Sheehan Disability Scale

Patients with panic disorder should be seen every 2 weeks during the first few weeks to adjust medication doses based on symptom improvement and to monitor side effects. Once stabilized, they can be seen every 2 months. The Hamilton Rating Scale for Anxiety (score less than or equal to 7 to 10) can be used to measure anxiety, and the Sheehan Disability Scale (with a goal of less than or equal to 1 on each item) can be used to measure for disability. During drug discontinuation, the frequency of appointments should be increased. 

Remission can be monitored with the Treatment Outcome PTSD Scale (score less than or equal to 5) and the Sheehan Disability Scale (score less than or equal to 1 on each item). 

The initial study of clonazepam in social phobia conducted by Versiani et al. [1989] showed an overall benefit of the drug. This 8-week, open trial of 40 subjects displayed statistically significant lowering of scores on the efficacy variables, which included the Clinical Global Improvement and Severity Scales [Guy 1976], Liebowitz Social Anxiety Scale [liebowitz 1987], Hamilton Anxiety Scale [M. Hamilton 1959], and the Sheehan Disability Scale [D. V. Sheehan 1986]. The mean dose of clonazepam was 3.9 mg/day [SD 0.5 mg]. Subjects in this study reported high rates of side effects, including sleepiness [67.5%], loss of libido [67.5%], and memory problems [35%]. 

The Sheehan Disability Scale (Sheehan et al., 1996) measures subjects evaluation of the extent to which their symptoms have disrupted work, social and/or home life. Each item is rated on an 11-point semi-analog continuum. This scale is utilized as a secondary outcome measure, combined with other more disease- or symptom-specific scales. 

Patients should be seen weekly for the first month, then biweekly through the second month. During months 3 to 6, patients can be seen monthly, then every 1 to 2 months from months 6 to 12. Responders after 1 year of pharmacotherapy can be seen every 3 months. Patients should be monitored for symptom response, side effects, and treatment adherence. Remission can be monitored with the Treatment Outcome PTSD Scale (score less than or equal to 5) and the Sheehan Disability Scale (score less than or equal to 1 on each item). 

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