SERTRALINE IS METABOLIZED BY MULTIPLE CYTOCHROME P450 ENZYMES, MONOAMINE OXIDASES, AND GLUCURONYL TRANSFERASES IN HUMAN: AN IN VITRO STUDY

1. R. Scott Obach, 2. Loretta M. Cox and 3. Larry M. Tremaine + Author Affiliations 1. Pharmacokinetics, Pharmacodynamics, and Drug Metabolism, Pfizer, Inc., Groton, Connecticut 1. Address correspondence to: R. Scott Obach, MS 4088, Groton Laboratories, Pfizer, Inc., Groton, CT 06340. E-mail: obachrs@groton.pfizer.com

Abstract
The oxidative and conjugative metabolism of sertraline was examined in vitro to identify the enzymes involved in the generation of N-desmethyl, deaminated, and N-carbamoylglucuronidated metabolites in humans. In human liver microsomes, sertraline was Ndemethylated and deaminated by cytochrome P450 (P450) enzymes with overall Km values of 98 and 114 M, respectively, but the intrinsic clearance for N-demethylation was approximately 20fold greater than for deamination. Using P450 isoform-selective inhibitors and recombinant heterologously expressed enzymes, it was demonstrated that several P450 enzymes catalyzed sertraline N-demethylation, with CYP2B6 contributing the greatest extent, and lesser contributions from CYP2C19, CYP2C9, CYP3A4, and CYP2D6. For deamination, data supported a role for CYP3A4 and CYP2C19. Purified human monoamine oxidases A and B also catalyzed sertraline deamination with comparable Km values (230-270 M). Monoamine oxidase B catalyzed the reaction approximately 3-fold faster than did monoamine oxidase A. Sertraline N-carbamoyl glucuronidation was measured in human liver microsomes in bicarbonate buffer and under a CO2 atmosphere (Km = 50 M) and was catalyzed at the fastest rate by recombinant

human UGT2B7. The observation that multiple enzymes appear to be involved in sertraline metabolism suggests that there should be no single agent that could substantially alter the pharmacokinetics of sertraline, nor should there be any single drug-metabolizing enzyme genetic polymorphism (e.g., CYP2D6, CYP2C19, CYP2C9, UGT1A1) that could profoundly impact the pharmacokinetics of sertraline.

Footnotes

Article, publication date, and citation information can be found at http://dmd.aspetjournals.org. doi:10.1124/dmd.104.002428. ABBREVIATIONS: P450, cytochrome P450; MAO, monoamine oxidase; PPP, 2phenyl-2-(1-piperdinyl)propane; RAF, relative activity factor; UDPGA, uridine diphosphoglucuronic acid; UGT, uridine diphosphoglucuronic acid transferase; HPLC, high-performance liquid chromatography; rP450, recombinant cytochrome P450; HLM, human liver microsome(s); CP-105,162, 4-(4-chlorophenyl)-1,2,3,4-tetrahydro-1naphthalenamine.
o o

Received September 20, 2004. Accepted November 12, 2004.

The American Society for Pharmacology and Experimental Therapeutics

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Top 25 Psychiatric Medication Prescriptions for 2011

By John M. Grohol, Psy.D.

These are the top 25 psychiatric medications by number of U.S. prescriptions dispensed in 2011, according to IMS Health. Ive also provided their 2009 and 2005 ranking (you can view the 2009 list here). To put the percent changes below into perspective, the U.S. total population rose approximately 1.6 percent from 2009 to 2011. That suggests that anything above 1.6 percent change was driven by other factors more people seeking treatment, more pharmaceutical advertising and marketing, or some other factor. The biggest movers and shakers on the list were Celexa moving up 15 spots to grab the second most-prescribed psychiatric drug in 2011 and Wellbutrin XL, moving from 22 to 13. Drugs used to treat attention deficit hyperactivity disorder (ADHD) generic amphetamine salts and methylphenidate enjoyed big gains as well.

2011 2009 2005 Brand name Rank Rank Rank (generic name) 1. 2. 3. 4. 5. 6. 7. 1. 17. 4. 3. 5. 2. 6. 1. 11. 2. 5. 4. 3. NA Xanax (alprazolam) Celexa (citalopram) Zoloft (sertraline) Ativan (lorazepam) Prozac (fluoxetine HCL) Lexapro (escitalopram) Desyrel (trazodone HCL) Cymbalta (duloxetine) Valium (diazepam) Seroquel (quetiapine) Paxil (paroxetine HCL) Effexor XR (venlafaxine HCL ER) Wellbutrin XL (bupropion HCL XL) Risperdal (risperidone) Amphetamine salts (Generic) Abilify

Used for Anxiety Depression, Anxiety Depression, Anxiety, OCD, PTSD, PMDD Anxiety, panic disorder Depression, Anxiety Depression, Anxiety Depression, Anxiety Depression, Anxiety, fibromyalgia, diabetic neuropathy Anxiety, Panic disorder Bipolar disorder, Depression Depression, Anxiety, Panic disorder Depression, Anxiety, Panic disorder

U.S. Prescriptions (% change from 2009) 47,792,000 (9%) 37,728,000 (36%) 37,208,000 (8%) 27,172,000 (4%) 24,507,000 (6%) 23,707,000 (- 16%) 22,591,000 (15%) 17,770,000 (6%) 14,694,000 (6%) 14,213,000 (- 11%) 13,990,000 (- 6%) 12,469,000 (NA for HCL ER) 12,151,000 (77%) 12,092,000 (14%) 9,682,000 (36%) 8,881,000

8.

7.

16.

9. 10. 11.

10. 8. 11.

9. 13. 10.

12.

9.

6.

13.

22.

10.

Depression Bipolar disorder, Schizophrenia, irritability in autism Attention deficit disorder Bipolar disorder,

14.

12.

14.

15. 16.

11. 15.

NA NA

(aripiprazole) 17. 19. NA Vyvanse (lisdexamfetamine) Wellbutrin SR (bupropion HCL SR) Vistaril* (hydroxyzine) Amphetamine salts ER (Generic) Buspar (buspirone) Zyprexa (olanzapine) Concerta (methylphenidate) Methylphenidate (generic) Pristiq (desvenlafaxine)

Schizophrenia, Depression Attention deficit disorder

(8%) 8,467,000 (50%) 8,456,000 (75%) 7,268,000 (9%) 6,499,000 (67%) 6,334,000 (15%) 4,576,000 (- 15%) 4,328,000 (- 45%) 4,248,000 (NA) 4,039,000 (61%)

18.

NA

NA

Depression

19.

13.

NA

Anxiety, tension

20.

NA

NA

Attention deficit disorder

21. 22. 23. 24. 25.

18. 20. 16. NA 25.

19. 17. NA NA NA

Sleep, Anxiety Bipolar disorder, Schizophrenia Attention deficit disorder Attention deficit disorder Depression

Notes: If no percentage change is listed, we did not track it in 2005. NA Rank not available for this year. * This is not a psychiatric medication, but is often prescribed for a mental health issue.

How This Data is Derived

Information in the National Prescription Audit (NPA) is derived from IMS Healths Xponent service, one of the most complete, national-level prescription databases in the U.S. Xponent captures roughly 70% Market Share of all prescriptions in the U.S. IMS then uses a patented projection methodology from a stratified and geographically balanced sample to represent 100% Market Share coverage of U.S. prescription activity at retail, mail service, long-term care, and managed care outlets.

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Abstract

Send to: Cochrane Database Syst Rev. 2006 Oct 18;(4):CD004856.

Behavioural and cognitive behavioural therapy for obsessive compulsive disorder in children and adolescents.
O'Kearney RT, Anstey KJ, von Sanden C.

Source
The Australian National University, Psychology, School of Psychology, The Australian National University, Canberra, ACT, Australia. richard.okearney@anu.edu.au

Abstract
BACKGROUND: While behavioural or cognitive-behavioural therapy (BT/CBT) is recommended as the psychotherapeutic treatment of choice for children and adolescents with obsessive-compulsive disorder (OCD), the application of BT/CBT to paediatric OCD may not be straightforward. OBJECTIVES: This review examines the overall efficacy of BT/CBT for paediatric OCD, its relative efficacy against psychopharmacology and whether there are benefits in using BT/CBT combined with medication. SEARCH STRATEGY: We searched CCDANCTR-Studies and CCDANCTR-References (searched on 5/8/2005), MEDLINE, EMBASE, PsycINFO, the reference lists of all selected studies and handsearched journals specifically related to behavioural treatment of OCD. SELECTION CRITERIA: Included studies were randomised controlled trials or quasi-randomised trials with participants who were 18 years of age or younger and had a diagnosis of OCD, established by clinical assessment or standardised diagnostic interview. Reviewed studies included the standard

behavioural or cognitive-behavioural techniques, either alone or in combination, compared with wait-list or pill placebo. DATA COLLECTION AND ANALYSIS: The quality of selected studies was assessed by two independent reviewers. The primary outcomes comprised of endpoint scores on the gold standard clinical outcome measure of OCD symptoms, distress and interference (CY-BOCS) and endpoint OCD status. MAIN RESULTS: Four studies with 222 participants were considered eligible for inclusion and for data extraction. Two studies showed significantly better post-treatment functioning and reduced risk of continuing with OCD at post-treatment for the BT/CBT group compared to placebo or wait-list comparisons. We suggested that the POTS 2004 result, equal to a difference of about eight points on the CY-BOCS, represented the best available estimate for the efficacy of BT/CBT relative to no treatment. (WMD -7.50; 95% CI -11.55, -3.45). Pooled evidence from two trials indicated that the efficacy of BT/CBT and medication did not differ significantly (WMD -3.87; 95% CI 8.15, 0.41). There was evidence of the benefit of combined BT/CBT and medication compared to medication alone (WMD -4.55; 95% CI -7.40, -1.70), but not relative to BT/CBT alone (WMD 2.80; 95% CI -7.55, 1.95). The rates of drop out suggested BT/CBT is an acceptable treatment to child and adolescent patients and their families. AUTHORS' CONCLUSIONS: Although only based on a small number of studies, behavioural or cognitive-behaviour therapy appears to be a promising treatment for OCD in children and adolescents. It can lead to better outcomes when combined with medication compared to medication alone. Additional trials are needed to confirm these findings. In the interim, consideration should be given to the ways in which BT/CBT might be made more widely available as a treatment for OCD in children and adolescents. PMID: 17054218 [PubMed - indexed for MEDLINE]

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Multicenter, Double-blind Comparison of Sertraline and Placebo in the Treatment of Posttraumatic Stress Disorder FREE
Jonathan R. T. Davidson, MD; Barbara O. Rothbaum, PhD; Bessel A. van der Kolk, MD; Carolyn R. Sikes, PhD; Gail M. Farfel, PhD [+] Author Affiliations Arch Gen Psychiatry. 2001;58(5):485-492. doi:10.1001/archpsyc.58.5.485. Text Size: A A A Article Figures

Tables References Comments

ABSTRACT
ABSTRACT | SUBJECTS AND METHODS | RESULTS | COMMENT | AUTHOR INFORMATION | REFERENCES

Background Posttraumatic stress disorder (PTSD) is a common illness associated with significant disability. Few large, placebo-controlled trials have been reported. Methods Outpatients with a DSM-III-R diagnosis of moderate-to-severe PTSD were randomized to 12 weeks of double-blind treatment with either sertraline (N = 100) in flexible daily doses in the range of 50 to 200 mg or placebo (N = 108). Primary outcome measures consisted of the Clinician-Administered PTSD Scale (CAPS-2) total severity score, the patientrated Impact of Event Scale (IES), and the Clinical Global Impression-Severity (CGI-S) and Improvement (CGI-I) ratings. Results Mixed-effects analyses found significantly steeper improvement slopes for sertraline compared with placebo on the CAPS-2 (t = 2.96, P = .003), the IES (t = 2.26, P = .02), the CGI-I score (t = 3.62, P<.001), and the CGI-S score (t = 4.40, P<.001). An intent-to-treat end-point analysis found a 60% responder rate for sertraline and a 38% responder rate for placebo (21 = 8.48, P = .004). Sertraline treatment was well tolerated, with a 9% discontinuation rate because of adverse events, compared with 5% for placebo. Adverse events that were significantly more common in subjects given sertraline compared with placebo consisted of insomnia (35% vs 22%), diarrhea (28% vs 11%), nausea (23% vs 11%), fatigue (13% vs 5%), and decreased appetite (12% vs 1%). Conclusion The results of the current study suggest that sertraline is a safe, well-tolerated, and significantly effective treatment for PTSD.

Figures in this Article

SINCE ITS original diagnostic formulation in 1980, considerable research has been conducted on posttraumatic stress disorder (PTSD). This research has established that PTSD is common, with a lifetime prevalence in the range of 7% to 12% and a 2:1 female-to-male ratio1- 3; chronic, with a median time-to-recovery in the range of 3 to 5 years1,4; and has high comorbidity, with a 6-fold increased risk, compared with community norms, of major depression, a 3-fold increased risk of alcoholism or substance abuse, an approximately 4-fold increased risk of panic disorder or agoraphobia, and an estimated suicide attempt rate of approximately 20%.1,5- 6 Posttraumatic stress disorder is also associated with significant functional and psychosocial disability7- 8 and notable increases in physical symptoms and health care utilization.5,9- 11 Currently, it is estimated that the most widely used treatments for PTSD in the community consist of counseling,12 symptomatic treatment of associated insomnia and anxiety with benzodiazepines or low-dose antidepressants, or self-medication with alcohol.13 An increasing number of studies have been conducted in an attempt to establish effective treatments for PTSD. Initial studies have reported promising results for cognitive and behavioral treatments,13- 16 but confirmation of the efficacy of cognitive or behavior therapies for PTSD awaits the results of additional well-designed clinical trials, with blinded and parallel control groups, and with larger sample sizes. Controlled trials testing the efficacy of drug therapy for PTSD are sparse. A comprehensive review published in 199217 found few placebo-controlled clinical trials, and limited efficacy for the few that were reported, although phenelzine, and, to a lesser extent, imipramine and amitriptyline, were more effective than placebo in combat veterans with PTSD.18- 19 Since that time, 2 equivocal or negative double-blind, placebo-controlled clinical trials have been published of brofaromine (since discontinued).20- 21 Results of 2 placebo-controlled studies have also been published, each with approximately 50 outpatients, suggesting efficacy for fluoxetine in PTSD in civilians, but not in combat veterans.22- 23 A potential therapy for PTSD must effectively treat the core symptoms of the disorder,24 consisting of reexperiencing (intrusive thoughts, nightmares, flashbacks, images, or memories); phobic avoidance of trauma-related situation; emotional numbing (flattened affect or detachment and/or loss of interest and motivation); and hyperarousal (startle reactions, poor concentration, irritability and jumpiness, insomnia, and hypervigilance). Optimally, a candidate therapy should

also be effective in restoring normal functioning and improving symptoms associated with common psychiatric comorbidity. Sertraline would seem to be such a drug, with demonstrated efficacy in the treatment of depression25- 28 and panic disorder,29- 31 and preliminary evidence of efficacy in alcoholism,32- 33 as well as uncontrolled pilot studies suggesting efficacy in PTSD.3435 We report here results of a large, multisite, placebo-controlled, double-blind trial designed to test the efficacy and tolerability of sertraline in the treatment of PTSD.

I started this list in the late 1980's and put it on the web in 1995. It's since been adopted and adapted onto many pages since then. Please don't ask me about curing phobias because I know little about them. My interest is in the names only. All the phobia names on this list have been found in some reference book.

If you're looking for a phobia name that's not on the list....I'm afraid I don't have it.

NAVIGATION The PHOBIA LIST FAQ's PageThe Indexed Phobia ListSITES TO LOOK FOR HELP WITH A PHOBIAHow Phobias are NamedPhobia Notes, Credits, & WhateverPhobia CategoriesPhobia TreatmentFear or Fearless QuotesPrivacy & Legal Stuff-

NEWS I have no news today. Fredd -Fredd --------------------------------------------------------------

If you appreciate the Phobia List, please help support it.

THE PHOBIA LIST

ABCDEFGHIJKLMNOPQR STUVWXYZ

or Click here for the Indexed

Phobia List online.

AAblutophobia- Fear of washing or bathing. Acarophobia- Fear of itching or of the insects that cause itching. Acerophobia- Fear of sourness. Achluophobia- Fear of darkness. Acousticophobia- Fear of noise. Acrophobia- Fear of heights. Aerophobia- Fear of drafts, air swallowing, or airbourne noxious substances. Aeroacrophobia- Fear of open high places. Aeronausiphobia- Fear of vomiting secondary to airsickness. Agateophobia- Fear of insanity. Agliophobia- Fear of pain. Agoraphobia- Fear of open spaces or of being in crowded, public places like markets. Fear of leaving a safe place. Agraphobia- Fear of sexual abuse. Agrizoophobia- Fear of wild animals. Agyrophobia- Fear of streets or crossing the street. Aichmophobia- Fear of needles or pointed objects. Ailurophobia- Fear of cats. Albuminurophobia- Fear of kidney disease. Alektorophobia- Fear of chickens. Algophobia- Fear of pain. Alliumphobia- Fear of garlic. Allodoxaphobia- Fear of opinions. Altophobia- Fear of heights. Amathophobia- Fear of dust. Amaxophobia- Fear of riding in a car. Ambulophobia- Fear of walking. Amnesiphobia- Fear of amnesia. Amychophobia- Fear of scratches or being scratched. Anablephobia- Fear of looking up. Ancraophobia- Fear of wind. (Anemophobia) Androphobia- Fear of men. Anemophobia- Fear of air drafts or wind.(Ancraophobia) Anginophobia- Fear of angina, choking or narrowness. Anglophobia- Fear of England or English culture, etc.

Angrophobia - Fear of anger or of becoming angry. Ankylophobia- Fear of immobility of a joint. Anthrophobia or Anthophobia- Fear of flowers. Anthropophobia- Fear of people or society. Antlophobia- Fear of floods. Anuptaphobia- Fear of staying single. Apeirophobia- Fear of infinity. Aphenphosmphobia- Fear of being touched. (Haphephobia) Apiphobia- Fear of bees. Apotemnophobia- Fear of persons with amputations. Arachibutyrophobia- Fear of peanut butter sticking to the roof of the mouth. Arachnephobia or Arachnophobia- Fear of spiders. Arithmophobia- Fear of numbers. Arrhenphobia- Fear of men. Arsonphobia- Fear of fire. Asthenophobia- Fear of fainting or weakness. Astraphobia or Astrapophobia- Fear of thunder and lightning.(Ceraunophobia, Keraunophobia) Astrophobia- Fear of stars or celestial space. Asymmetriphobia- Fear of asymmetrical things. Ataxiophobia- Fear of ataxia. (muscular incoordination) Ataxophobia- Fear of disorder or untidiness. Atelophobia- Fear of imperfection. Atephobia- Fear of ruin or ruins. Athazagoraphobia- Fear of being forgotton or ignored or forgetting. Atomosophobia- Fear of atomic explosions. Atychiphobia- Fear of failure. Aulophobia- Fear of flutes. Aurophobia- Fear of gold. Auroraphobia- Fear of Northern lights. Autodysomophobia- Fear of one that has a vile odor. Automatonophobia- Fear of ventriloquist's dummies, animatronic creatures, wax statues anything that falsly represents a sentient being. Automysophobia- Fear of being dirty. Autophobia- Fear of being alone or of oneself. Aviophobia or Aviatophobia- Fear of flying.

Home About Anxiety Disorders Childhood Disorders Mood Disorders Personality Disorders Genetic Disorders Contact

An Overview Of Thalassemia
Thalassemia, a genetic disorder, is growing every year all over the world, and nearly six crore of Indians are affected by this deadly disorder. Around 10,000 children are born with Thalassemia major every year. It is imperative to [...]

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Know the Details of Generalized Anxiety Disorder

Anxiety takes various forms from person to person. Generalized anxiety disorder (GAD) is one of the forms which are characterized by constant worry and tension. An individual having this type of disorder almost constantly keeps on worrying and feels stressed without [...]

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Insomnia Spreads Its Deadly Fangs In The Present Time

Sleep disorder has become very common these days as the current lifestyle has increased our anxiety and stress levels, and we at all times have to meet deadlines, to meet expectations of our family and boss. We live in a world which [...]

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An Insight Into Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder (ADHD), a disorder found in young children is rising every day all over the world and is a matter of grave concern for the children and parents. ADHD, a disorder impacts the child even when he [...]

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Know all about Human Genetic Disorder, Central Disorder, Body Disorder.
An individual is a byproduct of both what he acquires, that is at the time of birth, along with what he fosters gradually which is based on the early stages of his socializing in institutions like family, friends, society and other external forces. The combination of both moulds the end personality of a person which is ever evolving and dynamic. Disorders can be characterized by an abnormality in the gene which goes to show that the illness is acquired at the time of birth, also known as Human Genetic Disorder. There are several other disorders like Central Disorder, Body Disorder that hampers optimum ability of functioning of a person. There are also many different types of psychological disorders ranging from mild to serious damaging ones. In today's competitive scenario, normal appearing individuals are also posed with a lot of stress often unnoticed in order to keep up with the societal or peer pressure.

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The Liebowitz Social Anxiety Scale for Children and Adolescents Jos Olivares, Raquel Snchez-Garca and Jos Antonio Lpez-Pina Universidad de Murcia

The purpose of this study was to analyze the component structure and reliability of the Liebowitz Social Anxiety Scale for Children and Adolescents, self-report version (LSAS-CA-SR), in a Spanish community population. The sample was made up of 422 students from elementary and high schools, aged between 10 and 17 years. Exploratory factor analysis isolated one component for the Anxiety

subscale and one component for the Avoidance subscale. Medium-strong associations were found between the total score and subscale scores. LSAS-CA-SR scores had stronger associations with instruments of social anxiety. Internal consistency for the Fear subscale was .91, and for the Avoidance subscale, it was .89. Gender and age effects were assessed for LSAS-CA-SR scores. Effect sizes for age and gender and interaction of age and gender were very low on both the Fear and the Avoidance subscales. There were significant differences between female and male means on the Fear subscale. The findings suggest that the LSAS-CA-SR is reliable and valid.

La Escala de Ansiedad Social de Liebowitz para Nios y Adolescentes. El objetivo de este estudio fue analizar la estructura factorial y la fiabilidad de la Escala de Ansiedad Social para Nios y Adolescentes de Liebowitz en su versin autoinforme (LSAS-CA-SR), en una muestra comunitaria espaola de 422 estudiantes entre 10 y 17 aos. El anlisis factorial exploratorio aisl un componente para la subescala de ansiedad y un componente para la subescala de evitacin. Las correlaciones entre la puntuacin total y las puntuaciones de las subescalas fueron de medias a elevadas. Las puntuaciones de la LSAS-CA-SR obtuvieron correlaciones elevadas con otras medidas de ansiedad social. La consistencia interna en la subescala de miedo fue de 0,91, y en la subescala de evitacin de 0,89; los tamaos

del efecto para la edad y el gnero y su interaccin fueron bajos en ambas. Sin embargo, se encontraron diferencias significativas entre varones y mujeres en la subescala de miedo. Los hallazgos sugieren que la adaptacin de la LSAS-CA-SR es fiable y vlida.

Social phobia is defined as a marked and persistent fear of one or more social situations in which the person is exposed to possible scrutiny by others and fears that he or she may do something or act in a way that will be humiliating or embarrassing (APA, 2000). Studies on the course and treatment of social phobia in Spanish children and adolescents are few (Rosa, Olivares, & Iniesta, 2009). One reason may be that there are few assessment and diagnostic instruments for the young Spanish-speaking population. However, there are a number of instruments to assess social phobia in other cultures. One of these that has been tested empirically is the Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA-SR; Masia-Warner et al., 2003). The LSAS-CA-SR has an interview format and it includes situations which are modifications of the adult version (LSAS; Liebowitz, 1987). It contains 24 items: 12 items are social interaction situations, and the other 12 are performance situations. Each item assesses the fear level and the avoidance level on a Likert type scale: Clinician

ratings of anxiety (0= none, 1= mild, 2= moderate, 3= severe) and avoidance (0= never, 1= occasionally, 2= often, 3= usually). It provides seven scores: (1) anxiety related to social interaction, (2) performance anxiety, (3) total anxiety, (4) avoidance of social interaction, (5) avoidance of performance situations, (6) total avoidance, and (7) a total score. Masia-Warner et al. (2003) and Storch et al. (2006) evaluated the psychometric properties of the LSAS-CA-SR in a clinicianadministered format. They found that is a reliable and valid instrument for assessing social phobia in youngsters. The scores showed excellent internal consistency for the total score as well as for the specific subscale scores. No results on factor analysis were found by the authors. However an appropriate structure for instruments of fear and avoidance has been found, with excellent psychometric properties in self-report format for Spanish children and adolescents (Olivares, Snchez-Garca, Rosa, & Piqueras, 2004). This report presents the factorial structure, reliability and validity in the same population using a self-report version of LSAS-CA-SR.

Method

Fecha recepcin: 4-12-07 Fecha aceptacin: 31-1-09 Correspondencia: Jos Olivares

Facultad de Psicologa Universidad de Murcia 30100 Murcia (Spain) E-mail: jorelx@um.es

Participants

In this study we used a community sample. The sample size was 454 participants, 32 (7.05%) were excluded from this research

THE LIEBOWITZ SOCIAL ANXIETY SCALE FOR CHILDREN AND ADOLESCENTS

due to mistakes in their answers or because they did not have parental authorization to participate in the study. Finally, the Spanish sample comprised 422 participants (52% male and 48% female) from elementary and high schools in the region of Murcia, Spain. The participants were registered students at 11 public and state-assisted educational centres, selected at random from urban areas. The mean age was 13.5 years old (SD= 2.25), and the range was between 10 and 17 years old.

Instruments

To obtain information about the concurrent validity of LSASCA-SR we used other tests of social phobia: The Social Phobia and Anxiety Inventory for Children (SPAI-C; Beidel, Turner, & Morris, 1995), the Social Anxiety Scale for Adolescents (SAS-A; La Greca & Lopez, 1998), the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) (Mattick & Clarke, 1998), and Self-Statements related to Public Speaking (SSPS; Hofmann & DiBartolo, 2000). SPAI-C (Beidel et al., 1995) contains 26 items that assess anxiety experienced in social situations. SPAI-C is internally consistent (= .95) and its test-retest reliability is good (Beidel et al., 1995). SPAI-C showed good psychometric properties in both Spanish-speaking children and adolescent populations (= .94; Olivares et al., 2004). The SAS-A (La Greca & Lpez, 1998) consists of 22 items grouped into three subscales: fear of negative evaluations from peers (FNE), avoidance of new social situations (SASD-N), and generalized social inhibition (SAD-G). SAS-A showed good psychometric properties in Spanish-speaking children and adolescent populations (Olivares et al., 2005). The SPS and the SIAS were developed by Mattick and Clarke (1998). SIAS assesses anxiety behaviour in social relations and SPS assesses performance anxiety. Both tests showed good

psychometric properties in both Spanish-speaking children and adolescent populations (= .93 SPS- y .90 SIAS-; Olivares, Hidalgo, Rivero, Piqueras, & Amors, 2004). The SSPS (Hofmann & DiBartolo, 2000) assesses the grade of discomfort experienced by the subject while speaking in public or acting in front of an audience. It contains 10 items divided into two subscales: The SSPS-N contains five items with negative selfstatements, and the SSPS-P contains five items with positive selfstatements. The SSPS-N and the SSPS-P showed good psychometric properties in Spanish-speaking adolescent populations (= .856 SSPS-N ; = .686 SSPS-P and = .534 SSPS; Rivero, 2005).

Procedure

Following Balluerka, Gorostiaga, Alonso-Arbiol and Aramburu (2007), the LSAS-CA-SR was translated into Spanish by a professional translator an the translation was checked by a Spanis bilingual clinical psychologist. The both versions were sent to a bilingual native North American, a clinical psychologist of renowned prestige and specialist in evaluating anxiety disorders in children and adolescents. This expert also checked the meaning of the items in the original version and the translation was the same.

After our expert had verified that this was the case, the instrument was applied in a pilot study (range: 10-17 years old) (Olivares et al., 2004).

Prior to the application of the instruments, we presented the objectives of the research to the directors and psychologists of the participant educational centres, the evaluation instruments were described, and we sought permission to carry out the research. Additionally we encouraged the directors and psychologists collaboration in the investigation. Subsequent meetings were held with parents in order to explain the study, and to ask permission for their children to participate. All instruments were applied in the classroom. LSAS-CA-SR instructions were read aloud according to Fresco et al. (2001).

Data analysis

To evaluate the dimensional structure of the LSAS-CA-SR, a principal component analysis of a polychoric correlation matrix between items of the test was carried out for both scales (fear and avoidance) using MicroFACT (Waller, 2001). To obtain a factor solution with MicroFACT, it is necessary to specify the number of dimensions. MicroFACT shows several goodness-of-fit indices

(GFI and residual statistics) that enable us to make decisions on the relevant number of dimensions. We also used a scree-plot to assist the decision about the number of components. The reliability of each subscale was obtained with Cronbachs alpha coefficient. In addition, the LSAS-CA-SR concurrent validation with the other scales was calculated. We also used ANOVA to calculate the effect size and statistical significance for different variables (gender and age).

Results

Descriptive analysis of the LSAS-CA-SR

The mean fear subscale score was 13.58 (SD= 10.68) ranging between 0 and 61, while the mean on the avoidance subscale was 14.99 (SD= 11.53), ranging between 0 and 72. Both distributions were non normal because the nonparametric test of KolmogorovSmirnov was significant (fear scale, KS= .894, p<.000, and avoidance scale, KS= .894, p<.000). A possible explanation could be that this result may be affected by the high sample size however. The mean total score of this sample was 28.58 (SD= 20.49), with the scores ranging from 0 to 98.

Structural validity

Since MicroFACT requires the specification of the number of dimensions, we tested the goodness-of-fit index and the mean square residual with one, two or more factors to check the correct dimensionality of subscales. Satisfactory values for GFI may be .95 or greater and the mean residual around .02 (McDonald, 1999). Table 1 presents the GFI and the mean residual for fear and avoidance subscales with one and two dimensions. The GFI index was greater than .96, on both subscales (fear and avoidance), and the mean of residuals was less than .02, with only one dimension. Thus we believe that a unidimensional solution for both scales is the appropriate solution. Furthermore, the scree-plot (not included) suggested the same solution. Table 2 presents the components loadings and the eigenvalues of the fear and avoidance subscales of the LSAS-CA-SR. An examination of the components loadings showed the existence of medium item-trait correlations, which ranged