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Objective: Social anxiety is a common problem in psychotic disorders. The Liebowitz Social Anxiety Scale, Self-Rating version (LSAS-SR) is a widely used instrument to capture different aspects of social anxiety, but its psychometric properties have not been tested in this patient group. The aims of the present study were to evaluate the psychometric properties of the LSAS-SR in patients with first episode psychosis, to investigate whether it differentiated between active and passive social withdrawal and to test which clinical factors contributed to current level of social anxiety., Method: A total of 144 first episode psychosis patients from the ongoing Thematically Organized Psychosis (TOP) study were included at the time of first treatment. Diagnoses were set according to the Structured Clinical Interview (SCID-1) for DSM-IV. A factor analysis was carried out and the relationship of social anxiety to psychotic and general symptomatology measured by the Positive and Negative Syndrome Scale (PANSS) was evaluated. Possible contributors to social anxiety were analyzed using multiple hierarchic regression analysis., Results: The factor analysis identified three subscales: public performance, social interaction and observation. All three subscales showed satisfactory psychometric properties, acceptable convergent and discriminate properties, and confirmed previous findings in social anxiety samples. Self-esteem explained a significant amount of the variance in social anxiety, even after adjusting for the effects of delusions, suspiciousness and depression., Conclusion: The study shows that the LSAS-SR can be used in this patient group, that social anxiety is strongly related to both behavioral social avoidance and to self-esteem. The results support the use of this measure in assessment of social anxiety in both clinical settings and in research., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Background: General practitioners' (GPs) diagnostic skills lead to underidentification of generalized anxiety disorders (GAD) and major depressive episodes (MDE). Supplement of brief questionnaires could improve the diagnostic accuracy of GPs for these common mental disorders. The aims of this study were to examine the usefulness of The Hospital Anxiety and Depression Rating Scale (HADS) for GPs by: 1) Examining its psychometrics in the GPs' setting; 2) Testing its case-finding properties compared to patient-rated GAD and MDE (DSM-IV); and 3) Comparing its case finding abilities to that of the GPs using Clinical Global Impression-Severity (CGI-S) rating., Methods: In a cross-sectional survey study 1,781 patients in three consecutive days in September 2001 attended 141 GPs geographically spread in Norway. Sensitivity, specificity, optimal cut off score, and Area under the curve (AUC) for the HADS and the CGI-S were calculated with Generalized Anxiety Questionnaire (GAS-Q) as reference standard for GAD, and Depression Screening Questionnaire (DSQ) for MDE., Results: The HADS-A had optimal cut off > or =8 (sensitivity 0.89, specificity 0.75), AUC 0.88 and 76% of patients were correctly classified in relation to GAD. The HADS-D had by optimal cut off > or =8 (sensitivity 0.80 and specificity 0.88) AUC 0.93 and 87% of the patients were correctly classified in relation to MDE. Proportions of the total correctly classified at the CGI-S optimal cut-off > or =3 were 83% of patients for GAD and 81% for MDE., Conclusion: The results indicate that addition of the patients' HADS scores to GPs' information could improve their diagnostic accuracy of GAD and MDE.

Post-traumatic stress disorder (PTSD) has been included in the DSM category of psychiatric diagnoses since 1980, classified as an anxiety disorder. Since that time, its definition has undergone considerable change and today many physicians are not aware of its current diagnostic criteria or the clinical significance of its high degree of comorbidity with other psychiatric and somatic conditions. PTSD can appear in different forms, and its many manifestations often identified and dealt with, while the underlying pathological trauma and psychological damage continues unrecognized and untreated, resulting in negative consequences for the patient and society. The extent of the problem is considerable in North America but prevalence studies in Europe are practically non-existent amongst the general population, with the subsequent result being that the degree and severity of the problem in Europe remains unknown. This article briefly looks at the history and metamorphosis of PTSD and discusses its present niche in relation to primary healthcare.

The interrater reliability of the Structured Clinical Interview for DSM-III-R (SCID) was studied. Fifty-four audiotaped SCID interviews were rated independently by 3 raters. The highest interrater agreements were observed for schizophrenia (0.94), major depressive disorder (0.93), dysthymia (0.88), generalized anxiety disorder (0.95), panic disorder (0.88), alcohol use disorder (0.96) and other psychoactive substance use disorder (0.85). The remaining diagnoses of mood and anxiety disorders obtained acceptable interrater agreement (0.70-0.80), with an exception for obsessive-compulsive disorder (0.40). The poorest agreement was obtained for somatoform disorders ( -0.03). Lack of hierarchy in DSM-III-R allows for multiple Axis I diagnoses. Interrater reliability for multiple diagnoses was tested. Agreement was generally good for combinations of 2 diagnoses, and poorer when 3 diagnoses were combined. Our findings confirm that SCID yields highly reliable diagnoses. SCID is recommended for research on mental disorders.

The monozygotic (MZ)/dizygotic (DZ) concordance rates for schizophrenia and the relationship between schizophrenia and schizophrenic spectrum disorders were studied in a sample of 31 MZ and 28 DZ schizophrenic probands and their co-twins. All subjects were personally interviewed with structured diagnostic instruments and classified according to DSM-III-R criteria. The concordance rates of 48% for MZ twins and 4% for DZ twins indicate a genetic transmission of DSM-III-R schizophrenia. In addition to the schizophrenic co-twins, 3 MZ co-twins had a noneffective psychotic disorder, thus supporting the hypothesis that genes are involved in the development of Axis I schizophrenic spectrum disorders. Schizotypal and paranoid personality disorders were observed in both MZ and DZ co-twins. These disorders may be familially related to schizophrenia, but a genetic relationship was not confirmed for the Axis II spectrum disorders. A substantial number of MZ co-twins of schizophrenic probands had no mental disorder.

The relationship between ICD-9 anxiety states, phobic states, obsessive-compulsive disorder and DSM-III anxiety disorders is discussed. Data are presented which show that one third of ICD-9 anxiety states are diagnosed as affective disorders by DSM-III. Research concerning cases with a concurrent affective and anxiety disorder is discussed. It is finally concluded that while DSM-III has unsolved hierarchial problems, the identification of the two disorders, panic disorder and generalized anxiety disorder, seems advantageous and the inclusion of obsessive compulsive disorder, among the anxiety disorders, reasonable.