Background. The present study provides data on the reliability, validity and treatment sensitivity of the Liebowitz Social Anxiety Scale (LSAS), one of the most commonly used clinician-administered scales for the assessment of social phobia.

Method. Three hundred and eighty-two patients from several studies of the treatment of social phobia were evaluated. An independent assessor administered the LSAS to each patient prior to the initiation of treatment. Patients also completed other measures of social anxiety and avoidance, although the specific measures varied across samples.

Results. The LSAS and its subscales were normally distributed and demonstrated excellent internal consistency. The convergent validity of the LSAS was demonstrated via significant correlations with other commonly-used measures of social anxiety and avoidance. These correlations also tended to be larger than correlations with measures of depression, especially after treatment. However, the pattern of correlations of LSAS subscales with one another and with the other measures suggest that the fear subscales and the avoidance subscales may not be sufficiently distinct in clinical samples. The LSAS was also demonstrated to be sensitive to the effects of pharmacological treatments of social phobia over time and in comparison to double-blind pill placebo.

Conclusion. The LSAS appears to be a reliable, valid and treatment sensitive measure of social phobia. Further study of the LSAS, both in samples with severe social phobia and in community samples, is needed.

Background. According to DSM-III-R V-code conditions refer to marital relationships, family circumstances, interpersonal relationships, or stressful life events that are not attributable to a mental disorder but that are the focus of treatment. The purpose of the present study was to assess the prevalence and patient and treatment characteristics of adult psychiatric out-patients diagnosed with V-code conditions.

Methods. The records of all 5660 consecutive admissions to a psychiatric out-patient clinic over a 12-year period were studied retrospectively. On the basis of both primary and secondary DSM-III-R diagnoses on Axis I, two subgroups of patients were compared: (1) patients with V-code conditions; and (2) patients with mental disorders.

Results. Fourteen per cent of the patients had a V-code condition and no mental disorder, while the remaining patients were diagnosed with mental disorder (with or without an additional V-code condition). Comparisons of sociodemographic and clinical severity characteristics of the two groups indicated that patients with V-code conditions tended to have a higher socio-economic status and to present with less severe problems as assessed both by the primary therapist and the Symptom-Checklist-90. With respect to service use and treatment outcome variables, it appeared that V-code patients tended to be more frequently treated by couple/family therapy and to receive a slightly lower number of treatment sessions.

Conclusions. The pattern of results in The Netherlands seems comparable to results of previous North American studies. Implications of these findings for future studies and for use of mental health services are discussed.

Background. Current mental health legislation in the UK makes provision for the use of certain treatments in severely ill patients who are unable, or unwilling, to give informed consent. Under the terms of this legislation, electroconvulsive therapy (ECT) may be used, usually to treat severely depressed patients. A number of organizations have challenged this practice, stating that ECT should only be given with fully informed consent: it has been implied that patients receiving compulsory ECT (given without the patient's consent, under the terms of mental health legislation) find the treatment damaging and unhelpful.

Methods. A series of 150 patients receiving ECT in Aberdeen was studied. A proportion of the series (approximately 7%) received compulsory ECT. The views and treatment outcomes of compulsory patients were compared with those of patients giving informed consent for treatment.

Results. More than 80% of patients in both consenting and compulsory groups considered ECT to have helped them. Clinical outcome did not differ between the groups. Patients' views showed marked concordance with independent medical evaluation of outcome.

Conclusions. Outcome following ECT in non-consenting patients is equivalent to that seen in consenting patients whether rated by the patients themselves or by clinicians. Overall outcome is good, with more than 80% of patients benefiting from treatment. A ban on compulsory ECT would deny the access of seriously ill patients to an effective and acceptable treatment.

Background. Benzodiazepines (BZs) can impair explicit memory after a single dose and also when taken repeatedly for treatment of anxiety disorders. A previous study with agoraphobia/panic patients found that the BZ alprazolam impaired memory during an 8-week treatment and residual impairments were still manifest several weeks after drug withdrawal (Curran et al. 1994). The present study followed up the same group of patients 3·5 years after treatment to determine whether those memory impairments persisted.

Method. Thirty-one patients, 15 who had originally been treated with alprazolam and 16 with placebo, were assessed on a battery of psychometric tests and self-rating scales.

Results. Ex-alprazolam patients performed at the same levels as ex-placebo patients on the memory task and on other objective tests. Performance levels of both groups were similar to pre-treatment baselines, however there were differences in subjective ratings whereby ex-alprazolam patients rated themselves as less attentive and clear headed and more incompetent and clumsy than ex-placebo patients.

Conclusions. Explicit memory impairments found while patients were taking alprazolam and weeks after drug withdrawal did not persist 3·5 years later. We suggest that the memory impairments observed in our previous study weeks after withdrawal of alprazolam were not residual effects of alprazolam but rather were due to the drug's interference with practice effects on the tests and habituation of anxiety over repeated exposure to the test situation.

Background. We previously reported that in panic disorder a history of near-suffocation is associated with predominantly respiratory panic attacks. It might be hypothesized that the near-suffocation experienced in certain kinds of torture is also associated with the development of predominantly respiratory panic attacks.

Methods. A sample of patients who had experienced torture (N=14) was drawn from an Anxiety Disorders Clinic in South Africa. Subjects were questioned about symptoms of panic disorder, post-traumatic stress disorder and depression.

Results. Patients with a history of torture by suffocation were more likely than other patients to complain of predominantly respiratory symptoms during panic attacks. These patients also demonstrated higher levels of depressive symptoms.

Conclusions. While various interpretations of the data can be made, it is possible that torture by suffocation is associated with a specific symptomatic profile. Were such an association to be replicated, this would perhaps support the suffocation alarm hypothesis of panic disorder and provide evidence that specific environmental factors play a role in the development of this alarm.

The 10th Bethel-Cleveland Clinic Epilepsy International Symposium, on Comprehensive Care for People with Epilepsy will be held in Bielefeld, Germany, 14–18 April 1999.

For information and further details, please contact Mrs Ines Petzold, Epilepsie-Zentrum Bethel, Klinik Kidron, Maraweg 25, D-33617 Bielefeld, Germany. Telephone: +49 521 144 3152 – Fax: +49 521 144 3458.