These results replicate and extend previous findings of changes in caudate nucleus function with behavior therapy for obsessive-compulsive disorder. A prefrontal cortico-striato-thalamic brain system is implicated in mediation of symptoms of obsessive-compulsive disorder.

Subjects with MDD had regional brain metabolic abnormalities at baseline that tended to normalize with treatment. Regional metabolic changes appeared similar with the 2 forms of treatment. These results should be interpreted with caution because of study limitations (small sample size, lack of random assignment to treatment groups, and differential treatment response between treatment subgroups).

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It is important to identify patients with anxiety disorders in the primary care setting so that they may be appropriately treated. The authors propose administration of a brief, 40-item screening instrument, the Four Dimensional Anxiety Scale (FDAS), to distinguish anxiety disorders from anxiety associated with medical conditions and from normal anxiety. For anxiety disorders patients, responses to five items on the FDAS Emotional dimension and 10 items on the Cognitive dimension differ significantly from medical patients or normals, and may help identify them. With such early identification and referral, medical costs of inappropriate care can be minimized, and human suffering can be alleviated through referral to a specialty anxiety disorders clinic.

The authors describe the problem of impairment of medical students from the point of view of mental health professionals who have directed a large and successful evaluation and referral service for students suffering from a wide array of stress-related and mental disorders. They outline the nature of the impairment problems, the history of the efforts at their medical school to address these problems, and their recent experience in providing mental health services to students who are referred for evaluation and treatment. Diagnostic data, referral and the implications of mental disorders for medical students are discussed. The authors offer some suggestions for the formation of student well-being committees prior to the implementation of student assistance programmes to address the problems of substance abuse.