RG, Fresco DM. Source: Behaviour Research and Therapy. 2001 June; 39(6): 651-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11400710&dopt=Abstract

46

Social Phobia

•

Efficacy of citalopram and moclobemide in patients with social phobia: some preliminary findings. Author(s): Atmaca M, Kuloglu M, Tezcan E, Unal A. Source: Human Psychopharmacology. 2002 December; 17(8): 401-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12457375&dopt=Abstract

•

Elective mutism as a variant of social phobia. Author(s): Black B, Uhde TW. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 1992 November; 31(6): 1090-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1342579&dopt=Abstract

•

Embarrassment and social phobia: the role of parasympathetic activation. Author(s): Gerlach AL, Wilhelm FH, Roth WT. Source: Journal of Anxiety Disorders. 2003; 17(2): 197-210. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12614662&dopt=Abstract

•

Emotional imagery in simple and social phobia: fear versus anxiety. Author(s): McNeil DW, Vrana SR, Melamed BG, Cuthbert BN, Lang PJ. Source: Journal of Abnormal Psychology. 1993 May; 102(2): 212-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8315134&dopt=Abstract

•

Endoscopic sympathetic block--new treatment of choice for social phobia? Author(s): Pohjavaara P, Telaranta T, Vaisanen E. Source: Ann Chir Gynaecol. 2001; 90(3): 177-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11695789&dopt=Abstract

•

Enhanced Stroop interference for threat in social phobia. Author(s): Ami N, Freshman M, Foa E. Source: Journal of Anxiety Disorders. 2002; 16(1): 1-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12171210&dopt=Abstract

•

Epidemiology and natural course of social fears and social phobia. Author(s): Wittchen HU, Fehm L. Source: Acta Psychiatrica Scandinavica. Supplementum. 2003; (417): 4-18. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12950432&dopt=Abstract

Studies

47

•

Epidemiology of social phobia: a clinical approach. Author(s): Faravelli C, Zucchi T, Viviani B, Salmoria R, Perone A, Paionni A, Scarpato A, Vigliaturo D, Rosi S, D'adamo D, Bartolozzi D, Cecchi C, Abrardi L. Source: European Psychiatry : the Journal of the Association of European Psychiatrists. 2000 February; 15(1): 17-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10713798&dopt=Abstract

•

Epidemiology, patterns of comorbidity, and associated disabilities of social phobia. Author(s): Wittchen HU, Fehm L. Source: The Psychiatric Clinics of North America. 2001 December; 24(4): 617-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11723624&dopt=Abstract

•

Epinephrine infusions in patients with social phobia. Author(s): Papp LA, Gorman JM, Liebowitz MR, Fyer AJ, Cohen B, Klein DF. Source: The American Journal of Psychiatry. 1988 June; 145(6): 733-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3369562&dopt=Abstract

•

Evaluation of the efficacy, safety and physiological effects of fluvoxamine in social phobia. Author(s): DeVane CL, Ware MR, Emmanuel NP, Brawman-Mintzer O, Morton WA, Villarreal G, Lydiard RB. Source: International Clinical Psychopharmacology. 1999 November; 14(6): 345-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10565801&dopt=Abstract

•

Evidence for social phobia and other psychiatric disorders in adults who were growth hormone deficient during childhood. Author(s): Stabler B, Tancer ME, Ranc J, Underwood LE. Source: Anxiety. 1996; 2(2): 86-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9160606&dopt=Abstract

•

Exposure in vivo vs social skills training for social phobia: long-term outcome and differential effects. Author(s): Wlazlo Z, Schroeder-Hartwig K, Hand I, Kaiser G, Munchau N. Source: Behaviour Research and Therapy. 1990; 28(3): 181-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1973351&dopt=Abstract

•

Exposure therapy and sertraline in social phobia: I-year follow-up of a randomised controlled trial. Author(s): Haug TT, Blomhoff S, Hellstrom K, Holme I, Humble M, Madsbu HP, Wold JE. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2003 April; 182: 312-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12668406&dopt=Abstract

48

Social Phobia

•

Exposure with and without cognitive therapy for generalized social phobia: effects of individual and group treatment. Author(s): Scholing A, Emmelkamp PM. Source: Behaviour Research and Therapy. 1993 September; 31(7): 667-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8105778&dopt=Abstract

•

Factor structure of the Social Interaction Anxiety Scale and the Social Phobia Scale. Author(s): Safren SA, Turk CL, Heimberg RG. Source: Behaviour Research and Therapy. 1998 April; 36(4): 443-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9670604&dopt=Abstract

•

Familial aggregation of anxiety-related quantitative traits in generalized social phobia: clues to understanding “disorder” heritability? Author(s): Stein MB, Chartier MJ, Lizak MV, Jang KL. Source: American Journal of Medical Genetics. 2001 January 8; 105(1): 79-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11425006&dopt=Abstract

•

Family history of psychiatric disorders in social phobia. Author(s): Reich J, Yates W. Source: Comprehensive Psychiatry. 1988 January-February; 29(1): 72-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3342612&dopt=Abstract

•

Fear: the impact and treatment of social phobia. Author(s): Walker JR, Kjernisted KD. Source: Journal of Psychopharmacology (Oxford, England). 2000; 14(2 Suppl 1): S13-23. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10888027&dopt=Abstract

•

Flumazenil challenge in social phobia. Author(s): Coupland NJ, Bell C, Potokar JP, Dorkins E, Nutt DJ. Source: Depression and Anxiety. 2000; 11(1): 27-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10723632&dopt=Abstract

•

Fluoxetine and social phobia. Author(s): Berk M. Source: The Journal of Clinical Psychiatry. 1995 January; 56(1): 36-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7836341&dopt=Abstract

•

Fluoxetine efficacy in social phobia. Author(s): Van Ameringen M, Mancini C, Streiner DL. Source: The Journal of Clinical Psychiatry. 1993 January; 54(1): 27-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8428894&dopt=Abstract

Studies

49

•

Fluoxetine efficacy in social phobia. Author(s): Taylor LH. Source: The Journal of Clinical Psychiatry. 1997 March; 58(3): 124-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9108817&dopt=Abstract

•

Fluoxetine for the treatment of social phobia. Author(s): Black B, Uhde TW, Tancer ME. Source: Journal of Clinical Psychopharmacology. 1992 August; 12(4): 293-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1527235&dopt=Abstract

•

Fluoxetine in social phobia. Author(s): Schneier FR, Chin SJ, Hollander E, Liebowitz MR. Source: Journal of Clinical Psychopharmacology. 1992 February; 12(1): 62-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1552041&dopt=Abstract

•

Fluoxetine in social phobia: a double-blind, placebo-controlled pilot study. Author(s): Kobak KA, Greist JH, Jefferson JW, Katzelnick DJ. Source: Journal of Clinical Psychopharmacology. 2002 June; 22(3): 257-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12006895&dopt=Abstract

•

Fluoxetine treatment of social phobia. Author(s): Sternbach H. Source: Journal of Clinical Psychopharmacology. 1990 June; 10(3): 230-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2376621&dopt=Abstract

•

Fluvoxamine treatment of social phobia (social anxiety disorder): a double-blind, placebo-controlled study. Author(s): Stein MB, Fyer AJ, Davidson JR, Pollack MH, Wiita B. Source: The American Journal of Psychiatry. 1999 May; 156(5): 756-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10327910&dopt=Abstract

•

Four types of social phobia in a community sample. Author(s): Pollard CA, Henderson JG. Source: The Journal of Nervous and Mental Disease. 1988 July; 176(7): 440-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3411314&dopt=Abstract

•

Frequency and comorbidity of social phobia and social fears in adolescents. Author(s): Essau CA, Conradt J, Petermann F. Source: Behaviour Research and Therapy. 1999 September; 37(9): 831-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10458047&dopt=Abstract

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Functional brain imaging and pharmacotherapy in social phobia: single photon emission computed tomography before and after treatment with the selective serotonin reuptake inhibitor citalopram. Author(s): Van der Linden G, van Heerden B, Warwick J, Wessels C, van Kradenburg J, Zungu-Dirwayi N, Stein DJ. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2000 April; 24(3): 419-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10836490&dopt=Abstract

•

Functional impairment in social phobia. Author(s): Schneier FR, Heckelman LR, Garfinkel R, Campeas R, Fallon BA, Gitow A, Street L, Del Bene D, Liebowitz MR. Source: The Journal of Clinical Psychiatry. 1994 August; 55(8): 322-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8071299&dopt=Abstract

•

Gender comparison in alcoholics with concurrent social phobia: implications for alcoholism treatment. Author(s): Randall CL, Thomas SE, Thevos AK. Source: The American Journal on Addictions / American Academy of Psychiatrists in Alcoholism and Addictions. 2000 Summer; 9(3): 202-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11000916&dopt=Abstract

•

Generalized social phobia versus avoidant personality disorder: a commentary on three studies. Author(s): Widiger TA. Source: Journal of Abnormal Psychology. 1992 May; 101(2): 340-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1583229&dopt=Abstract

•

Generalized social phobia versus avoidant personality disorder: differences in psychopathology, personality traits, and social and occupational functioning. Author(s): van Velzen CJ, Emmelkamp PM, Scholing A. Source: Journal of Anxiety Disorders. 2000 July-August; 14(4): 395-411. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11043888&dopt=Abstract

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Generalized social phobia. Reliability and validity. Author(s): Mannuzza S, Schneier FR, Chapman TF, Liebowitz MR, Klein DF, Fyer AJ. Source: Archives of General Psychiatry. 1995 March; 52(3): 230-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7872851&dopt=Abstract

Studies

51

•

Genetic linkage to the serotonin transporter protein and 5HT2A receptor genes excluded in generalized social phobia. Author(s): Stein MB, Chartier MJ, Kozak MV, King N, Kennedy JL. Source: Psychiatry Research. 1998 December 14; 81(3): 283-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9925179&dopt=Abstract

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Group social skills training or cognitive group therapy as the clinical treatment of choice for generalized social phobia? Author(s): van Dam-Baggen R, Kraaimaat F. Source: Journal of Anxiety Disorders. 2000 September-October; 14(5): 437-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11095539&dopt=Abstract

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Growth hormone response to intravenous clonidine in social phobia: comparison to patients with panic disorder and healthy volunteers. Author(s): Tancer ME, Stein MB, Uhde TW. Source: Biological Psychiatry. 1993 November 1; 34(9): 591-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8292687&dopt=Abstract

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Heart rate and plasma norepinephrine responsivity to orthostatic challenge in anxiety disorders. Comparison of patients with panic disorder and social phobia and normal control subjects. Author(s): Stein MB, Tancer ME, Uhde TW. Source: Archives of General Psychiatry. 1992 April; 49(4): 311-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1558465&dopt=Abstract

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History of childhood abuse in panic disorder, social phobia, and generalized anxiety disorder. Author(s): Safren SA, Gershuny BS, Marzol P, Otto MW, Pollack MH. Source: The Journal of Nervous and Mental Disease. 2002 July; 190(7): 453-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12142846&dopt=Abstract

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Homework compliance, perceptions of control, and outcome of cognitive-behavioral treatment of social phobia. Author(s): Leung AW, Heimberg RG. Source: Behaviour Research and Therapy. 1996 May-June; 34(5-6): 423-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8687364&dopt=Abstract

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HPA axis response to a psychological stressor in generalised social phobia. Author(s): Condren RM, O'Neill A, Ryan MC, Barrett P, Thakore JH. Source: Psychoneuroendocrinology. 2002 August; 27(6): 693-703. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12084662&dopt=Abstract

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•

Hyperresponsivity to nicotinic acid challenge in generalized social phobia: a pilot study. Author(s): Bouwer C, Stein DJ. Source: European Neuropsychopharmacology : the Journal of the European College of Neuropsychopharmacology. 1998 December; 8(4): 311-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9928922&dopt=Abstract

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Hyperventilation and anxiety in panic disorder, social phobia, GAD and normal controls. Author(s): Holt PE, Andrews G. Source: Behaviour Research and Therapy. 1989; 27(4): 453-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2775155&dopt=Abstract

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Hyperventilation in panic disorder and social phobia. Author(s): Nardi AE, Valenca AM, Nascimento I, Mezzasalma MA, Zin WA. Source: Psychopathology. 2001 May-June; 34(3): 123-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11316957&dopt=Abstract

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Impaired conditional discrimination learning in social phobia. Author(s): Sachs G, Anderer P, Doby D, Saletu B, Dantendorfer K. Source: Neuropsychobiology. 2003; 47(2): 66-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12707487&dopt=Abstract

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Impaired positive inferential bias in social phobia. Author(s): Hirsch CR, Mathews A. Source: Journal of Abnormal Psychology. 2000 November; 109(4): 705-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11195994&dopt=Abstract

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Implications of the severity of social phobia. Author(s): Montgomery SA. Source: Journal of Affective Disorders. 1998 September; 50 Suppl 1: S17-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9851574&dopt=Abstract

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Implicit memory bias for threat-relevant information in individuals with generalized social phobia. Author(s): Amir N, Foa EB, Coles ME. Source: Journal of Abnormal Psychology. 2000 November; 109(4): 713-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11195995&dopt=Abstract

Studies

53

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In search of social phobia subtypes: similarity of feared social situations. Author(s): Stein MB, Deutsch R. Source: Depression and Anxiety. 2003; 17(2): 94-7. Erratum In: Depress Anxiety. 2003; 17(4): 229. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12621598&dopt=Abstract

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Incidence of DIS/DSM-IV social phobia in adults. Author(s): Neufeld KJ, Swartz KL, Bienvenu OJ, Eaton WW, Cai G. Source: Acta Psychiatrica Scandinavica. 1999 September; 100(3): 186-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10493084&dopt=Abstract

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Increased amygdala activation to angry and contemptuous faces in generalized social phobia. Author(s): Stein MB, Goldin PR, Sareen J, Zorrilla LT, Brown GG. Source: Archives of General Psychiatry. 2002 November; 59(11): 1027-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12418936&dopt=Abstract

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Individual response patterns and the effects of different behavioral methods in the treatment of social phobia. Author(s): Ost LG, Jerremalm A, Johansson J. Source: Behaviour Research and Therapy. 1981; 19(1): 1-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7225032&dopt=Abstract

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Information processing in social phobia. Author(s): Clark DM, McManus F. Source: Biological Psychiatry. 2002 January 1; 51(1): 92-100. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11801234&dopt=Abstract

•

Information processing in social phobia: a critical review. Author(s): Heinrichs N, Hofmann SG. Source: Clinical Psychology Review. 2001 July; 21(5): 751-70. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11434229&dopt=Abstract

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Integrated treatment of panic disorder and social phobia. Author(s): Menninger WW. Source: Bulletin of the Menninger Clinic. 1992 Spring; 56(2 Suppl A): A61-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1623341&dopt=Abstract

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Integrated treatment of social phobia. Author(s): Marshall JR. Source: Bulletin of the Menninger Clinic. 1995 Spring; 59(2 Suppl A): A27-37. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7795569&dopt=Abstract

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•

Interpretations for anxiety symptoms in social phobia. Author(s): Roth D, Antony MM, Swinson RP. Source: Behaviour Research and Therapy. 2001 February; 39(2): 129-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11153968&dopt=Abstract

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Inter-relationships among measures commonly used in research on social phobia. Author(s): Elting DT, Hope DA, Heimberg RG. Source: Depression and Anxiety. 1996-97; 4(5): 246-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9167793&dopt=Abstract

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Is elective mutism a social phobia? Author(s): Crumley FE. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 1993 September; 32(5): 1081-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8407760&dopt=Abstract

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Is self-criticism unique for depression? A comparison with social phobia. Author(s): Cox BJ, Rector NA, Bagby RM, Swinson RP, Levitt AJ, Joffe RT. Source: Journal of Affective Disorders. 2000 January-March; 57(1-3): 223-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10708835&dopt=Abstract

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Is social phobia related to lack of social skills? Duration of skill-related behaviours and ratings of behavioural adequacy. Author(s): Baker SR, Edelmann RJ. Source: The British Journal of Clinical Psychology / the British Psychological Society. 2002 September; 41(Pt 3): 243-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12396253&dopt=Abstract

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Is the comorbidity between social phobia and panic disorder due to familial cotransmission or other factors? Author(s): Horwath E, Wolk SI, Goldstein RB, Wickramaratne P, Sobin C, Adams P, Lish JD, Weissman MM. Source: Archives of General Psychiatry. 1995 July; 52(7): 574-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7598634&dopt=Abstract

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Issues in the design of trials for the evaluation of psychopharmacological treatments for social phobia. Author(s): Liebowitz MR, Heimberg RG. Source: International Clinical Psychopharmacology. 1996 June; 11 Suppl 3: 49-53. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8923110&dopt=Abstract

Studies

55

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Issues in the design of trials for the evaluation of psychosocial treatments for social phobia. Author(s): Heimberg RG, Liebowitz MR. Source: International Clinical Psychopharmacology. 1996 June; 11 Suppl 3: 55-64. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8923111&dopt=Abstract

•

Kava kava in the treatment of generalized anxiety disorder, simple phobia and specific social phobia. Author(s): Boerner RJ. Source: Phytotherapy Research : Ptr. 2001 November; 15(7): 646-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11746854&dopt=Abstract

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Levels of urinary free cortisol in social phobia. Author(s): Potts NL, Davidson JR, Krishnan KR, Doraiswamy PM, Ritchie JC. Source: The Journal of Clinical Psychiatry. 1991 November; 52 Suppl: 41-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1757455&dopt=Abstract

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Lifetime co-morbidities between social phobia and mood disorders in the US National Comorbidity Survey. Author(s): Kessler RC, Stang P, Wittchen HU, Stein M, Walters EE. Source: Psychological Medicine. 1999 May; 29(3): 555-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10405077&dopt=Abstract

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Lifetime patterns of social phobia: a retrospective study of the course of social phobia in a nonclinical population. Author(s): Chartier MJ, Hazen AL, Stein MB. Source: Depression and Anxiety. 1998; 7(3): 113-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9656091&dopt=Abstract

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Linking self-reported childhood behavioral inhibition to adolescent social phobia. Author(s): Hayward C, Killen JD, Kraemer HC, Taylor CB. Source: Journal of the American Academy of Child and Adolescent Psychiatry. 1998 December; 37(12): 1308-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9847504&dopt=Abstract

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Links between growth hormone deficiency, adaptation and social phobia. Author(s): Stabler B, Clopper RR, Siegel PT, Nicholas LM, Silva SG, Tancer ME, Underwood LE. Source: Hormone Research. 1996; 45(1-2): 30-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8742115&dopt=Abstract

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Long-term outcome of cognitive therapy's contribution to self-exposure in vivo to the treatment of generalized social phobia. Author(s): Salaberria K, Echeburua E. Source: Behavior Modification. 1998 July; 22(3): 262-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9670800&dopt=Abstract

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Long-term outcome of panic disorder and social phobia. Author(s): Hunt C, Andrews G. Source: Journal of Anxiety Disorders. 1998 July-August; 12(4): 395-406. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9699122&dopt=Abstract

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Long-term outcome of social phobia treated by exposure. Author(s): Fava GA, Grandi S, Rafanelli C, Ruini C, Conti S, Belluardo P. Source: Psychological Medicine. 2001 July; 31(5): 899-905. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11459387&dopt=Abstract

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Long-term treatment of social phobia with clonazepam. Author(s): Davidson JR, Ford SM, Smith RD, Potts NL. Source: The Journal of Clinical Psychiatry. 1991 November; 52 Suppl: 16-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1757453&dopt=Abstract

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Low dopamine D(2) receptor binding potential in social phobia. Author(s): Schneier FR, Liebowitz MR, Abi-Dargham A, Zea-Ponce Y, Lin SH, Laruelle M. Source: The American Journal of Psychiatry. 2000 March; 157(3): 457-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10698826&dopt=Abstract

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Low dose selegiline (L-Deprenyl) in social phobia. Author(s): Simpson HB, Schneier FR, Marshall RD, Campeas RB, Vermes D, Silvestre J, Davies S, Liebowitz MR. Source: Depression and Anxiety. 1998; 7(3): 126-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9656093&dopt=Abstract

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Low pregnenolone sulphate plasma concentrations in patients with generalized social phobia. Author(s): Heydari B, Le Melledo JM. Source: Psychological Medicine. 2002 July; 32(5): 929-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12171387&dopt=Abstract

Studies

57

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Lymphocyte beta-adrenoceptors in social phobia. Author(s): Stein MB, Huzel LL, Delaney SM. Source: Biological Psychiatry. 1993 July 1-15; 34(1-2): 45-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8396992&dopt=Abstract

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Magnetic resonance imaging in social phobia. Author(s): Potts NL, Davidson JR, Krishnan KR, Doraiswamy PM. Source: Psychiatry Research. 1994 April; 52(1): 35-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8047620&dopt=Abstract

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Magnetic resonance spectroscopy in social phobia: preliminary findings. Author(s): Davidson JR, Krishnan KR, Charles HC, Boyko O, Potts NL, Ford SM, Patterson L. Source: The Journal of Clinical Psychiatry. 1993 December; 54 Suppl: 19-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8276746&dopt=Abstract

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Major depression in panic disorder patients with comorbid social phobia. Author(s): Reiter SR, Otto MW, Pollack MH, Rosenbaum JF. Source: Journal of Affective Disorders. 1991 July; 22(3): 171-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1918660&dopt=Abstract

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Major depression in patients with social phobia. Author(s): Stein MB, Tancer ME, Gelernter CS, Vittone BJ, Uhde TW. Source: The American Journal of Psychiatry. 1990 May; 147(5): 637-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2327493&dopt=Abstract

•

Medical utilisation and costs in panic disorder: a comparison with social phobia. Author(s): Rees CS, Richards JC, Smith LM. Source: Journal of Anxiety Disorders. 1998 September-October; 12(5): 421-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9801962&dopt=Abstract

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Medication therapy for social phobia. Author(s): Marshall RD, Schneier FR, Fallon BA, Feerick J, Liebowitz MR. Source: The Journal of Clinical Psychiatry. 1994 June; 55 Suppl: 33-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8077172&dopt=Abstract

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Meeting of minds in psychiatry and homeopathy: an example in social phobia. Author(s): Davidson J, Gaylord S. Source: Alternative Therapies in Health and Medicine. 1995 July; 1(3): 36-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9359795&dopt=Abstract

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•

Memory bias against threat in social phobia. Author(s): Wenzel A, Holt CS. Source: The British Journal of Clinical Psychology / the British Psychological Society. 2002 March; 41(Pt 1): 73-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11931679&dopt=Abstract

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Memory bias in generalized social phobia: remembering negative emotional expressions. Author(s): Foa EB, Gilboa-Schechtman E, Amir N, Freshman M. Source: Journal of Anxiety Disorders. 2000 September-October; 14(5): 501-19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11095543&dopt=Abstract

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Memory bias in social phobia. Author(s): Rapee RM, McCallum SL, Melville LF, Ravenscroft H, Rodney JM. Source: Behaviour Research and Therapy. 1994 January; 32(1): 89-99. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8135726&dopt=Abstract

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Memory for facial expressions in social phobia. Author(s): Perez-Lopez JR, Woody SR. Source: Behaviour Research and Therapy. 2001 August; 39(8): 967-75. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11480837&dopt=Abstract

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Meta-analysis of cognitive-behavioral treatments for social phobia. Author(s): Taylor S. Source: Journal of Behavior Therapy and Experimental Psychiatry. 1996 March; 27(1): 19. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8814516&dopt=Abstract

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Methyl nicotinate-induced vasodilation in generalized social phobia. Author(s): Katzman M, Cornacchi S, Coonerty-Femiano A, Hughes B, Vermani M, Struzik L, Ross BM. Source: Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology. 2003 October; 28(10): 1846-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12888773&dopt=Abstract

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Mitral valve prolapse and social phobia. Author(s): Chaleby K, Ziady G. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1988 February; 152: 280-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3167351&dopt=Abstract

Studies

59

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Moclobemide in social phobia. Author(s): Duffett R. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1998 May; 172: 451-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9747419&dopt=Abstract

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Moclobemide in social phobia: a controlled dose-response trial. Author(s): Noyes R Jr, Moroz G, Davidson JR, Liebowitz MR, Davidson A, Siegel J, Bell J, Cain JW, Curlik SM, Kent TA, Lydiard RB, Mallinger AG, Pollack MH, Rapaport M, Rasmussen SA, Hedges D, Schweizer E, Uhlenhuth EH. Source: Journal of Clinical Psychopharmacology. 1997 August; 17(4): 247-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9241002&dopt=Abstract

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Moclobemide in social phobia: a pilot open study. GRP Group. Groupe de Recherche en Psychopharmacologie. Author(s): Bisserbe JC, Lepine JP. Source: Clinical Neuropharmacology. 1994; 17 Suppl 1: S88-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7954487&dopt=Abstract

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Moclobemide in the treatment of social phobia. Author(s): Nutt D, Montgomery SA. Source: International Clinical Psychopharmacology. 1996 June; 11 Suppl 3: 77-82. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8923114&dopt=Abstract

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Modafinil for social phobia and amphetamine dependence. Author(s): Camacho A, Stein MB. Source: The American Journal of Psychiatry. 2002 November; 159(11): 1947-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12411237&dopt=Abstract

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Multimodal comparisons of social phobia subtypes and avoidant personality disorder. Author(s): Boone ML, McNeil DW, Masia CL, Turk CL, Carter LE, Ries BJ, Lewin MR. Source: Journal of Anxiety Disorders. 1999 May-June; 13(3): 271-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10372342&dopt=Abstract

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Nefazodone for social phobia: a clinical case series. Author(s): Worthington JJ 3rd, Zucker BG, Fones CS, Otto MW, Pollack MH. Source: Depression and Anxiety. 1998; 8(3): 131-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9836065&dopt=Abstract

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Nefazodone in social phobia. Author(s): Van Ameringen M, Mancini C, Oakman JM. Source: The Journal of Clinical Psychiatry. 1999 February; 60(2): 96-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10084635&dopt=Abstract

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Negative interpretation bias in social phobia. Author(s): Amin N, Foa EB, Coles ME. Source: Behaviour Research and Therapy. 1998 October; 36(10): 945-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9714945&dopt=Abstract

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Neurobiological perspectives on social phobia: from affiliation to zoology. Author(s): Stein MB. Source: Biological Psychiatry. 1998 December 15; 44(12): 1277-85. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9861470&dopt=Abstract

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Neurobiology of social phobia. Author(s): Tancer ME. Source: The Journal of Clinical Psychiatry. 1993 December; 54 Suppl: 26-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8276747&dopt=Abstract

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Neurocognitive function in panic disorder and social phobia patients. Author(s): Asmundson GJ, Stein MB, Larsen DK, Walker JR. Source: Anxiety. 1994-95; 1(5): 201-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9160575&dopt=Abstract

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Neuroendocrine responsivity to monoaminergic system probes in generalized social phobia. Author(s): Tancer ME, Mailman RB, Stein MB, Mason GA, Carson SW, Golden RN. Source: Anxiety. 1994-95; 1(5): 216-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9160577&dopt=Abstract

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New developments in cognitive-behavioral therapy for social phobia. Author(s): Heimberg RG, Barlow DH. Source: The Journal of Clinical Psychiatry. 1991 November; 52 Suppl: 21-30. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1684581&dopt=Abstract

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New uses for antidepressants: social phobia. Author(s): Keck PE Jr, McElroy SL. Source: The Journal of Clinical Psychiatry. 1997; 58 Suppl 14: 32-6; Discussion 37-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9418744&dopt=Abstract

Studies

61

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Non-drug treatment for social phobia. Author(s): van Dyck R. Source: International Clinical Psychopharmacology. 1996 June; 11 Suppl 3: 65-70. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8923112&dopt=Abstract

•

Normal urinary free cortisol and postdexamethasone cortisol in social phobia: comparison to normal volunteers. Author(s): Uhde TW, Tancer ME, Gelernter CS, Vittone BJ. Source: Journal of Affective Disorders. 1994 March; 30(3): 155-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8006242&dopt=Abstract

•

Nurse-therapists at work: six case studies. 3. Social phobia. Author(s): McDona-d R. Source: Nurs Mirror Midwives J. 1975 May 8; 140(19): 60-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1039696&dopt=Abstract

•

Occupancy of brain serotonin transporters during treatment with paroxetine in patients with social phobia: a positron emission tomography study with 11C McN 5652. Author(s): Kent JM, Coplan JD, Lombardo I, Hwang DR, Huang Y, Mawlawi O, Van Heertum RL, Slifstein M, Abi-Dargham A, Gorman JM, Laruelle M. Source: Psychopharmacology. 2002 December; 164(4): 341-8. Epub 2002 September 11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12457263&dopt=Abstract

•

Open trial of interpersonal psychotherapy for the treatment of social phobia. Author(s): Lipsitz JD, Markowitz JC, Cherry S, Fyer AJ. Source: The American Journal of Psychiatry. 1999 November; 156(11): 1814-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10553749&dopt=Abstract

•

Over-representation of Myers Briggs Type Indicator introversion in social phobia patients. Author(s): Janowsky DS, Morter S, Tancer M. Source: Depression and Anxiety. 2000; 11(3): 121-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10875053&dopt=Abstract

•

Panic disorder and social phobia: current treatments and new strategies. Author(s): Davidson JR, Connor KM, Sutherland SM. Source: Cleve Clin J Med. 1998; 65 Suppl 1: Si39-44; Discussion Si45-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12033205&dopt=Abstract

62

Social Phobia

•

Panic disorder and social phobia: effects of comorbidity on familial transmission. Author(s): Fyer AJ, Mannuzza S, Chapman TF, Lipsitz J, Martin LY, Klein DF. Source: Anxiety. 1996; 2(4): 173-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9160619&dopt=Abstract

•

Panic disorder and social phobia: possible implications of comorbid depression for drug therapy. Author(s): Lydiard RB. Source: Anxiety. 1996; 2(2): 61-70. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9160603&dopt=Abstract

•

Patients with generalized social phobia direct their attention away from faces. Author(s): Chen YP, Ehlers A, Clark DM, Mansell W. Source: Behaviour Research and Therapy. 2002 June; 40(6): 677-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12051486&dopt=Abstract

•

Personality dimensions measured by the Temperament and Character Inventory (TCI) in subjects with social phobia. Author(s): Marteinsdottir I, Tillfors M, Furmark T, Anderberg UM, Ekselius L. Source: Nordic Journal of Psychiatry. 2003; 57(1): 29-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12745789&dopt=Abstract

•

Personality disorders and time to remission in generalized anxiety disorder, social phobia, and panic disorder. Author(s): Massion AO, Dyck IR, Shea MT, Phillips KA, Warshaw MG, Keller MB. Source: Archives of General Psychiatry. 2002 May; 59(5): 434-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11982447&dopt=Abstract

•

Personality traits in social phobia, I: Comparisons with healthy controls. Author(s): Fahlen T. Source: The Journal of Clinical Psychiatry. 1995 December; 56(12): 560-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8530332&dopt=Abstract

•

Personality traits in social phobia, II: Changes during drug treatment. Author(s): Fahlen T. Source: The Journal of Clinical Psychiatry. 1995 December; 56(12): 569-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8530333&dopt=Abstract

Studies

63

•

Personality traits in social phobia. Author(s): Marteinsdottir I, Furmark T, Tillfors M, Fredrikson M, Ekselius L. Source: European Psychiatry : the Journal of the Association of European Psychiatrists. 2001 April; 16(3): 143-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11353591&dopt=Abstract

•

Pharmacotherapy of social phobia. Author(s): Davidson JR. Source: Acta Psychiatrica Scandinavica. Supplementum. 2003; (417): 65-71. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12950437&dopt=Abstract

•

Pindolol potentiation of paroxetine for generalized social phobia: a double-blind, placebo-controlled, crossover study. Author(s): Stein MB, Sareen J, Hami S, Chao J. Source: The American Journal of Psychiatry. 2001 October; 158(10): 1725-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11579011&dopt=Abstract

•

Plasma neuropeptide Y in anxiety disorders: findings in panic disorder and social phobia. Author(s): Stein MB, Hauger RL, Dhalla KS, Chartier MJ, Asmundson GJ. Source: Psychiatry Research. 1996 January 31; 59(3): 183-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8930023&dopt=Abstract

•

Predicting anxious response to a social challenge: the predictive utility of the social interaction anxiety scale and the social phobia scale in a college population. Author(s): Gore KL, Carter MM, Parker S. Source: Behaviour Research and Therapy. 2002 June; 40(6): 689-700. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12051487&dopt=Abstract

•

Prevalence of childhood ADHD among patients with Generalized Anxiety Disorder and a comparison condition, Social Phobia. Author(s): Safren SA, Lanka GD, Otto MW, Pollack MH. Source: Depression and Anxiety. 2001; 13(4): 190-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11413566&dopt=Abstract

•

Profile of a large sample of patients with social phobia: comparison between generalized and specific social phobia. Author(s): Weinshenker NJ, Goldenberg I, Rogers MP, Goisman RM, Warshaw MG, Fierman EJ, Vasile RG, Keller MB. Source: Depression and Anxiety. 1996-97; 4(5): 209-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9167786&dopt=Abstract

64

Social Phobia

•

Psychological and pharmacological treatments of social phobia: a meta-analysis. Author(s): Fedoroff IC, Taylor S. Source: Journal of Clinical Psychopharmacology. 2001 June; 21(3): 311-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11386495&dopt=Abstract

•

Psychometric evaluation of the Social Phobia and Anxiety Inventory in college students. Author(s): Osman A, Barrios FX, Aukes D, Osman JR. Source: Journal of Clinical Psychology. 1995 March; 51(2): 235-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7797647&dopt=Abstract

•

Psychophysiological and subjective indicators of aversive pavlovian conditioning in generalized social phobia. Author(s): Hermann C, Ziegler S, Birbaumer N, Flor H. Source: Biological Psychiatry. 2002 August 15; 52(4): 328-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12208640&dopt=Abstract

•

Psychophysiological differences between subgroups of social phobia. Author(s): Hofmann SG, Newman MG, Ehlers A, Roth WT. Source: Journal of Abnormal Psychology. 1995 February; 104(1): 224-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7897046&dopt=Abstract

•

Putative clinical subtypes of social phobia: a factor-analytical study. Author(s): Perugi G, Nassini S, Maremmani I, Madaro D, Toni C, Simonini E, Akiskal HS. Source: Acta Psychiatrica Scandinavica. 2001 October; 104(4): 280-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11722303&dopt=Abstract

•

Quality of life in anxiety and social phobia. Author(s): Bech P, Angst J. Source: International Clinical Psychopharmacology. 1996 June; 11 Suppl 3: 97-100. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8923117&dopt=Abstract

•

Quality of life in social phobia. Author(s): Safren SA, Heimberg RG, Brown EJ, Holle C. Source: Depression and Anxiety. 1996-97; 4(3): 126-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9166641&dopt=Abstract

Studies

65

•

Randomised controlled general practice trial of sertraline, exposure therapy and combined treatment in generalised social phobia. Author(s): Blomhoff S, Haug TT, Hellstrom K, Holme I, Humble M, Madsbu HP, Wold JE. Source: The British Journal of Psychiatry; the Journal of Mental Science. 2001 July; 179: 23-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11435264&dopt=Abstract

•

Reaction time to threat stimuli in panic disorder and social phobia. Author(s): Cloitre M, Heimberg RG, Holt CS, Liebowitz MR. Source: Behaviour Research and Therapy. 1992 November; 30(6): 609-17. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1417686&dopt=Abstract

•

Recall of family factors in social phobia and panic disorder: comparison of mother and offspring reports. Author(s): Rapee RM, Melville LF. Source: Depression and Anxiety. 1997; 5(1): 7-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9250435&dopt=Abstract

•

Recent advances in the psychopharmacology of social phobia. Author(s): Den Boer JA, Van Vliet IM, Westenberg HG. Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 1994 July; 18(4): 625-45. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7938556&dopt=Abstract

•

Recent developments in the psychopharmacology of social phobia. Author(s): Den Boer JA, van Vliet IM, Westenberg HG. Source: European Archives of Psychiatry and Clinical Neuroscience. 1995; 244(6): 309-16. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7772614&dopt=Abstract

•

Recognition of facial affect by children and adolescents diagnosed with social phobia. Author(s): Simonian SJ, Beidel DC, Turner SM, Berkes JL, Long JH. Source: Child Psychiatry and Human Development. 2001 Winter; 32(2): 137-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11758879&dopt=Abstract

•

Recurrent images and early memories in social phobia. Author(s): Hackmann A, Clark DM, McManus F. Source: Behaviour Research and Therapy. 2000 June; 38(6): 601-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10846808&dopt=Abstract

66

Social Phobia

•

Relation of marital status to social phobia severity. Author(s): Hart TA, Turk CL, Heimberg RG, Liebowitz MR. Source: Depression and Anxiety. 1999; 10(1): 28-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10499187&dopt=Abstract

•

Relationship between adult social phobia and childhood anxiety. Author(s): Manfro GG, Isolan L, Blaya C, Maltz S, Heldt E, Pollack MH. Source: Revista Brasileira De Psiquiatria (Sao Paulo, Brazil : 1999). 2003 June; 25(2): 96-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12975706&dopt=Abstract

•

Relationship of social phobia with other psychiatric illness. Author(s): Van Ameringen M, Mancini C, Styan G, Donison D. Source: Journal of Affective Disorders. 1991 February; 21(2): 93-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1827645&dopt=Abstract

•

Responders and non-responders to drug treatment in social phobia: differences at baseline and prediction of response. Author(s): Slaap BR, van Vliet IM, Westenberg HG, Den Boer JA. Source: Journal of Affective Disorders. 1996 June 20; 39(1): 13-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8835649&dopt=Abstract

•

Response to alcohol in social phobia. Author(s): Naftolowitz DF, Vaughn BV, Ranc J, Tancer ME. Source: Anxiety. 1994; 1(2): 96-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9160554&dopt=Abstract

•

Response to 'Does reducing safety behaviours improve treatment response in patients with social phobia?'. Author(s): Battersby M. Source: The Australian and New Zealand Journal of Psychiatry. 2000 October; 34(5): 8713. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11037379&dopt=Abstract

•

Resting cardiovascular measures in patients with panic disorder and social phobia and health control subjects: relationship to habitual exercise frequency. Author(s): Asmundson GJ, Stein MB. Source: Anxiety. 1994; 1(1): 26-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9160543&dopt=Abstract

Studies

67

•

Reversible MAO inhibitors in social phobia bulimia, and other disorders. Author(s): Liebowitz MR. Source: Clinical Neuropharmacology. 1992; 15 Suppl 1 Pt A: 434A-435A. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1498905&dopt=Abstract

•

Reversible monoamine oxidase-A inhibitors in social phobia. Author(s): Liebowitz MR, Schneier F, Gitow A, Feerick J. Source: Clinical Neuropharmacology. 1993; 16 Suppl 2: S83-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8313403&dopt=Abstract

•

Risk factors for the incidence of social phobia as determined by the Diagnostic Interview Schedule in a population-based study. Author(s): Wells JC, Tien AY, Garrison R, Eaton WW. Source: Acta Psychiatrica Scandinavica. 1994 August; 90(2): 84-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7976463&dopt=Abstract

•

Risk of heavy drinking and alcohol use disorders in social phobia: a prospective analysis. Author(s): Crum RM, Pratt LA. Source: The American Journal of Psychiatry. 2001 October; 158(10): 1693-700. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11579004&dopt=Abstract

•

Role of serotonin drugs in the treatment of social phobia. Author(s): Tancer ME, Uhde TW. Source: The Journal of Clinical Psychiatry. 1997; 58 Suppl 5: 50-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9184626&dopt=Abstract

•

Scrutinizing the relationship between shyness and social phobia. Author(s): Chavira DA, Stein MB, Malcarne VL. Source: Journal of Anxiety Disorders. 2002; 16(6): 585-98. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12405519&dopt=Abstract

•

Selective attention in social phobia and the moderating effect of a concurrent depressive disorder. Author(s): Musa C, Lepine JP, Clark DM, Mansell W, Ehlers A. Source: Behaviour Research and Therapy. 2003 September; 41(9): 1043-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12914806&dopt=Abstract

68

Social Phobia

•

Self-administration of alcohol before and after a public speaking challenge by individuals with social phobia. Author(s): Abrams K, Kushner MG, Medina KL, Voight A. Source: Psychology of Addictive Behaviors : Journal of the Society of Psychologists in Addictive Behaviors. 2002 June; 16(2): 121-8. Erratum In: Psychol Addict Behav 2002 September; 16(3): 211. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12079250&dopt=Abstract

•

Self-focused attention in social phobia and social anxiety. Author(s): Spurr JM, Stopa L. Source: Clinical Psychology Review. 2002 September; 22(7): 947-75. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12238248&dopt=Abstract

•

Self-images play a causal role in social phobia. Author(s): Hirsch CR, Clark DM, Mathews A, Williams R. Source: Behaviour Research and Therapy. 2003 August; 41(8): 909-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12880646&dopt=Abstract

•

Self-medication in social phobia: a review of the alcohol literature. Author(s): Carrigan MH, Randall CL. Source: Addictive Behaviors. 2003 March; 28(2): 269-84. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12573678&dopt=Abstract

•

Self-reported and actual physiological responses in social phobia. Author(s): Edelmann RJ, Baker SR. Source: The British Journal of Clinical Psychology / the British Psychological Society. 2002 March; 41(Pt 1): 1-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11931674&dopt=Abstract

•

Sexual function and behavior in social phobia. Author(s): Bodinger L, Hermesh H, Aizenberg D, Valevski A, Marom S, Shiloh R, Gothelf D, Zemishlany Z, Weizman A. Source: The Journal of Clinical Psychiatry. 2002 October; 63(10): 874-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12416596&dopt=Abstract

•

Shyness and social phobia: a social work perspective on a problem in living. Author(s): Walsh J. Source: Health & Social Work. 2002 May; 27(2): 137-44. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12079168&dopt=Abstract

Studies

69

•

Shyness: relationship to social phobia and other psychiatric disorders. Author(s): Heiser NA, Turner SM, Beidel DC. Source: Behaviour Research and Therapy. 2003 February; 41(2): 209-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12547381&dopt=Abstract

•

Social phobia and the recall of autobiographical memories. Author(s): Wenzel A, Jackson LC, Holt CS. Source: Depression and Anxiety. 2002; 15(4): 186-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12112725&dopt=Abstract

•

Social phobia in adults with stuttering. Author(s): Stein MB, Baird A, Walker JR. Source: The American Journal of Psychiatry. 1996 February; 153(2): 278-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8561214&dopt=Abstract

•

Social phobia in general health care: an unrecognised undertreated disabling disorder. Author(s): Weiller E, Bisserbe JC, Boyer P, Lepine JP, Lecrubier Y. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1996 February; 168(2): 169-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8837906&dopt=Abstract

•

Social phobia in spasmodic torticollis: some conceptual issues. Author(s): Sharma P, Gupta N. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 2002 October; 73(4): 461; Author Reply 461-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12235327&dopt=Abstract

•

Social phobia in the Australian National Survey of Mental Health and Well-Being (NSMHWB). Author(s): Lampe L, Slade T, Issakidis C, Andrews G. Source: Psychological Medicine. 2003 May; 33(4): 637-46. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785465&dopt=Abstract

•

Social phobia subtyping with the MMPI-2. Author(s): Levin JB, Hermesh H, Marom S. Source: Journal of Clinical Psychology. 2001 December; 57(12): 1489-502. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11745591&dopt=Abstract

70

Social Phobia

•

Social phobia. Author(s): Filakovic P, Dordevic V, Koic E, Muzinic L. Source: Coll Antropol. 2003; 27 Suppl 1: 147-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12955904&dopt=Abstract

•

Social phobia: overview of community surveys. Author(s): Furmark T. Source: Acta Psychiatrica Scandinavica. 2002 February; 105(2): 84-93. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11939957&dopt=Abstract

•

Social phobia: research and clinical practice. Author(s): Alnaes R. Source: Nordic Journal of Psychiatry. 2001; 55(6): 419-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11839136&dopt=Abstract

•

Social phobia: still a neglected anxiety disorder? Author(s): Sheeran T, Zimmerman M. Source: The Journal of Nervous and Mental Disease. 2002 November; 190(11): 786-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12436021&dopt=Abstract

•

The diagnosis of social phobia. Author(s): Greist JH. Source: The Journal of Clinical Psychiatry. 1995; 56 Suppl 5: 5-12. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7782274&dopt=Abstract

•

The economic consequences of social phobia. Author(s): Patel A, Knapp M, Henderson J, Baldwin D. Source: Journal of Affective Disorders. 2002 April; 68(2-3): 221-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12063150&dopt=Abstract

•

The effect of practice on recall of emotional information in individuals with generalized social phobia. Author(s): Amir N, Coles ME, Brigidi B, Foa EB. Source: Journal of Abnormal Psychology. 2001 February; 110(1): 76-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11261403&dopt=Abstract

•

The efficacy of the selective serotonin reuptake inhibitors for social anxiety disorder (social phobia): a meta-analysis of randomized controlled trials. Author(s): van der Linden GJ, Stein DJ, van Balkom AJ. Source: International Clinical Psychopharmacology. 2000 August; 15 Suppl 2: S15-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11110015&dopt=Abstract

Studies

71

•

The impairments caused by social phobia in the general population: implications for intervention. Author(s): Kessler RC. Source: Acta Psychiatrica Scandinavica. Supplementum. 2003; (417): 19-27. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12950433&dopt=Abstract

•

The influence on treatment gain of comorbid avoidant personality disorder in patients with social phobia. Author(s): Oosterbaan DB, van Balkom AJ, Spinhoven P, de Meij TG, van Dyck R. Source: The Journal of Nervous and Mental Disease. 2002 January; 190(1): 41-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11838470&dopt=Abstract

•

The pharmacologic and expectancy effects of alcohol on social anxiety in individuals with social phobia. Author(s): Abrams K, Kushner M, Medina KL, Voight A. Source: Drug and Alcohol Dependence. 2001 October 1; 64(2): 219-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11543992&dopt=Abstract

•

The placebo response in social phobia. Author(s): Oosterbaan DB, van Balkom AJ, Spinhoven P, van Dyck R. Source: Journal of Psychopharmacology (Oxford, England). 2001 September; 15(3): 199203. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11565629&dopt=Abstract

•

The quest for biological correlates of social phobia: an interim assessment. Author(s): Dewar KM, Stravynski A. Source: Acta Psychiatrica Scandinavica. 2001 April; 103(4): 244-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11328236&dopt=Abstract

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The relationship of olfactory delusional disorder to social phobia. Author(s): Tada K, Kojima T. Source: The Journal of Nervous and Mental Disease. 2002 January; 190(1): 45-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11838032&dopt=Abstract

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The social phobia diagnostic questionnaire: preliminary validation of a new selfreport diagnostic measure of social phobia. Author(s): Newman MG, Kachin KE, Zuellig AR, Constantino MJ, Cashman-McGrath L. Source: Psychological Medicine. 2003 May; 33(4): 623-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12785464&dopt=Abstract

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The Social Thoughts and Beliefs Scale: a new inventory for assessing cognitions in social phobia. Author(s): Turner SM, Johnson MR, Beidel DC, Heiser NA, Lydiard RB. Source: Psychological Assessment. 2003 September; 15(3): 384-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14593839&dopt=Abstract

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The spectrum of social phobia in the Zurich cohort study of young adults. Author(s): Merikangas KR, Avenevoli S, Acharyya S, Zhang H, Angst J. Source: Biological Psychiatry. 2002 January 1; 51(1): 81-91. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11801233&dopt=Abstract

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The treatment of childhood social phobia: the effectiveness of a social skills trainingbased, cognitive-behavioural intervention, with and without parental involvement. Author(s): Spence SH, Donovan C, Brechman-Toussaint M. Source: Journal of Child Psychology and Psychiatry, and Allied Disciplines. 2000 September; 41(6): 713-26. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11039684&dopt=Abstract

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The treatment of social phobia: the differential effectiveness of exposure in vivo and an integration of exposure in vivo, rational emotive therapy and social skills training. Author(s): Mersch PP. Source: Behaviour Research and Therapy. 1995 March; 33(3): 259-69. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7726802&dopt=Abstract

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The voice of emotional memory: content-filtered speech in panic disorder, social phobia, and major depressive disorder. Author(s): McNally RJ, Otto MW, Hornig CD. Source: Behaviour Research and Therapy. 2001 November; 39(11): 1329-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11686267&dopt=Abstract

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Thought suppression: specificity in agoraphobia versus broad impairment in social phobia? Author(s): Fehm L, Margraf J. Source: Behaviour Research and Therapy. 2002 January; 40(1): 57-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11762427&dopt=Abstract

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Toward an integrative understanding of social phobia. Author(s): Li D, Chokka P, Tibbo P. Source: Journal of Psychiatry & Neuroscience : Jpn. 2001 May; 26(3): 190-202. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11394189&dopt=Abstract

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Treatment of social phobia with antidepressants. Author(s): Schneier FR. Source: The Journal of Clinical Psychiatry. 2001; 62 Suppl 1: 43-8; Discussion 49. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11206033&dopt=Abstract

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Tridimensional personality questionnaire: assessment in patients with social phobia and a control group. Author(s): Kim SW, Hoover KM. Source: Psychological Reports. 1996 February; 78(1): 43-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8839294&dopt=Abstract

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Uncharted waters: psychodynamic considerations in the diagnosis and treatment of social phobia. Author(s): Zerbe KJ. Source: Bulletin of the Menninger Clinic. 1994 Spring; 58(2 Suppl A): A3-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8044136&dopt=Abstract

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Urosepsis: an unusual presentation of a social phobia. Author(s): Brandt GT, Norwood AE, Ursano RJ. Source: The American Journal of Psychiatry. 1994 October; 151(10): 1520. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8092345&dopt=Abstract

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Use of medical services and treatment for panic disorder with agoraphobia and for social phobia. Author(s): Swinson RP, Cox BJ, Woszczyna CB. Source: Cmaj : Canadian Medical Association Journal = Journal De L'association Medicale Canadienne. 1992 September 15; 147(6): 878-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1525731&dopt=Abstract

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Use of the selective serotonin reuptake inhibitor citalopram in the treatment of generalized social phobia. Author(s): Bouwer C, Stein DJ. Source: Journal of Affective Disorders. 1998 April; 49(1): 79-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9574863&dopt=Abstract

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Validity issues in self-statement measures of social phobia and social anxiety. Author(s): Glass CR, Arnkoff DB. Source: Behaviour Research and Therapy. 1994 February; 32(2): 255-67. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8155065&dopt=Abstract

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Validity of the distinction between generalized social phobia and avoidant personality disorder. Author(s): Herbert JD, Hope DA, Bellack AS. Source: Journal of Abnormal Psychology. 1992 May; 101(2): 332-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1583228&dopt=Abstract

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Value of the Fear Questionnaire in differentiating agoraphobia and social phobia. Author(s): Cox BJ, Swinson RP, Shaw BF. Source: The British Journal of Psychiatry; the Journal of Mental Science. 1991 December; 159: 842-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1790455&dopt=Abstract

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Venlafaxine in social phobia. Author(s): Kelsey JE. Source: Psychopharmacology Bulletin. 1995; 31(4): 767-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8851651&dopt=Abstract

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CHAPTER 2. NUTRITION AND SOCIAL PHOBIA Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and social phobia.

Finding Nutrition Studies on Social Phobia The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “social phobia” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

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Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “social phobia” (or a synonym): •

A repeat proton magnetic resonance spectroscopy study in social phobia. Author(s): Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA. Source: Tupler, L A Davidson, J R Smith, R D Lazeyras, F Charles, H C Krishnan, K R Biol-Psychiatry. 1997 September 15; 42(6): 419-24 0006-3223

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Benzodiazepines and anticonvulsants for social phobia (social anxiety disorder). Author(s): Madison Institute of Medicine, Inc., and the University of Wisconsin Medical School, USA. [email protected] Source: Jefferson, J W J-Clin-Psychiatry. 2001; 62 Suppl 150-3 0160-6689

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Evidence for social phobia and other psychiatric disorders in adults who were growth hormone deficient during childhood. Author(s): Department of Psychiatry, School of Medicine, The University of North Carolina at Chapel Hill 27599-7160, USA. Source: Stabler, B Tancer, M E Ranc, J Underwood, L E Anxiety. 1996; 2(2): 86-9 10709797

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Hyperresponsivity to nicotinic acid challenge in generalized social phobia: a pilot study. Author(s): Dept. of Psychological Medicine, University of Otago, Dunedin, New Zealand. [email protected] Source: Bouwer, C Stein, D J Eur-Neuropsychopharmacol. 1998 December; 8(4): 311-3 0924-977X

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Kava kava in the treatment of generalized anxiety disorder, simple phobia and specific social phobia. Author(s): Department of Psychiatry, University of Munich, Nussbaumstr. 7, D-80336, Munich, Germany. Source: Boerner, R J Phytother-Res. 2001 November; 15(7): 646-7 0951-418X

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Panic disorder and social phobia: current treatments and new strategies. Author(s): Department of Psychiatry and Behavioral Services, Duke University Medical Center, Durham, North Carolina 27710, USA. Source: Davidson, J R Connor, K M Sutherland, S M Cleve-Clin-J-Med. 1998; 65 Suppl 1: SI39-44; discussion SI45-7 0891-1150

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Recent advances in the psychopharmacology of social phobia. Author(s): Department of Biological Psychiatry Academic Hospital Utrecht, The Netherlands. Source: Den Boer, J A Van Vliet, I M Westenberg, H G Prog-NeuropsychopharmacolBiol-Psychiatry. 1994 July; 18(4): 625-45 0278-5846

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Recent developments in the psychopharmacology of social phobia. Author(s): Department of Psychiatry, Academic Hospital, Utrecht, The Netherlands. Source: Den Boer, J A van Vliet, I M Westenberg, H G Eur-Arch-Psychiatry-ClinNeurosci. 1995; 244(6): 309-16 0940-1334

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Social phobia: issues in assessment and management. Author(s): Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina 27710, USA. Source: Connor, K M Davidson, J R Sutherland, S Weisler, R Epilepsia. 1999; 40 Suppl 6S60-5; discussion S73-4 0013-9580

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The quest for biological correlates of social phobia: an interim assessment. Author(s): Fernand-Seguin Research Centre, University of Montreal, Montreal, Quebec, Canada. Source: Dewar, K M Stravynski, A Acta-Psychiatr-Scand. 2001 April; 103(4): 244-51 0001690X

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Treatment of social phobia with antidepressants. Author(s): Anxiety Disorders Clinic, New York State Psychiatric Institute and the College of Physicians and Surgeons of Columbia University, New York 10032, USA. [email protected] Source: Schneier, F R J-Clin-Psychiatry. 2001; 62 Suppl 143-8; discussion 49 0160-6689

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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CHAPTER 3. ALTERNATIVE MEDICINE AND SOCIAL PHOBIA Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to social phobia. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to social phobia and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “social phobia” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to social phobia: •

“Change the mind and you change the brain”: effects of cognitive-behavioral therapy on the neural correlates of spider phobia. Author(s): Paquette V, Levesque J, Mensour B, Leroux JM, Beaudoin G, Bourgouin P, Beauregard M. Source: Neuroimage. 2003 February; 18(2): 401-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12595193&dopt=Abstract

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“Systematic desensitization therapy in examination phobia”. Author(s): Shukla GD, Nigam P. Source: J Assoc Physicians India. 1979 August; 27(8): 725-9. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=44293&dopt=Abstract

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Behavioral assessment and treatment of social phobia. An evaluative review. Author(s): Donohue BC, Van Hasselt VB, Hersen M. Source: Behavior Modification. 1994 July; 18(3): 262-88. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8037649&dopt=Abstract

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Cognitive biases in generalized social phobia. Author(s): Foa EB, Franklin ME, Perry KJ, Herbert JD. Source: Journal of Abnormal Psychology. 1996 August; 105(3): 433-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8772013&dopt=Abstract

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Cognitive-behavioral approaches to panic disorder and social phobia. Author(s): Barlow DH. Source: Bulletin of the Menninger Clinic. 1992 Spring; 56(2 Suppl A): A14-28. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1623337&dopt=Abstract

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Common changes in cerebral blood flow in patients with social phobia treated with citalopram or cognitive-behavioral therapy. Author(s): Furmark T, Tillfors M, Marteinsdottir I, Fischer H, Pissiota A, Langstrom B, Fredrikson M. Source: Archives of General Psychiatry. 2002 May; 59(5): 425-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11982446&dopt=Abstract

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Current status of psychotherapeutic interventions for social phobia. Author(s): Heimberg RG. Source: The Journal of Clinical Psychiatry. 2001; 62 Suppl 1: 36-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11206032&dopt=Abstract

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Effects of varying levels of anxiety within social situations: relationship to memory perspective and attributions in social phobia. Author(s): Coles ME, Turk CL, Heimberg RG, Fresco DM. Source: Behaviour Research and Therapy. 2001 June; 39(6): 651-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11400710&dopt=Abstract

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Embarrassment and social phobia: the role of parasympathetic activation. Author(s): Gerlach AL, Wilhelm FH, Roth WT. Source: Journal of Anxiety Disorders. 2003; 17(2): 197-210. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12614662&dopt=Abstract

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Functional brain imaging and pharmacotherapy in social phobia: single photon emission computed tomography before and after treatment with the selective serotonin reuptake inhibitor citalopram. Author(s): Van der Linden G, van Heerden B, Warwick J, Wessels C, van Kradenburg J, Zungu-Dirwayi N, Stein DJ.

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Source: Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2000 April; 24(3): 419-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10836490&dopt=Abstract •

Kava kava in the treatment of generalized anxiety disorder, simple phobia and specific social phobia. Author(s): Boerner RJ. Source: Phytotherapy Research : Ptr. 2001 November; 15(7): 646-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11746854&dopt=Abstract

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Meeting of minds in psychiatry and homeopathy: an example in social phobia. Author(s): Davidson J, Gaylord S. Source: Alternative Therapies in Health and Medicine. 1995 July; 1(3): 36-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9359795&dopt=Abstract

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Occupancy of brain serotonin transporters during treatment with paroxetine in patients with social phobia: a positron emission tomography study with 11C McN 5652. Author(s): Kent JM, Coplan JD, Lombardo I, Hwang DR, Huang Y, Mawlawi O, Van Heertum RL, Slifstein M, Abi-Dargham A, Gorman JM, Laruelle M. Source: Psychopharmacology. 2002 December; 164(4): 341-8. Epub 2002 September 11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12457263&dopt=Abstract

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Psychophysiological and subjective indicators of aversive pavlovian conditioning in generalized social phobia. Author(s): Hermann C, Ziegler S, Birbaumer N, Flor H. Source: Biological Psychiatry. 2002 August 15; 52(4): 328-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12208640&dopt=Abstract

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Psychosocial treatment prescriptions for generalized anxiety disorder, panic disorder, and social phobia, 1991-1996. Author(s): Goisman RM, Warshaw MG, Keller MB. Source: The American Journal of Psychiatry. 1999 November; 156(11): 1819-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10553751&dopt=Abstract

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Self-reported and actual physiological responses in social phobia. Author(s): Edelmann RJ, Baker SR. Source: The British Journal of Clinical Psychology / the British Psychological Society. 2002 March; 41(Pt 1): 1-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11931674&dopt=Abstract

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Serum interleukin-2 and soluble interleukin-2 receptor levels in generalized social phobia. Author(s): Rapaport MH, Stein MB. Source: Anxiety. 1994; 1(2): 50-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9160548&dopt=Abstract

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Social phobia and agoraphobia in alcoholism. Author(s): Cudrin JM. Source: The American Journal of Psychiatry. 1991 August; 148(8): 1096. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1853973&dopt=Abstract

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Social phobia. Longitudinal course and long-term outcome of cognitive-behavioral treatment. Author(s): Juster HR, Heimberg RG. Source: The Psychiatric Clinics of North America. 1995 December; 18(4): 821-42. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8748383&dopt=Abstract

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Social phobia: the Anxiety Disorders Associated of America helps raise the veil of ignorance. Author(s): Ross J. Source: The Journal of Clinical Psychiatry. 1991 November; 52 Suppl: 43-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1757456&dopt=Abstract

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The neurobiology of social phobia. Author(s): Bell CJ, Malizia AL, Nutt DJ. Source: European Archives of Psychiatry and Clinical Neuroscience. 1999; 249 Suppl 1: S11-8. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10361961&dopt=Abstract

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The quest for biological correlates of social phobia: an interim assessment. Author(s): Dewar KM, Stravynski A. Source: Acta Psychiatrica Scandinavica. 2001 April; 103(4): 244-51. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11328236&dopt=Abstract

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The treatment of social phobia in general practice. is exposure therapy feasible? Author(s): Haug TT, Hellstrom K, Blomhoff S, Humble M, Madsbu HP, Wold JE. Source: Family Practice. 2000 April; 17(2): 114-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10758071&dopt=Abstract

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The treatment of social phobia. Real-life rehearsal with nonprofessional therapists. Author(s): Falloon IR, Lloyd GG, Harpin RE.

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Source: The Journal of Nervous and Mental Disease. 1981 March; 169(3): 180-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7205244&dopt=Abstract •

Treatment of social phobia by exposure, cognitive restructuring, and homework assignments. Author(s): Heimberg RG, Becker RE, Goldfinger K, Vermilyea JA. Source: The Journal of Nervous and Mental Disease. 1985 April; 173(4): 236-45. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3981159&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON SOCIAL PHOBIA Overview In this chapter, we will give you a bibliography on recent dissertations relating to social phobia. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “social phobia” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on social phobia, we have not necessarily excluded nonmedical dissertations in this bibliography.

Dissertations on Social Phobia ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to social phobia. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

Aspects of Social Phobia by Marteinsdottir, Ina Torunn, PhD from Uppsala Universitet (Sweden), 2003, 71 pages http://wwwlib.umi.com/dissertations/fullcit/f281185

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Information Processing in Social Phobia: the Effect of Social Appraisal on the Anxiety Program by Mellings, Tanna Marlane Boucher, PhD from The University of British Columbia (Canada), 2002, 107 pages http://wwwlib.umi.com/dissertations/fullcit/NQ75054

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Psychosocial Predictors of Agoraphobia, Simple Phobia, and Social Phobia Onset in a United States National Sample by Magee, William Joesph, PhD from The University of Michigan, 1993, 308 pages http://wwwlib.umi.com/dissertations/fullcit/9409759

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The Effect of Alcohol on Social Phobic Anxiety (Social Phobias) by Himle, Joseph Alan, PhD from The University of Michigan, 1995, 249 pages http://wwwlib.umi.com/dissertations/fullcit/9542859

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Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. CLINICAL TRIALS AND SOCIAL PHOBIA Overview In this chapter, we will show you how to keep informed of the latest clinical trials concerning social phobia.

Recent Trials on Social Phobia The following is a list of recent trials dedicated to social phobia.8 Further information on a trial is available at the Web site indicated. •

Assessment and Treatment of Social Skills Deficits in Individuals with Social Phobia Condition(s): Phobic Disorders; Phobia, Social Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this study is to determine whether people with social phobia are deficient in certain social skills. If social skills deficits are evident, improvement measures will be implemented. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00073333

•

St. John's Wort vs Placebo in Social Phobia Condition(s): Phobic Disorders Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Complementary and Alternative Medicine (NCCAM) Purpose - Excerpt: The purpose of this study is to determine the effectiveness of St. John's Wort as compared to placebo (an inactive substance) in the treatment of outpatients with social phobia.

8

These are listed at www.ClinicalTrials.gov.

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Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00035412 •

Treatment of Childhood Social Phobia Condition(s): Phobic Disorders Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: This 4-year study will compare the long-term effectiveness of behavioral treatment, fluoxetine (Prozac), and placebo for treatment of social phobia in children and adolescents. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00043537

•

Treatment of Youth with ADHD and Anxiety Condition(s): Attention Deficit Hyperactivity Disorder; Anxiety, Separation; Social Phobia; Generalized Anxiety Disorder Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this NIMH-sponsored pilot study is to collect information on the efficacy and safety of drug treatments for children and adolescents who suffer from both ADHD and anxiety disorders. Specifically, the study will examine the benefits of the stimulant medication both alone and in combination with fluvoxamine, a selective serotonin reuptake inhibitor (SSRI) that has antianxiety effects. Young people aged 6 to 17 diagnosed with these co-occurring disorders may be eligible to participate. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00012584

•

Treatment for Anxiety in Children Condition(s): Obsessive-Compulsive Disorder; Anxiety Disorders; Generalized Anxiety Disorder; Social Phobia; Separation Anxiety Study Status: This study is completed. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this study is to see if it is effective to treat children with anxiety disorders with fluvoxamine. Fluvoxamine has been successfully used to treat obsessive-compulsive disorder (OCD) in adults and children. Anxiety disorders other than OCD, such as generalized anxiety disorder, social phobia, or separation anxiety, are very common in youth and are not always responsive to behavioral

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therapies alone. These disorders may respond to fluvoxamine. A child will be evaluated for 3 weeks before he/she is assigned randomly (like tossing a coin) to receive either fluvoxamine or an inactive placebo for 8 weeks. After this double-blind phase (neither the child/parents nor the doctor know which treatment is being given), the child will have the option of continuing treatment during a 4-month open-label extension period (both the child/parents and the doctor know which the child is receiving). A child may be eligible for this study if he/she: Is 6 to 17 years old and has been diagnosed with an anxiety disorder (i.e., generalized anxiety disorder, social phobia, or separation anxiety). Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000389 •

Treatment of Social Phobia Condition(s): Phobic Disorders; Social Phobia; Public speaking anxiety Study Status: This study is completed. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: Social phobia is a very common and debilitating disorder, with public speaking anxiety being the most common fear. Psychologists have found that treating patients for their fear of public speaking, through cognitive-behavioral treatment (talk-based therapy) or exposure treatment (where participants participate in actual public speaking sessions), not only helps patients overcome this fear but also helps them overcome their more general social fears. However, little is known about how this change occurs during therapy. This study tries to identify the factors that contribute most to successful therapy. Patients are assigned randomly (like tossing a coin) to 1 of 3 groups. Group 1 will receive cognitive-behavioral treatment and Group 2 will receive exposure treatment. Group 3 will not receive treatment. Study leaders will monitor patient response to treatment through behavioral tests and assessments. An individual may be eligible for this study if he/she: Has social phobia with public speaking anxiety. Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/show/NCT00000370

Keeping Current on Clinical Trials The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to the Web site at http://www.clinicaltrials.gov/ and search by “social phobia” (or synonyms).

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While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: •

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

•

For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

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For cancer trials, visit the National Cancer Institute: http://cancertrials.nci.nih.gov/

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For eye-related trials, visit and search the Web page of the National Eye Institute: http://www.nei.nih.gov/neitrials/index.htm

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For heart, lung and blood trials, visit the Web page of the National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/studies/index.htm

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For trials on aging, visit and search the Web site of the National Institute on Aging: http://www.grc.nia.nih.gov/studies/index.htm

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For rare diseases, visit and search the Web site sponsored by the Office of Rare Diseases: http://ord.aspensys.com/asp/resources/rsch_trials.asp

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For alcoholism, visit the National Institute on Alcohol Abuse and Alcoholism: http://www.niaaa.nih.gov/intramural/Web_dicbr_hp/particip.htm

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For trials on infectious, immune, and allergic diseases, visit the site of the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/clintrials/

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For trials on arthritis, musculoskeletal and skin diseases, visit newly revised site of the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health: http://www.niams.nih.gov/hi/studies/index.htm

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For hearing-related trials, visit the National Institute on Deafness and Other Communication Disorders: http://www.nidcd.nih.gov/health/clinical/index.htm

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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm

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For drug abuse trials, visit and search the Web site sponsored by the National Institute on Drug Abuse: http://www.nida.nih.gov/CTN/Index.htm

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For trials on mental disorders, visit and search the Web site of the National Institute of Mental Health: http://www.nimh.nih.gov/studies/index.cfm

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For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinical_Trials

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CHAPTER 6. PATENTS ON SOCIAL PHOBIA Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.9 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “social phobia” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on social phobia, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Social Phobia By performing a patent search focusing on social phobia, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an 9Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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example of the type of information that you can expect to obtain from a patent search on social phobia: •

Composition and methods for treating performance anxiety Inventor(s): DeVane; C. Lindsay (Mt. Pleasant, SC), Jackson; Cherry W. (Mt. Pleasant, SC), Kellner; Charles H. (Sullivans Island, SC) Assignee(s): Medical University of South Carolina (charleston, Sc) Patent Number: 5,525,347 Date filed: January 31, 1995 Abstract: The invention provides a pharmaceutical composition for treating performance anxiety and social phobia comprising a therapeutic amount for the treatment of a patient of a.beta.-adrenergic receptor blocking compound and an antidiaphoretic compound. The preferred.beta.-adrenergic receptor blocking compound is the lipophilic.beta.-blocker propranolol HCL. The anti-diaphoretic compound of the present invention is preferably glycopyrrolate. The composition for treating performance anxiety and social phobia can further include a pharmaceutically acceptable carrier. A method of preventing or treating performance anxiety or social phobia in a patient comprising administering the composition of the invention to a patient in need of such treatment is also provided. The composition administered in the present method comprises a therapeutic amount of a.beta.-adrenergic receptor blocking compound and an anti-diaphoretic compound. Excerpt(s): The present invention is directed to the treatment of performance anxiety. More specifically the invention provides a composition and method for treating performance anxiety. Many people experience a "normal" fear of public speaking. However, for some people that fear that he or she may do something or act in a way that will be humiliating or embarrassing is sufficient to cause avoidance behavior to the point of interfering with occupational or social functioning. In this situation, a diagnosis of performance anxiety may be appropriate. Public speaking is the most common fear in social phobia (Uhde et al., 1991), followed by eating in public, writing in public, and using public lavatories. Social phobia is one of several major anxiety disorders and can constitute a chronic and disabling illness. There is currently no FDA approved treatment for social phobia although case reports suggest efficacy for several drug classes (the beta adrenergic receptor blockers, including propranolol hydrochloride (10-120 mg) (The Handbook of Psychiatric Drug Therapy, (Little, Brown and Co., Boston/Toronto, Pub., Ch. 7, p. 142) and The Psychiatric Drug Handbook, (Mosby Year Book, Pub., Ch. 7, pp. 247-248) benzodiazepines; and monoamine oxidase inhibitors). Web site: http://www.delphion.com/details?pn=US05525347__

•

Compositions containing sertraline and a 5-HT.sub.1D receptor agonist or antagonist Inventor(s): Chenard; Bertrand L. (New York, NY), Howard; Harry R. (New York, NY), Macor; John E. (New York, NY), Schulz; David W. (New York, NY), Sprouse; Jeffrey S. (New York, NY) Assignee(s): Pfizer Inc. (new York, Ny) Patent Number: 5,597,826 Date filed: September 14, 1994

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Abstract: The present invention relates to novel compositions containing the serotonin selective re-uptake inhibitor (SSRI), preferably (1S-cis)-4-(3,4-dichlorophenyl)-1,2,3,4tetrahydro-N-methyl-1-naphthalenam ine, and an agonist or antagonist of the serotonin 1 (5-HT.sub.1) receptor and to the use of such compositions for treating or preventing a condition selected from mood disorders, including depression, seasonal affective disorders and dysthmia, anxiety disorders including generalized anxiety disorder and panic disorder; agoraphobia, avoidant personality disorder; social phobia; obsessive compulsive disorder; post-traumatic stress disorder; memory disorders including dementia, amnestic disorders and age-associated memory impairment; disorders of eating behavior, including anorexia nervosa and bulimia nervosa; obesity; cluster headache; migraine; pain; Alzheimer's disease; chronic paroxysmal hemicrania; headache associated with vascular disorders; Parkinson's disease, including dementia in Parkinson's disease, neuroleptic-induced parkinsonism and tardive dyskinesias; endocrine disorders such as hyperprolactinaemia; vasospasm (particularly in the cerebral vasculature); hypertension; disorders in the gastrointestinal tract where changes in motility and secretion are involved; sexual dysfunction, including premature ejaculation; and chemical dependencies. Excerpt(s): The present invention relates to novel compositions containing the serotonin selective re-uptake inhibitor (SSRI) (1S-cis)-4-(3,4- dichlorophenyl)-1,2,3,4-tetrahydro-Nmethyl-1-naphthalenemine (hereinafter sertraline) and an agonist or antagonist of the serotonin 1 (5-HT.sub.1) receptor and to the use of such compositions for treating or preventing a condition selected from mood disorders, including depression, seasonal effective disorders and dysthmia, anxiety disorders including generalized anxiety disorder and panic disorder; agoraphobia, avoidant personality disorder; social phobia; obsessive compulsive disorder; post-traumatic stress disorder; memory disorders including dementia, amnestic disorders and age-associated memory impairment; disorders of eating behavior, including anorexia nervosa and bulimia nervosa; obesity; cluster headache; migraine; pain; Alzheimer's disease; chronic paroxysmal hemicrania; headache associated with vascular disorders; Parkinson's disease, including dementia in Parkinson's disease, neuroleptic-induced parkinsonism and tardive dyskinesias; endocrine disorders such as hyperprolactinaemia; vasospasm (particularly in the cerebral vasculature); hypertension; disorders in the gastrointestinal tract where changes in motility and secretion are involved; sexual dysfunction, including premature ejaculation; and chemical dependencies. U.S. Pat. No. 4,536,518 issued Aug. 20, 1985 refers to sertraline and derivatives thereof and states that these compounds are useful as antidepressant agents. U.S. Pat. No. 4,940,731 issued Jul. 10, 1990 refers to a method of treating premature ejaculation using sertraline. Web site: http://www.delphion.com/details?pn=US05597826__ •

Drug combinations Inventor(s): Taylor; Duncan Paul (Kalamazoo, MI) Assignee(s): Pharmacia & Upjohn Company (kalamazoo, Mi) Patent Number: 6,500,827 Date filed: July 11, 2001 Abstract: This patent application describes a new combination treatment of selective, noradrenaline-reuptake inhibitors (NARI) and specifically, reboxetine, and pindolol to provide rapid relief to patients suffering from depression, general anxiety, attention

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deficit hyperactivity disorder (ADHD), anxiety disorders such as obsessive compulsive disorders (OCD), panic disorders (PD), social phobia (SD) and the like. Excerpt(s): This invention describes new treatments that should provide for a fast acting rapid onset of relief from several nervous system disorders, and it involves the administration of the drug reboxetine in combination with the drug pindolol. The introduction of tricyclic antidepressants in the early 1960s has provided a major advance in the treatment of neuropsychiatric disorders. Reactive and endogenous depressions, diagnoses formerly carrying grave prognostic implications, have become, with the introduction of the tricyclics, manageable disorders with a much smaller toll on the patient and the society as a whole. The early tricyclic compounds were reuptake inhibitors of all the catecholamines released in the synaptic cleft, thus resulting in prolongation and enhancement of the dopamine (DA), noradrenaline (NA) and serotonin (5-hydroxytryptamine=5-HT) action. Lack of selectivity also causes undesired side effects particularly on the acetylcholine (especially the muscarinic component), and histamine mediated neurotransmission. Web site: http://www.delphion.com/details?pn=US06500827__ •

Duplications of human chromosome 15q24-25 and anxiety disorders, diagnostic methods for their detection Inventor(s): Estivill Palleja; Xavier (Barcelona, ES), Gratacos; Monica (Barcelona, ES), Nadal; Marga (Barcelona, ES), Pujana; Miguel Angel (Barcelona, ES), Volpini; Victor (Barcelona, ES) Assignee(s): Palleja, Zavier Estivell (barcelona, Es) Patent Number: 6,225,057 Date filed: July 23, 1998 Abstract: A method for identifying a person at risk for developing an anxiety disorder, said anxiety disorder selected from the group consisting of agoraphobia, social phobia, panic attacks, panic disorders, simple phobia, mood disorders, major depression, schizophrenia, and hypermobility syndrome associated with duplication of a region of the genomic sequence of human chromosome 15q24-25 defined by boundaries D15S925 (proximal end) and DS15S736 (distal end). The method comprises identifying the presence of duplication in the region of the genomic sequence of human chromosome 15q24-25 defined by the boundaries D15S925 (proximal end) and DS15S736 (distal end) in said person. Excerpt(s): Panic disorder, agoraphobia, social phobia and other anxiety disorders affect 5-10% of the general population. There are no biochemical, cytological or molecular tools for the diagnosis of anxiety disorders. Moreover, the gene or genes predisposing to anxiety disorders have not yet been localised. We have studied the clinical association between panic/agoraphobia and joint hypermobility syndrome, and have identified several pedigrees in which these disorders cosegregate. We have detected a 10 centiMorgan (cM) duplication of human chromosome 15 (15q24-25) in the affected subjects of families with several members suffering from anxiety and depression disorders. The 15q24-25 duplication segregates with panic disorder, agoraphobia, social phobia, depression and joint hypermobility syndrome. The 15q24-25 duplication is strongly linked to panic disorder, agoraphobia, social phobia and joint hypermobility syndrome (lod score 4.9). Affected-only analysis for the phenotype defined only by the anxiety disorders gave a lod score of 3.36. All but one of the 45 subjects of these families

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with these anxiety disorders had the 15q24-25 duplication. Mosaicism was detected in 80% of the affected subjects, with 40-70% of their lymphocytes having the 15q24-25 duplication. We have also studied 50 unrelated non-familial cases of panic disorder and/or agoraphobia and all had the 15q24-25 duplication. The duplicated region contains 10 known genes of which NTRK3 and LOXL1 are likely to be involved in anxiety and joint hypermobility. We propose that this genomic mutation, which is present in 7% of the general population, is the major susceptibility mutation for panic disorder, agoraphobia, major depression and social phobia in familial and sporadic cases. We have developed cytological, cytogenetic and molecular methods for the specific diagnosis of the 15q24-25 duplication causing anxiety disorders. Anxiety disorders are neurotic alterations that include generalised anxiety disorder, phobic disorders, panic disorders (panic attacks, panic disorder and agoraphobia) and obsessive-compulsive disorders. The prevalence of this group of alterations is estimated in about 10% in the adult population and up to 5% in infantile patients. Several million people worldwide are affected by anxiety disorders, but the actual prevalence rates of these alterations are probably higher. Anxiety and panic disorders aggregate in families. The familial transmission of anxiety disorders has often been explained by common familial environmental factors. Twin studies of anxiety disorders have shown a high concordance among monozygotic twins. The mode of familial transmission of panic disorder is unclear, but it has been suggested that anxiety, panic attacks and agoraphobia have an autosomal dominant pattern of inheritance with incomplete penetrance. Although a major gene is supposed to be involved in panic disorder, multifactorial/polygenic inheritance has also been postulated. Web site: http://www.delphion.com/details?pn=US06225057__ •

Method of treating symptoms of panic attacks Inventor(s): Cox; Stephen M. (Lexington, KY), Lawrence; Lowell J. (Richmond, KY) Assignee(s): Ptrl East, Inc. (richmond, Ky) Patent Number: 6,432,172 Date filed: March 7, 1996 Abstract: A method is provided for treating an individual for the symptoms of panic disorder and related maladies including agoraphobia, social phobia and claustrophobia. The method includes the step of reducing the levels of carbon dioxide being inspired by the individual. Excerpt(s): The present invention relates generally to the medical treatment field and, more particularly, to a method of treating the symptoms of panic attacks resulting from panic disorder, agoraphobia, social phobia and claustrophobia. Anxiety has been defined as a feeling of fear, dread or apprehension that arises without a clear or appropriate justification. Anxiety includes a number of symptoms that are physical, psychological and behavioral in nature. Anxiety during a panic attack may manifest itself in a number of physical signs that are typically produced from over activity of the sympathetic nervous system or even from tension in the skeletal muscles. These physical manifestations include palpitations, dry mouth, dilation of the pupils, sweating, throat tightening, trembling, dizziness and even nausea. Psychological manifestations include irritability, restlessness and loss of concentration. Behavioral manifestations primarily include avoidance behavior: that is, running away from the feared object or situation. This avoidance behavior is commonly associated with specific environments including shopping malls, stores, restaurants, church services, meetings, classes, automobiles

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(particularly on bridges, in tunnels or in congested traffic), airplanes and elevators. Many of these "agoraphobic environments" may be characterized as an enclosed space with a high ratio of the number of people to the volume of air in the enclosed space. Of course, where a relatively large number of individuals are exhaling carbon dioxide (CO.sub.2) into a relatively small volume of enclosed space the ambient level of carbon dioxide rises. In fact the CO.sub.2 level may rise by as much as 200% or more above the level present in the ambient outdoor atmosphere. Web site: http://www.delphion.com/details?pn=US06432172__

Patent Applications on Social Phobia As of December 2000, U.S. patent applications are open to public viewing.10 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to social phobia: •

Combinations of SSRI and estrogenic agents Inventor(s): Jenkins, Simon N.; (Audubon, PA) Correspondence: Arnold S. Milowsky; American Home Products Corporation; Patent Law Department - 2B; Five Giralda Farms; Madison; NJ; 07940; US Patent Application Number: 20020042432 Date filed: June 29, 2001 Abstract: This invention comprises methods of depression, anxiety, generalized anxiety disorder (GAD), hot flush, post partum depression, premenstrual syndrome, obesity, obsessive compulsive disorder, post-traumatic stress disorder, social phobia, disruptive behavior disorders, impulse control disorders, borderline personality disorder, chronic fatigue disorder, premature ejaculation, pain, attention deficit disorders, with and without hyperactivity, Gilles de la Tourette syndrome, bulimia nervosa, or Shy Drager Syndrome comprising administration of a selective serotonin reuptake inhibitor and compound of the formulae I or II: 1wherein Z is a moiety selected from the group of: 2wherein: R.sub.1 is selected from H, OH or the C.sub.1-C.sub.12 esters or C.sub.1C.sub.12 alkyl ethers thereof, benzyloxy, or halogen; or C.sub.1-C.sub.4 halogenated ethers including trifluoromethyl ether and trichloromethyl ether; R.sub.2, R.sub.3, R.sub.4, R.sub.5, and R.sub.6 are H, OH or C.sub.1-C.sub.12 esters or C.sub.1-C.sub.12 alkyl ethers thereof, halogens, or C.sub.1-C.sub.4 halogenated ethers, cyano, C.sub.1C.sub.6 alkyl, or trifluoromethyl, with the proviso that, when R.sub.1 is H, R.sub.2 is not OH; Y is the moiety: 3R.sub.7 and R.sub.8 are alkyl or concatenated together to form an optionally substituted, nitrogen-containing ring; or a pharmaceutically acceptable salt thereof. Excerpt(s): This application claims the benefit of U.S. Provisional Application No. 60/216,408, filed Jul. 6, 2000. This invention relates to methods of using substituted indole compounds in the combination with a selective serotonin reuptake inhibitor (SSRI) for the treatment, prevention, inhibition or alleviation of depression, anxiety, generalized anxiety disorder (GAD), hot flush, post partum depression, premenstrual syndrome, obesity, obsessive compulsive disorder, social phobia, disruptive behavior

10

This has been a common practice outside the United States prior to December 2000.

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disorders, impulse control disorders, borderline personality disorder, chronic fatigue disorder, premature ejaculation, pain, post-traumatic stress disorder, attention deficit disorders, with and without hyperactivity, Gilles de la Tourette syndrome, bulimia nervosa, or Shy Drager Syndrome and related pharmaceutical compositions and kits. as well as their use as estrogenic agents, including the treatment of bone loss, cardiovascular disease, maladies associated with or resulting from the proliferation or abnormal development of endometrial or endometrial-like tissues, and disease states or syndromes associated with estrogen deficiency. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Methods, kits and compositions for using pyrrole derivatives Inventor(s): Clary, Cathryn M.; (New York, NY), Donevan, Sean; (Dexter, MI), Eisman, Perry S.; (Southampton, NY), Kavoussi, Richard; (Ann Arbor, MI), Ma, Lyou-Fu; (Ann Arbor, MI), Pande, Atul; (East Lyme, CT), Van Beek, Jeroen; (Ridgefield, CT) Correspondence: Pfizer INC.; Patent Department, Ms8260-1611; Eastern Point Road; Groton; CT; 06340; US Patent Application Number: 20030022915 Date filed: April 25, 2002 Abstract: The present invention provides methods and kits for treating obsessivecompulsive disorder, acute stress disorder, post traumatic stress disorder, social anxiety disorder, somatization disorder, specific social phobia, premenstrual dysphoric disorder, anxiety associated with a medical condition, adjustment disorder with anxious mood, dysthymia, specific phobia or fibromyalgia using a compound of Formula I or a pharmaceutically acceptable salt, optical isomer or prodrug thereof 1The present invention also provides compositions comprising a compound of Formula I or a pharmaceutically acceptable salt, optical isomer or prodrug thereof and an additional compound useful to treat the aforementioned conditions. Excerpt(s): This application claims priority of U.S. Provisional Application No. 60/287,545, filed Apr. 30, 2001. The present invention provides methods, kits and compositions for treating obsessive-compulsive disorder, acute stress disorder, post traumatic stress disorder, social anxiety disorder, somatization disorder, specific social phobia, premenstrual dysphoric disorder, anxiety associated with a medical condition and in particular anxiety associated with Alzheimer's disease, adjustment disorder with anxious mood, dysthymia, specific phobia or fibromyalgia. The present invention also provides compositions, methods and kits comprising a compound of Formula I or a pharmaceutically acceptable salt, optical isomer or prodrug thereof, and an additional compound that is useful to treat obsessive-compulsive disorder, acute stress disorder, post traumatic stress disorder, social anxiety disorder, somatization disorder, specific social phobia, premenstrual dysphoric disorder, anxiety associated with a medical condition, adjustment disorder with anxious mood, dysthymia, specific phobia or fibromyalgia. The compound (+)-2-(7-chloro-1,8-naphthyridine-2-yl)-3-(5-methyl-2-oxo-hexyl)-1-isoindolinone, also called pagoclone, is a GABA (gamma amino butyric acid) receptor ligand that is presently being evaluated in human clinical studies for the treatment of generalized anxiety disorder and panic disorder. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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New drug combinations Inventor(s): Taylor, Duncan Paul; (Kalamazoo, MI) Correspondence: Stephen L. Nesbitt; Pharmacia & Upjohn Company; Global Intellectual Property; 301 Henrietta Street; Kalamazoo; MI; 49001; US Patent Application Number: 20030078262 Date filed: November 5, 2002 Abstract: This patent application describes, a new combination treatment of selective, noradrenaline-reuptake inhibitors (NARI) and specifically, reboxetine, and pindolol to provide rapid relief to patients suffering from depression, general anxiety, attention deficit hyperactivity disorder (ADHD), anxiety disorders such as obsessive compulsive disorders (OCD), panic disorders (PD), social phobia (SD) and the like. Excerpt(s): This invention describes new treatments that should provide for a fast acting rapid onset of relief from several nervous system disorders, and it involves the administration of the drug reboxetine in combination with the drug pindolol. The introduction of tricyclic antidepressants in the early 1960s has provided a major advance in the treatment of neuropsychiatric disorders. Reactive and endogenous depressions, diagnoses formerly carrying grave prognostic implications, have become, with the introduction of the tricyclics, manageable disorders with a much smaller toll on the patient and the society as a whole. The early tricyclic compounds were reuptake inhibitors of all the catecholamines released in the synaptic cleft, thus resulting in prolongation and enhancement of the dopamine (DA), noradrenaline (NA) and serotonin (5-hydroxytryptamine=5-HT) action. Lack of selectivity also causes undesired side effects particularly on the acetylcholine (especially the muscarinic component), and histamine mediated neurotransmission. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

•

New pharmaceutical compositions Inventor(s): Lang, Steffen; (Reinach, CH), Liechti, Kurt; (Oberwil, CH) Correspondence: Thomas Hoxie; Novartis Corporation; Patent And Trademark Dept; 564 Morris Avenue; Summit; NJ; 079011027 Patent Application Number: 20020156099 Date filed: April 10, 2002 Abstract: Spontaneously dispersible pharmaceutical compositions comprising a piperidine, e.g. 1-acyl-piperidine Substance P Antagonist and its use in the treatment of CNS disorders, e.g. depression and social phobia, and respiratory diseases, e.g. asthma and chronic bronchitis. Excerpt(s): The present invention relates to novel pharmaceutical compositions in which the active agent is a piperidine substance P antagonist, in particular a N-benzoyl-2benzyl-4-(azanaphthloyl-amino) piperidine, useful for treatment and prevention of e.g. central nervous system disorders, e.g. depression, social phobia, or respiratory diseases, e.g. asthma and chronic bronchitis. 1-Acylpiperidine substance P antagonists are a class of compounds described e.g. in published European patent EP 0532456B1, the contents of which publication is incorporated herein by reference. Similarly, N-benzoyl-2-benzyl4-(azanaphthoyl-amino) piperidines and their activity as Substance P Antagonists are described in published European patent application EP 0707006A, the contents of which

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application is incorporated herein by reference. Piperidine substance P antagonists, such as disclosed in EP 0532456B1 and EP 0707006A, present highly specific difficulties in relation to administration generally and galenic compositions in particular, including in particular problems of drug bioavailability and variability in inter- and intra-patient dose response, necessitating development of a non-conventional dosage form. In accordance with the present invention it has now surprisingly been found that stable pharmaceutical compositions with Piperidine substance P antagonists, having particularly interesting bioavailability characteristics and reduced variability in interand intra-subject bioavailability parameters, are obtainable. These novel compositions have been found to meet or substantially reduce the difficulties encountered previously. It has been shown that the compositions in accordance with the present invention may enable effective dosaging with concomitant enhancement as well as reduced variability of resorption/bioavailability levels for and between individual patients. Thus, the invention may achieve effective therapy with tolerable dosage levels of such Piperidine substance P antagonists, and may permit closer standardization and optimization of daily dosage requirements for each individual. Consequently, occurrence of potential undesirable side-effects is diminished and overall cost of therapy may be reduced. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Novel heteroaryl derivatives, their preparation and use Inventor(s): Andersen, Kim; (Virum, DK), Krog-Jensen, Christian; (Copenhagen, DK), Mikkelsen, Gitte; (Ballerup, DK), Mikkelsen, Ivan; (Koge, DK), Moltzen, Ejner Knud; (Gentofte, DK), Rottlander, Mario; (Valby, DK), Ruhland, Thomas; (Valby, DK) Correspondence: Darby & Darby P.C.; 805 Third Avenue; New York; NY; 10022; US Patent Application Number: 20030050306 Date filed: June 25, 2002 Abstract: A heteroaryl derivative having the formula (I) 1any of its enantiomers or any mixture thereof, wherein X is --O--, --S--, or CR.sup.4R.sup.5--; and Y is -CR.sup.6R.sup.7; --CR.sup.6R.sup.7--CR.s- up.8R.sup.9--, or --CR.sup.6--CR.sup.7; or X and Y together form a group --CR.sup.4.dbd.R.sup.5--, or --CR.sup.4.dbd.CR.sup.5-CR.sup.6R.sup.7--; Z is --O--, or --S--; W is N, C, or CH; n is 2, 3, 4, 5, 6, 7, 8, 9 or 10; m is 2 or 3; A is O or S wherein the doted lines mean an optional bond. The compounds of the invention are considered useful for the treatment of affective disorders such as general anxiety disorder, panic disorder, obsessive compulsive disorder, depression, social phobia and eating disorders, and neurological disorders such as psychosis. Excerpt(s): This application is a Continuation of International Application No. PCT/DK00/00741, filed Dec. 29, 2000. The disclosure of the prior application is hereby incorporated by reference. The present invention relates to novel heteroaryl derivatives potently binding to the 5-HT.sub.1A receptor, pharmaceutical compositions containing these compounds and the use thereof for the treatment of certain psychiatric and neurological disorders. The compounds of the invention are also potent dopamine D.sub.4 receptor ligands and are considered to be particularly useful for the treatment of depression and psychosis. Furthermore, many compounds of the invention have potent serotonin reuptake inhibition activity and/or effect at dopamine D.sub.3 receptors. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Keeping Current In order to stay informed about patents and patent applications dealing with social phobia, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “social phobia” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on social phobia. You can also use this procedure to view pending patent applications concerning social phobia. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 7. BOOKS ON SOCIAL PHOBIA Overview This chapter provides bibliographic book references relating to social phobia. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on social phobia include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “social phobia” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “social phobia” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “social phobia” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

Anxiety Disorders Comorbid with Depression - Volume 2: Social Phobia, Generalized Anxiety Disorder, Obsessive Compulsive Disorder and Post Traumatic Stress Disorder - Pocketbook by Dan J. Stein, Eric Hollander; ISBN: 1841840505; http://www.amazon.com/exec/obidos/ASIN/1841840505/icongroupinterna

•

Cognitive-Behavioral Group Therapy for Social Phobia: Basic Mechanisms and Clinical Strategies by Richard G. Heimberg (Author), Robert E. Becker (Author); ISBN: 1572307706; http://www.amazon.com/exec/obidos/ASIN/1572307706/icongroupinterna

•

Do you feel afraid and uncomfortable when you are around other people? : a real illness : social phobia (SuDoc HE 20.8102:IL 6/PHOBIA) by U.S. Dept of Health and Human Services; ISBN: B000112WUO; http://www.amazon.com/exec/obidos/ASIN/B000112WUO/icongroupinterna

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•

Extreme Fear, Shyness, and Social Phobia (Series in Affective Science) by Louis A. Schmidt (Editor), Jay Schulkin (Editor); ISBN: 0195166582; http://www.amazon.com/exec/obidos/ASIN/0195166582/icongroupinterna

•

Fear of Humiliation: Integrated Treatment of Social Phobia and Comorbid Conditions by W. Walter Menninger (Editor), American Psychiatric Association; ISBN: 1568214650; http://www.amazon.com/exec/obidos/ASIN/1568214650/icongroupinterna

•

From Social Anxiety to Social Phobia : Multiple Perspectives by Stefan G. Hofmann (Author), Patricia Marten DiBartolo (Author); ISBN: 0205281893; http://www.amazon.com/exec/obidos/ASIN/0205281893/icongroupinterna

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I Think They Think.: Overcoming Social Phobia by Ronald M. Rapee (Author); ISBN: 1572304936; http://www.amazon.com/exec/obidos/ASIN/1572304936/icongroupinterna

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Overcoming Shyness and Social Phobia: A Step-By-Step Guide (Clinical Application of Evidence-Based Psychotherapy) by Ronald M. Rapee; ISBN: 0765701200; http://www.amazon.com/exec/obidos/ASIN/0765701200/icongroupinterna

•

Shy Children, Phobic Adults: Nature and Treatment of Social Phobia by Deborah C. Beidel, Samuel M. Turner; ISBN: 1557984611; http://www.amazon.com/exec/obidos/ASIN/1557984611/icongroupinterna

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Social Phobia by Liebowitz.; ISBN: 9998039592; http://www.amazon.com/exec/obidos/ASIN/9998039592/icongroupinterna

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Social Phobia : A Guide by John H., M.D. Greist, et al; ISBN: 1890802093; http://www.amazon.com/exec/obidos/ASIN/1890802093/icongroupinterna

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Social Phobia: Alleviating Anxiety in an Age of Self-Promotion by Donald Capps; ISBN: 0827234406; http://www.amazon.com/exec/obidos/ASIN/0827234406/icongroupinterna

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Social Phobia: Clinical and Research Perspectives by Murray B. Stein (Editor); ISBN: 0880486538; http://www.amazon.com/exec/obidos/ASIN/0880486538/icongroupinterna

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Social Phobia: Clinical Application of Evidence-Based Psychotherapy (Clinical Application of Evidence-Based Psychotherapy) by Ronald M. Rapee, William C. Sanderson; ISBN: 0765700042; http://www.amazon.com/exec/obidos/ASIN/0765700042/icongroupinterna

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Social Phobia: Diagnosis, Assessment, and Treatment by Richard G. Heimberg (Editor), et al; ISBN: 1572300124; http://www.amazon.com/exec/obidos/ASIN/1572300124/icongroupinterna

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Social Phobia: From Shyness to Stage Fright by John R. Marshall; ISBN: 0465078966; http://www.amazon.com/exec/obidos/ASIN/0465078966/icongroupinterna

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Social Phobia: The Family and the Brain by Maria Tillfors; ISBN: 9155450962; http://www.amazon.com/exec/obidos/ASIN/9155450962/icongroupinterna

Chapters on Social Phobia In order to find chapters that specifically relate to social phobia, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and social phobia using the “Detailed Search” option. Go to the following

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hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “social phobia” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on social phobia: •

Coping with Employment Discrimination Against Diabetics: Trends on Social Medicine and Social Psychology Source: in Assal, J., Golay, A., and Visser, A.P., eds. New Trends in Patient Education: A Trans-Cultural and Inter-Disease Approach. Amsterdam, The Netherlands: Elsevier Science B.V. 1995. p. 203-208. Contact: Available from Elsevier Science. Regional Sales Office, Customer Support Department, 655 Avenue of the Americas, New York, NY 10010. (212) 633-3730. Fax (212) 633-3680. E-mail: [email protected]. PRICE: $209.50 (as of 1996). ISBN: 0444822348. Summary: This book chapter reports on a study that investigated employment discrimination against people with diabetes in Europe. The study addresses the impact of diabetes on the patient's career and daily work, in order to determine the extent of discrimination. People with insulin-dependent diabetes (IDDM) were questioned about their experience; a questionnaire was also developed to evaluate patients' social and employment problems. The authors discuss how elements of an education program can optimize social skills and help patients address discrimination issues. In a group of six to eight patients, assertive behavior in the workplace is modelled (e.g., for hypoglycemia, social phobia) by applying psychological methods (behavior modification role-playing). The patients learn assertive behavior in social situations with superiors and colleagues and develop self-confidence. The information in this chapter was presented at the Proceedings of the Patient Education 2000 Congress, held in 1994. 6 figures. 11 references. (AA-M).

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CHAPTER 8. PERIODICALS AND NEWS ON SOCIAL PHOBIA Overview In this chapter, we suggest a number of news sources and present various periodicals that cover social phobia.

News Services and Press Releases One of the simplest ways of tracking press releases on social phobia is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “social phobia” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to social phobia. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “social phobia” (or synonyms). The following was recently listed in this archive for social phobia: •

Therapy helps teens with social phobia Source: Reuters Health eLine Date: June 29, 2000

•

Fluvoxamine treats severe social phobia Source: Reuters Health eLine Date: May 13, 1999

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•

FDA approves Paxil for social phobia Source: Reuters Health eLine Date: May 12, 1999

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Fluvoxamine effective in patients with serious forms of social phobia Source: Reuters Medical News Date: May 11, 1999

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Paroxetine effective for generalized social phobia Source: Reuters Medical News Date: August 26, 1998

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Paroxetine helps social phobia Source: Reuters Health eLine Date: August 25, 1998

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Raising Awareness Of Social Phobia Source: Reuters Health eLine Date: December 26, 1997

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Paxil CR gets FDA nod for social phobia. Source: Reuters Medical News Date: October 17, 2003

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GSK antidepressant gets FDA nod for social phobia. Source: Reuters Industry Breifing Date: October 17, 2003

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Zoloft gets FDA OK for social phobia, Pfizer says Source: Reuters Health eLine Date: February 10, 2003

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Pfizer's Zoloft wins OK for social phobia Source: Reuters Industry Breifing Date: February 10, 2003

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Brain activity difference found in social phobia Source: Reuters Health eLine Date: November 20, 2002

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Social phobia common and disabling, study suggests Source: Reuters Health eLine Date: November 23, 2000

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Social phobia linked to dropping out of school Source: Reuters Health eLine Date: October 09, 2000

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Two Serotonin Reuptake Inhibitors Show Efficacy For Depression, Social Phobia Source: Reuters Medical News Date: March 04, 1997

•

Social Phobia More Than Shyness Source: Reuters Health eLine Date: August 30, 1996

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The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “social phobia” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “social phobia” (or synonyms). If you know the name of a company that is relevant to social phobia, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “social phobia” (or synonyms).

Academic Periodicals covering Social Phobia Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to social phobia. In addition to

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these sources, you can search for articles covering social phobia that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for social phobia. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with social phobia. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The

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following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to social phobia: Paroxetine •

Systemic - U.S. Brands: Paxil http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202717.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDICES

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute11: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

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National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

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National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

11

These publications are typically written by one or more of the various NIH Institutes.

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•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.12 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:13 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

12

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 13 See http://www.nlm.nih.gov/databases/databases.html.

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•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway14 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.15 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “social phobia” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 6148 See Details 100 6 3 6257

HSTAT16 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.17 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.18 Simply search by “social phobia” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

14

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

15

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 16 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 17 18

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists19 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.20 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.21 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

19 Adapted 20

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 21 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on social phobia can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to social phobia. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to social phobia. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “social phobia”:

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Other guides Obsessive-Compulsive Disorder http://www.nlm.nih.gov/medlineplus/obsessivecompulsivedisorder.html Panic Disorder http://www.nlm.nih.gov/medlineplus/panicdisorder.html Teen Mental Health http://www.nlm.nih.gov/medlineplus/teenmentalhealth.html

Within the health topic page dedicated to social phobia, the following was listed: •

General/Overviews Phobia Source: National Women's Health Information Center http://www.4woman.gov/faq/phobia.htm Phobias Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=DS00272

•

Treatment Anxiety Disorders Information: Guide to Treatment Source: Anxiety Disorders Association of America http://www.adaa.org/AnxietyDisorderInfor/GuidetoTre.cfm Beyond Shyness: Overcoming the Fear of Social Situations Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=HQ00585 Medications Source: National Institute of Mental Health http://www.nimh.nih.gov/publicat/medicate.cfm Psychosocial Treatments Source: National Alliance for the Mentally Ill http://www.nami.org/Content/ContentGroups/Helpline1/Psychosocial_Treatme nts.htm

•

Specific Conditions/Aspects Panic Disorder: Panic Attacks and Agoraphobia Source: American Academy of Family Physicians http://familydoctor.org/137.xml Social Phobia, a Real Illness Source: National Institute of Mental Health http://www.nimh.nih.gov/anxiety/sophri1.cfm Specific (Simple) Phobia Source: Anxiety Disorders Association of America http://www.adaa.org/AnxietyDisorderInfor/SpecificPhobia.cfm

Patient Resources

•

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Children Coping With Anxiety, Fears and Phobias Source: Nemours Foundation http://kidshealth.org/parent/emotions/feelings/anxiety.html Fears and Phobias Source: American Academy of Pediatrics http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZL158M8FC& sub_cat=21 Figuring Out Phobias Source: Nemours Foundation http://kidshealth.org/kid/feeling/emotion/phobias.html

•

From the National Institutes of Health Anxiety Disorders Source: National Institute of Mental Health http://www.nimh.nih.gov/anxiety/anxiety.cfm

•

Journals/Newsletters Reporter Online Source: Anxiety Disorders Association of America http://www.adaa.org/aboutADAA/OnlineNewsletter.cfm

•

Organizations Anxiety Disorders Association of America http://www.adaa.org/ National Alliance for the Mentally Ill http://www.nami.org/ National Institute of Mental Health http://www.nimh.nih.gov/

•

Research Anxiety Disorders Research at the National Institute of Mental Health Source: National Institute of Mental Health http://www.nimh.nih.gov/publicat/anxresfact.cfm

•

Statistics Statistics and Facts About Anxiety Disorders Source: Anxiety Disorders Association of America http://www.adaa.org/mediaroom/index.cfm

•

Teenagers All About Anxiety Source: Nemours Foundation http://kidshealth.org/teen/your_mind/mental_health/anxiety.html

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Fears and Phobias Source: Nemours Foundation http://kidshealth.org/teen/your_mind/mental_health/phobias.html Social Phobia Source: Nemours Foundation http://kidshealth.org/teen/your_mind/mental_health/social_phobia.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. Healthfinder™ Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Facts About Social Phobia Summary: This 2-page fact sheet covers the prevalence, causes, and treatments for social phobia. Source: National Institute of Mental Health, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6630 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to social phobia. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

Patient Resources

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

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Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to social phobia. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with social phobia. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about social phobia. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “social phobia” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “social phobia”. Type the following hyperlink into your

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Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “social phobia” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “social phobia” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.22

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

22

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)23: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

23

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

•

Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

•

Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

•

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

•

Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

•

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

•

Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

•

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

•

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

•

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

•

Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

•

Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

•

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

•

Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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•

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

•

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

•

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

•

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

•

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

•

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

•

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

•

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

•

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

•

Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

•

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

•

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

•

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

•

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

•

Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

•

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

•

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

•

National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

•

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

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•

Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

•

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

•

New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

•

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

•

New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

•

New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

•

New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

•

New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

•

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

•

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

•

Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

•

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

•

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

•

Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

•

Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

•

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

•

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

•

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

•

Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

•

Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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•

South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

•

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

•

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

•

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

•

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

•

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). The NIH suggests the following Web sites in the ADAM Medical Encyclopedia when searching for information on social phobia: •

Basic Guidelines for Social Phobia Social phobia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000957.htm

•

Signs & Symptoms for Social Phobia Anxiety Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm Rapid heart rate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003077.htm

•

Diagnostics and Tests for Social Phobia Blood pressure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003398.htm Heart rate Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003399.htm

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•

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Background Topics for Social Phobia Alcohol use Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001944.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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SOCIAL PHOBIA DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. 3-dimensional: 3-D. A graphic display of depth, width, and height. Three-dimensional radiation therapy uses computers to create a 3-dimensional picture of the tumor. This allows doctors to give the highest possible dose of radiation to the tumor, while sparing the normal tissue as much as possible. [NIH] Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Abdominal Pain: Sensation of discomfort, distress, or agony in the abdominal region. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acyl: Chemical signal used by bacteria to communicate. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH] Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aetiology: Study of the causes of disease. [EU] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the

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tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Agoraphobia: Obsessive, persistent, intense fear of open places. [NIH] Akathisia: 1. A condition of motor restlessness in which there is a feeling of muscular quivering, an urge to move about constantly, and an inability to sit still, a common extrapyramidal side effect of neuroleptic drugs. 2. An inability to sit down because of intense anxiety at the thought of doing so. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alkalosis: A pathological condition that removes acid or adds base to the body fluids. [NIH] Allergen: An antigenic substance capable of producing immediate-type hypersensitivity (allergy). [EU] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveolar Process: The thickest and spongiest part of the maxilla and mandible hollowed out into deep cavities for the teeth. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amine: An organic compound containing nitrogen; any member of a group of chemical compounds formed from ammonia by replacement of one or more of the hydrogen atoms by organic (hydrocarbon) radicals. The amines are distinguished as primary, secondary, and tertiary, according to whether one, two, or three hydrogen atoms are replaced. The amines include allylamine, amylamine, ethylamine, methylamine, phenylamine, propylamine, and many other compounds. [EU] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amnestic: Nominal aphasia; a difficulty in finding the right name for an object. [NIH]

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Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH]

Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aneurysm: A sac formed by the dilatation of the wall of an artery, a vein, or the heart. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Animal model: An animal with a disease either the same as or like a disease in humans. Animal models are used to study the development and progression of diseases and to test new treatments before they are given to humans. Animals with transplanted human cancers or other tissues are called xenograft models. [NIH] Anomalies: Birth defects; abnormalities. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anorexia Nervosa: The chief symptoms are inability to eat, weight loss, and amenorrhea. [NIH]

Antibacterial: A substance that destroys bacteria or suppresses their growth or reproduction. [EU] Antibiotic: A drug used to treat infections caused by bacteria and other microorganisms. [NIH]

Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: A drug used to treat depression. [NIH] Antiemetic: An agent that prevents or alleviates nausea and vomiting. Also antinauseant. [EU]

Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble

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substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antipsychotic: Effective in the treatment of psychosis. Antipsychotic drugs (called also neuroleptic drugs and major tranquilizers) are a chemically diverse (including phenothiazines, thioxanthenes, butyrophenones, dibenzoxazepines, dibenzodiazepines, and diphenylbutylpiperidines) but pharmacologically similar class of drugs used to treat schizophrenic, paranoid, schizoaffective, and other psychotic disorders; acute delirium and dementia, and manic episodes (during induction of lithium therapy); to control the movement disorders associated with Huntington's chorea, Gilles de la Tourette's syndrome, and ballismus; and to treat intractable hiccups and severe nausea and vomiting. Antipsychotic agents bind to dopamine, histamine, muscarinic cholinergic, a-adrenergic, and serotonin receptors. Blockade of dopaminergic transmission in various areas is thought to be responsible for their major effects : antipsychotic action by blockade in the mesolimbic and mesocortical areas; extrapyramidal side effects (dystonia, akathisia, parkinsonism, and tardive dyskinesia) by blockade in the basal ganglia; and antiemetic effects by blockade in the chemoreceptor trigger zone of the medulla. Sedation and autonomic side effects (orthostatic hypotension, blurred vision, dry mouth, nasal congestion and constipation) are caused by blockade of histamine, cholinergic, and adrenergic receptors. [EU] Antispasmodic: An agent that relieves spasm. [EU] Anus: The opening of the rectum to the outside of the body. [NIH] Anxiety: Persistent feeling of dread, apprehension, and impending disaster. [NIH] Anxiety Disorders: Disorders in which anxiety (persistent feelings of apprehension, tension, or uneasiness) is the predominant disturbance. [NIH] Anxiolytic: An anxiolytic or antianxiety agent. [EU] Apathy: Lack of feeling or emotion; indifference. [EU] Aphasia: A cognitive disorder marked by an impaired ability to comprehend or express language in its written or spoken form. This condition is caused by diseases which affect the language areas of the dominant hemisphere. Clinical features are used to classify the various subtypes of this condition. General categories include receptive, expressive, and mixed forms of aphasia. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Artifacts: Any visible result of a procedure which is caused by the procedure itself and not by the entity being analyzed. Common examples include histological structures introduced by tissue processing, radiographic images of structures that are not naturally present in living tissue, and products of chemical reactions that occur during analysis. [NIH] Astrocytes: The largest and most numerous neuroglial cells in the brain and spinal cord. Astrocytes (from "star" cells) are irregularly shaped with many long processes, including those with "end feet" which form the glial (limiting) membrane and directly and indirectly contribute to the blood brain barrier. They regulate the extracellular ionic and chemical environment, and "reactive astrocytes" (along with microglia) respond to injury. Astrocytes have high- affinity transmitter uptake systems, voltage-dependent and transmitter-gated ion channels, and can release transmitter, but their role in signaling (as in many other functions) is not well understood. [NIH] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to

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strains of unusual type. [EU] Autonomic: Self-controlling; functionally independent. [EU] Autonomic Nervous System: The enteric, parasympathetic, and sympathetic nervous systems taken together. Generally speaking, the autonomic nervous system regulates the internal environment during both peaceful activity and physical or emotional stress. Autonomic activity is controlled and integrated by the central nervous system, especially the hypothalamus and the solitary nucleus, which receive information relayed from visceral afferents; these and related central and sensory structures are sometimes (but not here) considered to be part of the autonomic nervous system itself. [NIH] Autoradiography: A process in which radioactive material within an object produces an image when it is in close proximity to a radiation sensitive emulsion. [NIH] Axons: Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. [NIH] Baclofen: A GABA derivative that is a specific agonist at GABA-B receptors. It is used in the treatment of spasticity, especially that due to spinal cord damage. Its therapeutic effects result from actions at spinal and supraspinal sites, generally the reduction of excitatory transmission. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Basal Ganglia: Large subcortical nuclear masses derived from the telencephalon and located in the basal regions of the cerebral hemispheres. [NIH] Basal Ganglia Diseases: Diseases of the basal ganglia including the putamen; globus pallidus; claustrum; amygdala; and caudate nucleus. Dyskinesias (most notably involuntary movements and alterations of the rate of movement) represent the primary clinical manifestations of these disorders. Common etiologies include cerebrovascular disease; neurodegenerative diseases; and craniocerebral trauma. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Behavior Therapy: The application of modern theories of learning and conditioning in the treatment of behavior disorders. [NIH] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benzene: Toxic, volatile, flammable liquid hydrocarbon biproduct of coal distillation. It is used as an industrial solvent in paints, varnishes, lacquer thinners, gasoline, etc. Benzene causes central nervous system damage acutely and bone marrow damage chronically and is carcinogenic. It was formerly used as parasiticide. [NIH] Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any Hisomer. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU]

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Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bloating: Fullness or swelling in the abdomen that often occurs after meals. [NIH] Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bowel Movement: Body wastes passed through the rectum and anus. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Bulimia: Episodic binge eating. The episodes may be associated with the fear of not being able to stop eating, depressed mood, or self-deprecating thoughts (binge-eating disorder) and may frequently be terminated by self-induced vomiting (bulimia nervosa). [NIH] Buspirone: An anxiolytic agent and a serotonin receptor agonist belonging to the azaspirodecanedione class of compounds. Its structure is unrelated to those of the benzodiazepines, but it has an efficacy comparable to diazepam. [NIH] Butyric Acid: A four carbon acid, CH3CH2CH2COOH, with an unpleasant odor that occurs in butter and animal fat as the glycerol ester. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, polyand heterosaccharides. [EU] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Cardiac: Having to do with the heart. [NIH] Cardioselective: Having greater activity on heart tissue than on other tissue. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH]

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Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Central Nervous System Infections: Pathogenic infections of the brain, spinal cord, and meninges. DNA virus infections; RNA virus infections; bacterial infections; mycoplasma infections; Spirochaetales infections; fungal infections; protozoan infections; helminthiasis; and prion diseases may involve the central nervous system as a primary or secondary process. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Chemoreceptor: A receptor adapted for excitation by chemical substances, e.g., olfactory and gustatory receptors, or a sense organ, as the carotid body or the aortic (supracardial) bodies, which is sensitive to chemical changes in the blood stream, especially reduced oxygen content, and reflexly increases both respiration and blood pressure. [EU] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chorea: Involuntary, forcible, rapid, jerky movements that may be subtle or become confluent, markedly altering normal patterns of movement. Hypotonia and pendular reflexes are often associated. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as choreatic disorders. Chorea is also a frequent manifestation of basal ganglia diseases. [NIH] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all

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human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Citalopram: A selective neuronal serotonin reuptake inhibitor and a clinically effective antidepressant with tolerable side effects. The drug is also effective in reducing ethanol uptake in alcoholics and is used in depressed patients who also suffer from tardive dyskinesia (TD) in preference to tricyclic antidepressants, which aggravate this condition. [NIH]

Clinical Medicine: The study and practice of medicine by direct examination of the patient. [NIH]

Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Clonazepam: An anticonvulsant used for several types of seizures, including myotonic or atonic seizures, photosensitive epilepsy, and absence seizures, although tolerance may develop. It is seldom effective in generalized tonic-clonic or partial seizures. The mechanism of action appears to involve the enhancement of gaba receptor responses. [NIH] Clonic: Pertaining to or of the nature of clonus. [EU] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Cognition: Intellectual or mental process whereby an organism becomes aware of or obtains knowledge. [NIH] Cognitive behavior therapy: A system of psychotherapy based on the premise that distorted or dysfunctional thinking, which influences a person's mood or behavior, is common to all psychosocial problems. The focus of therapy is to identify the distorted thinking and to replace it with more rational, adaptive thoughts and beliefs. [NIH] Cognitive restructuring: A method of identifying and replacing fear-promoting, irrational beliefs with more realistic and functional ones. [NIH] Cognitive Therapy: A direct form of psychotherapy based on the interpretation of situations (cognitive structure of experiences) that determine how an individual feels and behaves. It is based on the premise that cognition, the process of acquiring knowledge and forming beliefs, is a primary determinant of mood and behavior. The therapy uses behavioral and verbal techniques to identify and correct negative thinking that is at the root of the aberrant behavior. [NIH] Colitis: Inflammation of the colon. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial

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diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complete remission: The disappearance of all signs of cancer. Also called a complete response. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Computed tomography: CT scan. A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized tomography and computerized axial tomography (CAT) scan. [NIH] Computerized axial tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray

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machine. Also called CAT scan, computed tomography (CT scan), or computerized tomography. [NIH] Computerized tomography: A series of detailed pictures of areas inside the body, taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computerized axial tomography (CAT) scan and computed tomography (CT scan). [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Consciousness: Sense of awareness of self and of the environment. [NIH] Constipation: Infrequent or difficult evacuation of feces. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Controlled clinical trial: A clinical study that includes a comparison (control) group. The comparison group receives a placebo, another treatment, or no treatment at all. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cranial: Pertaining to the cranium, or to the anterior (in animals) or superior (in humans) end of the body. [EU] Craniocerebral Trauma: Traumatic injuries involving the cranium and intracranial structures (i.e., brain; cranial nerves; meninges; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage. [NIH] Criterion: A standard by which something may be judged. [EU]

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Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cytotoxic: Cell-killing. [NIH] Cytotoxic chemotherapy: Anticancer drugs that kill cells, especially cancer cells. [NIH] Dangerous Behavior: Actions which have a high risk of being harmful or injurious to oneself or others. [NIH] Data Collection: Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Deamination: The removal of an amino group (NH2) from a chemical compound. [NIH] Decarboxylation: The removal of a carboxyl group, usually in the form of carbon dioxide, from a chemical compound. [NIH] Delirium: (DSM III-R) an acute, reversible organic mental disorder characterized by reduced ability to maintain attention to external stimuli and disorganized thinking as manifested by rambling, irrelevant, or incoherent speech; there are also a reduced level of consciousness, sensory misperceptions, disturbance of the sleep-wakefulness cycle and level of psychomotor activity, disorientation to time, place, or person, and memory impairment. Delirium may be caused by a large number of conditions resulting in derangement of cerebral metabolism, including systemic infection, poisoning, drug intoxication or withdrawal, seizures or head trauma, and metabolic disturbances such as hypoxia, hypoglycaemia, fluid, electrolyte, or acid-base imbalances, or hepatic or renal failure. Called also acute confusional state and acute brain syndrome. [EU] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dendrites: Extensions of the nerve cell body. They are short and branched and receive stimuli from other neurons. [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Depersonalization: Alteration in the perception of the self so that the usual sense of one's own reality is lost, manifested in a sense of unreality or self-estrangement, in changes of body image, or in a feeling that one does not control his own actions and speech; seen in depersonalization disorder, schizophrenic disorders, and schizotypal personality disorder.

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Some do not draw a distinction between depersonalization and derealization, using depersonalization to include both. [EU] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Derealization: Is characterized by the loss of the sense of reality concerning one's surroundings. [NIH] Dermatitis: Any inflammation of the skin. [NIH] Desensitization: The prevention or reduction of immediate hypersensitivity reactions by administration of graded doses of allergen; called also hyposensitization and immunotherapy. [EU] Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive system: The organs that take in food and turn it into products that the body can use to stay healthy. Waste products the body cannot use leave the body through bowel movements. The digestive system includes the salivary glands, mouth, esophagus, stomach, liver, pancreas, gallbladder, small and large intestines, and rectum. [NIH] Dilatation: The act of dilating. [NIH] Dilatation, Pathologic: The condition of an anatomical structure's being dilated beyond normal dimensions. [NIH] Dilation: A process by which the pupil is temporarily enlarged with special eye drops (mydriatic); allows the eye care specialist to better view the inside of the eye. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Discrimination: The act of qualitative and/or quantitative differentiation between two or more stimuli. [NIH] Discrimination Learning: Learning that is manifested in the ability to respond differentially to various stimuli. [NIH] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used

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to designate a position on the dental arch farther from the median line of the jaw. [EU] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dominance: In genetics, the full phenotypic expression of a gene in both heterozygotes and homozygotes. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Drinking Behavior: Behaviors associated with the ingesting of water and other liquids; includes rhythmic patterns of drinking (time intervals - onset and duration), frequency and satiety. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Monitoring: The process of observing, recording, or detecting the effects of a chemical substance administered to an individual therapeutically or diagnostically. [NIH] Duodenum: The first part of the small intestine. [NIH] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Dysphoria: Disquiet; restlessness; malaise. [EU] Dysphoric: A feeling of unpleasantness and discomfort. [NIH] Dyspnea: Difficult or labored breathing. [NIH] Dystonia: Disordered tonicity of muscle. [EU] Eating Disorders: A group of disorders characterized by physiological and psychological disturbances in appetite or food intake. [NIH] Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents (Dorland, 27th ed). [NIH] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Ejaculation: The release of semen through the penis during orgasm. [NIH] Elective: Subject to the choice or decision of the patient or physician; applied to procedures that are advantageous to the patient but not urgent. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the

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latter being a high-energy biproduct of nuclear decay. [NIH] Elementary Particles: Individual components of atoms, usually subatomic; subnuclear particles are usually detected only when the atomic nucleus decays and then only transiently, as most of them are unstable, often yielding pure energy without substance, i.e., radiation. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Emulsion: A preparation of one liquid distributed in small globules throughout the body of a second liquid. The dispersed liquid is the discontinuous phase, and the dispersion medium is the continuous phase. When oil is the dispersed liquid and an aqueous solution is the continuous phase, it is known as an oil-in-water emulsion, whereas when water or aqueous solution is the dispersed phase and oil or oleaginous substance is the continuous phase, it is known as a water-in-oil emulsion. Pharmaceutical emulsions for which official standards have been promulgated include cod liver oil emulsion, cod liver oil emulsion with malt, liquid petrolatum emulsion, and phenolphthalein in liquid petrolatum emulsion. [EU] Encephalitis: Inflammation of the brain due to infection, autoimmune processes, toxins, and other conditions. Viral infections (see encephalitis, viral) are a relatively frequent cause of this condition. [NIH] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endometrial: Having to do with the endometrium (the layer of tissue that lines the uterus). [NIH]

Endometrium: The layer of tissue that lines the uterus. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Essential Tremor: A rhythmic, involuntary, purposeless, oscillating movement resulting from the alternate contraction and relaxation of opposing groups of muscles. [NIH] Estrogen: One of the two female sex hormones. [NIH] Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Ether: One of a class of organic compounds in which any two organic radicals are attached directly to a single oxygen atom. [NIH]

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Eukaryotic Cells: Cells of the higher organisms, containing a true nucleus bounded by a nuclear membrane. [NIH] Evoke: The electric response recorded from the cerebral cortex after stimulation of a peripheral sense organ. [NIH] Excitatory: When cortical neurons are excited, their output increases and each new input they receive while they are still excited raises their output markedly. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Expiration: The act of breathing out, or expelling air from the lungs. [EU] Extensor: A muscle whose contraction tends to straighten a limb; the antagonist of a flexor. [NIH]

Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Facial: Of or pertaining to the face. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fathers: Male parents, human or animal. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fixation: 1. The act or operation of holding, suturing, or fastening in a fixed position. 2. The condition of being held in a fixed position. 3. In psychiatry, a term with two related but distinct meanings : (1) arrest of development at a particular stage, which like regression (return to an earlier stage), if temporary is a normal reaction to setbacks and difficulties but if protracted or frequent is a cause of developmental failures and emotional problems, and (2) a close and suffocating attachment to another person, especially a childhood figure, such as one's mother or father. Both meanings are derived from psychoanalytic theory and refer to 'fixation' of libidinal energy either in a specific erogenous zone, hence fixation at the oral, anal, or phallic stage, or in a specific object, hence mother or father fixation. 4. The use of a fixative (q.v.) to preserve histological or cytological specimens. 5. In chemistry, the process whereby a substance is removed from the gaseous or solution phase and localized, as in carbon dioxide fixation or nitrogen fixation. 6. In ophthalmology, direction of the gaze so that the visual image of the object falls on the fovea centralis. 7. In film processing, the chemical removal of all undeveloped salts of the film emulsion, leaving only the developed silver to form a permanent image. [EU] Fluorine: A nonmetallic, diatomic gas that is a trace element and member of the halogen family. It is used in dentistry as flouride to prevent dental caries. [NIH] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Flush: Transient, episodic redness of the face and neck caused by certain diseases, ingestion of certain drugs or other substances, heat, emotional factors, or physical exertion. [EU] Fluvoxamine: A selective serotonin reuptake inhibitor. It is effective in the treatment of depression, obsessive-compulsive disorders, anxiety, panic disorders, and alcohol amnestic disorders. [NIH] Forearm: The part between the elbow and the wrist. [NIH]

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Fovea: The central part of the macula that provides the sharpest vision. [NIH] Functional magnetic resonance imaging: A noninvasive tool used to observe functioning in the brain or other organs by detecting changes in chemical composition, blood flow, or both. [NIH]

GABA: The most common inhibitory neurotransmitter in the central nervous system. [NIH] Gallbladder: The pear-shaped organ that sits below the liver. Bile is concentrated and stored in the gallbladder. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastrin: A hormone released after eating. Gastrin causes the stomach to produce more acid. [NIH]

Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Genetics: The biological science that deals with the phenomena and mechanisms of heredity. [NIH] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glycerol: A trihydroxy sugar alcohol that is an intermediate in carbohydrate and lipid metabolism. It is used as a solvent, emollient, pharmaceutical agent, and sweetening agent. [NIH]

Glycopyrrolate: A muscarinic antagonist used as an antispasmodic, in some disorders of the gastrointestinal tract, and to reduce salivation with some anesthetics. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Halogens: A family of nonmetallic, generally electronegative, elements of group VIIa of the periodic table. They are all multivalent and have oxidation numbers of -1 (the most common), 1, 3, 5, and 7. [NIH]

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Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Headache: Pain in the cranial region that may occur as an isolated and benign symptom or as a manifestation of a wide variety of conditions including subarachnoid hemorrhage; craniocerebral trauma; central nervous system infections; intracranial hypertension; and other disorders. In general, recurrent headaches that are not associated with a primary disease process are referred to as headache disorders (e.g., migraine). [NIH] Headache Disorders: Common conditions characterized by persistent or recurrent headaches. Headache syndrome classification systems may be based on etiology (e.g., vascular headache, post-traumatic headaches, etc.), temporal pattern (e.g., cluster headache, paroxysmal hemicrania, etc.), and precipitating factors (e.g., cough headache). [NIH] Health Services: Services for the diagnosis and treatment of disease and the maintenance of health. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Hemicrania: An ache or a pain in one side of the head, as in migraine. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Heritability: The proportion of observed variation in a particular trait that can be attributed to inherited genetic factors in contrast to environmental ones. [NIH] Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Heterozygotes: Having unlike alleles at one or more corresponding loci on homologous chromosomes. [NIH] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Histidine: An essential amino acid important in a number of metabolic processes. It is required for the production of histamine. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Homozygotes: An individual having a homozygous gene pair. [NIH] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1

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isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hypersensitivity: Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperthyroidism: Excessive functional activity of the thyroid gland. [NIH] Hyperventilation: A pulmonary ventilation rate faster than is metabolically necessary for the exchange of gases. It is the result of an increased frequency of breathing, an increased tidal volume, or a combination of both. It causes an excess intake of oxygen and the blowing off of carbon dioxide. [NIH] Hypoglycemia: Abnormally low blood sugar [NIH] Hypokinesia: Slow or diminished movement of body musculature. It may be associated with basal ganglia diseases; mental disorders; prolonged inactivity due to illness; experimental protocols used to evaluate the physiologic effects of immobility; and other conditions. [NIH] Hypotension: Abnormally low blood pressure. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Immunology: The study of the body's immune system. [NIH] Immunotherapy: Manipulation of the host's immune system in treatment of disease. It includes both active and passive immunization as well as immunosuppressive therapy to prevent graft rejection. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Impulse Control Disorders: Disorders whose essential features are the failure to resist an impulse, drive, or temptation to perform an act that is harmful to the individual or to others. Individuals experience an increased sense of tension prior to the act and pleasure, gratification, or release of tension at the time of committing the act. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In Situ Hybridization: A technique that localizes specific nucleic acid sequences within intact chromosomes, eukaryotic cells, or bacterial cells through the use of specific nucleic acid-labeled probes. [NIH] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infantile: Pertaining to an infant or to infancy. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an

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area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Interneurons: Most generally any neurons which are not motor or sensory. Interneurons may also refer to neurons whose axons remain within a particular brain region as contrasted with projection neurons which have axons projecting to other brain regions. [NIH] Intestines: The section of the alimentary canal from the stomach to the anus. It includes the large intestine and small intestine. [NIH] Intracellular: Inside a cell. [NIH] Intracellular Membranes: Membranes of subcellular structures. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Intrinsic Factor: A glycoprotein secreted by the cells of the gastric glands that is required for the absorption of vitamin B 12. Deficiency of intrinsic factor results in pernicious anemia. [NIH]

Involuntary: Reaction occurring without intention or volition. [NIH] Irritable Bowel Syndrome: A disorder that comes and goes. Nerves that control the muscles in the GI tract are too active. The GI tract becomes sensitive to food, stool, gas, and stress. Causes abdominal pain, bloating, and constipation or diarrhea. Also called spastic colon or mucous colitis. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kava: Dried rhizome and roots of Piper methysticum, a shrub native to Oceania and known for its anti-anxiety and sedative properties. Heavy usage results in some adverse effects. It contains alkaloids, lactones, kawain, methysticin, mucilage, starch, and yangonin. Kava is also the name of the pungent beverage prepared from the plant's roots. [NIH]

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Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Lactation: The period of the secretion of milk. [EU] Language Disorders: Conditions characterized by deficiencies of comprehension or expression of written and spoken forms of language. These include acquired and developmental disorders. [NIH] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lectin: A complex molecule that has both protein and sugars. Lectins are able to bind to the outside of a cell and cause biochemical changes in it. Lectins are made by both animals and plants. [NIH] Lesion: An area of abnormal tissue change. [NIH] Levodopa: The naturally occurring form of dopa and the immediate precursor of dopamine. Unlike dopamine itself, it can be taken orally and crosses the blood-brain barrier. It is rapidly taken up by dopaminergic neurons and converted to dopamine. It is used for the treatment of parkinsonism and is usually given with agents that inhibit its conversion to dopamine outside of the central nervous system. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Ligands: A RNA simulation method developed by the MIT. [NIH] Limbic: Pertaining to a limbus, or margin; forming a border around. [EU] Limbic System: A set of forebrain structures common to all mammals that is defined functionally and anatomically. It is implicated in the higher integration of visceral, olfactory, and somatic information as well as homeostatic responses including fundamental survival behaviors (feeding, mating, emotion). For most authors, it includes the amygdala, epithalamus, gyrus cinguli, hippocampal formation (see hippocampus), hypothalamus, parahippocampal gyrus, septal nuclei, anterior nuclear group of thalamus, and portions of the basal ganglia. (Parent, Carpenter's Human Neuroanatomy, 9th ed, p744; NeuroNames, http://rprcsgi.rprc.washington.edu/neuronames/index.html (September 2, 1998)). [NIH] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lipid: Fat. [NIH] Lipophilic: Having an affinity for fat; pertaining to or characterized by lipophilia. [EU] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lod: The lowest analyte content which, if actually present, will be detected with reasonable statistical certainty and can be identified according to the identification criteria of the

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method. If both accuracy and precision are constant over a concentration range. [NIH] Lod Score: The total relative probability, expressed on a logarithmic scale, that a linkage relationship exists among selected loci. Lod is an acronym for "logarithmic odds." [NIH] Loneliness: The state of feeling sad or dejected as a result of lack of companionship or being separated from others. [NIH] Longitudinal Studies: Studies in which variables relating to an individual or group of individuals are assessed over a period of time. [NIH] Long-Term Care: Care over an extended period, usually for a chronic condition or disability, requiring periodic, intermittent, or continuous care. [NIH] Lutein Cells: The cells of the corpus luteum which are derived from the granulosa cells and the theca cells of the Graafian follicle. [NIH] Magnetic Resonance Imaging: Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. [NIH] Magnetic Resonance Spectroscopy: Spectroscopic method of measuring the magnetic moment of elementary particles such as atomic nuclei, protons or electrons. It is employed in clinical applications such as NMR Tomography (magnetic resonance imaging). [NIH] Malaise: A vague feeling of bodily discomfort. [EU] Mandible: The largest and strongest bone of the face constituting the lower jaw. It supports the lower teeth. [NIH] Mania: Excitement of psychotic proportions manifested by mental and physical hyperactivity, disorganization of behaviour, and elevation of mood. [EU] Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] Manifest: Being the part or aspect of a phenomenon that is directly observable : concretely expressed in behaviour. [EU] Marital Status: A demographic parameter indicating a person's status with respect to marriage, divorce, widowhood, singleness, etc. [NIH] Medial: Lying near the midsaggital plane of the body; opposed to lateral. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Medical Records: Recording of pertinent information concerning patient's illness or illnesses. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH]

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Membrane Proteins: Proteins which are found in membranes including cellular and intracellular membranes. They consist of two types, peripheral and integral proteins. They include most membrane-associated enzymes, antigenic proteins, transport proteins, and drug, hormone, and lectin receptors. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. [NIH] Memory Disorders: Disturbances in registering an impression, in the retention of an acquired impression, or in the recall of an impression. Memory impairments are associated with dementia; craniocerebraltrauma; encephalitis; alcoholism (see also alcohol amnestic disorder); schizophrenia; and other conditions. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Menopause: Permanent cessation of menstruation. [NIH] Menstrual Cycle: The period of the regularly recurring physiologic changes in the endometrium occurring during the reproductive period in human females and some primates and culminating in partial sloughing of the endometrium (menstruation). [NIH] Menstruation: The normal physiologic discharge through the vagina of blood and mucosal tissues from the nonpregnant uterus. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Health Services: Organized services to provide mental health care. [NIH] Mesolimbic: Inner brain region governing emotion and drives. [NIH] Meta-Analysis: A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness, plan new studies, etc., with application chiefly in the areas of research and medicine. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Microscopy: The application of microscope magnification to the study of materials that cannot be properly seen by the unaided eye. [NIH] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two

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hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Monoamine Oxidase: An enzyme that catalyzes the oxidative deamination of naturally occurring monoamines. It is a flavin-containing enzyme that is localized in mitochondrial membranes, whether in nerve terminals, the liver, or other organs. Monoamine oxidase is important in regulating the metabolic degradation of catecholamines and serotonin in neural or target tissues. Hepatic monoamine oxidase has a crucial defensive role in inactivating circulating monoamines or those, such as tyramine, that originate in the gut and are absorbed into the portal circulation. (From Goodman and Gilman's, The Pharmacological Basis of Therapeutics, 8th ed, p415) EC 1.4.3.4. [NIH] Mood Disorders: Those disorders that have a disturbance in mood as their predominant feature. [NIH] Motility: The ability to move spontaneously. [EU] Motion Sickness: Sickness caused by motion, as sea sickness, train sickness, car sickness, and air sickness. [NIH] Movement Disorders: Syndromes which feature dyskinesias as a cardinal manifestation of the disease process. Included in this category are degenerative, hereditary, post-infectious, medication-induced, post-inflammatory, and post-traumatic conditions. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Multicenter study: A clinical trial that is carried out at more than one medical institution. [NIH]

Multivalent: Pertaining to a group of 5 or more homologous or partly homologous chromosomes during the zygotene stage of prophase to first metaphasis in meiosis. [NIH] Mutism: Inability or refusal to speak. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action

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toward a goal he believes will satisfy the impulse. [NIH] Neocortex: The largest portion of the cerebral cortex. It is composed of neurons arranged in six layers. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neonatal period: The first 4 weeks after birth. [NIH] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neuroanatomy: Study of the anatomy of the nervous system as a specialty or discipline. [NIH]

Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropeptide: A member of a class of protein-like molecules made in the brain. Neuropeptides consist of short chains of amino acids, with some functioning as neurotransmitters and some functioning as hormones. [NIH] Neurosis: Functional derangement due to disorders of the nervous system which does not affect the psychic personality of the patient. [NIH] Neurotic: 1. Pertaining to or characterized by neurosis. 2. A person affected with a neurosis. [EU]

Neurotransmitters: Endogenous signaling molecules that alter the behavior of neurons or effector cells. Neurotransmitter is used here in its most general sense, including not only messengers that act directly to regulate ion channels, but also those that act through second messenger systems, and those that act at a distance from their site of release. Included are neuromodulators, neuroregulators, neuromediators, and neurohumors, whether or not acting at synapses. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nonverbal Communication: Transmission of emotions, ideas, and attitudes between individuals in ways other than the spoken language. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a

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widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Normal Distribution: Continuous frequency distribution of infinite range. Its properties are as follows: 1) continuous, symmetrical distribution with both tails extending to infinity; 2) arithmetic mean, mode, and median identical; and 3) shape completely determined by the mean and standard deviation. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the next. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Ondansetron: A competitive serotonin type 3 receptor antagonist. It is effective in the treatment of nausea and vomiting caused by cytotoxic chemotherapy drugs, including cisplatin, and it has reported anxiolytic and neuroleptic properties. [NIH] Ophthalmology: A surgical specialty concerned with the structure and function of the eye and the medical and surgical treatment of its defects and diseases. [NIH] Orgasm: The crisis of sexual excitement in either humans or animals. [NIH] Orthostatic: Pertaining to or caused by standing erect. [EU] Outpatient: A patient who is not an inmate of a hospital but receives diagnosis or treatment in a clinic or dispensary connected with the hospital. [NIH] Ovum: A female germ cell extruded from the ovary at ovulation. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxygen Consumption: The oxygen consumption is determined by calculating the difference between the amount of oxygen inhaled and exhaled. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Panic Disorder: A type of anxiety disorder characterized by unexpected panic attacks that last minutes or, rarely, hours. Panic attacks begin with intense apprehension, fear or terror and, often, a feeling of impending doom. Symptoms experienced during a panic attack include dyspnea or sensations of being smothered; dizziness, loss of balance or faintness; choking sensations; palpitations or accelerated heart rate; shakiness; sweating; nausea or other form of abdominal distress; depersonalization or derealization; paresthesias; hot

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flashes or chills; chest discomfort or pain; fear of dying and fear of not being in control of oneself or going crazy. Agoraphobia may also develop. Similar to other anxiety disorders, it may be inherited as an autosomal dominant trait. [NIH] Parent-Child Relations: The interactions between parent and child. [NIH] Paresthesias: Abnormal touch sensations, such as burning or prickling, that occur without an outside stimulus. [NIH] Parkinsonism: A group of neurological disorders characterized by hypokinesia, tremor, and muscular rigidity. [EU] Paroxetine: A serotonin uptake inhibitor that is effective in the treatment of depression. [NIH]

Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Partial remission: The shrinking, but not complete disappearance, of a tumor in response to therapy. Also called partial response. [NIH] Parturition: The act or process of given birth to a child. [EU] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Penis: The external reproductive organ of males. It is composed of a mass of erectile tissue enclosed in three cylindrical fibrous compartments. Two of the three compartments, the corpus cavernosa, are placed side-by-side along the upper part of the organ. The third compartment below, the corpus spongiosum, houses the urethra. [NIH] Pentagastrin: A synthetic polypeptide that has effects like gastrin when given parenterally. It stimulates the secretion of gastric acid, pepsin, and intrinsic factor, and has been used as a diagnostic aid. [NIH] Pepsin: An enzyme made in the stomach that breaks down proteins. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Personality Disorders: A major deviation from normal patterns of behavior. [NIH] PH: The symbol relating the hydrogen ion (H+) concentration or activity of a solution to that of a given standard solution. Numerically the pH is approximately equal to the negative logarithm of H+ concentration expressed in molarity. pH 7 is neutral; above it alkalinity increases and below it acidity increases. [EU] Phallic: Pertaining to the phallus, or penis. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharmacotherapy: A regimen of using appetite suppressant medications to manage obesity by decreasing appetite or increasing the feeling of satiety. These medications decrease appetite by increasing serotonin or catecholamine—two brain chemicals that affect mood and appetite. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phobia: A persistent, irrational, intense fear of a specific object, activity, or situation (the phobic stimulus), fear that is recognized as being excessive or unreasonable by the

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individual himself. When a phobia is a significant source of distress or interferes with social functioning, it is considered a mental disorder; phobic disorder (or neurosis). In DSM III phobic disorders are subclassified as agoraphobia, social phobias, and simple phobias. Used as a word termination denoting irrational fear of or aversion to the subject indicated by the stem to which it is affixed. [EU] Phobic Disorders: Anxiety disorders in which the essential feature is persistent and irrational fear of a specific object, activity, or situation that the individual feels compelled to avoid. The individual recognizes the fear as excessive or unreasonable. [NIH] Phototherapy: Treatment of disease by exposure to light, especially by variously concentrated light rays or specific wavelengths. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Piperidines: A family of hexahydropyridines. Piperidine itself is found in the pepper plant as the alkaloid piperine. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polygenic Inheritance: A phenotypic outcome that is determined by more than one gene, such as a variety of physical characteristics or diseases. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Population Control: Includes mechanisms or programs which control the numbers of individuals in a population of humans or animals. [NIH] Post partum: After childbirth, or after delivery. [EU] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Post-traumatic: Occurring as a result of or after injury. [EU] Post-traumatic stress disorder: A psychological disorder that develops in some individuals after a major traumatic experience such as war, rape, domestic violence, or accident. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practicability: A non-standard characteristic of an analytical procedure. It is dependent on the scope of the method and is determined by requirements such as sample throughout and costs. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis,

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therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Pregnenolone: Steroid hormone. [NIH] Premenstrual: Occurring before menstruation. [EU] Premenstrual Syndrome: A syndrome occurring most often during the last week of the menstrual cycle and ending soon after the onset of menses. Some of the symptoms are emotional instability, insomnia, headache, nausea, vomiting, abdominal distension, and painful breasts. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probe: An instrument used in exploring cavities, or in the detection and dilatation of strictures, or in demonstrating the potency of channels; an elongated instrument for exploring or sounding body cavities. [NIH] Prodrug: A substance that gives rise to a pharmacologically active metabolite, although not itself active (i. e. an inactive precursor). [NIH] Progesterone: Pregn-4-ene-3,20-dione. The principal progestational hormone of the body, secreted by the corpus luteum, adrenal cortex, and placenta. Its chief function is to prepare the uterus for the reception and development of the fertilized ovum. It acts as an antiovulatory agent when administered on days 5-25 of the menstrual cycle. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Prolactin: Pituitary lactogenic hormone. A polypeptide hormone with a molecular weight of about 23,000. It is essential in the induction of lactation in mammals at parturition and is synergistic with estrogen. The hormone also brings about the release of progesterone from lutein cells, which renders the uterine mucosa suited for the embedding of the ovum should fertilization occur. [NIH] Prolapse: The protrusion of an organ or part of an organ into a natural or artificial orifice. [NIH]

Prophase: The first phase of cell division, in which the chromosomes become visible, the nucleus starts to lose its identity, the spindle appears, and the centrioles migrate toward opposite poles. [NIH] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH]

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Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychogenic: Produced or caused by psychic or mental factors rather than organic factors. [EU]

Psychomotor: Pertaining to motor effects of cerebral or psychic activity. [EU] Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH] Psychotomimetic: Psychosis miming. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured

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in liters per minute. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pupil: The aperture in the iris through which light passes. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Randomized clinical trial: A study in which the participants are assigned by chance to separate groups that compare different treatments; neither the researchers nor the participants can choose which group. Using chance to assign people to groups means that the groups will be similar and that the treatments they receive can be compared objectively. At the time of the trial, it is not known which treatment is best. It is the patient's choice to be in a randomized trial. [NIH] Randomized Controlled Trials: Clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table. Treatment allocations using coin flips, odd-even numbers, patient social security numbers, days of the week, medical record numbers, or other such pseudo- or quasi-random processes, are not truly randomized and trials employing any of these techniques for patient assignment are designated simply controlled clinical trials. [NIH] Rape: Unlawful sexual intercourse without consent of the victim. [NIH] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego function. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Receptors, Serotonin: Cell-surface proteins that bind serotonin and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH]

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Refer: To send or direct for treatment, aid, information, de decision. [NIH] Refraction: A test to determine the best eyeglasses or contact lenses to correct a refractive error (myopia, hyperopia, or astigmatism). [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Relaxation Techniques: The use of muscular relaxation techniques in treatment. [NIH] Remission: A decrease in or disappearance of signs and symptoms of cancer. In partial remission, some, but not all, signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although there still may be cancer in the body. [NIH] Research Design: A plan for collecting and utilizing data so that desired information can be obtained with sufficient precision or so that an hypothesis can be tested properly. [NIH] Resorption: The loss of substance through physiologic or pathologic means, such as loss of dentin and cementum of a tooth, or of the alveolar process of the mandible or maxilla. [EU] Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Respiratory System: The tubular and cavernous organs and structures, by means of which pulmonary ventilation and gas exchange between ambient air and the blood are brought about. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Retrospective study: A study that looks backward in time, usually using medical records and interviews with patients who already have or had a disease. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Role-play: In this method, a conflict is artificially constructed, and the trainee is given a strategic position in it. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Salivation: 1. The secretion of saliva. 2. Ptyalism (= excessive flow of saliva). [EU] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Seasonal Affective Disorder: A syndrome characterized by depressions that recur annually at the same time each year, usually during the winter months. Other symptoms include anxiety, irritability, decreased energy, increased appetite (carbohydrate cravings), increased duration of sleep, and weight gain. SAD (seasonal affective disorder) can be treated by daily exposure to bright artificial lights (phototherapy), during the season of recurrence. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a

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gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selegiline: A selective, irreversible inhibitor of Type B monoamine oxidase. It is used in newly diagnosed patients with Parkinson's disease. It may slow progression of the clinical disease and delay the requirement for levodopa therapy. It also may be given with levodopa upon onset of disability. (From AMA Drug Evaluations Annual, 1994, p385) The compound without isomeric designation is Deprenyl. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Serotonin: A biochemical messenger and regulator, synthesized from the essential amino acid L-tryptophan. In humans it is found primarily in the central nervous system, gastrointestinal tract, and blood platelets. Serotonin mediates several important physiological functions including neurotransmission, gastrointestinal motility, hemostasis, and cardiovascular integrity. Multiple receptor families (receptors, serotonin) explain the broad physiological actions and distribution of this biochemical mediator. [NIH] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH]

Sex Characteristics: Those characteristics that distinguish one sex from the other. The primary sex characteristics are the ovaries and testes and their related hormones. Secondary sex characteristics are those which are masculine or feminine but not directly related to reproduction. [NIH] Shyness: Discomfort and partial inhibition of the usual forms of behavior when in the presence of others. [NIH] Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Small intestine: The part of the digestive tract that is located between the stomach and the large intestine. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Behavior: Any behavior caused by or affecting another individual, usually of the same species. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and

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processes that influence the life of an individual or community. [NIH] Social Work: The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. [NIH] Somatic: 1. Pertaining to or characteristic of the soma or body. 2. Pertaining to the body wall in contrast to the viscera. [EU] Somnolence: Sleepiness; also unnatural drowsiness. [EU] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spastic: 1. Of the nature of or characterized by spasms. 2. Hypertonic, so that the muscles are stiff and the movements awkward. 3. A person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Spatial disorientation: Loss of orientation in space where person does not know which way is up. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sperm: The fecundating fluid of the male. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinal Nerves: The 31 paired peripheral nerves formed by the union of the dorsal and ventral spinal roots from each spinal cord segment. The spinal nerve plexuses and the spinal roots are also included. [NIH] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

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Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stool: The waste matter discharged in a bowel movement; feces. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Striatum: A higher brain's domain thus called because of its stripes. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Substrate: A substance upon which an enzyme acts. [EU] Suppression: A conscious exclusion of disapproved desire contrary with repression, in which the process of exclusion is not conscious. [NIH] Supraspinal: Above the spinal column or any spine. [NIH] Sympathetic Nervous System: The thoracolumbar division of the autonomic nervous system. Sympathetic preganglionic fibers originate in neurons of the intermediolateral column of the spinal cord and project to the paravertebral and prevertebral ganglia, which in turn project to target organs. The sympathetic nervous system mediates the body's response to stressful situations, i.e., the fight or flight reactions. It often acts reciprocally to the parasympathetic system. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Synapsis: The pairing between homologous chromosomes of maternal and paternal origin during the prophase of meiosis, leading to the formation of gametes. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH]

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Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] Temperament: Predisposition to react to one's environment in a certain way; usually refers to mood changes. [NIH] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Temporal Lobe: Lower lateral part of the cerebral hemisphere. [NIH] Thalamic: Cell that reaches the lateral nucleus of amygdala. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Tidal Volume: The volume of air inspired or expired during each normal, quiet respiratory cycle. Common abbreviations are TV or V with subscript T. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tomography: Imaging methods that result in sharp images of objects located on a chosen plane and blurred images located above or below the plane. [NIH] Tonic: 1. Producing and restoring the normal tone. 2. Characterized by continuous tension. 3. A term formerly used for a class of medicinal preparations believed to have the power of restoring normal tone to tissue. [EU] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Torticollis: Wryneck; a contracted state of the cervical muscles, producing twisting of the neck and an unnatural position of the head. [EU] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Trace element: Substance or element essential to plant or animal life, but present in extremely small amounts. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH]

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Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, practicability, etc., of these interventions in individual cases or series. [NIH]

Tremor: Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of Parkinson disease. [NIH] Trichotillomania: Compulsion to pull out one's hair. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tyramine: An indirect sympathomimetic. Tyramine does not directly activate adrenergic receptors, but it can serve as a substrate for adrenergic uptake systems and monoamine oxidase so it prolongs the actions of adrenergic transmitters. It also provokes transmitter release from adrenergic terminals. Tyramine may be a neurotransmitter in some invertebrate nervous systems. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urinary: Having to do with urine or the organs of the body that produce and get rid of urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilation: Physiological dilation of the blood vessels without anatomic change. For dilation with anatomic change, dilatation, pathologic or aneurysm (or specific aneurysm) is used. [NIH] Vasodilator: An agent that widens blood vessels. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventral: 1. Pertaining to the belly or to any venter. 2. Denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU]

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Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Vivo: Outside of or removed from the body of a living organism. [NIH] War: Hostile conflict between organized groups of people. [NIH] Weight Gain: Increase in body weight over existing weight. [NIH] Xenograft: The cells of one species transplanted to another species. [NIH] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to treat cancer. [NIH] Yeasts: A general term for single-celled rounded fungi that reproduce by budding. Brewers' and bakers' yeasts are Saccharomyces cerevisiae; therapeutic dried yeast is dried yeast. [NIH]

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INDEX 3 3-dimensional, 24, 133 A Abdomen, 133, 138, 152, 166 Abdominal, 133, 151, 157, 160 Abdominal Pain, 133, 151 Aberrant, 133, 140 Acetylcholine, 94, 98, 133, 139 Acyl, 98, 133 Adaptation, 55, 133 Adjustment, 97, 133 Adolescence, 9, 10, 11, 133 Adrenal Cortex, 133, 142, 160 Adrenal Medulla, 133, 139, 146, 156 Adrenergic, 92, 133, 136, 145, 146, 160, 166, 168 Adverse Effect, 133, 151, 164 Aetiology, 24, 133 Affinity, 26, 133, 134, 136, 152 Agonist, 92, 93, 134, 137, 138, 145, 156 Agoraphobia, 20, 34, 44, 72, 73, 74, 82, 85, 93, 94, 95, 120, 134, 158, 159 Akathisia, 134, 136 Algorithms, 134, 138 Alkaloid, 134, 156, 159 Alkalosis, 8, 134 Allergen, 134, 144 Alternative medicine, 107, 134 Alveolar Process, 134, 163 Alveoli, 134, 168 Amenorrhea, 134, 135 Amine, 134, 149 Amino Acids, 134, 156, 159, 161 Amnestic, 93, 134, 147, 154 Amphetamine, 15, 59, 135, 144 Amygdala, 6, 16, 25, 53, 135, 137, 152, 167 Anal, 28, 135, 147 Anatomical, 135, 144, 150 Anesthetics, 135, 146, 148 Aneurysm, 135, 168 Angina, 135, 160 Angina Pectoris, 135, 160 Animal model, 12, 135 Anomalies, 43, 135 Anorexia, 93, 135 Anorexia Nervosa, 93, 135 Antibacterial, 135, 165 Antibiotic, 135, 165

Antibody, 134, 135, 141, 149, 153, 162, 165 Anticonvulsant, 135, 140 Antidepressant, 93, 106, 135, 140, 147 Antiemetic, 135, 136 Antigen, 134, 135, 141, 149, 150, 153 Antipsychotic, 5, 136, 156 Antispasmodic, 136, 148 Anus, 135, 136, 138, 151 Anxiety Disorders, 4, 8, 9, 10, 12, 14, 17, 19, 20, 22, 23, 24, 27, 29, 30, 32, 39, 40, 41, 46, 50, 51, 56, 57, 58, 59, 63, 67, 77, 80, 82, 88, 92, 93, 94, 98, 101, 120, 121, 136, 158 Anxiolytic, 136, 138, 157 Apathy, 136, 156 Aphasia, 134, 136 Arterial, 136, 150, 160, 167 Arteries, 136, 138, 142, 154, 155 Artifacts, 25, 136 Astrocytes, 136, 155 Atypical, 15, 136 Autonomic, 23, 36, 133, 136, 137, 157, 158, 166 Autonomic Nervous System, 137, 158, 166 Autoradiography, 7, 137 Axons, 137, 151 B Baclofen, 33, 137 Bacteria, 133, 135, 136, 137, 143, 154, 165, 168 Bacterial Physiology, 133, 137 Basal Ganglia, 136, 137, 139, 150, 152 Basal Ganglia Diseases, 137, 139, 150 Base, 13, 134, 137, 143, 152, 167 Behavior Therapy, 27, 58, 137 Benign, 137, 149 Benzene, 137 Benzodiazepines, 26, 37, 76, 92, 137, 138 Bioavailability, 99, 137 Biochemical, 94, 137, 152, 164 Biopsy, 5, 138 Biotechnology, 31, 32, 107, 115, 138 Bloating, 138, 151 Blood Platelets, 138, 164 Blood pressure, 17, 24, 131, 138, 139, 150, 155 Blood vessel, 138, 139, 164, 166, 167, 168 Body Fluids, 134, 138

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Bowel, 135, 138, 144, 166 Bowel Movement, 138, 144, 166 Branch, 129, 138, 158, 165, 167 Bronchi, 138, 146 Bronchial, 138, 149 Bronchitis, 98, 138 Bulimia, 67, 93, 96, 97, 138 Buspirone, 33, 39, 138 Butyric Acid, 97, 138 C Carbohydrate, 138, 148, 163 Carbon Dioxide, 24, 95, 96, 138, 143, 147, 148, 150, 163 Cardiac, 23, 138, 146, 155, 165 Cardioselective, 138, 160 Cardiovascular, 66, 97, 135, 138, 139, 164 Cardiovascular disease, 97, 139 Case report, 92, 139, 140 Case series, 38, 40, 59, 139, 140 Catecholamine, 139, 145, 158 Causal, 68, 139 Cell Respiration, 139, 163 Central Nervous System, 98, 133, 135, 137, 139, 144, 148, 149, 152, 164 Central Nervous System Infections, 139, 149 Cerebral, 39, 41, 80, 93, 137, 139, 143, 146, 147, 156, 161, 165, 167 Cerebrovascular, 137, 139 Cerebrum, 139 Cervical, 139, 167 Chemoreceptor, 136, 139 Cholinergic, 136, 139, 156 Chorea, 136, 139 Chromosome, 94, 139, 152 Chronic, 8, 11, 22, 25, 92, 93, 96, 97, 98, 140, 153, 161 CIS, 93, 140 Cisplatin, 140, 157 Citalopram, 40, 41, 46, 50, 73, 80, 140 Clinical Medicine, 140, 160 Clinical study, 140, 142 Clinical trial, 5, 9, 19, 23, 28, 29, 35, 87, 90, 115, 140, 142, 155, 161, 162 Clonazepam, 32, 43, 56, 140 Clonic, 140 Cloning, 138, 140 Cognition, 6, 13, 140, 156 Cognitive behavior therapy, 27, 140 Cognitive restructuring, 83, 140 Cognitive Therapy, 34, 38, 48, 56, 140 Colitis, 140, 151

Comorbidity, 4, 22, 23, 25, 26, 29, 34, 38, 47, 49, 54, 55, 62, 140 Complement, 141 Complementary and alternative medicine, 79, 83, 141 Complementary medicine, 79, 141 Complete remission, 141, 163 Computational Biology, 115, 141 Computed tomography, 50, 80, 141, 142 Computerized axial tomography, 141, 142 Computerized tomography, 15, 141, 142 Concomitant, 99, 142 Confusion, 142, 156 Congestion, 136, 142 Consciousness, 142, 143, 144 Constipation, 136, 142, 151 Consultation, 29, 142 Contraindications, ii, 142 Control group, 4, 12, 30, 73, 142 Controlled clinical trial, 22, 28, 142, 162 Controlled study, 43, 49, 142 Coronary, 135, 139, 142, 154, 155 Coronary heart disease, 139, 142 Coronary Thrombosis, 142, 154, 155 Cortex, 16, 142, 147, 156 Cortical, 6, 142, 147, 164 Cortisol, 17, 24, 55, 61, 142 Cranial, 142, 149, 158 Craniocerebral Trauma, 137, 142, 149 Criterion, 41, 142 Curative, 143, 167 Cutaneous, 5, 143 Cytotoxic, 143, 157 Cytotoxic chemotherapy, 143, 157 D Dangerous Behavior, 19, 143 Data Collection, 23, 143 Databases, Bibliographic, 115, 143 Deamination, 143, 155 Decarboxylation, 143, 149 Delirium, 136, 143 Delusions, 5, 143, 161 Dementia, 93, 136, 143, 154 Dendrites, 143, 156 Dental Caries, 143, 147 Depersonalization, 143, 157 Depressive Disorder, 15, 19, 20, 67, 72, 144, 152 Derealization, 144, 157 Dermatitis, 5, 144, 145 Desensitization, 79, 144 Dextroamphetamine, 135, 144

Index 173

Diagnostic procedure, 91, 107, 144 Diarrhea, 144, 151 Diastolic, 144, 150 Digestion, 138, 144, 152, 166 Digestive system, 90, 144 Dilatation, 135, 144, 160, 168 Dilatation, Pathologic, 144, 168 Dilation, 95, 144, 168 Direct, iii, 15, 23, 32, 62, 109, 140, 144, 145, 163 Discrimination, 52, 103, 144 Discrimination Learning, 52, 144 Dissociation, 134, 144 Distal, 94, 144, 161 Dizziness, 95, 145, 157 Dominance, 7, 145 Dopamine, 15, 26, 33, 44, 56, 94, 98, 99, 135, 136, 144, 145, 152, 155 Drinking Behavior, 6, 145 Drive, ii, vi, 75, 145, 150 Drug Interactions, 110, 145 Drug Monitoring, 26, 145 Duodenum, 145, 166 Dyskinesia, 136, 140, 145 Dysphoria, 11, 145 Dysphoric, 97, 144, 145 Dyspnea, 145, 157 Dystonia, 136, 145 E Eating Disorders, 24, 99, 145 Eczema, 5, 145 Effector, 133, 141, 145, 156 Efficacy, 8, 9, 10, 11, 15, 22, 27, 29, 30, 32, 46, 47, 48, 49, 70, 88, 92, 106, 138, 145, 168 Ejaculation, 26, 93, 96, 97, 145, 164 Elective, 46, 54, 67, 145 Electrons, 137, 145, 153, 157, 162 Elementary Particles, 145, 146, 153, 161 Empirical, 8, 14, 18, 27, 35, 146 Emulsion, 137, 146, 147 Encephalitis, 146, 154 Endemic, 146, 165 Endometrial, 97, 146 Endometrium, 146, 154 Environmental Health, 114, 116, 146 Enzymatic, 141, 143, 146, 149 Enzyme, 145, 146, 155, 158, 166 Epidemic, 146, 165 Epinephrine, 47, 133, 145, 146, 156, 168 Esophagus, 144, 146, 166 Essential Tremor, 40, 146

Estrogen, 97, 146, 160 Ethanol, 140, 146 Ether, 96, 146 Eukaryotic Cells, 147, 150 Evoke, 147, 166 Excitatory, 137, 147 Exogenous, 145, 147 Expiration, 147, 163 Extensor, 147, 161 Extraction, 12, 147 Extrapyramidal, 134, 136, 145, 147 F Facial, 58, 65, 147 Family Planning, 115, 147 Fat, 138, 142, 147, 152 Fathers, 6, 147 Fatigue, 96, 97, 147 Fixation, 16, 147 Fluorine, 38, 147 Fluoxetine, 38, 41, 48, 49, 88, 147 Flush, 96, 147 Fluvoxamine, 9, 10, 11, 19, 47, 49, 88, 105, 106, 147 Forearm, 138, 147 Fovea, 147, 148 Functional magnetic resonance imaging, 16, 21, 148 G GABA, 6, 26, 97, 137, 140, 148 Gallbladder, 133, 144, 148 Ganglia, 133, 137, 148, 156, 158, 166 Gas, 138, 147, 148, 149, 151, 156, 161, 163, 168 Gas exchange, 148, 163, 168 Gastric, 148, 149, 151, 158 Gastric Acid, 148, 158 Gastrin, 148, 149, 158 Gastrointestinal, 93, 146, 148, 164, 166 Gastrointestinal tract, 93, 146, 148, 164 Gene, 94, 138, 145, 148, 149, 159 Genetics, 15, 19, 36, 44, 48, 145, 148 Genotype, 148, 158 Gland, 133, 148, 150, 157, 164, 166 Glucose, 148, 151 Glycerol, 138, 148 Glycopyrrolate, 92, 148 Governing Board, 148, 160 Growth, 28, 33, 35, 47, 51, 55, 76, 133, 135, 148, 159, 168 H Habitual, 66, 148 Halogens, 96, 148

174

Social Phobia

Haptens, 134, 149 Headache, 93, 149, 160 Headache Disorders, 149 Health Services, 25, 149 Heart attack, 139, 149 Hemicrania, 93, 149 Hemorrhage, 142, 149, 166 Hemostasis, 149, 164 Heredity, 148, 149 Heritability, 12, 48, 149 Heterogeneity, 134, 149 Heterozygotes, 145, 149 Histamine, 94, 98, 136, 149 Histidine, 149 Homogeneous, 24, 149 Homologous, 149, 155, 166 Homozygotes, 145, 149 Hormone, 33, 47, 51, 55, 76, 142, 146, 148, 149, 151, 154, 160 Hydrogen, 134, 137, 138, 149, 155, 157, 158, 161 Hypersensitivity, 31, 134, 144, 150 Hypertension, 93, 139, 149, 150, 160 Hyperthyroidism, 150, 160 Hyperventilation, 8, 52, 150 Hypoglycemia, 103, 150 Hypokinesia, 150, 158 Hypotension, 136, 150 I Id, 77, 83, 120, 122, 128, 130, 150 Immunology, 134, 150 Immunotherapy, 144, 150 Impairment, 4, 6, 8, 9, 10, 11, 16, 41, 50, 72, 93, 143, 145, 150, 154, 161 Impulse Control Disorders, 96, 97, 150 In situ, 6, 7, 150 In Situ Hybridization, 6, 7, 150 In vitro, 150 In vivo, 7, 47, 56, 72, 150 Indicative, 101, 150, 158, 168 Induction, 136, 150, 160 Infancy, 150 Infantile, 95, 150 Infarction, 150 Inflammation, 138, 140, 144, 146, 151 Ingestion, 147, 151, 159 Inhalation, 31, 151, 159 Innervation, 7, 151 Inotropic, 145, 151 Insomnia, 151, 160 Insulin, 103, 151 Insulin-dependent diabetes mellitus, 151

Interleukin-2, 82, 151 Intermittent, 151, 153 Interneurons, 7, 151 Intestines, 133, 148, 151 Intracellular, 151, 154, 162 Intracellular Membranes, 151, 154 Intravenous, 51, 151 Intrinsic, 6, 134, 151, 158 Intrinsic Factor, 151, 158 Involuntary, 137, 139, 146, 151, 155, 165 Irritable Bowel Syndrome, 3, 151 J Joint, 94, 151 K Kava, 55, 76, 81, 151 Kb, 114, 152 L Lactation, 152, 160 Language Disorders, 4, 152 Large Intestine, 144, 151, 152, 162, 164 Latent, 22, 31, 152 Lectin, 152, 154 Lesion, 152, 167 Levodopa, 152, 164 Library Services, 128, 152 Ligands, 99, 152 Limbic, 7, 135, 152 Limbic System, 135, 152 Linkage, 51, 152, 153 Lipid, 148, 151, 152 Lipophilic, 92, 152 Lithium, 136, 152 Liver, 133, 144, 146, 148, 152, 155 Localized, 143, 147, 152, 155, 159 Lod, 94, 152, 153 Lod Score, 94, 153 Loneliness, 11, 153 Longitudinal Studies, 31, 153 Long-Term Care, 24, 153 Lutein Cells, 153, 160 M Magnetic Resonance Imaging, 153 Magnetic Resonance Spectroscopy, 8, 38, 76, 153 Malaise, 145, 153 Mandible, 134, 153, 163 Mania, 7, 153 Manic, 136, 152, 153, 161 Manic-depressive psychosis, 153, 161 Manifest, 26, 95, 153 Marital Status, 66, 153 Medial, 6, 7, 153

Index 175

Mediate, 7, 28, 30, 145, 153 Mediator, 151, 153, 164 Medical Records, 153, 163 MEDLINE, 115, 153 Meiosis, 153, 155, 166 Membrane, 24, 136, 141, 147, 153, 154, 155 Membrane Proteins, 24, 154 Memory, 15, 17, 20, 21, 45, 52, 58, 72, 80, 93, 135, 143, 154 Memory Disorders, 93, 154 Meninges, 139, 142, 154 Menopause, 154, 160 Menstrual Cycle, 154, 160 Menstruation, 134, 154, 160 Mental Disorders, 90, 150, 154, 161 Mental Health, iv, 5, 16, 24, 69, 87, 88, 89, 90, 114, 116, 120, 121, 122, 154 Mental Health Services, iv, 5, 24, 116, 154 Mesolimbic, 136, 154 Meta-Analysis, 64, 70, 154 Metabolite, 154, 160 MI, 93, 97, 98, 132, 154 Microbiology, 133, 136, 154 Microscopy, 7, 154 Modeling, 28, 154 Modification, 14, 36, 56, 80, 103, 154, 162 Molecular, 19, 94, 115, 117, 138, 141, 154, 160, 162, 168 Molecular Structure, 154, 168 Molecule, 136, 137, 141, 144, 145, 152, 154, 157, 162 Monitor, 89, 155 Monoamine, 13, 67, 92, 135, 144, 155, 164, 168 Monoamine Oxidase, 13, 67, 92, 135, 144, 155, 164, 168 Mood Disorders, 4, 7, 16, 55, 93, 94, 155 Motility, 93, 155, 164 Motion Sickness, 155 Movement Disorders, 136, 155 Mucosa, 155, 160 Multicenter study, 19, 155 Multivalent, 148, 155 Mutism, 40, 46, 54, 155 Mydriatic, 144, 155 Myocardial infarction, 142, 154, 155, 160 Myocardium, 135, 154, 155 N Nausea, 26, 95, 135, 136, 155, 157, 160 NCI, 1, 90, 113, 140, 155 Necrosis, 151, 154, 155 Need, 3, 21, 26, 92, 102, 123, 155, 167

Neocortex, 7, 156 Neonatal, 7, 156 Neonatal period, 7, 156 Nerve, 133, 137, 143, 151, 153, 155, 156, 165, 166, 168 Nervous System, 8, 94, 98, 135, 137, 139, 153, 156, 158, 166, 168 Neural, 6, 25, 79, 155, 156 Neuroanatomy, 6, 152, 156 Neuroleptic, 93, 134, 136, 156, 157 Neuromuscular, 133, 156 Neuromuscular Junction, 133, 156 Neuronal, 140, 156 Neurons, 7, 143, 147, 148, 151, 152, 156, 166 Neuropeptide, 63, 156 Neurosis, 156, 159 Neurotic, 5, 95, 156 Neurotransmitters, 156 Nicotine, 6, 156 Nitrogen, 96, 134, 147, 156, 168 Nonverbal Communication, 156, 161 Norepinephrine, 51, 133, 145, 156 Normal Distribution, 7, 157 Nuclei, 6, 135, 145, 152, 153, 157, 161 Nucleic acid, 150, 156, 157 Nucleus, 137, 146, 147, 153, 157, 160, 161, 167 O Ondansetron, 45, 157 Ophthalmology, 147, 157 Orgasm, 145, 157 Orthostatic, 51, 136, 157 Outpatient, 21, 157 Ovum, 157, 160 Oxidation, 148, 157 Oxygen Consumption, 157, 163 P Palliative, 157, 167 Pancreas, 133, 144, 151, 157 Parent-Child Relations, 28, 158 Paresthesias, 157, 158 Parkinsonism, 93, 136, 152, 158 Paroxetine, 23, 26, 33, 61, 63, 81, 106, 110, 158 Paroxysmal, 93, 135, 149, 158 Partial remission, 158, 163 Parturition, 158, 160 Pathologic, 138, 142, 150, 158, 161, 163 Penis, 145, 158 Pentagastrin, 45, 158 Pepsin, 158

176

Social Phobia

Peripheral Nervous System, 8, 158, 166 Personality Disorders, 20, 36, 158 PH, 15, 40, 50, 80, 158 Phallic, 147, 158 Pharmacologic, 5, 71, 158, 167 Pharmacotherapy, 13, 50, 63, 80, 158 Phenotype, 94, 158 Phobic Disorders, 87, 88, 89, 95, 159 Phototherapy, 159, 163 Physiologic, 31, 134, 150, 154, 159, 162, 163, 168 Physiology, 8, 23, 159 Pilot study, 49, 52, 76, 88, 159 Piperidines, 98, 159 Plants, 134, 138, 148, 152, 157, 159 Plasma, 51, 56, 63, 149, 159, 164 Poisoning, 143, 155, 159 Polygenic Inheritance, 95, 159 Polypeptide, 158, 159, 160 Population Control, 12, 159 Post partum, 96, 159 Posterior, 135, 157, 159 Post-traumatic, 13, 93, 96, 97, 149, 155, 159 Post-traumatic stress disorder, 13, 93, 96, 97, 159 Potentiation, 63, 159 Practicability, 159, 168 Practice Guidelines, 116, 159 Precursor, 37, 145, 146, 152, 156, 160, 168 Pregnenolone, 56, 160 Premenstrual, 96, 97, 160 Premenstrual Syndrome, 96, 160 Prevalence, 3, 9, 10, 11, 17, 25, 26, 63, 95, 122, 160 Probe, 16, 160 Prodrug, 97, 160 Progesterone, 160, 165 Progression, 135, 160, 164 Progressive, 143, 148, 155, 160 Projection, 151, 157, 160 Prolactin, 33, 160 Prolapse, 58, 160 Prophase, 155, 160, 166 Propranolol, 92, 160 Protein S, 138, 160 Proteins, 134, 136, 141, 154, 155, 156, 158, 159, 161, 162 Protocol, 10, 11, 25, 42, 161 Protons, 149, 153, 161, 162 Proximal, 94, 144, 161 Pruritic, 145, 161 Psoriasis, 5, 161

Psychic, 156, 161, 164 Psychogenic, 37, 161 Psychomotor, 143, 156, 161 Psychopathology, 6, 17, 20, 23, 26, 27, 40, 50, 52, 161 Psychosis, 99, 136, 161 Psychotherapy, 22, 61, 102, 140, 161 Psychotomimetic, 135, 144, 161 Public Policy, 115, 161 Publishing, 8, 31, 161 Pulmonary, 138, 150, 161, 163, 168, 169 Pulmonary Artery, 138, 161, 169 Pulmonary Ventilation, 150, 161, 163 Pulse, 25, 155, 162 Pupil, 144, 155, 162 Q Quality of Life, 26, 43, 162 R Radiation, 133, 135, 137, 146, 162, 169 Radiation therapy, 133, 162 Radioactive, 137, 150, 162 Randomized, 8, 9, 10, 11, 13, 22, 26, 41, 70, 145, 162 Randomized clinical trial, 8, 13, 162 Randomized Controlled Trials, 9, 10, 11, 70, 162 Rape, 159, 162 Reality Testing, 161, 162 Receptor, 15, 24, 51, 56, 82, 92, 93, 97, 99, 133, 136, 138, 139, 140, 145, 157, 162, 164 Receptors, Serotonin, 162, 164 Rectum, 136, 138, 144, 148, 152, 162 Recur, 162, 163 Recurrence, 153, 162, 163 Refer, 1, 141, 145, 147, 151, 156, 161, 163 Refraction, 163, 165 Regimen, 145, 158, 163 Relapse, 12, 40, 163 Relaxation Techniques, 5, 163 Remission, 6, 17, 21, 62, 153, 162, 163 Research Design, 13, 14, 19, 22, 163 Resorption, 99, 163 Respiration, 31, 138, 139, 155, 163 Respiratory Physiology, 23, 163, 168 Respiratory System, 31, 163 Retrospective, 55, 163 Retrospective study, 55, 163 Rigidity, 158, 159, 163 Risk factor, 12, 13, 19, 23, 67, 163 Role-play, 17, 103, 163 S Salivary, 24, 144, 163

Index 177

Salivary glands, 144, 163 Salivation, 148, 163 Schizophrenia, 13, 24, 25, 94, 154, 163 Screening, 29, 140, 163 Seasonal Affective Disorder, 93, 163 Secretion, 93, 149, 151, 152, 158, 163, 164 Sedative, 151, 164 Seizures, 140, 143, 158, 164 Selegiline, 56, 164 Semen, 145, 164 Sertraline, 47, 65, 92, 93, 164 Sex Characteristics, 133, 164 Shyness, 31, 36, 67, 68, 69, 102, 106, 120, 164 Side effect, 26, 94, 98, 109, 133, 134, 136, 140, 164, 167 Signs and Symptoms, 163, 164 Skeletal, 95, 164, 165 Skeleton, 151, 164 Skull, 142, 164, 167 Small intestine, 145, 149, 151, 164 Smooth muscle, 149, 164, 165, 166 Social Behavior, 6, 30, 164 Social Environment, 162, 164 Social Work, 68, 165 Somatic, 133, 152, 153, 158, 165 Somnolence, 26, 165 Spasm, 136, 165 Spasmodic, 69, 165 Spastic, 151, 165 Spasticity, 137, 165 Spatial disorientation, 145, 165 Specialist, 123, 144, 165 Species, 7, 146, 153, 164, 165, 166, 169 Specificity, 21, 28, 31, 72, 134, 165 Spectrum, 72, 165 Sperm, 139, 165 Spinal cord, 136, 137, 139, 154, 156, 158, 165, 166 Spinal Nerves, 158, 165 Sporadic, 95, 165 Steroid, 142, 160, 165 Stimulant, 88, 135, 144, 149, 165 Stimulus, 16, 145, 151, 158, 166, 167 Stomach, 11, 133, 144, 146, 148, 149, 151, 155, 158, 164, 166 Stool, 151, 152, 166 Stress, 4, 5, 22, 45, 97, 101, 137, 139, 142, 151, 155, 166 Striatum, 16, 166 Stroke, 90, 114, 139, 166 Subarachnoid, 149, 166

Subspecies, 165, 166 Substance P, 98, 154, 164, 166 Substrate, 12, 166, 168 Suppression, 72, 166 Supraspinal, 137, 166 Sympathetic Nervous System, 95, 137, 166 Sympathomimetic, 135, 144, 145, 146, 157, 166, 168 Symptomatic, 9, 10, 11, 15, 31, 166 Synapsis, 166 Synaptic, 7, 94, 98, 156, 166 Synaptic Transmission, 156, 166 Synergistic, 160, 167 Systemic, 110, 138, 143, 146, 162, 167 Systolic, 150, 167 T Tardive, 93, 136, 140, 167 Temperament, 19, 23, 62, 167 Temporal, 6, 135, 149, 167 Temporal Lobe, 6, 135, 167 Thalamic, 7, 167 Therapeutics, 110, 155, 167 Threshold, 150, 167 Thrombosis, 160, 166, 167 Tidal Volume, 24, 150, 167 Tissue, 133, 136, 137, 138, 146, 148, 152, 153, 155, 156, 158, 163, 164, 165, 167 Tolerance, 140, 167 Tomography, 15, 61, 81, 153, 167 Tonic, 140, 167 Tooth Preparation, 133, 167 Torticollis, 69, 167 Toxic, iv, 137, 156, 167 Toxicity, 145, 167 Toxicology, 116, 167 Trace element, 147, 167 Transfection, 138, 167 Transmitter, 133, 136, 145, 153, 157, 168 Treatment Outcome, 15, 30, 168 Tremor, 158, 168 Trichotillomania, 5, 168 Tricyclic, 5, 94, 98, 140, 168 Trigger zone, 136, 168 Tryptophan, 164, 168 Tyramine, 155, 168 Tyrosine, 145, 168 U Unconscious, 135, 150, 168 Urinary, 55, 61, 168 Urine, 168 Uterus, 139, 146, 154, 160, 168

178

Social Phobia

V Vaccine, 161, 168 Vascular, 93, 149, 151, 168 Vasodilation, 58, 168 Vasodilator, 145, 149, 168 Vein, 135, 151, 168 Ventilation, 24, 168 Ventral, 16, 165, 168 Ventricle, 135, 161, 162, 167, 169 Veterinary Medicine, 115, 169

Vivo, 72, 169 W War, 159, 169 Weight Gain, 163, 169 X Xenograft, 135, 169 X-ray, 141, 142, 162, 169 Y Yeasts, 158, 169

Index 179

180

Social Phobia