Diazepam was compared to placebo and phenobarbital sodium in a double-blind study with 472 anxious psychoneurotic patients. Patients were treated in 3 settings — medical clinic, general practice and private psychiatric practice. The treatment setting was found to be at least as important as the medication in producing a treatment response. Compared to placebo, both diazepam and phenobarbital produced more clinical improvement. In general practice the 2 active drugs were about equally effective. In private psychiatric practice the treatment of choice was diazepam. In medical clinic the treatment of choice, particularly after 4 weeks of medication, was phenobarbital. These differences do not appear to be explained by doctor effects. Rather, these differences seem to depend upon patient behavior patterns and social class as well as upon a medical as opposed to a psychiatric orientation to treatment. In determining a given drug treatment, the physician, however, has to consider not only clinical improvement, but also drug related side effects, particularly sedation in this case. And here diazepam has a great advantage over phenobarbital, even in the general practice population. We therefore may reach the conclusion that diazepam represents the treatment of choice for both middle social class populations, general practice and private psychiatric practice, while phenobarbital represents the treatment of choice for low social class medical clinic patients.
Key-Words Drug Effects - Population Effects - Improvement - Characteristic Response Pattern
Data were collected in the offices of private psychiatrists, general practitioners and internists, and in the Medical Clinic of the Philadelphia General Hospital.This work was supported by USPHS Grants MH-08957-8. The authors wish to express their sincere thanks to Dr. Ilhan H. Tuzel, Assistant Medical Director of Hoffmann-La Roche Laboratories, who provided all medication.
The authors also wish to express their gratitude to Drs. Carranza, Case, DeSilverio, Feldman, Gordon, Gray, Heaney, Meckelnburg, Vandervort, Weise, and Yee, who participated in the data collection phase of the study; and to Mrs. Jean Anderson, Social Worker; Miss Reita Brandt, Programmer; and Miss JoAnn Hughes, Assistant Private Practice Coordinator, for their active role in the data handling of the study.
Mr. Hesbacher is Instructor in Sociology, Department of Psychiatry, University of Pennsylvania, and Research Associate, Philadelphia General Hospital. Dr. Rickels is Professor of Psychiatry, University of Pennsylvania, and Director of the Psychopharmacology Unit, Philadelphia General Hospital. Drs. Hutchison, Raab, Sablosky, Whalen, and Phillips are private physicians and members of our Private Practice Research Group.