The Journal of clinical psychiatry
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Clinical Trial Controlled Clinical Trial
Clinical assessment of the safety and efficacy of lorazepam, a new benzodiazepine derivative, in the treatment of anxiety.
In a four-week double-blind study of 68 adult outpatients, lorazepam a new benzodiazepine, administered at an average total daily dosage level of 3.1 mg on a b.i.d. regimen, was clearly superior to placebo in the treatment of neurotic anxiety and its related symptoms. The lorazepam-treated group showed significantly greater improvement than the placebo-treated group (both clinically and statistically), as evidenced by the greater changes on the physician-rated Global Scale as well as by the greater changes in almost all categories on the physician-rated Hamilton Anxiety Scale and the patient-rated Lipman-Rickels 35-Item Self-Rating Scale. There were no clinically significant changes in vital signs or laboratory values and only one side effect, urinary retention (resolved without discontinuing the drug), was reported.
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To function effectively as primary care specialists, psychiatrists must remain ever alert to the possibility of organic disorders in patients who at first show only psychiatric symptoms. A case is presented in which hysterical overlay led to misdiagnosis in a 31 year woman, who dies of a diffuse medullary glioma 3 1/2 years after onset of "conversion" symptoms. The authors point out how the label "hysterical" clouds longitudinal objective diagnostic observations especially when initial clinical and laboratory data fail to support a definitive organic diagnosis.