Met Recovery Criteria Research Articles

Factors associated with non-response and nutrional status of non-responders at 6-month post-discharge: a cohort study nested in a MUAC-based nutrition programme for acutely malnourished children in Mirriah, Niger.

In the treatment of acute malnutrition (AM), non-response is considered a treatment failure for not meeting recovery criteria within a therapeutic window of 12-16 weeks, but this category of children is misunderstood. As current research emphasizes ways to simplify and optimize treatment protocols, non-response emerges as a new issue to enhance program efficiency. A prospective cohort study was conducted from 2019 to 2020 at two health centres in Mirriah, Niger among children aged 6-59 months with uncomplicated AM treated under the Optimising treatment for Acute MAlnutrition (OptiMA) protocol. Children who did not meet recovery criteria by 12 weeks (mid-upper arm circumference (MUAC) ≥125 mm without oedema for two consecutive weeks) were classified as non-responders. Non-responders received a home visit six-months post-discharge. Logistic regression was used to analyze factors associated with non-responders compared with children who recovered. Of the 1,112 children enrolled, 909 recovered and 139 were non-responders, of which 127 (80.6%) had significant MUAC gain (mean: +9.6 mm, sd = 5.1) at discharge. Girls (adjusted hazard ratio (aHR) = 2.07, 95% CI 1.33-3.25), children <12 months of age (aHr = 4.23, 95% CI 2.02-9.67), those with a MUAC <115 mm (aHR = 11.1, 95% CI 7.23-17.4) or severe stunting (aHR = 2.5, 1.38-4.83) at admission and a negative or flat MUAC trajectory between admission and week 4 (aHR = 4.66, 95% CI 2.54-9.13) were more likely to be non-responders. The nutritional status of non-responders had generally improved 6 months after discharge, but only 40% had achieved MUAC ≥125 mm. Non-responders are not a homogeneous group; while most children ultimately show significant nutritional improvement, rapid hospital referral is crucial for those not gaining MUAC early in treatment. As efforts to expand MUAC-based programming progress, adapting exit criterion and/or providing additional food supplementation with smaller daily ration for children with risk factors discussed here may help improve programme efficiency without adding to the cost of treatment.

Ultrasound-Guided Glenohumeral Corticosteroid Injection for the Treatment of Adhesive Capsulitis of the Shoulder: The Role of Clinical Stage in Response to Treatment.

Treatment for idiopathic adhesive capsulitis of the shoulder remains controversial. Stages 1 to 2 reflect an inflammatory process supporting a rationale for intra-articular glenohumeral joint corticosteroid injection to treat synovial inflammation and prevent progression to capsular fibrosis. We hypothesize that an intra-articular ultrasound-guided glenohumeral injection (USGI) of corticosteroid in patients diagnosed with Stage 1 or 2 idiopathic adhesive capsulitis will result in timely functional recovery and resolution of pain and stiffness. Case series. Level 4. Patients with Stage 1 or 2 idiopathic adhesive capsulitis treated with an intra-articular corticosteroid injection were included. Patients were seen by a single physician and diagnosed using history and physical examination with careful attention to measurement of glenohumeral range of motion (ROM). A total of 61 patients met inclusion criteria. ROM measurements documented in the patient charts were recorded in forward flexion, abduction, internal rotation, and external rotation in neutral abduction. All ROM measurements were performed pre- and postinjection. All patients were treated with an USGI of local anesthetic and depomedrol. Recovery criteria were defined as forward flexion, abduction, and external rotation within 15° of the contralateral side and internal rotation within 3 spinous process levels of the contralateral side. A total of 11 patients with Stage 1 and 50 patients with Stage 2 adhesive capsulitis comprised the final study cohort. Within the Stage 1 cohort, all 11 patients met recovery criteria for forward flexion and internal rotation (100%), 10 met recovery criteria for abduction (91%), and 8 met recovery criteria for external rotation (73%). Within the Stage 2 cohort, 31 patients met recovery criteria for forward flexion (62%), 30 met recovery criteria for abduction (60%), 36 met recovery criteria for internal rotation (72%), and 25 met recovery criteria for external rotation (50%). The difference in time to recovery in days was statistically significant in all ROM planes and was within 2 to 6 weeks for patients in Stage 1 and 7 to 10 weeks for Stage 2. USGI for early adhesive capsulitis allows patients to recover ROM more rapidly if performed early after onset of pain and stiffness. These results stress the importance of recognition of idiopathic adhesive capsulitis in its early stages and subsequent intervention with an intra-articular glenohumeral corticosteroid injection.

Paper 89: Ultrasound-guided Glenohumeral Corticosteroid Injection for the Treatment of Adhesive Capsulitis of the Shoulder: The Role of Clinical Stage in Response to Treatment

Objectives:The treatment for idiopathic adhesive capsulitis of the shoulder remains controversial. The pathophysiology of adhesive capsulitis supports the rationale for intra-articular glenohumeral joint corticosteroid injection to treat the synovial inflammation in stages 1 and 2, that results in capsular fibrosis in the later stages of adhesive capsulitis. We hypothesize that an intra-articular ultrasound-guided glenohumeral injection (USGI) of corticosteroid in patients diagnosed with stage 1 or stage 2 idiopathic adhesive capsulitis will result in timely functional recovery and resolution of pain and stiffness.Methods:This is a retrospective analysis of a cohort of patients with stage 1 or stage 2 idiopathic adhesive capsulitis, diagnosed using history and physical examination. A total of 61 patients met inclusion criteria. Range of motion (ROM) measurements documented in the patient charts were recorded in four planes: forward flexion, abduction, internal rotation, and external rotation in neutral abduction. All ROM measurements were performed pre-injection and at all subsequent post-injection visits by a single treating physician. All patients were treated with an ultrasound-guided intra-articular injection of local anesthetic and depomedrol. Recovery criteria were defined as forward flexion, abduction, and external rotation to within 15 degrees of the contralateral side and internal rotation to within three spinous process levels of the contralateral side.Results:A total of 11 patients with Stage 1 and 50 patients with Stage 2 adhesive capsulitis comprised the study cohort. The mean age was 55 years (SD=8, range: 38 to 72) and 49 (80%) patients were female. Within the stage 1 cohort, all 11 patients met recovery criteria for forward flexion (100%), 10 patients met recovery criteria for abduction (91%), 11 patients met recovery criteria for internal rotation (100%), and 8 patients met recovery criteria for external rotation (73%). Within the stage 2 cohort, 31 patients met recovery criteria for forward flexion (62%), 30 patients met recovery criteria for abduction (60%), 36 patients met recovery criteria for internal rotation (72%), and 24 patients met recovery criteria for external rotation (48%). Time to recovery in days for each ROM compared between the stage 1 and stage 2 cohorts was statistically significant in all ROM planes (forward flexion (p<0.0001), abduction (p<0.0001), internal rotation (p=0.0008), and external rotation (p=0.0096)), indicating a greater proportion of stage 1 patients had a shorter time to recovery after injection. Figures 1-4 depict cumulative survival functions between Stage 1 and Stage 2 patients for each individual ROM measurement.Conclusions:USGI for early adhesive capsulitis allows patients to recover ROM more rapidly. Importantly, Stage 1 patients recovered faster than Stage 2 patients in all ROM planes, with only forward flexion reaching statistical significance. This suggests that prompt recognition of early idiopathic adhesive capsulitis and subsequent USGI with corticosteroid and local anesthetic plays an important role in timely recovery of motion and symptom resolution thus shortening the natural history of this disease and preventing the development of significant fibrosis.Figure 1.Cumulative survival functions between Stage 1 and Stage 2 patients for Forward FlexionFigure 2.Cumulative survival functions between Stage 1 and Stage 2 patients for AbductionFigure 3.Cumulative survival functions between Stage 1 and Stage 2 patients for Internal RotationFigure 4.Cumulative survival functions between Stage 1 and Stage 2 patients for External Rotation

Routine Cognitive Behavioural Therapy for Anxiety and Depression is More Effective at Repairing Symptoms of Psychopathology than Enhancing Wellbeing

The primary focus of classic cognitive behavioural therapy (CBT) for depression and anxiety is on decreasing symptoms of psychopathology. However, there is increasing recognition that it is also important to enhance wellbeing during therapy. This study investigates the extent to which classic CBT for anxiety and depression leads to symptom relief versus wellbeing enhancement, analysing routine outcomes in patients receiving CBT in high intensity Improving Access to Psychological Therapy (IAPT) Services in the UK. At intake, there were marked symptoms of anxiety and depression (a majority of participants scoring in the severe range) and deficits in wellbeing (a majority of participants classified as languishing, relative to general population normative data). CBT was more effective at reducing symptoms of anxiety and depression than repairing wellbeing. As a result, at the end of treatment, a greater proportion of participants met recovery criteria for anxiety and depression than had moved from languishing into average or flourishing levels of wellbeing. Given the importance of wellbeing to client definitions of recovery, the present results suggest a greater emphasis should be placed on enhancing wellbeing in classic CBT.

Brief Metacognitive Therapy for Emotional Distress in Adult Cancer Survivors.

Background: Adult cancer survivors often experience substantial psychological morbidity following the completion of acute cancer treatment. Unfortunately, current psychological interventions are of limited efficacy. This study explored if metacognitive therapy (MCT); a brief transdiagnostic psychological intervention was potentially efficacious and could be delivered effectively to adult cancer survivors with psychological morbidity.Methods: An open trial with 3- and 6-month follow-up evaluated the treatment effects of MCT in 27 consecutively referred individuals to a clinical psychology health service specializing in psycho-oncology. Each participant received a maximum of six 1-hour sessions of MCT. Levels of anxiety, depression, fear of cancer recurrence, post-traumatic stress symptoms, health related quality of life, and metacognitive beliefs and processes were assessed using self-report questionnaires.Results: MCT was associated with statistically significant reductions across all outcome measures which were maintained through to 6-month follow-up. In the ITT sample on the primary treatment outcome measure, the Hospital Anxiety and Depression Scale-Total, 59% of participants met recovery criteria at post-treatment and 52% at 6-month follow-up, respectively. No participants significantly deteriorated. In the completer sample (N = 20), 80% recovered at post-treatment and 70% at 6-month follow-up. MCT was acceptable to patients with approximately 75% of patients completing all treatment sessions.Conclusion: MCT, a brief transdiagnostic psychological intervention can be delivered effectively to a heterogenous group of cancer survivors with promising treatment effects. Examining the efficacy of brief MCT against the current gold standard psychological intervention would be a valuable advance toward improving the quality of life of cancer survivors.

F127. GLOBAL RECOVERY IN A FIRST EPISODE PSYCHOSIS PROGRAM IN SOUTH AMERICA

BackgroundMetanalisis show that global recovery, (a state of clinical and social well functioning) is achieved by 13.5% patients (25%-75% quartiles 8.1–20%) (Jääskeläinen, 2013) diagnosed with schizophrenia. It has also been suggested that recovery is higher in low or lower middle-income countries compared to high and upper middle income countries. However, this is only based in a few studies. We here looked at the number of patients with first episode psychosis that met recovery criteria based on both clinical and social domains in a South American early intervention sample. We also examined whether recovery was associated with factors such as diagnoses, sex, education, substance use and duration of untreated psychosis.MethodsThis is a cross-sectionall study in an outpatient First Episode Psychosis program in Chile. We gathered information on different aspects of the patients, including sociodemographic, clinical, functional and metabolic status. FAST (Functional Assessment Short Test) and SS-DSM5 (Symptom Severity Scale of the DSM5 for Schizophrenia) were applied to patients. Global recovery was defined as the presence for at least 6 months of: 1. Working or studying. 2. SS-DSM5 scale with no dimension with score over two. 3. FAST with score under 21 (which correlates with GAF > 61). The group who met recovery criteria (improvement in both clinical and social domains) was identified, and correlation and regression analysis were performed to explore the association between global recovery and selected variables.ResultsWe included 80 patients in this study. Overall, 20% met global recovery criteria. Patients who did not accomplish recovery did so because of being unemployed (80.6%), not studying (79.7%), or scoring above threshold in SS-DSM5 cognitive (54.7%) and negative (54.7%) symptom domains. Univariate correlation analyses showed a significant association of global recovery with recreational drug use, diagnoses, and duration of untreated psychosis (all corrected for multiple comparisons). After multiple regression analysis including these variables, age and gender, the only one associated with recovery was shorter duration of untreated psychosis (p=0.02) OR 0.616 (IC95% 0.409–0.925).DiscussionThe number of patients achieving global recovery is consistent with the one reported for schizophrenia in previous meta-analysis and with studies on recovery after first episode psychosis (16.6% (25%-75% quartiles 9–20.4)) (Jääskeläinen, 2013). Negative and cognitive symptoms frequently impair patient recovery. On the other hand the duration of untreated psychosis shows itself as one of the most important characteristics related with functional prognoses.

On poverty, politics and psychology: the socioeconomic gradient of mental healthcare utilisation and outcomes.

Since 2008, the Improving Access to Psychological Therapies (IAPT) programme has disseminated evidence-based interventions for depression and anxiety problems. In order to maintain quality standards, government policy in England sets the expectation that 50% of treated patients should meet recovery criteria according to validated patient-reported outcome measures. Using national IAPT data, we found evidence suggesting that the prevalence of mental health problems is greater in poorer areas and that these areas had lower average recovery rates. After adjusting benchmarks for local index of multiple deprivation, we found significant differences between unadjusted (72.5%) and adjusted (43.1%) proportions of underperforming clinical commissioning group areas.

Testing the Effectiveness of Cognitive Analytic Therapy for Hypersexuality Disorder: An Intensive Time-Series Evaluation

The evidence base for treatment of hypersexuality disorder (HD) has few studies with appropriate methodological rigor. This study therefore conducted a single case experiment of cognitive analytic therapy (CAT) for HD using an A/B design with extended follow-up. Cruising, pornography usage, masturbation frequency and associated cognitions and emotions were measured daily in a 231-day time series. Following a three-week assessment baseline (A: 21 days), treatment was delivered via outpatient sessions (B: 147 days), with the follow-up period lasting 63 days. Results show that cruising and pornography usage extinguished. The total sexual outlet score no longer met caseness, and the primary nomothetic hypersexuality outcome measure met recovery criteria. Reduced pornography consumption was mediated by reduced obsessionality and greater interpersonal connectivity. The utility of the CAT model for intimacy problems shows promise. Directions for future HD outcome research are also provided.

A Systematic Review and Meta-Analysis of Recovery in Schizophrenia

Our primary aims were (a) to identify the proportion of individuals with schizophrenia and related psychoses who met recovery criteria based on both clinical and social domains and (b) to examine if recovery was associated with factors such as gender, economic index of sites, and selected design features of the study. We also examined if the proportions who met our definition of recovery had changed over time. A comprehensive search strategy was used to identify potential studies, and data were extracted for those that met inclusion criteria. The proportion who met our recovery criteria (improvements in both clinical and social domains and evidence that improvements in at least 1 of these 2 domains had persisted for at least 2 years) was extracted from each study. Meta-regression techniques were used to explore the association between the recovery proportions and the selected variables. We identified 50 studies with data suitable for inclusion. The median proportion (25%-75% quantiles) who met our recovery criteria was 13.5% (8.1%-20.0%). Studies from sites in countries with poorer economic status had higher recovery proportions. However, there were no statistically significant differences when the estimates were stratified according to sex, midpoint of intake period, strictness of the diagnostic criteria, duration of follow-up, or other design features. Based on the best available data, approximately, 1 in 7 individuals with schizophrenia met our criteria for recovery. Despite major changes in treatment options in recent decades, the proportion of recovered cases has not increased.

Remission and recovery during the first outpatient year of the early course of schizophrenia

BackgroundAlthough in the early course of schizophrenia relapse prevention is of paramount importance, there is an increasing emphasis on establishing and maintaining sustained periods of symptom remission. Recovery in the early course of illness is also possible, although the rates of recovery are lower than for symptom remission. Symptom remission and recovery rates vary considerably across recent-onset schizophrenia studies because of a lack of consistency in treatment interventions and in applying operational outcome criteria. MethodPatients who were within two years of their first psychotic episode (N=77) that were treated with continuous antipsychotic medication in conjunction with psychosocial interventions (without targeted work rehabilitation) were assessed during the first outpatient year after hospital discharge. Published operational criteria were used to classify symptom remission and recovery. ResultsThe rate of full symptom remission maintained for 6months was 36%, while the rate of recovery for 6months was 10%. When the same criteria were applied for a continuous period of one year, 22% of patients were found to achieve symptom remission but only 1% of patients met recovery criteria. Using multivariate prediction, the WAIS Comprehension score was a significant predictor of 6months of good functional outcome. ConclusionsAlthough some schizophrenia patients can achieve both symptom remission and recovery in the early course of illness, the overall rate of symptom remission during the first post-hospitalization year is much higher than the rate of recovery. This suggests that interventions targeting work and social functioning are likely necessary to raise the chances of recovery. Cognitive factors can be predictive of good functional outcome even in the early course of schizophrenia.

The Implementation of Computerized Cognitive Behavioural Therapies in a Service User-Led, Third Sector Self Help Clinic

The efficacy and effectiveness of a computerized cognitive behavioural therapy (CCBT) package, Beating the Blues, has been demonstrated in a large randomized controlled trial and several pragmatic studies in the National Health Service (NHS). The current study tests the generalizability of this finding to the implementation of CCBT in a service user-led, third sector Self Help Clinic. 510 referrals for the Beating the Blues program were received over a 16 month period in routine care. The Patient Health Questionnaire Depression (PHQ-9) and Anxiety (GAD-7) Scales were administered pre-treatment and during each treatment session. The 10-item Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), Work and Social Adjustment Scale and Patient Experience Questionnaire were also administered pre-treatment and immediately on completing treatment. More than two-thirds of referrals were suitable for treatment and completed a baseline assessment; 84% of these started the Beating the Blues program. Two-hundred and twenty-six people meeting caseness criteria at baseline completed at least two sessions of CCBT. Of these, 50% met recovery criteria at their final point of measurement. Completer and intention-to-treat analysis also demonstrated statistically and clinically significant improvements on key outcome measures. CCBT can be effectively implemented in a service user-led, third sector Self Help Clinic, increasing access to psychological therapies to meet local needs for tier two interventions for depression and anxiety.

Temporal Patterns of Recovery Across Eating Disorder Subtypes

To compare patterns of recovery in individuals with index episodes of anorexia nervosa (AN) and bulimia nervosa (BN). Using Kaplan-Meier methods and Cox proportional hazards models, comparisons were conducted that were conditional on duration of eating disorder from onset and included a conservative recovery criterion of 3 asymptomatic years. Data collection was retrospective and from two of the international Price Foundation genetic studies on 901 individuals with eating disorders. Using Kaplan-Meier methods, 11% of those with index AN and 10% of those with index BN met recovery criteria at 10 years. At 15 years, 16% of those with index AN and 25% of those with index BN met recovery criteria. In a Cox proportional hazards model the index BN group had three times the rate of recovery at 10-14 years (p=0.01) than the index AN group. Initially the probability of recovery was greater for those with index AN, but as the duration of the eating disorder lengthened those with BN had higher probabilities of recovery. Replication of these results with prospective data using similarly stringent recovery criteria and methods is required to confirm trends.

Neurocognitive correlates of recovery from schizophrenia

BACKGROUND. Evidence has mounted that some patients with schizophrenia experience remission of symptoms and restoration of social and vocational functioning. The purpose of this study was to identify neurocognitive variables associated with recovery from schizophrenia. Twenty-eight patients diagnosed with DSM-IV schizophrenia or schizoaffective disorder and who met our operational definition of recovery from schizophrenia underwent a battery of neurocognitive tests. These subjects were matched with schizophrenia patients who did not meet recovery criteria ('non-recovered') and with normal controls. On tests of executive functioning, verbal fluency and verbal working memory, recovered subjects performed significantly better than non-recovered subjects and were comparable to normal controls. Patient groups did not differ on a test that assessed early visual processing, but both groups performed significantly worse than normal controls. Three measures of frontal lobe functioning appear to be neurocognitive domains associated with recovery from schizophrenia. These findings help narrow the search for targets for cognitive remediation that may have implications for improving community functioning.

Population Characteristics of Greenback Cutthroat Trout in Streams: Their Relation to Model Predictions andRecovery Criteria

Fishes listed under the U.S. Endangered Species Act receive intensive management, but evaluations of population characteristics are rare. We report population and habitat characteristics of federally threatened greenback cutthroat trout Oncorhynchus clarki stomias in 12 streams in north-central Colorado surveyed in 1998 and 1999. Our objectives were to assess population size, structure, and distribution, to evaluate a model developed by Harig and Fausch (2002) to assess translocation success, and to compare population characteristics to those reported in the recovery plan. Allopatric population sizes in 10 streams varied from 170 to 7,347 greenback cutthroat trout at least 75 mm long, whereas the 2 streams with brook trout throughout supported 0–142 greenback cutthroat trout. Populations displayed few upstream–downstream trends in fish abundance or mean length, and the coefficient of variation among sampled reaches within streams averaged 61%. As the density of fish at least 75 mm long increased, the percentage of juvenile (<75 mm) fish in a population increased, the percentage of adult (>125 mm) fish longer than 200 mm decreased, and the average weight of a 200-mm fish declined. The abundance of juvenile fish was positively correlated with summer water temperature. Population estimates were highly correlated with the translocation model index values, suggesting that the translocation model may apply to other cutthroat trout taxa in similar environments. Of the 12 streams for which our extensive field data are available, 4 satisfied the recovery criteria we studied and other criteria in the recovery plan; 8 did not. We conclude that many populations of greenback cutthroat trout, including some that meet recovery criteria, are still at risk of extinction and that a reliable monitoring protocol needs to be established.

Divalproex did not differ from placebo or lithium in preventing recurrence of new mood episodes in bipolar I disorder, remission phase

Bowden CL, Calabrese JR, McElroy SL, et al, for the Divalproex Maintenance Study Group. A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I...

Cognitive Therapy for Depression: A Review of Its Efficacy

The empirical status of cognitive therapy for depression, based on Aaron T. Beck’s model, is reviewed. Available evidence suggests that cognitive therapy is at least as effective in the short run as other psychotherapies, as well as pharmacotherapy. Patients in cognitive therapy experience a large reduction in depressive symptoms and a substantial portion meet recovery criteria at the end of a 12- or 16-week acute treatment period. Moreover, there is evidence that cognitive therapy produces a prophylactic effect. Thus, we conclude that cognitive therapy works well and should be strongly considered as a first-line treatment for depressed people.

Efficacy of a Brief Psychosocial Treatment for Panic Disorder in an Active Duty Sample: Implications for Military Readiness

The efficacy of a brief cognitive-behavioral treatment for panic in military personnel was evaluated. Active duty military patients (N = 37) presenting at outpatient psychiatry and psychology clinics were randomly assigned to immediate or delayed treatment conditions. All patients met Diagnostic and Statistical Manual of Mental Disorders criteria for a primary diagnosis of panic disorder with or without agoraphobia. At posttreatment, 80% of the immediate treatment group, compared to 0% of the delayed treatment group, met recovery criteria on all major clinical facets of panic disorder (i.e., panic attacks, panic-related worry, phobic avoidance). At follow-up, 75% of the treated group continued to meet recovery criteria, suggesting maintenance of treatment gains. A majority of those patients (58%) taking benzodiazepines at the start of treatment were successfully discontinued by posttreatment. Brief, skill-based treatments for panic disorder are effective for a majority of active duty personnel. These treatments may also improve military readiness by facilitating benzodiazepine discontinuation.

Nonpsychiatric medical comorbidity, health perceptions, and treatment outcome in patients with panic disorder.

Panic disorder is frequently complicated by high rates of co-occurring nonpsychiatric medical conditions. The present study examined the relationship between medical morbidity, perceived physical health, and treatment outcome in panic disorder. Patients meeting the American Psychiatric Association's Diagnostic and Statistical Manual of mental disorders (1994) criteria for panic disorder (N = 71) completed 12 sessions of cognitive-behavioral treatment and were assessed at posttreatment and 6-month follow-up. Medical comorbidity and perceived health were both found to be related to end-state functioning. Medical comorbidity did not uniquely predict outcome beyond its shared variance with perceived health. At posttreatment, 71% of patients who perceived their physical health as good met recovery criteria compared with only 35% of those who perceived their health as poor. At follow-up, 67% of those who perceived their physical health as good met composite recovery criteria compared with only 33% of those with perceived poor health. These findings offer preliminary support for the impact of physical health, both actual and perceived, on treatment outcome of patients with panic disorder.

Nonpsychiatric medical comorbidity, health perceptions, and treatment outcome in patients with panic disorder.

Panic disorder is frequently complicated by high rates of co-occurring nonpsychiatric medical conditions. The present study examined the relationship between medical morbidity, perceived physical health, and treatment outcome in panic disorder. Patients meeting the American Psychiatric Association's Diagnostic and Statistical Manual of mental disorders (1994) criteria for panic disorder (N = 71) completed 12 sessions of cognitive-behavioral treatment and were assessed at posttreatment and 6-month follow-up. Medical comorbidity and perceived health were both found to be related to end-state functioning. Medical comorbidity did not uniquely predict outcome beyond its shared variance with perceived health. At posttreatment, 71% of patients who perceived their physical health as good met recovery criteria compared with only 35% of those who perceived their health as poor. At follow-up, 67% of those who perceived their physical health as good met composite recovery criteria compared with only 33% of those with perceived poor health. These findings offer preliminary support for the impact of physical health, both actual and perceived, on treatment outcome of patients with panic disorder.