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Anxietydisorders are the most prevalent mental health conditions. Although they are less visible than schizophrenia, depression, and bipolar disorder, they can be just as disabling. The diagnoses of anxietydisorders are being continuously revised. Both dimensional and structural diagnoses have been used in clinical treatment and research, and both methods have been proposed for the new classification in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-5). However, each of these approaches has limitations. More recently, the emphasis in diagnosis has focused on neuroimaging and genetic research. This approach is based partly on the need for a more comprehensive understanding of how biology, stress, and genetics interact to shape the symptoms of anxiety. Anxietydisorders can be effectively treated with psychopharmacological and cognitive-behavioral interventions. These inter ventions have different symptom targets; thus, logical combinations of these strategies need to be further studied in order to improve future outcomes. New developments are forthcoming in the field of alternative strategies for managing anxiety and for treatment-resistant cases. Additional treatment enhancements should include the development of algorithms that can be easily used in primary care and with greater focus on managing functional impairment in patients with anxiety. PMID:23599668
Bystritsky, Alexander; Khalsa, Sahib S; Cameron, Michael E; Schiffman, Jason
CONTEXT With growing recognition that most forms of psychopathology are best represented as dimensions or spectra, a central question becomes how to implement dimensional diagnosis in a way that is empirically sound and clinically useful. Prototype matching, which involves comparing a patient's clinical presentation with a prototypical description of the disorder, is an approach to diagnosis that has gained increasing attention with forthcoming revisions to both the DSM and the International Classification of Diseases. OBJECTIVE To examine prototype diagnosis for mood and anxietydisorders. DESIGN, SETTING, AND PATIENTS In the first study, we examined clinicians' DSM-IV and prototype diagnoses with their ratings of the patients' adaptive functioning and patients' self-reported symptoms. In the second study, independent interviewers made prototype diagnoses following either a systematic clinical interview or a structured diagnostic interview. A third interviewer provided independent ratings of global adaptive functioning. Patients were recruited as outpatients (study 1; N = 84) and from primary care clinics (study 2; N = 143). MAIN OUTCOME MEASURES Patients' self-reported mood, anxiety, and externalizing symptoms along with independent clinical ratings of adaptive functioning. RESULTS Clinicians' prototype diagnoses showed small to moderate correlations with patient-reported psychopathology and performed as well as or better than DSM-IV diagnoses. Prototype diagnoses from independent interviewers correlated on average r = .50 and showed substantial incremental validity over DSM-IV diagnoses in predicting adaptive functioning. CONCLUSIONS Prototype matching is a viable alternative for psychiatric diagnosis. As in research on personality disorders, mood and anxietydisorder prototypes outperformed DSM-IV decision rules in predicting psychopathology and global functioning. Prototype matching has multiple advantages, including ease of use in clinical practice, reduced artifactual comorbidity, compatibility with naturally occurring cognitive processes in diagnosticians, and ready translation into both categorical and dimensional diagnosis. PMID:23403467
The criteria from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental' Disorders (DSM-III-R) for anxietydisorders relevant to children and adolescents are reviewed. Empirically supported behavioral and pharmacological therapies specific to separation anxietydisorder, avoidant disorder, overanxious disorder, simple phobia, obsessive compulsive disorder, and sleep terror disorder are discussed. Exposure-based treatments are indicated in most cases in which
Psychiatric disorders including anxietydisorders, are becoming more and more important in medico-legal assessment. Anxietydisorders are frequent in the general population. However, they may not be reliably diagnosed even by psychiatric experts because the disorders' symptoms may fail to manifest themselves during the examination. Functional impairments related to anxietydisorders are similarly problematic to assess. Finally, given the existence of effective therapies, it is hard to explain why patients with anxietydisorders have to be assessed at all. This report discusses the various and quite heterogeneous concepts associated with the word "anxiety". Anxietydisorder as a disease is differentiated from anxiety as a physiological emotion. Evidence concerning the etiology of anxietydisorders is compiled and strategies for medico-legal assessment, including the efficacy of therapies, are presented. PMID:22808641
Anxiety symptoms and disorders are common in community settings and in primary and secondary care. Symptoms can be mild and transient, but many people are troubled by severe symptoms that cause great personal distress, and which impair social and occupational function. The societal burden associated with anxietydisorders is considerable, but many of those who might benefit from treatment are
David S. Baldwin; Khalil I. Ajel; Matthew J. Garner
... is the best treatment approach for many people. How to Get Help for AnxietyDisorders If you think you have an anxietydisorder, the first person you should see is your family doctor. A physician can determine whether the symptoms that alarm ...
Papers presented at Sterling Forest Conference Center, New York in September 1982 on anxiety and anxietydisorders are presented. The Volume is a series of interrelated statements about research on anxiety and the anxietydisorders by many of the leading ...
Exposure of the general population to a 1:4 lifetime risk of disabling anxiety has inspired generations of fundamental and clinical psychopharmacologists, from the era of the earliest benzodiazepines (BZ) to that of the selective serotonin reuptake inhibitors (SSRIs) and related compounds, eg, the serotonin and norepinephrine reuptake inhibitors (SNRIs). This comprehensive practical review summarizes current therapeutic research across the spectrum of individual disorders: generalized anxietydisorder (GAD), panic disorder (PD) and agoraphobia (social anxietydisorder), compulsive disorder (OCD), phobic disorder (including social phobia), and posttraumatic stress disorder (PTSD). Specific diagnosis is a precondition to successful therapy: despite substantial overlap, each disorder responds preferentially to specific pharmacotherapy. Comorbidity with depression is common; hence the success of the SSRIs, which were originally designed to treat depression. Assessment (multidomain measures versus individual end points) remains problematic, as-frequently-do efficacy and tolerability The ideal anxiolytic remains the Holy Grail of worldwide psychopharmacologic research.
Cassano, Giovanni B.; Rossi, Nicolo Baldini; Pini, Stefano
Anxietydisorders are common in individuals with developmental disabilities (DDs), although they may not be diagnosed and\\u000a treated as often as they are in patients without DDs. Patients with mental retardation, autism, and other pervasive developmental\\u000a disorders may exhibit comorbid anxietydisorders, such as generalized anxietydisorder (GAD), obsessive-compulsive disorder\\u000a (OCD), phobias, and other anxiety symptoms at much higher rates
Diagnosing and managing anxietydisorders may be quite challenging at times. Time constraints and sheer patient volume may prohibit the primary care clinician from making complete and appropriate mental health diagnoses. It is not uncommon for a patient to have complex coexisting disorders with overlapping symptoms. Determining a primary versus a secondary diagnosis may also be difficult. Interestingly, long-term follow-up
Lesa J. Feather; John K. Spraggins; James D. Helsley
Objective: To report on the reliability of the Chinese-bilingual Structured Clinical Interview for DSM-IV (Axis I, Patient version) Project (CB-SCID-I\\/P), stage 2: anxietydisorders, adjustment disorders, and 'no diagnosis'. Patients and Methods: Newly registered outpatients were consecutively recruited from 2 sites, the Li Ka Shing Psychiatric Centre and Alice Ho Mui Ling Nethersole Psychiatric Clinic. The reliability of the CB-SCID-I\\/P
BACKGROUND Transdiagnostic cognitive-behavioral treatments for anxietydisorders have been gaining increased attention and empirical study in recent years. Despite this, research on transdiagnostic anxiety treatments has, to date, relied on open trials, or comparisons to waitlist conditions, published benchmarks, or relaxation-based interventions. METHODS The current study was a randomized clinical trial examining the efficacy of a 12-week transdiagnostic cognitive-behavioral group treatment in comparison to 12-week diagnosis-specific group CBT protocols for panic disorder, social anxietydisorder and generalized anxietydisorder. RESULTS Results from 46 treatment initiators suggested significant improvement during treatment, strong evidence for treatment equivalence across transdiagnostic and diagnosis-specific CBT conditions, and no differences in treatment credibility. CONCLUSIONS This study provides evidence supporting the efficacy of transdiagnostic CBT by comparison to current gold-standard diagnosis-specific CBT for social anxietydisorder, generalized anxietydisorder, and panic disorder. Transdiagnostic group CBT has the benefit of potentially easing dissemination and increasing access to evidence based treatments for anxiety without sacrificing efficacy.
Social anxietydisorder, also called social phobia, is a disorder characterized by extreme fear and\\/or avoidance of social or performance situations that involve evaluation or possible scrutiny by others. This disorder encompasses both isolated performance anxiety and generalized fears of many social encounters, leading to significant impairment and dysfunction in social, family, educational, and occupational functioning. It is often complicated
Anxietydisorders is one of the most prevalent diagnostic categories identified in children and adolescents. This chapter\\u000a provides an overview of the epidemiology of childhood anxietydisorders. Several pathways of etiology are presented, specifically\\u000a genetics, parent–child attachment, parental anxiety and parenting style, and life experiences. Six of the common childhood\\u000a anxietydisorders, separation anxietydisorder, specific phobia, social phobia, generalized
|This article reports on school functioning for 227 youth ages 7-14 (M = 10.3) with principal diagnoses of separation anxietydisorder (n = 40), social phobia (n = 58), generalized anxietydisorder (n = 76), or no diagnoses (n = 53). School functioning data were gathered via parent and teacher report. Youth with no diagnoses demonstrated…
Mychailyszyn, Matthew P.; Mendez, Julia L.; Kendall, Philip C.
This article proposes a revision of the historical evolution of the concepts of generalized anxietydisorder (GAD). Currently, Darwin's evolutionary theory is the hegemonic paradigm for modern science and influences research on mental disorders. Throughout the 20th Century, the editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association) have changed the diagnostic criteria for GAD, reflecting the prevailing psychiatric understanding of this disorder. The prevalence and symptoms of major depression and GAD show the fragility of the categorical conception of these conditions. Differences in cultural views towards anxietydisorders also suggest that anxiety cannot have a uniform definition. This article provides contributions for reflecting future guidelines concerning the diagnostic criteria for GAD in DSM-V. PMID:20690210
Coutinho, Fernanda Corrêa; Dias, Gisele Pereira; do Nascimento Bevilaqua, Mário Cesar; Gardino, Patricia Franca; Pimentel Rangé, Bernard; Nardi, Antonio Egidio
The past decade has seen a rapid progression in our knowledge of the neurobiological basis of fear and anxiety. Specific neurochemical and neuropeptide systems have been demonstrated to play important roles in the behaviors associated with fear and anxiety-producing stimuli. Long-term dysregulation of these systems appears to contribute to the development of anxietydisorders, including panic disorder, posttraumatic stress disorder
Anxiety symptoms and disorders have long been described in schizophrenia. This article reviews the epidemiology, phenomenology,\\u000a and neurobiologic underpinnings of comorbid anxiety symptoms and disorders in schizophrenia. Recent literature was obtained\\u000a by Medline searches using key words relating to schizophrenia and anxiety symptoms or disorders. There is some evidence that\\u000a anxiety may be a core symptom dimension in schizophrenia, although
Jacqueline E. Muller; Liezl Koen; Soraya Seedat; Robin A. Emsley; Daniel J. Stein
There is now growing realization that many women suffer from new onset or worsening of anxietydisorders during pregnancy.\\u000a Studies of anxiety symptoms in pregnancy show that a significant portion of women are affected. Anxiety symptoms in pregnancy\\u000a have been associated with adverse fetal and infant outcomes. Furthermore, having an anxietydisorder during pregnancy is one\\u000a of the strongest risk
Over the last few years, neuroimaging techniques have contributed greatly to the identification of the structural and functional neuroanatomy of anxietydisorders. The amygdala seems to be a crucial structure for fear and anxiety, and has consistently been found to be activated in anxiety-provoking situations. Apart from the amygdala, the insula and anterior cinguiate cortex seem to be critical, and all three have been referred to as the “fear network.” In the present article, we review the main findings from three major lines of research. First, we examine human models of anxietydisorders, including fear conditioning studies and investigations of experimentally induced panic attacks. Then we turn to research in patients with anxietydisorders and take a dose look at post-traumatic stress disorder and obsessive-compulsive disorder. Finally, we review neuroimaging studies investigating neural correlates of successful treatment of anxiety, focusing on exposure-based therapy and several pharmacological treatment options, as well as combinations of both.
Family functioning and anxietydisorders, the most prevalent forms of psychiatric disorder, influence one another. The empirical literature on family studies of anxietydisorder (ie, aggregration of disorders within families), on parent-child relationships and anxietydisorders, and on marriage and anxietydisorders is reviewed. Finally, the challenges for patients and their families of post-traumatic stress disorder are discussed.
... phobia, everyday interactions cause irrational anxiety, fear, self-consciousness and embarrassment. Social anxietydisorder is a chronic ... other health conditions can increase feelings of self-consciousness and may trigger social anxietydisorder in some ...
Anxiety symptoms and disorders are associated with a range of general medical disorders. This association may be a physiologic\\u000a consequence of the general medical disorder, a psychologic reaction to the experience of having a medical illness, a side\\u000a effect of treatment, or a chance occurrence. This article briefly reviews the associations of panic disorder with seizure\\u000a disorder, Klüver-Bucy syndrome, mitral
\\u000a The diagnosis of anxietydisorders in children and adolescents is associated with several problems including high comorbidity\\u000a and low clinical utility of diagnostic categories. This chapter will begin by outlining the weaknesses of the current categorical\\u000a diagnostic system and reviewing the history and evidence for taking a dimensional approach to the diagnosis of anxietydisorders\\u000a in children and adolescents. The
Personality traits and most anxietydisorders are strongly related. In this article, we review existing evidence for ways\\u000a in which personality traits may relate to anxietydisorders: 1) as predisposing factors, 2) as consequences, 3) as results\\u000a of common etiologies, and 4) as pathoplastic factors. Based on current information, we conclude the following: 1) Personality\\u000a traits such as high neuroticism,
Data regarding the co-occurrence of anxiety symptoms or syndromes in schizophrenia is scant. Hierarchical assumptions embedded in diagnostic systems and methodologic difficulties hamper the development of studies on accessory symptomatology outside of the core positive-negative-disorganized symptoms. Recent studies have repeatedly challenged these assumptions by presenting data on comorbid disorders in schizophrenia. We review the current knowledge about anxiety comorbidity in
Raphael J. Braga; Georgios Petrides; Ivan Figueira
... Brochures Resources Children and Teens Childhood AnxietyDisorders PTSD Symptoms in Children Age Six and Younger Anxiety and Depression Podcasts About Children and Teens Treatment Choosing a Therapist for Your Child Helping Children and Teens With Anxiety ...
... Brochures Resources Children and Teens Childhood AnxietyDisorders PTSD Symptoms in Children Age Six and Younger Anxiety and Depression Podcasts About Children and Teens Treatment Choosing a Therapist for Your Child Helping Children and Teens With Anxiety ...
Anxietydisorders are characterized by overwhelming anxiety or fear and are chronic and relentless if left untreated. Current\\u000a available treatments for anxietydisorders are inadequate and some have severe side effects, thus warranting a better understanding\\u000a of the etiology and mechanisms underlying anxiety and the development of anxietydisorders. In this chapter, the use of animal\\u000a models to identify molecular
This review considers recent research assessing psychophysiological reactivity to fear imagery in anxietydisorder patients. As in animal subjects, fear cues prompt in humans a state of defensive motivation in which autonomic and somatic survival reflexes are markedly enhanced. Thus, a startle stimulus presented in a fear context yields a stronger (potentiated) reflex, providing a quantitative measure of fearful arousal. This fear potentiation is further exaggerated in specific or social phobia individuals when viewing pictures or imagining the phobic object. Paradoxically, fear imagery studies with more severe anxietydisorder patients—panic disorder with agoraphobia, generalized anxietydisorder, or anxious patients with comorbid depression—show a blunted, less robust fear potentiated response. Furthermore, this reflex blunting appears to systematically be more pronounced over the anxietydisorder spectrum, coincident with lengthier chronicity, worsening clinician-based judgments of severity and prognosis, and increased questionnaire-based indices of negative affectivity, suggesting that normal defensive reactivity may be compromised by an experience of long-term stress.
The stigma associated with mental illness can lead to a range of negative outcomes, including delaying or avoiding help seeking. Identifying the characteristics of people who are more likely to hold stigmatizing attitudes enables the development of targeted stigma reduction programs. However, no previous research has systematically examined the predictors of anxiety stigma. This study used the Generalized Anxiety Stigma Scale (GASS) to assess the predictors of personal stigma and perceived stigma associated with Generalized AnxietyDisorder. A community sample of 617 Australian adults completed a survey that included the GASS, the Depression Stigma Scale, exposure to anxietydisorders, emotional distress and a range of demographic characteristics. Linear regression models indicated that women, people with greater exposure to anxietydisorders and people reporting a previous anxietydiagnosis had lower personal stigma toward anxiety. Higher exposure to anxietydisorders and rurality were significantly associated with higher perceived anxiety stigma. Results also suggested that respondents who had only been exposed to anxietydisorders through the media tended to be no more stigmatizing than respondents who had direct contact with people with an anxietydisorder. Media campaigns may be an effective vehicle for decreasing stigmatizing views in the community. PMID:23218916
Batterham, Philip J; Griffiths, Kathleen M; Barney, Lisa J; Parsons, Alison
... Disorder (OCD) Panic Disorder & Agoraphobia Posttraumatic Stress Disorder (PTSD) Social AnxietyDisorder Symptoms Treatment News and Research Social Anxiety and Alcohol Abuse Specific Phobias Depression ...
An increasing number of studies are beginning to recognize the heightened risk for the development of substance use disorders among individuals with an anxietydisorderdiagnosis, and the possible interplay between these disorders is receiving more attention in theoretical, clinical, and empirical spheres (e.g., Goodwin et al., 2002; Morissette, Tull, Gulliver, Kamholz, & Zimering, 2007; Stewart, 1996; Zvolensky & Schmidt,
Matthew T. Tull; David E. Baruch; Michelle S. Duplinsky; C. W. Lejuez
|Purpose: This paper examines gender as a moderating variable between having an anxietydisorderdiagnosis and coronary artery bypass grafting surgery (CABG) outcomes in rural patients. Methods: Using the 2008 Nationwide Inpatient Sample (NIS) database, 17,885 discharge records of patients who underwent a primary CABG surgery were identified.…
Dao, Tam K.; Voelkel, Emily; Presley, Sherine; Doss, Brendel; Huddleston, Cashuna; Gopaldas, Raja
Research progress in the anxietydisorders is predicated on a useful classification system. In this paper, we review the reliability and validity data for theDiagnostic and Statistical Manual of Mental Disorders, 3rd ed. (DSM-III) anxietydisorders and discuss the salient issues associated with both the conceptualization of anxietydisorders and the diagnostic criteria offered in the DSM-III. It is concluded
Jerome A. Cerny; William G. Himadi; David H. Barlow
AnxietyDisorders in Children and Adolescents (Fact Sheet) Publications by Language In English En Español Publications by Topic Disorders Attention Deficit Hyperactivity Disorder (ADHD) (4 Items) Anxiety ...
Reports the characteristics of a large, representative sample of treatment seeking anxious youth (N =488). Participants, aged 7–17 years (mean 10.7 yrs), had a principal DSM-IV diagnosis of separation anxietydisorder (SAD), generalized anxietydisorder (GAD), or social phobia (SP). Although youth with a co-primary diagnosis for which a different disorder-specific treatment would be indicated (e.g., major depressive disorder, substance abuse) were not included, there were few other exclusion criteria. Participants and their parent/guardian underwent an extensive baseline assessment using a broad array of measures capturing diagnostic status, anxiety symptoms and severity, and areas of functional impairment. Means and standard deviations of the measures of psychopathology and data on diagnostic status are provided. The sample had moderate to severe anxietydisorder and was highly comorbid, with 55.3% of participants meeting criteria for at least one non-targeted DSM-IV disorder. Anxietydisorders in youth often do not present as a single/focused disorder: such disorders in youth overlap in symptoms and are highly comorbid among themselves.
Kendall, Philip C.; Compton, Scott N.; Walkup, John T.; Birmaher, Boris; Albano, Anne Marie; Sherrill, Joel; Ginsburg, Golda; Rynn, Moira; McCracken, James; Gosch, Elizabeth; Keeton, Courtney; Bergman, Lindsey; Sakolsky, Dara; Suveg, Cindy; Iyengar, Satish; March, John; Piacentini, John
Anxiety symptoms and disorders are highly prevalent in children and adolescents with Autism Spectrum Disorder (ASD), although they are often unrecognized or misdiagnosed. The purpose of the present review is to (1) provide clinicians with practical information on assessment and diagnosis of co-morbid anxiety in children and adolescents with ASD, (2) summarize and critically examine the literature on anxiety in
Bonnie M. MacNeil; Vicki A. Lopes; Patricia M. Minnes
\\u000a Anxiety is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association\\u000a (Diagnostic and Statistical Manual of Mental Disorders, 2000)) as an “apprehensive anticipation of future danger or misfortune\\u000a accompanied by a feeling of dysphoria or somatic symptoms of tension” (American Psychiatric Association (Diagnostic and Statistical\\u000a Manual of Mental Disorders, 2000 p. 820)). The anxietydisorders
Luana Marques; Anne Chosak; Naomi M. Simon; Dieu-My Phan; Sabine Wilhelm; Mark Pollack
Several epidemiological studies confirmed that AnxietyDisorders as a group are the most prevalent psychiatric conditions in the United States. The importance of these conditions is underlined by the fact that they cause significant disability, poor quality of life, alcohol and drug abuse. Anxietydisorders are treatable conditions and respond to the front-line interventions such as serotonin reuptake inhibitors and
Community studies indicate that 19% of men and 31% of women will develop some type of anxietydisorder during their lifetime. The impact of gender is profound in that it increases the likelihood of developing an anxietydisorder by 85% in women compared to men. Sex difference in prevalence rates are apparent as early as age 6, when girls are twice as likely as boys to have an anxietydisorder. In the National Comorbidity Survey, the prevalence rates for panic disorder in women and men were 5% and 2%, respectively. Agoraphobia, which often coexists with panic disorder, has a lifetime prevalence rate of 7% in women and 3.5% in men. Prevalence of trauma is increased in young women as well, and is experienced earlier in life; 62% of sexual assaults are inflicted on females < or = 18 years of age, and 29% occur in children < 11 years of age. Comorbidity of anxiety in women complicates other medical conditions as well. For example, panic disorder is highly comorbid with CHD, which remains the leading cause of death in women in developed countries. Fluctuations in reproductive hormone levels during the female life cycle is thought to be responsible for modulating anxiety. This is often implicated in the later age of onset, the more sudden and acute symptom emergence, and the more episodic course of OCD in women, and in the high prevalence(47.4%) of PMDD. Pregnancy appears to be a protective period for some anxietydisorders, including panic, while for others, such as OCD, it may be associated with onset. Hormonal changes during pregnancy, such as increased prolactin, oxytocin, and cortisol, may contribute to the suppression of stress response that occurs during this period. Despite a large and growing body of literature on anxietydisorders in general, the available data relating to women and girls falls short of informing aspects of diagnosis, treatment, and prevention that may entail sex differences. Additional work is required to understand the biological and psychosocial causes of these differences. PMID:15487127
A growing body of research suggests that the construct of emotion regulation is important for understanding the onset, maintenance, and treatment of anxietydisorders. In this review, we provide a selective overview of this emerging field and highlight the major sources of evidence. First, evidence suggests that the construct of emotion regulation can be differentiated from the construct of emotion. Second, there is a large and consistent body of research demonstrating that emotion regulation strategies can modulate emotional responding, and this finding is observed in both behavioral and neuroimaging studies. Third, measures of emotion regulation explain incremental variance in measures of anxietydisorder symptoms not accounted for by measures of negative affect. Although the research implicating emotion regulation in the anxietydisorders is promising, future research will be necessary to further clarify causal mechanisms explaining how emotion regulation confers vulnerability for anxietydisorders and to improve the clarity and consistency of definitions of emotion regulation.
\\u000a A range of medications have been shown effective for the treatment of social anxietydisorder. The largest trials to date\\u000a have been with various selective serotonin reuptake inhibitors (SSRIs). Several of these agents have been registered for the\\u000a treatment of social anxietydisorder with agencies such as the FDA or EMEA, meta-analyses confirm their efficacy and safety,\\u000a and expert consensus
The relationship between anxiety and alcohol use is a topic of great theoretical and practical interest for both scientists interested in the nature and causes of psychopathology and practitioners working with anxious and\\/or alcohol abusing clients. Although it has been clearly established that anxietydisorders and alcohol use disorders are highly ‘‘comorbid’’ or co-occurring conditions (e.g., see Kushner, Abrams &
|Background: Few longitudinal studies of child and adolescent psychopathology have examined the links between specific childhood anxietydisorders and adolescent psychiatric disorder. In this paper we test the predictive specificity of separation anxietydisorder (SAD), overanxious disorder (OAD), generalized anxietydisorder (GAD), and social…
Bittner, Antje; Egger, Helen L.; Erkanli, Alaattin; Costello, E. Jane; Foley, Debra L.; Angold, Adrian
A review of studies of cognitive–behavioral therapy (CBT) for generalized anxietydisorder, panic disorder with and without agoraphobia, and social phobia indicates that CBT is consistently more effective than waiting-list and placebo control groups. In general, CBT has proved more beneficial than supportive therapy as well. Comparisons with active behavioral treatments provide more variable results. Converging evidence suggests that cognitive
Background Adult separation anxietydisorder (ASAD) has been identified recently, but there is a paucity of data about its prevalence and associated characteristics amongst anxiety patients. This study assessed the prevalence and risk factor profile associated with ASAD in an anxiety clinic. Methods Clinical psychologists assigned 520 consecutive patients to DSM-IV adult anxiety subcategories using the SCID. We also measured demographic factors and reports of early separation anxiety (the Separation Anxiety Symptom Inventory and a retrospective diagnosis of childhood separation anxietydisorder). Other self-report measures included the Adult Separation Anxiety Symptom Questionnaire (ASA-27), the Depression, Anxiety, Stress Scales (DASS-21), personality traits measured by the NEO PI-R and the Work and Social Adjustment Scale. These measures were included in three models examining for overall differences and then by gender: Model 1 compared the conventional SCID anxiety subtypes (excluding PTSD and OCD because of insufficient numbers); Model 2 divided the sample into those with and without ASAD; Model 3 compared those with ASAD with the individual anxiety subtypes in the residual group. Results Patients with ASAD had elevated early separation anxiety scores but this association was unique in females only. Except for social phobia in relation to some comparisons, those with ASAD recorded more severe symptoms of depression, anxiety and stress, higher neuroticism scores, and greater levels of disability. Conclusions Patients with ASAD attending an anxiety clinic are highly symptomatic and disabled. The findings have implications for the classification, clinical identification and treatment of adult anxietydisorders.
Anxietydisorders are common disorders in childhood, and developmental differences must be considered when diagnosing and\\u000a treating patients in this age group. Recent research has illuminated the course of childhood anxietydisorders, including\\u000a how they can be precursors to continued anxiety and mood problems in adulthood. Recent studies of cognitive-behavioral therapy,\\u000a the first-line psychosocial treatment for childhood anxiety, have focused
Paul Arnold; S. Preeya Banerjee; Rashmi Bhandari; Jennifer Ivey; Michelle Rose; David R. Rosenberg
Experimental psychopathologists have increasingly relied upon the concepts and methods of cognitive psychology in their attempts to elucidate information-processing biases associated with anxietydisorders. Many of these biases presumably constitute instances of automatic, not strategic, processing. But research has shown that attributes of automaticity (i.e. capacity-free, unconsious, involuntary) do not all apply to selective processing of threat associated with anxiety.
Anxietydisorders are frequent and burdensome psychiatric diseases. Despite their moderate to strong heritabilities, the search for candidate genes has been limited by methodological shortcomings hitherto, e.g., the use of clinically defined, but neurobiologically heterogeneous categorical phenotypes. Investigating neurobiological response patterns associated with fear processing as an intermediate phenotype might aid in overcoming these difficulties. The existing imaging literature on the neurobiological correlates of fear processing and anxietydisorders points to a pivotal role of the amygdala in the human fear circuit. Therefore, amygdala responsiveness to anxiety-related stimuli was suggested as an intermediate phenotype for anxietydisorders. The present article provides an overview of imaging genetic studies investigating genetic effects on amygdala responsiveness with particular emphasis on recent imaging genetic findings in anxiety-related traits, panic disorder and social phobia. The existing studies consistently reveal strong genetic effects on the responsiveness of the fear circuit, particularly of genetic variants previously discussed as potential susceptibility variants for anxiety, e.g., the COMT 158val allele or the 5-HTTLPR short allele. Further research will be necessary involving larger sample sizes to allow for investigating gene-gene and gene-environment interactions. More evolved statistical and neuroimaging methods such as effective connectivity measures could lead to a better understanding of imaging endophenotypes and the nature of gene-brain relationships. Longitudinal studies in patient samples will be required to elucidate how genetically influenced neurobiological intermediate phenotypes are associated with subtype, severity and the course of anxietydisorders, thereby having the potential for developing individualized therapy regimes derived from neurobiological research. PMID:19944771
This review summarizes findings on the epidemiology and etiology of anxietydisorders among children and adolescents including separation anxietydisorder, specific phobia, social phobia, agoraphobia, panic disorder, and generalized anxietydisorder, also highlighting critical aspects of diagnosis, assessment, and treatment. Childhood and adolescence is the core risk phase for the development of anxiety symptoms and syndromes, ranging from transient mild symptoms to full-blown anxietydisorders. This article critically reviews epidemiological evidence covering prevalence, incidence, course, and risk factors. The core challenge in this age span is the derivation of developmentally more sensitive assessment methods. Identification of characteristics that could serve as solid predictors for onset, course, and outcome will require prospective designs that assess a wide range of putative vulnerability and risk factors. This type of information is important for improved early recognition and differential diagnosis as well as prevention and treatment in this age span.
|Examined the prevalence of anxiety, mood, and substance use disorders in the parents of anxietydisordered (AD) children relative to children with no psychological disorder (NPD). The specificity of relationships between child and parent anxietydisorders was also investigated. Results revealed higher prevalence rates of anxietydisorders in…
Hughes, Alicia A.; Furr, Jami M.; Sood, Erica D.; Barmish, Andrea J.; Kendall, Philip C.
Given the enormous contribution of anxietydisorders to the burden of disease, it is key to optimize their prevention and treatment. In this critical review we assess advances in the pharmacotherapy of anxietydisorders, as well as remaining challenges, in recent decades, the field has seen rigorous clinical trial methods to quantify the efficacy and safety of serendipitously discovered agents, more focused development of medications with selective mechanisms of action, and the gradual translation of insights from laboratory research into proof-of-principle clinical trials. On the positive side, a considerable database of studies shows efficacy and relative tolerability of the selective serotonin reuptake inhibitors in the major anxietydisorders, and secondary analyses of such datasets have informed questions such as optimal definition of response and remission, optimal dose and duration, and comparative efficacy of different agents. Significant challenges in the field include barriers to appropriate diagnosis and treatment of anxietydisorders, failure of a significant proportion of patients to respond to first-line pharmacotherapy agents, and a limited database of efficacy or effectiveness studies to guide treatment in such cases.
\\u000a Anxietydisorders in childhood are quite common, affecting between 6 and 20% of all children (Costello, Mustillo, Erkanli,\\u000a Keeler, & Angold, 2003). Anxietydisorders can adversely impact social and academic functioning as well as self-esteem (Mendlowicz\\u000a & Stein, 2000). Children with anxietydisorders grow up to having greater rates of depression, new anxietydisorders, substance\\u000a abuse, educational underachievement, and suicide
Animal models may be useful in investigating the fundamental mechanisms underlying psychiatric disorders, and may contribute\\u000a to the development of new medications. A computerized literature search was used to collect studies on recently developed\\u000a animal models for anxietydisorders. Particular cognitive-affective processes (eg, fear conditioning, control of stereotypic movements, social submissiveness, and trauma sensitization) may be particularly\\u000a relevant to understanding
Joachim D. K. Uys; Dan J. Stein; Willie M. U. Daniels; Brian H. Harvey
One hundred sixty subjects meeting DSM-III-R criteria for the five major anxietydisorders were compared on the extent to which they reported features characteristic of social phobia. The results indicated that many patients in the anxietydisorder categories experience some degree of social anxiety. The differences between subjects with a primary diagnosis of social phobia and subjects with other anxiety
Ronald M. Rapee; William C. Sanderson; David H. Barlow
|This article describes six common types of anxietydisorders: (1) generalized anxietydisorder; (2) panic disorder; (3) obsessive-compulsive disorder; (4) post-traumatic stress disorder; (5) specific phobias; and (6) social phobia. Treatment of anxietydisorders have two components that can be offered separately or in combination. They are…
Method: Participants consisted of 127 children and 51 adolescents with a primary anxietydiagnosis. Children were randomly assigned to a standardized group CBT or individual CBT; adolescents received individual CBT. Parents received four training sessions. Participants were evaluated at pre- and post-treatment with a clinical interview and with self- and parent-reported questionnaires. Lifetime anxiety and mood disorders in parents were
J. S. Legerstee; A. C. Huizink; W. van Gastel; J. M. Liber; P. D. A. Treffers; F. C. Verhulst; E. M. W. J. Utens
The responses of 271 outpatients with diagnoses of agoraphobia with panic attacks, panic disorder, generalized anxietydisorder, social phobia, obsessive-compulsive disorder, or depression (major depressive disorder or dysthymic disorder) to the Agoraphobic Cognitions Questionnaire (ACQ) and the Body Sensations Questionnaire (BSQ) were examined. Agoraphobics scored significantly higher than all other groups on fear of body sensations associated with anxiety. In
Danger and harm are avoided by strategic decisions made at all three levels of the triune forebrain: rational (neomammalian), emotional (paleomammalian), and instinctive (reptilian). This applies also to potential harm from conspecifics, which leads to a choice between escalating and de-escalating strategies. Anxiety is a component of de-escalating strategies mediated by the paleomammalian and reptilian forebrains. When the neomammalian (rational) brain fails to deal with the threat of conspecific danger, these more primitive de-escalating strategies may be activated and may present as anxietydisorders. The capacity for concealment of anxiety and other forms of negative affect has also evolved, and excessive concealment may lead to psychopaihology by breaking the negative feedback loop of excessive motivation, leading to impaired performance, leading to signals of distress, and leading to reduced exhortation to succeed on the part of parents and teachers; this situation is illustrated by a model based on the Yerkes-Dodson law.
This article reviews the evidence from random- ized, placebo-controlled trials and meta-analyses of pharmacological treatments of the following anxietydisorders: generalized anxietydisorder, panic dis- order, social anxietydisorder, and post-traumatic stress disorder. There is evidence from multiple ran- domized, placebo-controlled trials to support the use of selective serotonin reuptake inhibitors as first-line pharmacotherapy in these disorders, and a number
\\u000a Psychiatric illness is highly prevalent among children and adolescents. For example, Costello, Mustillo, Erkanli, Keeler,\\u000a and Angold (2003) psychiatrically evaluated over one thousand children aged 9 to 13 years yearly until age 16 years. The 3-month\\u000a prevalence of any disorder was 13%. However, over the course of the study, 31% of girls and 42% of boys had at least one
The concept of generalized anxiety has evolved over many years, from initial descriptions of “anxiety neurosis” to recognition of generalized anxietydisorder (GAD) as a clinical entity included in the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980. Since 1980, the definition of GAD has undergone further change, with modifications in the salience of
|Anxiety sensitivity (AS), a cognitive risk factor for anxietydisorders, was evaluated in a homogeneous obsessive-compulsive disorder (OCD) sample. A total of 280 individuals with OCD completed measures. Evaluation of the Anxiety Sensitivity Index revealed a latent structure that was congruent with previous studies showing a single higher order…
Calamari, John E.; Rector, Neil A.; Woodard, John L.; Cohen, Robyn J.; Chik, Heather M.
The frequent comorbidity of anxietydisorders and mood disorders has been documented in previous studies. However, it remains unclear whether specific anxiety traits or disorders are more closely associated with unipolar major depression (MDD) or bipolar disorder (BPD). We sought to examine whether MDD and BPD can be distinguished by their association with specific types of anxiety comorbidity. Individuals with
Naomi M Simon; Jordan W Smoller; Maurizio Fava; Gary Sachs; Stephanie R Racette; Roy Perlis; Shamsah Sonawalla; Jerrold F Rosenbaum
Epidemiological studies show that anxietydisorders are highly prevalent and an important cause of functional impairment; they constitute the most frequent menial disorders in the community. Phobias are the most common with the highest rates for simple phobia and agoraphobia. Panic disorder (PD) and obsessive-compulsive disorder (OCD) are less frequent (2% lifetime prevalence), and there are discordant results for social phobia (SP) (2%-16%) and generalized anxietydisorder (GAD) (3%-30%). These studies underline the importance of an accurate definition of disorders using unambiguous diagnostic and assessment criteria. The boundaries between anxietydisorders are often ill defined and cases may vary widely according to the definition applied. Simple phobia, agoraphobia, and GAD are more common in vmrnen, while there is no gender différence for SP, PD, and OCD, Anxietydisorders are more common in separated, divorced, and widowed subjects; their prevalence is highest in subjects aged 25 to 44 years and lowest in subjects aged >65 years. The age of onset of the different types of anxietydisorders varies widely: phobic disorders begin early in life, whereas PD occurs in young adulthood. Clinical - rather than epidemiological - studies have examined risk factors such as life events, childhood experiences, and familial factors. Anxietydisorders have a chronic and persistent course, and are frequently comorbid with other anxietydisorders, depressive disorders, and substance abuse. Anxietydisorders most frequently precede depressive disorders or substance abuse, Comorbid diagnoses may influence risk factors like functional impairment and quality of life. It remains unclear whether certain anxietydisorders (eg, PD) are risk factors for suicide. The comorbidity of anxietydisorders has important implications for assessment and treatment and the risk factors should be explored. The etiology, natural history, and outcome of these disorders need to be further addressed in epidemiological studies.
Background: The literature suggests that dysfunctional parenting and insecure attachment may increase risk of anxiety-related psychopathology. This study aimed at testing the association between anxietydisorders, attachment insecurity and dysfunctional parenting while controlling for factors usually not controlled for in previous studies, such as gender, age, and being ill. Methods: A sample of 32 non-psychotic inpatients with SCID-I diagnosis of an anxietydisorder, either alone or in comorbidity, was compared with two age- and sex-matched control groups consisting of 32 non-clinical participants and 32 in-patients with drug-resistant epilepsy. Study measures included the Experience in Close Relationships questionnaire (ECR) and the Parental Bonding Instrument (PBI). Results: The patients with anxietydisorders scored significantly higher on attachment-related anxiety and avoidance than patients with drug-resistant epilepsy and non-clinical participants. These findings were independent of comorbidity for mood disorders. ECR scores did not differ among diagnostic subgroups (generalized anxietydisorder, panic disorder, other anxietydisorders). Patients with anxietydisorders scored significantly lower on PBI mother’s care and borderline significantly lower on PBI father's care than patients with drug-resistant epilepsy. Conclusions: Although limitations such as the relatively small sample size and the cross-sectional nature suggest caution in interpreting these findings, they are consistent with the few previous adult studies performed on this topic and corroborate Bowlby's seminal hypothesis of a link between negative attachment-related experiences, attachment insecurity, and clinical anxiety. Attachment theory provides a useful theoretical framework for integrating research findings from several fields concerning the development of anxietydisorders and for planning therapeutic interventions.
Research on relationships between anxiety and depression has proceeded at a rapid pace since the 1980s. The similarities and differences between these two conditions, as well as many of the important features of the comorbidity of these disorders, are well understood. The genotypic structure of anxiety and depression is also fairly well documented. Generalized anxiety and ma- jor depression share
Although clinical impressions suggest that patients with body dysmorphic disorder (BDD) experience distress in social situations, social anxiety in BDD has received little investigation. This study examined social anxiety in 81 patients with BDD and change in social anxiety with pharmacotherapy. Subjects completed the Social Avoidance and Distress Scale (SADS) and were assessed with measures of BDD symptomatology. Participants in
|Examined three aspects of childhood anxiety and peer liking: (1) whether or not children can detect anxiety in age-mates, (2) the degree to which peer-reported anxiety, self-reported anxiety, and presence of anxietydisorders are associated with peer liking, and (3) whether or not self-reported anxiety and presence of anxietydisorders are…
Comorbidity between bipolar disorder and anxietydisorders has attracted considerable attention in recent years. However,\\u000a a majority of the earlier studies examined anxietydisorders in acutely ill patients resulting in a possible confounding effect\\u000a of the affective episodes. This study examines the prevalence of anxietydisorders in remitted bipolar subjects recruited\\u000a from a psychiatric hospital in India and their effect
A. Zutshi; Y. C. Janardhan Reddy; K. Thennarasu; C. R. Chandrashekhar
Smoking is highly prevalent across most anxietydisorders. Tobacco use increases risk for the later development of certain anxietydisorders, and smokers with anxietydisorders have more severe withdrawal symptoms during smoking cessation than smokers without anxietydisorders. The authors critically examined the relationships among anxiety,…
Morissette, Sandra Baker; Tull, Matthew T.; Gulliver, Suzy Bird; Kamholz, Barbara Wolfsdorf; Zimering, Rose T.
Selective attentional biases, often documented with a modified Stroop task, are considered to play an important role in the etiology and maintenance of anxiety. Two competing explanations for these effects are selectivity for highly emotional words in general vs. selectivity for disorder-specific words. We tested these explanations in 32 patients with generalized anxietydisorder (GAD), 29 patients with social phobia
Eni S Becker; Mike Rinck; Jürgen Margraf; Walton T Roth
The empirical research on the condition labeled separation anxietydisorder (SAD) is reviewed, including studies on its diagnostic criteria, etiology, natural history, and response to behavior therapy. Although the available treatment reports are promising, little experimental evidence exists that specifically demonstrates the efficacy of behavior therapy or any other approach to care for the child with separation anxietydisorder. It
Negatively valenced thoughts are assumed to play a central role in the development and maintenance of anxiety. However, the role of positive thoughts in anxiety is rather unclear. In the current study we examined the role of negative and positive self-statements in the anxiety level of anxious and non-anxious children. Participants were 139 anxietydisordered children and 293 non-anxious children (8-18 years). Compared to non-anxious children, anxious children reported more negative thoughts, less positive thoughts and lower State of Mind (SOM) ratios (ratio of positive to negative thoughts). Negative thoughts and SOM ratios were the strongest predictors of anxiety level in anxious children; whereas both negative and positive thoughts were the strongest predictors of anxiety level in non-anxious children. To conclude, a lack of positive thoughts might be more than just an epiphenomenon of anxiety level and might deserve a place in the cognitive model of anxiety. PMID:21978721
Hogendoorn, Sanne M; Prins, Pier J M; Vervoort, Leentje; Wolters, Lidewij H; Nauta, Maaike H; Hartman, Catharina A; Moorlag, Harma; de Haan, Else; Boer, Frits
Less than one third of people afflicted with generalized anxietydisorder (GAD) experience spontaneous remission, and the symptoms of GAD wax and wane throughout a person's life. The burden of GAD may be reduced with psychopharmacologic therapy. The medications with the most evidence of efficacy in GAD are the benzodiazepines, including a new long-acting formulation of alprazolam. These drugs have a low incidence of side effects but may cause physical dependence, withdrawal, and sedation. Antidepressants are also efficacious in GAD but act less quickly than benzodiazepines. Tricyclic antidepressants such as imipramine may substantially reduce symptoms of anxiety but are not considered a first-line therapy because of their side effects spectrum. The extended-release formulation of venlafaxine and selective serotonin reuptake inhibitors such as paroxetine and sertraline are also efficacious in GAD. While their association with sexual dysfunction may be intolerable for some adults, these drugs may be more appropriate than the benzodiazepines because their chronic use does not lead to dependence. Buspirone also significantly reduces symptoms of GAD and is associated with less sexual dysfunction than SSRIs and less sedation than benzodiazepines. Combining antidepressant and benzodiazepine therapy or medication treatment and psychotherapy may lead to an increase in improvement in patients not responding to 1 treatment approach alone. The most effective treatment for managing the recurrent symptoms of this chronic disorder will remain unknown until more long-term studies using both drug and nondrug therapies are conducted. Remission rates are still only about 40%, signifying the need for improved treatment interventions. PMID:12562113
According to cognitive theories of anxiety, anxious adults interpret ambiguous situations in a negative way: They overestimate danger and underestimate their abilities to cope with danger. The present study investigated whether children with social phobia, separation anxietydisorder, and generalized anxietydisorder have such a bias, compared to a clinical and a normal control group. Children were exposed to stories
Since the introduction of distinct anxietydisorders in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, there has been a growing interest in these conditions, leading to a wealth of pharmacotherapy trials. Guidelines for the\\u000a treatment of anxietydisorders have been developed on the basis of systematic reviews of the literature and expert consensus\\u000a in areas where data
The relationship between anxiety and depression was examined in a sample of 106 children and adolescents referred to an outpatient anxietydisorder clinic for children. Twenty-eight percent of patients with DSM-III diagnoses of anxietydisorders displayed a concurrent major depression. Children with anxietydisorders plus major depression were found (1) to be older, (2) to demonstrate more severe anxiety symptomatology,
Cyd C. Strauss; Cynthia G. Last; Michel Hersen; Alan E. Kazdin
|Bipolar disorder (BD) is a chronic, debilitating disorder with recurrent manic and depressive episodes. More than 75% of bipolar patients have a current or lifetime diagnosis of a comorbid anxietydisorder. Comorbid anxiety in BD is associated with greater illness severity, greater functional impairment, and poorer illness-related outcomes.…
Ellard, Kristen K.; Deckersbach, Thilo; Sylvia, Louisa G.; Nierenberg, Andrew A.; Barlow, David H.
Introduction The aim of this study was to evaluate the evidence for the efficacy of acupuncture in the treatment of anxiety and anxietydisorders by systematic review of the relevant research.Methods Searches of the major biomedical databases (MEDLINE, EMBASE, ClNAHL, PsycINFO, Cochrane Library) were conducted between February and July 2004. Specialist complementary medicine databases were also searched and efforts made
Karen Pilkington; Graham Kirkwood; Hagen Rampes; Mike Cummings; Janet Richardson
... anxiety, researchers found. Anxiety tended to start in early childhood, around the same time as the chronic stomach ... the anxiety - most anxietydisorders traced back to early childhood. A ‘VICIOUS CYCLE' Szigethy, who wasn't involved ...
Examined three aspects of childhood anxiety and peer liking: (1) whether or not children can detect anxiety in age-mates,\\u000a (2) the degree to which peer-reported anxiety, self-reported anxiety, and presence of anxietydisorders are associated with\\u000a peer liking, and (3) whether or not self-reported anxiety and presence of anxietydisorders are associated with peer liking\\u000a after controlling for peer-reported anxiety.
Unlike other DSM-IV anxietydisorders, separation anxietydisorder (SAD) has been considered a disorder that typically begins in childhood, and could be diagnosed only in adults "if onset is before 18." Moreover, SAD is the only DSM-IV anxietydisorder placed under "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence" whereas most anxietydisorders typically start--and are diagnosed--in childhood. Therefore, adult SAD may have been under-recognized and under-diagnosed. A literature review was carried out on behalf of the Anxiety, Obsessive-Compulsive Spectrum, Posttraumatic, and Dissociative Disorders DSM-5 workgroup to explore the evidence for SAD in adulthood, focusing on potentially relevant clinical characteristics and risk factors. The review revealed that SAD in adulthood is prevalent, often comorbid and debilitating. The DSM-IV age-of-onset criterion was not supported as a substantial portion of adults report first onset in adulthood. Research on putative risk factors is limited to childhood SAD: SAD runs in families, albeit patterns of familial aggregation and heritability estimates indicate low specificity. Tentative evidence for biomarkers and biased cognitive processes exists, again pointing to moderate SAD-specificity only. Further research on the epidemiology, etiology, and treatment of ASAD, using DSM-5 criteria, is needed, and particularly prospective-longitudinal studies to understand the developmental trajectories of separation anxietydisorder from childhood to adulthood. PMID:23673209
Body Dysmorphic Disorder (BDD) is a debilitating disorder that often goes undetected in clinical practice. To provide information on the diagnostic correlates of BDD, we examined rates among outpatients seeking treatment for anxietydisorders. Participants (N = 165) were evaluated with a structured clinical interview and received the following primary diagnoses: panic disorder (n = 80), obsessive-compulsive disorder (n =
Sabine Wilhelm; Michael W. Otto; Bonnie G. Zucker; Mark H. Pollack
... preventing the thoughts or making them go away. Treatment for anxietydisorders usually includes both medication and cognitive ... way they react to anxiety-provoking situations. Current treatments can be highly effective for most people. Dr. Denise Chavira, a psychologist at ...
Neurotransmitter-neuroendocrine and cardiovascular responses to the administration of a psychologically stressful mixed-model test (Mental Arithmetic, Stroop Color Word Interference Task, Trier Social Stress Test) were examined in 20 male peripubertal subjects affected by anxietydisorder (group A: 14 with generalized anxietydisorder, 6 with generalized anxietydisorder and separation anxietydisorder) and 20 junior school adolescents, matched for age, without
G. Gerra; A. Zaimovic; U. Zambelli; M. Timpano; N. Reali; S. Bernasconi; F. Brambilla
Background Social AnxietyDisorder (SAD) is a common disorder and its high prevalence and lifelong chronicity are such that it represents a substantial public health problem. The observation that serotonergic agents appear to be effective for its treatment suggests that patients may have abnormal serotonergic neurotransmission within the central nervous system. We investigated the efficacy of Escitalopram in treatment resistant patients with SAD. Method Twenty-nine adult outpatients participated in a 12-week open-label trial of escitalopram. All the subjects had a primary diagnosis of SAD and had failed at least one previous adequate trial of paroxetine. Escitalopram was orally administered starting with a dose of 10 mg/day following a 1-week titration. Results The escitalopram treatment was characterized by good tolerability (drop-out rate due to intolerance: 10.3%), and 24 subjects completed the study trial. At the end of the 12-week treatment period, 14 subjects (48.3%) were considered as responders on the basis of the Clinical Global Impression-Improvement (CGI-I) (much or very much improved) scale and the Liebowitz Scale for Social Anxiety (LSAS) (reduction >35% compared to baseline). We observed a significant mean reduction in the Sheehan Disability Scale Work (p < .05) and Social (p < .05) subscores, but not in the Family subscore. Conclusion These data suggest escitalopram has a role in the treatment of resistant SAD, especially in view of the favourable tolerability profile observed in the patients. Controlled studies are required to further investigate these findings and to compare escitalopram with other treatments for this disorder.
Generalised anxietydisorder (GAD) has a point prevalence of 4.4% among the adult population in England. It is characterised by a persistent, unfocused sense of threat, associated with symptoms of tension, autonomic hyperactivity and vigilance. It is a chronic relapsing condition, with a remission rate of 38% after five years. Most patients are not recognised in primary care and only a third of those identified by the 2007 household survey in England were receiving treatment. GAD is frequently comorbid with other mental health conditions; it is often difficult to establish a reliable diagnosis. Patients with GAD seldom complain of feeling overanxious and worrying excessively. GPs should be alert to the possibility of GAD when patients express frequent concerns about their health or other matters. NICE recommends a stepped care approach to treatment. The first step is to explain the nature of GAD and discuss treatment options. GPs should then offer one of the following: non-facilitated self-help, guided self-help or psychoeducation group participation. If patients have marked functional impairment or if low-intensity interventions have proved ineffective, a choice of. individual CBT or applied relaxation, or drug treatment (SSRIs) should be offered. Patients should be referred if there is: an inadequate response to high-intensity interventions or drug therapy, severe anxiety with marked functional impairment or a high risk of self-harm or suicide. PMID:21510507
BACKGROUND: Previous research has identified high rates of comorbid anxietydisorders among individuals presenting with primary CG. In the present study, we examined the prevalence of comorbid CG in bereaved primary anxietydisorder (AD) patients compared to bereaved healthy controls. We also examined the impairment associated with comorbid CG in AD. METHODS: Participants were 242 bereaved adults (mean (SD) age = 41.5 (13.1), 44.2% women) with a primary AD diagnosis, including generalized anxietydisorder (GAD; n = 57), panic disorder (PD; n = 49), posttraumatic stress disorder (PTSD; n = 29), and generalized social anxietydisorder (GSAD; n = 107), as well as 155 bereaved healthy controls with no current DSM-IV Axis I diagnosis (mean (SD) age = 43.0 (13.6), 51.0% women). CG symptoms were measured using the 19-item inventory of complicated grief (ICG), with threshold CG defined as an ICG score of ?30. Quality of life and functional impairment were assessed with the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and the Range of Impaired Functioning Tool (LIFE-RIFT), respectively. RESULTS: Participants with primary ADs had significantly higher rates of threshold CG symptoms than bereaved controls (12.0% vs. 0.65%; Fisher's Exact P < 0.001). Rates of threshold CG were significantly elevated for each AD when compared to bereaved controls. After adjustment for age, sex, education, and comorbid major depressive disorder, threshold CG was associated with lower quality of life (? = -0.140, P = 0.023) and greater impairment (? = 0.141, P = 0.035) among individuals with AD. CONCLUSIONS: Our findings suggest that threshold CG is of clinical relevance in bereaved individuals with a primary anxietydisorder. Screening for CG in patients with ADs may be warranted. PMID:23495105
|The odds of a lifetime diagnosis of social anxietydisorder increased by 3.79 times for children who had a stable report of behavioral inhibition from their mothers. This finding has important implications for the early identification and prevention of social anxietydisorder.|
\\u000a What role does parenting play in the development, maintenance, and amelioration of child anxiety? In this chapter, we address\\u000a this question by reviewing the current state of knowledge regarding the nature and direction of the relationship between parenting\\u000a and child anxiety. Numerous theoretical models outline the role that various parenting practices may play in the development,\\u000a maintenance, and amelioration of
|This study investigated whether anxiety-disordered (AD) parents differ in their childrearing style from non-disordered parents. A clinical sample of 36 AD parents with children aged 6-18 was compared with a normal control sample of 36 parents. Childrearing was assessed through parent report and child report. The results demonstrated significant…
Anxietydisorders are among the most common psychiatric disorders in children and adolescents with estimated prevalence rates of between five and ten percent. Comorbidity rates are high--in particular for further anxiety and depressive disorders. The etiology is considered to be multifactorial, with genetic, biological and temperamental factors as well as stressful life events, parental role models and parenting all playing a part. Therapeutic programs combine psychological counseling--including the family--psychotherapy and psychopharmacotherapy, as required. As psychotherapy, cognitive-behavioral interventions have proven highly effective. In severe disorders that prevent the overcoming of complex anxiety/phobias (e.g. going to school impossible), psychopharmacotherapeutic measures can be helpful, and may support, or, in individual cases even make possible, successful psychotherapy. PMID:15357500
Objective To discuss psychotherapies for depression and anxiety that have emerged in recent years and to evaluate their current level of empirical support. Method An electronic and a manual literature search of psychotherapies for mood and anxietydisorders were conducted. Results Five new therapies for mood disorders and 3 interventions for posttraumatic stress disorder with co-occurring substance abuse met criteria for inclusion in this review. Fewer psychotherapies have been developed for other anxietydisorders. Although research for some of the psychotherapies has demonstrated superiority to usual care, none have firmly established efficacy or specific benefits over other established psychotherapies. Conclusions A plurality of the new psychotherapies introduced and established in the past 5 years have been different assimilations of previously established cognitive-behavioural, interpersonal, or psychodynamic models. While initial results are promising for some, more rigorous efficacy trials and replications are necessary before conclusions can be drawn regarding their relative benefits.
Stirman, Shannon Wiltsey; Toder, Katherine; Crits-Christoph, Paul
|Background: Separation anxietydisorder (SAD) is one of the most common anxietydisorders in childhood and is predictive of adult anxietydisorders, especially panic disorder. However, the disorder has seldom been studied and the attempt to distinguish SAD from other anxietydisorders with regard to psychophysiology has not been made. We expected…
Kossowsky, Joe; Wilhelm, Frank H.; Roth, Walton T.; Schneider, Silvia
A study was conducted to compare the efficacy of meditation with that of imipramine and chlordiazepoxide in the treatment of Generalized AnxietyDisorder. At the end of five weeks, meditation was found to be as effective as pharmacotherapy in controlling symptoms of anxiety. It was superior in altering trait anxiety (TMAS Scores). Meditation is an easy to learn and cost effective therapy. It has a distinct edge over pharmacotherapy in that it is does not have the associated problems of habit formation,-withdrawal effects, overdosage or other undesirable effects.
This paper reviews the molecular neuroimaging of anxietydisorders, and attempts to put recent advances in the context of\\u000a previous findings. Knowledge of the metabolic correlates of symptom severity and treatment response in obsessive-compulsive\\u000a disorder has been significantly extended, particularly response to selective serotonin reuptake inhibitor medication. However,\\u000a the first neuroreceptor studies of serotonin transporter availability in obsessive-compulsive disorder have
Anxietydisorders commonly co-occur with substance use disorders. It is known that alcohol-dependent patients are at greater risk of a relapse if they have a comorbid anxietydisorder. There is a lot of literature reporting on the efficacy of treatments that target anxiety or alcohol addiction separately but less research has examined treatments that address these disorders when they co-occur. Anxiety treatment for alcohol-dependent patients with a co-occuring anxietydisorder can alleviate anxiety symptoms but has no significant effect on the outcomes of alcohol treatment. Efficient combinations of psychotherapy and pharmacotherapy can improve outcomes of comorbid disorders. PMID:23887470
Anxietydisorders are the most common psychiatric disorders in the general population of the United States. Recent findings indicate that the prevalence of certain anxietydisorders may be higher in African Americans. In addition, anxietydisorders in African Americans may be manifested differently. Despite the high prevalence and the suggestion of different patterns of manifestation, a paucity of research exists
This study investigated the role of control beliefs in childhood anxietydisorders. The sample comprised 117 youth aged 9-17 years (86 met diagnostic criteria for an anxietydisorder and the remaining 31 were nonreferred comparison participants). Partici- pants' anxiety levels and their perceptions of control over anxiety-related events (e.g., \\
Carl F. Weems; Wendy K. Silverman; Ronald M. Rapee; Armando A. Pina
This article reviews the current screening and assessment tools for anxietydisorders in children and adolescents, as well as evidence-based treatment interventions for these disorders. The following anxietydisorders are discussed: separation anxietydisorder, generalized anxietydisorder, specific phobia, panic disorder, social anxietydisorder (social phobia), and selective mutism. There are several well-studied screening and assessment tools to identify childhood anxietydisorders early and differentiate the various anxietydisorders. Evaluations of baseline somatic symptoms, severity, and impairment ratings of the anxietydisorders, and collecting ratings from several sources is clinically helpful in assessment and treatment follow-up. Cognitive-behavioral therapy (CBT) has been extensively studied and has shown good efficacy in treatment of childhood anxietydisorders. A combination of CBT and medication may be required for moderate to severely impairing anxietydisorders and may improve functioning better than either intervention alone. Selective serotonin reuptake inhibitors are currently the only medications that have consistently shown efficacy in treatment of anxietydisorders in children and adolescents. Despite proven efficacy, the availability of CBT in the community is limited. Current research is focusing on early identification of anxietydisorders in community settings, increasing the availability of evidence-based interventions, and modification of interventions for specific populations. PMID:21225481
Anxietydisorders generally have an early age of onset and can contribute to the development of comorbid disorders later in life. Thus, it is important to identify adolescent risk factors for anxiety. Past research has identified early pubertal timing as a risk factor for anxiety, typically measured as a general construct through self-report. The current study used data from the National Comorbidity Survey-Replication (NCS-R) to examine recollection of early and late menarche as a predictor of posttraumatic stress disorder (PTSD), specific phobias (SP), social anxietydisorder (SAD), generalized anxietydisorder (GAD), and panic disorder (PD) among women. Findings showed that early timing predicted increased risk of a lifetime diagnosis of PTSD, SP, and SAD, whereas late pubertal timing only predicted increased rates of SAD. Examination of race as a potential moderator of these relationships did not yield significant findings, but these analyses were limited by low power. Other limitations and future directions are discussed. PMID:22901773
There are little available data on African-American children with anxietydisorders. Treatment-seeking African-American (n=30) and white children (n=139), with a current DSM-III-R anxietydisorder, were compared on sociodemographic background variables, clinical characteristics, and lifetime rates of specific DSM-III-R anxietydisorders. Overall, results suggested that the anxiety-disordered African-American and white children who sought treatment from an outpatient mental health facility were
Clinician-guided Internet-based cognitive behavioural therapy (iCBT) programs are clinically effective at treating specific anxietydisorders. The present study examined the efficacy of a transdiagnostic Internet-based cognitive behavioural treatment (iCBT) program to treat more than one anxietydisorder within the same program (the Anxiety Program). Eighty six individuals meeting diagnostic criteria for generalized anxietydisorder (GAD), panic disorder, and\\/or social phobia
Nickolai Titov; Gavin Andrews; Luke Johnston; Emma Robinson; Jay Spence
|This study examined emotion management skills in addition to the role of emotional intensity and self-efficacy in emotion regulation in 26 children with anxietydisorders (ADs) ages 8 to 12 years and their counterparts without any form of psychopathology. Children completed the Children's Emotion Management Scales (CEMS) and Emotion Regulation…
|Objective: To characterize informant disagreement for separation anxietydisorder (SAD). Method: The sample comprised 2,779 8- to 17-year-old twins from a community-based registry. Children and their parents completed a personal interview about the child's psychiatric history. Parents completed a personal interview about their own psychiatric…
In psychiatry, the use of pharmacological challenges in panic disorder is unique in that the clinical phenomenon of central interest (i.e., the panic attack) can be provoked readily and assessed in the clinical laboratory setting. During the past 20 years pharmacological challenge studies have increased our knowledge concerning the neurobiology of panic disorder remarkably and may ultimately result in novel
This review evaluates evidence of attentional biases in generalized anxietydisorder (GAD) and depressive disorder from studies using modified Stroop and visual probe tasks. There appears to be fairly consistent evidence for an attentional bias for external negative cues in GAD, and for the involvement of non-conscious processes in this bias. By contrast, in clinical depression, the evidence for an
Psychological disorders have kept away and incapacitated professionals in different sectors of activities. The most serious problems may be associated with various types of pathologies; however, it appears, more often, as psychotic disorders, mood disorders, anxietydisorders, antisocial personality, multiple personality and addiction, causing a micro level damage to the individual and his/her family and in a macro level to the production system and the country welfare. The lack of early diagnosis has provided reactive measures, and sometimes very late, when the professional is already showing psychological signs of incapacity to work. This study aims to help the early diagnosis of psychological disorders with a hybrid proposal of an expert system that is integrated to structured methodologies in decision support (Multi-Criteria Decision Analysis - MCDA) and knowledge structured representations into production rules and probabilities (Artificial Intelligence - AI). PMID:21431598
Objective: To estimate the correlates of mood and anxietydisorders among rural, urban and metropolitan residents in the United States. Methods: We analyzed the National Co-morbidity Survey (NCS), which yields the distribution and correlates of psychiatric disorders in a probability sample of U.S. population using DSM-III-R for diagnosis. Logistic regressions of mood and anxietydisorders were stratified by geographical area.
Little is known about the links between anxietydisorders and parent-child attachment disorganization and quality of peer relationships in late adolescence. This study examined the quality of attachment and peer relationships among adolescents with and without anxietydisorders in a sample of 109 low- to moderate-income families. Psychopathology was assessed with the SCID-I. Attachment disorganization and dysfunction in peer relationships were measured using semi-structured interviews and behavioral observations. Adolescents with anxietydisorders and comorbid conditions showed higher levels of attachment disorganization across three measurement approaches, as well as higher levels of dysfunction in peer relationships than those with no Axis I diagnosis. Adolescents without anxietydisorders but with other Axis I disorders differed only in the quality of school relationships from those with no diagnoses. The pattern of results suggests that pathological anxiety, in the context of other comorbidities, may be a marker for more pervasive levels of social impairment. PMID:23247207
Brumariu, Laura E; Obsuth, Ingrid; Lyons-Ruth, Karlen
In psychiatry, the use of pharmacological challenges in panic disorder is unique in that the clinical phenomenon of central interest (i.e., the panic attack) can be provoked readily and assessed in the clinical laboratory setting. During the past 20 years pharmacological challenge studies have increased our knowledge concerning the neurobiology of panic disorder remarkably and may ultimately result in novel and more causal treatment strategies. Moreover, the differences in sensitivity to certain panicogens such as serotonergic agents, lactate, carbon dioxide and cholecystokinin tetrapeptide are likely to be fruitful in serving as biological markers of subtypes of panic disorders and should be a major focus of research, as the identification of reliable endophenotypes is currently one of the major rate-limiting steps in psychiatric genetic studies. PMID:16594268
|To study the distinction between self-reports of anxiety and depression, a factor analysis was conducted using responses of 298 anxietydisorder patients on the Beck Depression Inventory and the State Anxiety subscale of the State-Trait Anxiety Inventory. Results suggest that the two conditions can be reliably differentiated in self-reports.…
Objective: Approximately 30% of women experience some type of anxietydisorder during their lifetime. In addition, some evidence exists that anxietydisorders can affect pregnancy outcomes. This article reviews the literature on the course of generalized anxietydisorder (GAD) and panic disorder during pregnancy and the postpartum period and presents guidelines for management. Data Sources and Study Selection: An English language electronic search of relevant studies using PubMed (January 1, 1985–January 2004) was performed using the search terms anxiety and pregnancy, maternal mental illness, panic and pregnancy, psychotropic medications in pregnancy, and treatment options in pregnancy. Review articles and primary pharmacologic treatment articles were selected for discussion. Data Extraction and Synthesis: Despite the extensive use of psychotropic drugs such as antidepressants during pregnancy, there is a scarcity of information regarding the effect of such exposure on the developing fetus. Review articles and primary pharmacologic treatment trials were analyzed and incorporated into the review based on adequate methodology, completeness of data, and information on pregnancy outcome. Conclusion: It is important that physicians understand the course of these disorders during pregnancy and available treatments so they appropriately counsel women who are or intend to become pregnant. The goal of treatment during pregnancy and lactation is sufficient treatment for syndrome remission. To minimize the potential for neonatal withdrawal and maternal toxicity after delivery, vigilant monitoring of side effects is indicated. Also, if possible, nonpharmacologic treatment, such as cognitive-behavioral therapy, should be first-line treatment in pregnant women with GAD or panic disorder.
Rubinchik, Sofya M.; Kablinger, Anita S.; Gardner, J. Suzette
This review poses the question, is it possible to prevent the development of anxietydisorders through selective interventions? The article begins with a review of the major psychosocial risk factors for anxietydisorders. Evidence is reviewed to support the role of inhibited temperament, parent anxiety, environmental support of avoidant coping, and vicarious and instructional learning of avoidance as risks for
|There is a substantial literature relating the personality trait "anxiety sensitivity" (AS; tendency to fear anxiety-related sensations) and its lower order dimensions to the mood and anxiety (i.e., internalizing) disorders. However, particularly given the disorders' high comorbidity rates, it remains unclear whether AS is broadly related to…
This study investigated the relationship between social anxiety, depressive symptoms, and behavioral avoidance among adult patients with Social AnxietyDisorder (SAD). Epidemiological literature shows SAD is the most common comorbid disorder associated with Major Depressive Disorder (MDD), though the relationship between these disorders has not been investigated. In most cases, SAD onset precedes MDD, suggesting symptoms associated with SAD might
In this paper we examine the nature of automatic cognitive processing in anxietydisorders and Major Depressive Disorder (MDD). Rather than viewing automaticity as a unitary construct, we follow a social cognition perspective (Bargh, 1994) that argues for four theoretically independent features of automaticity: unconscious (processing of emotional stimuli occurs outside awareness), efficient (processing emotional meaning uses minimal attentional resources), unintentional (no goal is needed to engage in processing emotional meaning), and uncontrollable (limited ability to avoid, alter or terminate processing emotional stimuli). Our review of the literature suggests that most anxietydisorders are characterized by uncontrollable, and likely also unconscious and unintentional, biased processing of threat-relevant information. In contrast, MDD is most clearly typified by uncontrollable, but not unconscious or unintentional, processing of negative information. For the anxietydisorders and for MDD, there is not sufficient evidence to draw firm conclusions about efficiency of processing, though early indications are that neither anxietydisorders nor MDD are characterized by this feature. Clinical and theoretical implications of these findings are discussed and directions for future research are offered. In particular, it is clear that paradigms that more directly delineate the different features of automaticity are required to gain a more comprehensive and systematic understanding of the importance of automatic processing in emotion dysregulation.
Teachman, Bethany A.; Joormann, Jutta; Steinman, Shari; Gotlib, Ian H.
The purpose of this study was to investigate the relation between persistent prolonged dysfunction in parents and the development of Generalized Anxietydisorder (GAD). Initially, 940 adult subjects from a general practice were studied. Thirty-two parents aged 24 to 61yr diagnosed with GAD served as the experimental group, while 117 healthy normal parents aged 24–66yr made up the control group.
\\u000a Stress is a risk factor for depressive and anxietydisorders. Changes in lifestyle patterns that are associated with increased\\u000a stress therefore place a greater burden on mental health. Stress challenges the organism’s homeostatic mechanisms, triggering\\u000a a cascade of events that should, normally, maintain or allow a return to equilibrium. Stressful events are perceived by sensory\\u000a systems in the brain, facilitating
ObjectiveThe major aim of this research is to determine whether infants who were anxiously\\/resistantly attached in infancy develop more anxietydisorders during childhood and adolescence than infants who were securely attached. To test different theories of anxietydisorders, newborn temperament and maternal anxiety were included in multiple regression analyses.
SUSAN L. WARREN; LISA HUSTON; BYRON EGELAND; L. ALAN SROUFE
nxiety is a normal emotion experienced at some time by vir- tually all humans. Pathological anxiety is less commonly expe- rienced and may arise from an anxietydisorder in the context of a depressive or psychotic illness or from one of a number of somatic illnesses, such as hyperthyroidism. The range of anxietydisorders and appropriate choice of therapies is
Cognitive behavioural therapy (CBT) is a psychological treatment of choice for anxietydisorders. It works by understanding connections between thoughts, behaviours, emotions and physical feelings. It also uses the principle that anxiety is the result of overestimating threat or the individual underestimating their own capacity to deal with that threat. Exposure is a group of techniques used in anxietydisorders
|Even though generalized anxietydisorder (GAD) is one of the most common of the anxietydisorders, relatively little is known about its precursors. Bowlby's attachment theory provides a framework within which these precursors can be considered. According to Bowlby, adult anxiety may be rooted in childhood experiences that leave a child uncertain…
Cassidy, Jude; Lichtenstein-Phelps, June; Sibrava, Nicholas J.; Thomas, Charles L., Jr.; Borkovec, Thomas D.
Social anxietydisorder (SAD) is considered to be one of the most common anxietydisorders. Despite its high prevalence, the disorder is still considerably underdiagnosed and undertreated. SAD shows a typically early onset in childhood or early adolescence and generally becomes chronic. The disease places a massive burden on patients lives, affecting not only their social interactions but also their educational and professional activities, thereby constituting a severe disability. Although substantial progress in the study of the etiology of SAD has been made, no commonly accepted model has emerged yet. Data from genetic and neuroimaging studies point towards a contribution of several neurotransmitter systems (i.e. norepinephrine, dopamine and serotonin) to the pathophysiology of this disorder. Functional magnetic resonance imaging studies have repeatedly emphasized the central role of the amygdalae and insula in the neural circuitry of the disorder. Selective serotonin reuptake inhibitors (SSRI) are commonly accepted as first line therapy, however other substance classes like serotonin norepineprine reuptake inhibitors (SNRI), monoamine oxidase inhibitors (MAOI), benzodiazepines and several other agents have also proved effective. There is still a substantial lack of data on therapeutic options in cases of non-responsive SAD as well as on add-on therapy. A combined treatment-approach including psychotherapy (e.g. cognitive behavioural therapy) may prove useful. PMID:19935490
This study examines childhood anxietydisorders as well as their impact on the development of anxietydisorders in adulthood. It also compares the effectiveness of different treatment methods and examines common risk factors, such as family history or genetic influence. This study measures the impact on school performance, social relationships, and other components of daily functioning. Literature suggests that anxiety
Comorbidity of mood and anxietydisorders is common in patients suffering from post-traumatic stress disorder (PTSD). The current study evaluated the efficacy and tolerability of sertraline in a subgroup of PTSD patients suffering from anxiety or depression comorbidity. Two multicenter, 12-week, double-blind, flexible-dose US studies of adult outpatients from the general population with a DSM-III-R diagnosis of PTSD evaluated the
One hundred thirty patients presenting at an anxietydisorders research clinic were administered a structured interview (i.e., AnxietyDisorders Interview Schedule-Revised). Diagnoses were made in accordance with Diagnostic and Statistical Manual (rev. 3rd ed.) criteria. Seventy percent of patients received at least one additional but secondary Axis I diagnosis. The most common additional diagnoses were simple and social phobia, which
William C. Sanderson; Peter A. DiNardo; Ronald M. Rapee; David H. Barlow
This study investigated the role of control beliefs in childhood anxietydisorders. The sample comprised 117 youth aged 9–17 years (86 met diagnostic criteria for an anxietydisorder and the remaining 31 were nonreferred comparison participants). Participants' anxiety levels and their perceptions of control over anxiety-related events (e.g., “things that might be harmful,” “feeling shaky or nervous”) were assessed. Findings
Carl F. Weems; Wendy K. Silverman; Ronald M. Rapee; Armando A. Pina
The study of the genetics of complex behaviors has evolved dramatically from the days of the nature versus nurture debates that dominated much of the past century. Here we discuss advances in our understanding of the genetics of affective and anxietydisorders. In particular, we highlight our growing understanding of specific gene-environment interactions that occur during critical periods in development, setting the stage for later behavioral phenotypes. We review the recent literature in the field, focusing on recent advances in our understanding of the role of the serotonin system in establishing normal anxiety levels during development. We emphasize the importance of understanding the effect of genetic variation at the level of functional circuits and provide examples from the literature of how such an approach has been exploited to study novel genetic endpoints, including genetically based variation in response to medication, a potentially valuable phenotype that has not received much attention to date. PMID:16318591
|The aim of this cross-sectional community-based study was to examine the sensitivity and specificity of the Screen for Child Anxiety Related Emotional Disorders (SCARED) to the diagnosis of anxietydisorders (AD). Participants were 119 students aged 9-18. Psychiatric diagnoses were assessed by a psychiatrist throughout a structural clinical…
The purpose of this study was to determine the validity of the State–Trait Anxiety Inventory (STAI) in predicting DSM-III-R anxietydisorders based on the Diagnostic Interview Schedule for Children (DISC, Version 2.3) and using Asian\\/Pacific Islander adolescents. An overall prevalence rate of 9.19% for generalized anxietydisorder, overanxious disorder, or social phobia was consistent with past studies. As hypothesized, STAI
Earl S Hishinuma; Robin H Miyamoto; Stephanie T Nishimura; Deborah A Goebert; Noelle Y. C Yuen; George K Makini; Naleen N Andrade; Ronald C Johnson; Barry S Carlton
Anxietydisorders in Parkinson’s disease (PD) have been found to exceed prevalence rates in the geriatric population. Anxiety\\u000a occurs more frequently in PD than in most other medical illnesses of comparable disability. Thus, anxiety may be etiologically\\u000a related to the neurobiological changes that accompany PD and not simply a behavioral reaction to chronic disability. The anxiety\\u000a disorder in PD tends
This study investigated whether anxiety-disordered (AD) parents differ in their childrearing style from non-disordered parents. A clinical sample of 36 AD parents with children aged 6-18 was compared with a normal control sample of 36 parents. Childrearing was assessed through parent report and child report. The results demonstrated significant differences in childrearing style between AD parents and non-disordered control parents, both from the perspective of the parent and from that of the child. AD parents reported a less nurturing and more restrictive rearing style than control parents. Their children did not report more rejection or less warmth than children of control parents; they did, however, report significantly more overprotection than children of control parents. The findings, from parental as well as child reports, apply to both AD mothers and AD fathers. PMID:16775762
The present study examines the influence of diagnostic comorbidity on the demographic, psychiatric, and functional status of youth with a primary diagnosis of obsessive compulsive disorder (OCD). Two hundred and fifteen children (ages 5–17) referred to a university-based OCD specialty clinic were compared based on DSM-IV diagnostic profile: OCD without comorbid anxiety or externalizing disorder, OCD plus anxietydisorder, and OCD plus externalizing disorder. No age or gender differences were found across groups. Higher OCD severity was found for the OCD + ANX group, while the OCD + EXT group reported greater functional impairment than the other two groups. Lower family cohesion was reported by the OCD + EXT group compared to the OCD group and the OCD + ANX group reported higher family conflict compared to the OCD + EXT group. The OCD + ANX group had significantly lower rates of tic disorders while rates of depressive disorders did not differ among the three groups. The presence of comorbid anxiety and externalizing psychopathology are associated with greater symptom severity and functional and family impairment and underscores the importance of a better understanding of the relationship of OCD characteristics and associated disorders. Results and clinical implications are further discussed.
Lewin, Adam B.; Bergman, R. Lindsey; Lee, Joyce C.; Piacentini, John
BACKGROUND: Structural models of emotional disorders propose that anxietydisorders can be classified into fear and distress disorders. Sources of evidence for this distinction come from genetic, self-report and neurophysiological data from adults. The present study examined whether this distinction relates to cognitive processes, indexed by attention bias towards threat, which is thought to cause and maintain anxietydisorders. Method Diagnostic and attention bias data were analysed from 435 children between 5 and 13 years of age; 158 had principal fear disorder (specific phobia, social phobia or separation anxietydisorder), 75 had principal distress disorder (generalized anxietydisorder, GAD) and 202 had no psychiatric disorder. Anxious children were a clinic-based treatment-seeking sample. Attention bias was assessed on a visual-probe task with angry, neutral and happy faces. RESULTS: Compared to healthy controls, children with principal distress disorder (GAD) showed a significant bias towards threat relative to neutral faces whereas children with principal fear disorder showed an attention bias away from threat relative to neutral faces. Overall, children displayed an attention bias towards happy faces, irrespective of diagnostic group. CONCLUSIONS: Our findings support the distinction between fear and distress disorders, and extend empirically derived structural models of emotional disorders to threat processing in childhood, when many anxietydisorders begin and predict lifetime impairment. PMID:23591000
Social anxietydisorder (SAD) is a common disorder that can lead to significant impairment. In this chapter, the author provides background on the disorder and reviews hypothesized familial and temperamental risk factors. In particular, it highlights the Massachusetts General Hospital (MGH) Longitudinal Study of Children at Risk for Anxiety, now…
The aim of this study was to investigate the prevalence rate of disordered eating behaviors in young female athletes and to compare the anxiety levels of the athletes with or without disordered eating behaviors. Female athletes (n=243) of 15 to 25 years old from the city, Edirne, in Turkey participated our study. Disordered eating behaviors and anxiety levels of participants were
Over the past several decades, evidence-based treatments have emerged for each major anxietydisorder. These include primarily behavioural, cognitive, and pharmacological approaches. In addition, researchers continue to develop new ways of treating anxietydisorders and to improve on existing treatments. This article discusses several new and emerging treatments for anxietydisorders, including attentional training, virtual reality-based treatments, mindfulness and acceptance-based
Background Psychiatric disorders are common in irritable bowel syndrome (IBS) patients. The prevalence of psychiatric disorders in IBS patients varies in different cultures. We conducted this study to determine the prevalence of psychiatric disorders Methods In a cross-sectional study, 256 IBS patients were selected (using the criteria of Rome III) and evaluated for psychiatric disorders. In the first phase, subjects were screened using the General Health Questionnaire 28 (GHQ28). In the second phase, those who had scores ? 23 were assessed through semi-structured psychiatric interviews. Results Thirty out of 256 subjects had no significant psychiatric symptoms after performing GHQ28. In further psychiatric evaluation of the remaining subjects (226) who suffered from some degree of a psychiatric problem, 36 were diagnosed without Anxiety/Depressive disorder. Thus 66 subjects (25.8%) were known as a group without any significant psychiatric problem. A total of 190 subjects (74.2%) with anxiety-depressive problems were diagnosed; 89 were suffering from pure anxietydisorders, 41 were suffering from depressive disorders and 60 had co-morbid anxiety-depressive disorders. When comparing anxiety-depressive patients (n = 190) with normal subjects (n = 66), gender (P = 0.016), occupation (P = 0.002) and intensity of IBS (P < 0.001) showed statistically significant differences. Conclusion The high prevalence of anxiety-depressive disorders in this study indicates the necessity of psychiatric assessment, early diagnosis and treatment of the patients with IBS. It may improve management of the patients suffering from IBS.
From an emotion regulation framework, generalized anxietydisorder (GAD) can be conceptualized as a syndrome involving heightened intensity of subjective emotional experience, poor understanding of emotion, negative reactivity to emotional experience, and the use of maladaptive emotion management strategies (including over-reliance on cognitive control strategies such as worry). The current study sought to replicate previous findings of emotion dysregulation among
Cynthia L. Turk; Richard G. Heimberg; Jane A. Luterek; Douglas S. Mennin; David M. Fresco
Self-compassion refers to having an accepting and caring orientation towards oneself. Although self-compassion has been studied primarily in healthy populations, one particularly compelling clinical context in which to examine self-compassion is social anxietydisorder (SAD). SAD is characterized by high levels of negative self-criticism as well as an abiding concern about others' evaluation of one's performance. In the present study, we tested the hypotheses that: (1) people with SAD would demonstrate less self-compassion than healthy controls (HCs), (2) self-compassion would relate to severity of social anxiety and fear of evaluation among people with SAD, and (3) age would be negatively correlated with self-compassion for people with SAD, but not for HC. As expected, people with SAD reported less self-compassion than HCs on the Self-Compassion Scale and its subscales. Within the SAD group, lesser self-compassion was not generally associated with severity of social anxiety, but it was associated with greater fear of both negative and positive evaluation. Age was negatively correlated with self-compassion for people with SAD, whereas age was positively correlated with self-compassion for HC. These findings suggest that self-compassion may be a particularly important target for assessment and treatment in persons with SAD. PMID:21895450
Werner, Kelly H; Jazaieri, Hooria; Goldin, Philippe R; Ziv, Michal; Heimberg, Richard G; Gross, James J
Previous research has examined the relationship between social anxietydisorder (SAD) and substance use disorders. Cannabis use disorders (CUDs) are becoming increasingly problematic within the population of individuals with SAD, yet the nature of this comorbidity remains largely unexamined. The aim of the current study from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to examine differences between outpatients with SAD with versus without comorbid CUDs. The current study included 873 outpatients with a current diagnosis of SAD. Patients with SAD and comorbid CUDs (n = 173) were then compared to those with SAD without CUDs (n = 700) on demographic and clinical characteristics. Compared to patients without the comorbidity, patients with comorbid SAD and CUDs were more likely to have a lifetime diagnosis of PTSD and specific phobia and lifetime substance use disorders (including alcohol). SAD patients with comorbid CUDs were also more likely to report better physical health, and fewer limitations related to their physical health. These analyses remained significant after controlling for gender, the presence of other substance use disorders, mood disorders, and other anxietydisorders. Findings of this study suggest that there may be a unique relationship between SAD and CUDs that can potentially impact the clinical presentation of individuals with SAD. Future research is needed to examine the impact of this comorbidity in other patient populations. PMID:22047609
Tepe, Elizabeth; Dalrymple, Kristy; Zimmerman, Mark
|Anxiety sensitivity (AS), which refers to the tendency to interpret anxiety-related bodily sensations as having potentially harmful somatic, psychological or social consequences, has been proposed as a vulnerability factor for the development of panic disorder (PD). The current study examined the anxiety sensitivity levels in children of parents…
van Beek, N.; Perna, G.; Schruers, K.; Muris, P.; Griez, E.
The symptom complex of panic disorder and generalized anxietydisorder suggests an etiological role for hyperventilation. The present study investigates the overlap between DSM-III-R panic disorder, panic disorder with agoraphobia and generalized anxietydisorder with hyperventilation syndrome (HVS). The anxietydisorder diagnoses were based on a structured interview, and HVS determined by the so-called hyperventilation provocation test (a brief period
In western literature, the oldest description of symptoms of PTSD, an anxiety group of disorder, is seen in Homer’s Iliad written around 720 BC. According to Shay, Achilles was suffering from symptoms of PTSD. However, in the Indian literature it was mentioned around 5000 BC. The description of a PTSD-like syndrome is seen in the Ramayana, although it was not described as PTSD or by any other similar name. Ravana’s brother Marrich was having symptoms of PTSD after he was grievously hurt by Lord Rama’s arrow and was almost dead. This traumatic event threatened his physical integrity. He developed all the symptoms of PTSD, like hyper-arousal, re-experiencing the events and avoidance. He also gave up his natural work of harassing the monk and got engaged in meditation and austerities. His symptoms lasted for many years till Lord Rama killed him, while he was masquerading as a golden deer to deceive Sita. In another ancient epic Shrimad Bhagavatam, Maharshi Ved Vyasa described the symptoms of Generalized AnxietyDisorder (GAD). The demon King Kansha developed GAD-like symptoms, when Lord Krishna killed all his demons and threatened to kill him. He developed symptoms of GAD, like excessive worry about the attack from his arch foe Krishna, difficulty in concentration and difficulty in falling asleep. Like Marrich, the symptoms of Kansha also lasted until Lord Krishna killed him.
In western literature, the oldest description of symptoms of PTSD, an anxiety group of disorder, is seen in Homer's Iliad written around 720 BC. According to Shay, Achilles was suffering from symptoms of PTSD. However, in the Indian literature it was mentioned around 5000 BC. The description of a PTSD-like syndrome is seen in the Ramayana, although it was not described as PTSD or by any other similar name. Ravana's brother Marrich was having symptoms of PTSD after he was grievously hurt by Lord Rama's arrow and was almost dead. This traumatic event threatened his physical integrity. He developed all the symptoms of PTSD, like hyper-arousal, re-experiencing the events and avoidance. He also gave up his natural work of harassing the monk and got engaged in meditation and austerities. His symptoms lasted for many years till Lord Rama killed him, while he was masquerading as a golden deer to deceive Sita. In another ancient epic Shrimad Bhagavatam, Maharshi Ved Vyasa described the symptoms of Generalized AnxietyDisorder (GAD). The demon King Kansha developed GAD-like symptoms, when Lord Krishna killed all his demons and threatened to kill him. He developed symptoms of GAD, like excessive worry about the attack from his arch foe Krishna, difficulty in concentration and difficulty in falling asleep. Like Marrich, the symptoms of Kansha also lasted until Lord Krishna killed him. PMID:21180424
Background Internalizing psychopathology, anxiety in particular, is assumed to contribute to the development of gender Identity disorder\\u000a (GID). Until now, anxiety has only been reported in studies using parent-report questionnaires; physiological correlates of\\u000a anxiety have not been studied. In this study we assessed anxiety and stress in children with GID by measuring their cortisol,\\u000a heart rate (HR) and skin conductance levels
Madeleine S. C. Wallien; Stephanie H. M. van Goozen; Peggy T. Cohen-Kettenis
The aim of the study was to investigate the extent of social anxiety in different mental disorders. A total of 341 patients aged 7-18 years participated in the study. To measure social anxiety, the German version (SPAIK) of the Social Phobia and Anxiety Inventory for Children (SPAI-C) was used. Subgroups were built dependent on mental disorders. A total score above 20, which was assumed to indicate social anxiety, was observed in children with selective mutism (n = 9; M = 22.68; SD = 11.29) and in children with Asperger's Syndrome (n = 7; M = 20.77; SD = 13.77). Patients who had the following mental disorders also showed a higher total score of social anxiety: obsessive-compulsive disorder, anorexia nervosa, schizophrenia, depression and conduct disorder. In none of these disorders, however, did the mean total score exceed the cut-off of 20. PMID:16523252
Melfsen, Siebke; Walitza, Susanne; Warnke, Andreas
Anxietydisorders are a significant problem in the community, and recent neuroimaging research has focused on determining the brain circuits that underlie them. Research on the neurocircuitry of anxietydisorders has its roots in the study of fear circuits in animal models and the study of brain responses to emotional stimuli in healthy humans. We review this research, as well as neuroimaging studies of anxietydisorders. In general, these studies have reported relatively heightened amygdala activation in response to disorder-relevant stimuli in post-traumatic stress disorder, social phobia, and specific phobia. Activation in the insular cortex appears to be heightened in many of the anxietydisorders. Unlike other anxietydisorders, post-traumatic stress disorder is associated with diminished responsivity in the rostral anterior cingulate cortex and adjacent ventral medial prefrontal cortex. Additional research will be needed to (1) clarify the exact role of each component of the fear circuitry in the anxietydisorders, (2) determine whether functional abnormalities identified in the anxietydisorders represent acquired signs of the disorders or vulnerability factors that increase the risk of developing them, (3) link the findings of functional neuroimaging studies with those of neurochemistry studies, and (4) use functional neuroimaging to predict treatment response and assess treatment-related changes in brain function.
The proper treatment of synovial proliferative disorders depends on an accurate diagnosis and a knowledge of the natural history of these afflictions. A simple classification of the major synovial disorders with a brief general description of each, highlighting the prominent clinical features, is helpful. A thorough history and physical examination should enable the clinician to categorize the nature of the synovial disorder. Further evaluation and consultation can then be directed within the appropriate category. Radiologic, laboratory, and microscopic studies aid in arriving at a definitive diagnosis. Once a diagnosis has been established, therapy or further evaluation can be instituted. PMID:3006715
|The present study first examined the links between reactive temperament (negative affectivity), regulative temperament (effortful control [EC]) and internalizing problems in adolescents (12-18 years) with anxietydisorders (ANX; N = 39) and without anxietydisorders (nANX; N = 35). Links differed between ANX and nANX participants. Negative…
Vervoort, Leentje; Wolters, Lidewij H.; Hogendoorn, Sanne M.; Prins, Pier J.; de Haan, Else; Boer, Frits; Hartman, Catharina A.
The present study first examined the links between reactive temperament (negative affectivity), regulative temperament (effortful control [EC]) and internalizing problems in adolescents (12-18 years) with anxietydisorders (ANX; N = 39) and without anxietydisorders (nANX; N = 35). Links differed between ANX and nANX participants. Negative…
Vervoort, Leentje; Wolters, Lidewij H.; Hogendoorn, Sanne M.; Prins, Pier J.; de Haan, Else; Boer, Frits; Hartman, Catharina A.
|This study examined the incidence and correlates of functional gastrointestinal symptoms in children with anxietydisorders. Participants were 6-13 year old children diagnosed with one or more anxietydisorders (n = 54) and non-clinical control children (n = 51). Telephone diagnostic interviews were performed with parents to determine the…
Waters, Allison M.; Schilpzand, Elizabeth; Bell, Clare; Walker, Lynn S.; Baber, Kari
Intolerance of uncertainty (IU) is the tendency to react negatively to uncertain situations or events, and it has been found to be an important maintaining factor in a number of different anxietydisorders. It is often included as a part of cognitive behavioural interventions for anxietydisorders but its specific contribution to treatment outcome…
The role of neurosteroids in neuropsychiatric disorders has been thoroughly investigated in many research studies that have stressed their significant pathophysiological function in neuropsychiatry. In this review, we will focus mainly on the steroids active on the GABAA receptors studied in anxiety and depression.The aim is to discuss the controversial results reported in research on anxiety and depressive disorders. We
Patrizia Longone; Rainer Rupprecht; Gaia A. Manieri; Giorgio Bernardi; Elena Romeo; Augusto Pasini
|Fearful temperaments have been identified as a major risk factor for anxietydisorders. However, descriptions of fearful temperament and several forms of anxietydisorder show strong similarities. This raises the question whether these terms may simply refer to different aspects of the same underlying construct. The current review examines…
Cognitive-behavioral treatment for all anxietydisorders involves exposure to feared situations and feared emotions. Dropout from therapy is a continued problem for final treatment effectiveness. A meta-emotional model of fear of negative emotions (and anxious sensations and thoughts) is advanced that can be used as a transdiagnostic treatment model for anxietydisorders. According to this model, anxious individuals hold theories
AIMS: The aim of this study was to investigate the effect of juggling therapy for anxietydisorder patients. DESIGN AND METHOD: Subjects were 17 female outpatients who met the DSM-IV diagnostic criteria for anxietydisorders. Subjects were treated with standard psychotherapy, medication and counseling for 6 months. For the last 3 months of treatment, subjects were randomized into either a
|Empirical research highlights the need for improving the childhood anxietydisorder diagnostic classification system. In particular, inconsistencies in the stability estimates of childhood anxietydisorders and high rates of comorbidity call into the question the utility of the current "DSM" criteria. This paper makes a case for utilizing a…
|Objective: There are insufficient data on generalized anxietydisorder in children and adolescents. Symptoms and comorbidity of generalized anxietydisorder are described as a function of age, gender, and comorbidity in a consecutive series of referred children and adolescents. Method: One hundred fifty-seven outpatients (97 males and 60 females,…
Judgmental biases for threat-relevant stimuli are thought to be important mechanisms underlying the etiology and maintenance of anxietydisorders. Previous research has shown that adults with social anxietydisorder rate negative social events as more likely (probability) to occur as well as more distressing (cost) than do nonanxious controls. However, no empirical research has examined whether this is also the
Alyssa A. Rheingold; James D. Herbert; Martin E. Franklin
Judgmental biases for threat-relevant stimuli are thought to be important mechanisms underlying the etiology and maintenance of anxietydisorders. Previous research has shown that adults with social anxietydisorder rate negative social events as more likely (probability) to occur as well as more distressing (cost) than do nonanxious controls. However, no empirical research has examined whether this is also the
Alyssa A. Rheingold; James D. Herbert; Martin E. Franklin
While Wells’ metacognitive model of generalized anxietydisorder (GAD) posits that certain metacognitive processes, such as negative meta-worry (negative beliefs about worry), are more strongly associated with symptoms of GAD than other anxietydisorders in adults, research has yet to determine whether the same pattern is true for younger individuals. We examined the relationship between several metacognitive processes and anxietydisorder diagnostic status in a sample of 98 youth aged 7–17 years. Twenty youth with GAD were compared with similarly sized groups of youth with obsessive-compulsive disorder (OCD, n = 18), social phobia (SOC, n = 20), separation anxietydisorder (SAD, n = 20), and healthy controls who were not patients (NONP, n = 20) using a self-report measure of metacognition adapted for use with young people in this age range (Metacognitions Questionnaire for Children). Contrary to expectations, only one specific metacognitive process was significantly associated with an anxietydisorderdiagnosis, in that the controls endorsed a greater degree of cognitive monitoring (self-reported awareness of one’s thoughts) than those with SAD. In addition, there was a trend indicating that nonpatients scored higher than youth with GAD on this scale. These surprising results suggest potentially differing patterns in the relationships between symptoms and metacognitive awareness in anxious youth, depending on the type of anxietydisorder presentation.
Bacow, Terri Landon; May, Jill Ehrenreich; Brody, Leslie R; Pincus, Donna B
Trait anxiety and eating disorder (ED) symptomatology are often thought to be inextricably linked. Because anxiety often precedes an ED, predicts poor outcome, and persists even after recovery from an ED, it is important to examine whether certain factors have the ability to potentially attenuate anxiety’s effect on eating pathology. In the current study, we examined two possible moderating factors: coping skills and social support. Participants were 96 females seen at one point for an ED at a Midwestern clinic, including 53 with a current ED diagnosis and 43 who no longer met criteria for an ED and who were at varying levels of recovery. Results revealed that emotion-oriented coping moderated the relation between anxiety and ED symptoms. Individuals who were high in trait anxiety and who reported low levels of emotion-oriented coping reported much lower levels of ED symptomatology than those with high trait anxiety and high emotion-oriented coping. Contrary to our hypotheses, task-oriented coping, avoidance-oriented coping, and perceived social support (total, family, friend, and special person) did not emerge as moderators of the relation between trait anxiety and eating pathology. Results provide growing support that factors that interact with anxiety can lessen anxiety’s effect on eating pathology. Implications for treatment and future directions are discussed.
Increasingly, emphasis is being placed on measurement-based care to improve the quality of treatment. Although much of the focus has been on depression, measurement-based care may be particularly applicable to social anxietydisorder (SAD) given its high prevalence, high comorbidity with other disorders, and association with significant functional impairment. Many self-report scales for SAD currently exist, but these scales possess limitations related to length and/or accessibility that may serve as barriers to their use in monitoring outcome in routine clinical practice. Therefore, the aim of the current study was to develop and validate the Clinically Useful Social AnxietyDisorder Outcome Scale (CUSADOS), a self-report measure of SAD. The CUSADOS was designed to be reliable, valid, sensitive to change, brief, easy to score, and easily accessible, to facilitate its use in routine clinical settings. The psychometric properties of the CUSADOS were examined in 2415 psychiatric outpatients who were presenting for treatment and had completed a semi-structured diagnostic interview. The CUSADOS demonstrated excellent internal consistency, and high item-total correlations and test-retest reliability. Within a sub-sample of 381 patients, the CUSADOS possessed good discriminant and convergent validity as it was more highly correlated with other measures of SAD than with other psychiatric disorders. Furthermore, scores were higher in outpatients with a current diagnosis of SAD compared to those without a SAD diagnosis. Preliminary support also was obtained for the sensitivity to change of the CUSADOS in a sample of 15 outpatients receiving treatment for comorbid SAD and depression. Results from this validation study in a large psychiatric sample show that the CUSADOS possesses good psychometric properties. Its brevity and ease of scoring also suggest that it is feasible to incorporate into routine clinical practice. PMID:23642634
Background Primary care physicians often treat older adults with Generalized AnxietyDisorder. Objective To estimate physician diagnosis and recognition of anxiety and compare health service use among older adults with GAD with\\u000a two comparison samples with and without other DSM diagnoses. Methods Participants were 60+ patients of a multi-specialty medical organization. Administrative database and medical records were\\u000a reviewed for a
Jessica Calleo; Melinda A. Stanley; Anthony Greisinger; Oscar Wehmanen; Michael Johnson; Diane Novy; Nancy Wilson; Mark Kunik
BACKGROUND Theory suggests that natural selection conserved reactivity in part because highly reactive women spontaneously abort less fit conceptuses, particularly small males. Other literature argues that high reactivity manifests clinically as anxietydisorders. If true, births to women diagnosed with anxietydisorders should exhibit a low secondary sex ratio (i.e. ratio of male to female births). We explored whether births to women diagnosed with anxietydisorders exhibit a lower sex ratio than births to women diagnosed with other psychiatric disorders, or to women without mental health diagnoses. METHODS We performed a case–control comparison of the secondary sex ratios among groups of women categorized by mental health diagnosis using birth records linked to data from California County Mental Health system records. We compared sex ratios among 5994 deliveries to mothers diagnosed with anxietydisorders, 23 443 deliveries to mothers diagnosed with other psychiatric disorders and 1 099 198 ‘comparison’ births. RESULTS Although comparison births exhibited a higher sex ratio than births to women diagnosed with anxietydisorders or with other diagnoses, differences were not statistically significant. Births to African American women diagnosed with anxietydisorders, however, exhibited sex ratios significantly lower than comparison births among African Americans (OR = 0.89, P = 0.038) or births to African American women with other mental health diagnoses (OR = 0.88, P = 0.042). CONCLUSIONS We found that infants born to African American women diagnosed with anxietydisorders exhibited a significantly lower secondary sex ratio than reference groups. We urge confirmatory tests of our findings and discuss implications of the reactivity/anxiety hypothesis for psychiatry, obstetrics and public health.
Subbaraman, M.S.; Goldman-Mellor, S.J.; Anderson, E.S.; LeWinn, K.Z.; Saxton, K.B.; Shumway, M.; Catalano, R.
Individuals with generalized anxietydisorder (GAD) display poor emotional conflict adaptation, a cognitive control process requiring the adjustment of performance based on previous-trial conflict. It is unclear whether GAD-related conflict adaptation difficulties are present during tasks without emotionally-salient stimuli. We examined conflict adaptation using the N2 component of the event-related potential (ERP) and behavioral responses on a Flanker task from 35 individuals with GAD and 35 controls. Groups did not differ on conflict adaptation accuracy; individuals with GAD also displayed intact RT conflict adaptation. In contrast, individuals with GAD showed decreased amplitude N2 principal component for conflict adaptation. Correlations showed increased anxiety and depressive symptoms were associated with longer RT conflict adaptation effects and lower ERP amplitudes, but not when separated by group. We conclude that individuals with GAD show reduced conflict-related component processes that may be influenced by compensatory activity, even in the absence of emotionally-salient stimuli. PMID:24005064
Larson, Michael J; Clawson, Ann; Clayson, Peter E; Baldwin, Scott A
Cognitive models of social anxiety posit that recurrent interpretation of ambiguous information as threatening maintains symptoms (e.g. Clark & Wells, 1995, pp. 69-93, Social phobia: Diagnosis, assessment, and treatment. New York: Guilford Press; Rapee & Heimberg, 1997, pp. 741-756, Behavior Research and Therapy, 35). However, biased interpretation may also be represented as a failure to make a benign interpretation of the ambiguous event. Furthermore, interpretation bias can be characterized by both an online (automatic) component and an offline (effortful) component (Hirsch & Clark, 2004, pp. 799-825, Clinical Psychology Review, 24). To measure both benign and threat biases, as well as examine the effect of social anxiety on offline versus online interpretations, Beard and Amir (2009, pp. 1135-1141, Behaviour Research and Therapy, 46) developed the Word Sentence Association Paradigm (WSAP). In the current study, we administered the WSAP to a group of participants diagnosed with social anxietydisorder (SAD) as well as to a group of non-anxious control (NAC) participants. We found that participants with SAD demonstrated a lack of benign online bias, but not an online threat bias when compared to NACs. However, when examining offline biases, SAD patients endorsed social threat interpretations and rejected benign social interpretations to a greater degree than non-anxious individuals. Our results, when taken together, clearly implicate the role of reduced bias toward benign information in SAD. PMID:22545788
Amir, Nader; Prouvost, Caroline; Kuckertz, Jennie M
Objectives Older adults face a number of barriers to receiving psychotherapy, such as a lack of transportation and access to providers. One way to overcome such barriers is to provide treatment by telephone. The purpose of this study was to examine the effects of cognitive behavioral therapy delivered by telephone (CBT-T) to older adults diagnosed with an anxietydisorder. Design Randomized controlled trial. Setting Participants' homes. Participants Sixty participants ? 60 years of age with a diagnosis of Generalized AnxietyDisorder, Panic Disorder, or AnxietyDisorder Not Otherwise Specified. Intervention CBT-T vs. information-only comparison. Measurements Co-primary outcomes included worry (Penn State Worry Questionnaire) and general anxiety (State Trait Anxiety Inventory). Secondary outcomes included clinician-rated anxiety (Hamilton Anxiety Rating Scale), anxiety sensitivity (Anxiety Sensitivity Index), depressive symptoms (Beck Depression Inventory), quality of life (SF-36), and sleep (Insomnia Severity Index). Assessments were completed prior to randomization, immediately upon completion of treatment, and 6 months after completing treatment. Results CBT-T was superior to information-only in reducing general anxiety (ES = 0.71), worry (ES = 0.61), anxiety sensitivity (ES = 0.85), and insomnia (ES = 0.82) at the post-treatment assessment; however, only the reductions in worry were maintained by the 6 month follow-up assessment (ES = 0.80). Conclusions These results suggest that CBT-T may be efficacious in reducing anxiety and worry in older adults, but additional sessions may be needed to maintain these effects.
Brenes, Gretchen A.; Miller, Michael E.; Williamson, Jeff D.; McCall, W. Vaughn; Knudson, Mark; Stanley, Melinda A.
Comorbid depression and anxietydisorders are commonly experienced in mothers. Both maternal depression and anxiety as well as their comorbidity has been shown to increase psychopathology in children, however, there is limited research focusing on African American families. The aim of this study is to examine whether comorbid anxietydisorders are associated with maternal depression severity, kinship support, and child behavioral problems in a sample of African American mothers with depression. African American mothers (n = 77) with a past year diagnosis of a depressive disorder and a child between the ages of ages 8–14 were administered a clinician interview and measures of maternal depression severity, kinship support, and child behavior problems (internalizing and externalizing) in a cross-sectional design. Results showed that more than half (58%) of the mothers had a comorbid anxietydisorder and a third had Posttraumatic Stress Disorder (PTSD). Regression analyses showed that comorbid PTSD and Social Phobia were positively associated with maternal depression severity. Maternal comorbid Obsessive Compulsive Disorder (OCD) was associated with child internalizing symptoms. The findings are consistent with other research demonstrating negative outcomes with maternal comorbidity of depression and anxiety, however, there is limited research focused on maternal depression and OCD or PTSD. The study suggests that it is important to consider comorbid anxiety and cultural issues when conceptualizing, studying, and treating mothers with depression and their families.
This study examined the temporal sequencing of eating and anxietydisorders to delineate which anxietydisorders increase eating disorder risk and whether individuals with eating disorders are at greater risk for particular anxietydisorders. The sample was drawn from the Oregon Adolescent Depression Project. Temporal relations between specific eating and anxietydisorders were examined after controlling for relevant variables (e.g., mood disorders, other anxietydisorders) over 14 years. After excluding those with anorexia nervosa (AN) in adolescence (T1), OCD was the only T1 anxietydisorder to predict AN by age 30 (T4). No T1 anxietydisorder was associated with T4 bulimia nervosa (BN). Although T1 AN did not increase risk of any T4 anxietydisorder, T1 BN appeared to increase risk for social anxiety and panic disorders. Evidence that eating disorders may have differential relations to particular anxietydisorders could inform prevention and treatment efforts.
Buckner, Julia D.; Silgado, Jose; Lewinsohn, Peter M.
Since the mid-90s several studies have proven the existence of an Adult form of the Separation AnxietyDisorder (ASAD) not yet nosologically recognized by the international psychiatric classification systems (DSM and ICD). An increasing amount of evidence showed that the separation anxietydisorder may arise at any age, not always in continuation with the correspondent childhood disorder. So, a revision of the diagnostic criteria for this disorder is brought into question, as the onset is currently limited before 18 years of age. Different tools have been developed for the assessment of ASAD: 1) the Adult Separation Anxiety Structured Interview (ASA-SI), a semi-structured interview with items derived and adapted from the DSM-IV-TR childhood disorder; 2) the Adult Separation Anxiety-27 (ASA-27), a self-administered rating scale containing the same items of ASA-SI; 3) the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), a structured interview including two specific forms for childhood and adulthood. However, according to available evidence, the separation anxiety may be a dimension with cross-nosographical presentation in nearly all the commonest mood and anxietydisorders; moreover, it is connected to greater personal dysfunction and lower responsiveness to treatment. Furthermore, a deeper comprehension of the psychobiological nature of separation anxiety should lead to newer and more effective therapeutic intervention. Literature is reviewed awaiting the publication of DSM-V. PMID:23160046
Although anxietydisorders, like depression, are increasingly being associated with metabolic and cardiovascular burden, in contrast with depression, the role of inflammation in anxiety has sparsely been examined. This large cohort study examines the association between anxietydisorders and anxiety characteristics with several inflammatory markers. For this purpose, persons (18–65 years) with a current (N=1273) or remitted (N=459) anxietydisorder (generalized anxietydisorder, social phobia, panic disorder, agoraphobia) according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and healthy controls (N=556) were selected from the Netherlands Study of Depression and Anxiety. In addition, severity, duration, age of onset, anxiety subtype and co-morbid depression were assessed. Inflammatory markers included C-reactive protein (CRP), interleukin (IL)-6 and tumor-necrosis factor (TNF)-?. Results show that after adjustment for sociodemographics, lifestyle and disease, elevated levels of CRP were found in men, but not in women, with a current anxietydisorder compared with controls (1.18 (s.e.=1.05) versus 0.98 (s.e.=1.07) mg?l?1, P=0.04, Cohen's d=0.18). No associations were found with IL-6 or TNF-?. Among persons with a current anxietydisorder, those with social phobia, in particular women, had lower levels of CRP and IL-6, whereas highest CRP levels were found in those with an older age of anxietydisorder onset. Especially in persons with an age of onset after 50 years, CRP levels were increased compared with controls (1.95 (s.e.=1.18) versus 1.27 (s.e.=1.05) mg?l?1, P=0.01, Cohen's d=0.37). In conclusion, elevated inflammation is present in men with current anxietydisorders. Immune dysregulation is especially found in persons with a late-onset anxietydisorder, suggesting the existence of a specific late-onset anxiety subtype with a distinct etiology, which could possibly benefit from alternative treatments.
Vogelzangs, N; Beekman, A T F; de Jonge, P; Penninx, B W J H
|Research indicates that depression and anxiety are highly comorbid in youth. Little is known, however, about the clinical and family characteristics of youth with principal anxietydisorders and comorbid depressive diagnoses. The present study examined the demographic, clinical, and family characteristics of 200 anxiety-disordered children and…
O'Neil, Kelly A.; Podell, Jennifer L.; Benjamin, Courtney L.; Kendall, Philip C.
Research indicates that depression and anxiety are highly comorbid in youth. Little is known, however, about the clinical and family characteristics of youth with principal anxietydisorders and comorbid depressive diagnoses. The present study examined the demographic, clinical, and family characteristics of 200 anxiety-disordered children and…
O'Neil, Kelly A.; Podell, Jennifer L.; Benjamin, Courtney L.; Kendall, Philip C.
Women who were referred with an eating disorder (ED) were compared with a matched normal control group to answer the following questions: What are the frequencies of anxietydisorders in cases of anorexia and bulimia nervosa diagnosed according to DSM-IV criteria? Are anxietydisorders significantly more frequent among women with an eating disorder than among women from the community? We
Nathalie T. Godart; Martine F. Flament; Florence Curt; Fabienne Perdereau; François Lang; Jean Luc Venisse; Olivier Halfon; Paul Bizouard; Gwenolé Loas; Maurice Corcos; Philippe Jeammet; Jacques Fermanian
This study investigated the relationship between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) and comorbid anxiety, depressive, and substance use disorders over the first 12-month period following a cancer diagnosis. Individuals recently diagnosed with 1st onset head and neck or lung malignancy were assessed for ASD within the initial month following their diagnosis and reassessed for PTSD and
Social anxietydisorder (SAD) and body dysmorphic disorder (BDD) are two separate, but conceptually overlapping nosological entities. In this review, we examine similarities between SAD and BDD in comorbidity, phenomenology, cognitive biases, treatment outcome, and cross-cultural aspects. Our review suggests that SAD and BDD are highly comorbid, show a similar age of onset, share a chronic trajectory, and show similar cognitive biases for interpreting ambiguous social information in a negative manner. Furthermore, research from treatment outcome studies have demonstrated that improvements in SAD were significantly correlated with improvements in BDD. Findings from cross-cultural research suggest that BDD may be conceived as a subtype of SAD in some Eastern cultures. Directions for future research and clinical implications of these findings are discussed.
Rationale Pediatric anxiety is a prevalent psychiatric disorder that may have important implications for school, social, and academic\\u000a function. Psychopharmacological approaches to the treatment of pediatric anxiety have expanded over the past 20 years and\\u000a increasing empirical evidence helps guide current clinical practice.\\u000a \\u000a \\u000a \\u000a Objective To review studies which examine the pharmacological treatment of pediatric anxietydisorders, including obsessive–compulsive\\u000a disorder and to summarize treatment
Over the last decade, psychopharmacologic treatments for pediatric anxietydisorders have been developed and increasingly subjected to randomized, controlled trials. The authors summarize the data concerning the use of tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), atypical anxiolytics, and benzodiazepines. The extant data suggest that SSRIs--both as monotherapy and when combined with psychotherapy--are effective in the treatment of pediatric anxietydisorders. In addition, some TCAs and SNRIs are effective. However, randomized controlled trials do not suggest efficacy for benzodiazepines or the atypical anxiolytic, buspirone, for children and adolescents with anxietydisorders. PMID:22800992
Strawn, Jeffrey R; Sakolsky, Dara J; Rynn, Moira A
AIMTo investigate the rate and nature of anxiety symptoms and disorders in children, and their relation to social adversities in a cultural sample not previously researched.METHODS237 children aged 9 to 13 years living in the Gaza Strip were selected randomly from 112 schools. Children completed the revised manifest anxiety scale (a questionnaire with yes\\/no answers for 28 anxiety items and
This chapter begins with a review of the prevalence, assessment, and clinical presentation of anxiety in the perinatal period.\\u000a Next, we discuss two forms of treatment for anxiety that have been found effective in clinical research: cognitive-behavioral\\u000a therapy and certain classes of medication. The effectiveness of these treatments with each of the anxietydisorders is discussed,\\u000a as is the issue
Jonathan S. Abramowitz; Karin Larsen; Katherine M. Moore
Background This study prospectively examined the natural clinical course of six anxietydisorders over 7 years of follow-up in individuals with personality disorders (PDs) and/or major depressive disorder. Rates of remission, relapse, new episode onset and chronicity of anxietydisorders were examined for specific associations with PDs. Method Participants were 499 patients with anxietydisorders in the Collaborative Longitudinal Personality Disorders Study, who were assessed with structured interviews for psychiatric disorders at yearly intervals throughout 7 years of follow-up. These data were used to determine probabilities of changes in disorder status for social phobia (SP), generalized anxietydisorder (GAD), obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder and panic disorder with agoraphobia. Results Estimated remission rates for anxietydisorders in this study group ranged from 73% to 94%. For those patients who remitted from an anxietydisorder, relapse rates ranged from 34% to 67%. Rates for new episode onsets of anxietydisorders ranged from 3% to 17%. Specific PDs demonstrated associations with remission, relapse, new episode onsets and chronicity of anxietydisorders. Associations were identified between schizotypal PD with course of SP, PTSD and GAD; avoidant PD with course of SP and OCD; obsessive-compulsive PD with course of GAD, OCD, and agoraphobia; and borderline PD with course of OCD, GAD and panic with agoraphobia. Conclusions Findings suggest that specific PD diagnoses have negative prognostic significance for the course of anxietydisorders underscoring the importance of assessing and considering PD diagnoses in patients with anxietydisorders.
Ansell, E. B.; Pinto, A.; Edelen, M. O.; Markowitz, J. C.; Sanislow, C. A.; Yen, S.; Zanarini, M.; Skodol, A. E.; Shea, M. T.; Morey, L. C.; Gunderson, J. G.; McGlashan, T. H.; Grilo, C. M.
|While parenting behaviors among anxious parents have been implicated in the familial transmission of anxiety, little is known about whether these parenting behaviors are unique to specific parental anxietydisorders. The current study examined differences in the use of five specific parenting behaviors (i.e., warmth/positive affect, criticism,…
Budinger, Meghan Crosby; Drazdowski, Tess K.; Ginsburg, Golda S.
The authors investigated the psychometric properties of the Beck Anxiety Inventory (BAI) in a sample of 75 older generalized anxietydisorder (GAD) patients and a comparison group of 32 older adults without significant psychopathology. Internal consistency was above .80, and the BAI showed evidence of convergent validity in both groups. Evidence for discriminant validity with respect to measures of depression
This study examined relations between anxiety, aggression, social understanding, IQ, and diagnosis in a sample of 231 children (ages 2–9) diagnosed with Autism Spectrum Disorders (ASDs; Autistic Disorder, Asperger's Disorder, Pervasive Developmental Disorder Not Otherwise Specified) in a hospital setting. Children were administered tests of IQ, and parents completed measures of remaining variables. ASD diagnosis was associated with level of
Laura A. Niditch; R. Enrique Varela; Jodi L. Kamps; Trenesha Hill
Avoidant Personality Disorder (AvPD) has a high level of symptom overlap and comorbidity with Generalized Social AnxietyDisorder (GSAD). We examined whether the presence of comorbid AvPD adds significant clinically relevant information for individuals seeking treatment for GSAD. Results suggested that AvPD was significantly associated with poorer quality of life and greater disability in univariate, but not multivariate analyses. Endorsement of more AvPD symptoms was associated with increased disability, increased risk of intimacy, and lower social support, even after covariate adjustment. Specifically, AvPD item 3, hard to be “open” even with people you are close to, was most strongly correlated with quality of life and disability. A binary diagnosis of AvPD alone adds little beyond a marker of greater GSAD severity and depression among patients with GSAD, while a specific feature of AvPD not captured by the GSAD diagnosis, namely emotional guardedness, may be associated with greater impairment.
Marques, Luana; Porter, Eliora; Keshaviah, Aparna; Pollack, Mark H.; Van Ameringen, Michael; Stein, Murray B.; Simon, Naomi M.
Although there is a small but growing body of literature examining the psychopathology of anxiety among Native Americans, no data are available regarding the efficacy of empirically supported treatments for anxietydisorders among Native Americans. Moreover, exceptional challenges arise in adapting mainstream approaches to Native Americans, such…
Generalized AnxietyDisorder (GAD) can be treated effectively with cognitive-behavioral therapy. When working with clients who have GAD, therapy can focus on four central areas that help to promote therapeutic change. The initial focus of therapy is on developing a sound therapeutic alliance and educating the client about anxiety symptoms. Skills training focuses on relaxation training and cognitive changes that
The current study examined relationships between attachment style, behavioral inhibition, and anxietydisorders symptoms not only relying on youths' self-report but also including the parents' point of view. A large group of young adolescents aged 11–15 years and their parents (N = 280) completed measures of attachment style and behavioral inhibition and the Revised Children's Anxiety and Depression Scale, a
Although there is a small but growing body of literature examining the psychopathology of anxiety among Native Americans, no data are available regarding the efficacy of empirically supported treatments for anxietydisorders among Native Americans. Moreover, exceptional challenges arise in adapting mainstream approaches to Native Americans, such as language barriers, contrasting beliefs about the cause and treatment of emotional illness
|Objective: To evaluate the prevalence of somatic symptoms (SSs) in children and adolescents with anxietydisorders; the relationship between SSs and anxiety severity, impairment, and child global functioning; and the impact of fluvoxamine (FLV) versus pill placebo (PBO) on reducing SSs. Method: As part of a double-blind, placebo-controlled trial,…
The present study first examined the links between reactive temperament (negative affectivity), regulative temperament (effortful control [EC]) and internalizing problems in adolescents (12–18 years) with anxietydisorders (ANX; N = 39) and without anxietydisorders (nANX; N = 35). Links differed between ANX and nANX participants. Negative affectivity predicted internalizing problems, with almost no role of EC in nANX, but a protective role of
Leentje Vervoort; Lidewij H. Wolters; Sanne M. Hogendoorn; Pier J. Prins; Else de Haan; Frits Boer; Catharina A. Hartman
Psychophysiological response to fear memory imagery was assessed in specific phobia, social anxietydisorder, panic disorder with agoraphobia, post-traumatic stress disorder (PTSD), and healthy controls. Heart rate, skin conductance, and corrugator muscle were recorded as participants responded to tone cues signaling previously memorized descriptor sentences. Image contents included personal fears, social fears, fears of physical danger, and neutral (low arousal)
Bruce N. Cuthbert; Peter J. Lang; Cyd Strauss; David Drobes; Christopher J. Patrick; Margaret M. Bradley
The neurobiology of the anxietydisorders, which include panic disorder, post-traumatic stress disorder (PTSD), and specific ph o- bias, among others, has been clarified by advances in the field of classical or Pavlovian conditioning, and in our understandin g of basic mechanisms of memory and learning. Fear conditioning occurs when a neutral conditioned stimulus (such as a tone) is paired
AMIR GARAKANI; SANJAY J. MATHEW; DENNIS S. CHARNEY
The relationship between selective mutism (SM) and childhood anxietydisorders is illustrated through an examination of their temperamental, environmental, and biological etiologies. SM is also explored as a symptom of the specific anxietydisorders of social phobia, separation anxiety, and posttraumatic stress disorder. The etiology and symptom overlap demonstrates SM as being an anxietydisorder or a variant of a
BACKGROUND: The developing world is faced with a high burden of anxietydisorders. The exact prevalence of anxietydisorders in Pakistan is not known. There is a need to develop an evidence base to aid policy development on tackling anxiety and depressive disorders in the country. This is the first pilot study to address the prevalence of anxietydisorders and
Hassan Khan; Saira Kalia; Ahmed Itrat; Abdullah Khan; Mahwash Kamal; Muhammad A Khan; Roha Khalid; Salman Khalid; Sunniya Javed; Sanniya Javed; Affan Umer; Haider Naqvi
Comorbid anxietydisorders are common in children with autism spectrum disorders (ASD). However, studies comparing children with ASD to clinically anxious children are rare. This study investigated anxiety problems and health-related quality of life in children with high-functioning ASD and comorbid anxietydisorders (referred to as the ASD group), compared with children with anxietydisorders (referred to as the AD
Francisca J. A. van Steensel; Susan M. Bögels; Carmen D. Dirksen
|Anxietydisorders are among the most common psychiatric disorders in childhood. Nonetheless, theoretical knowledge of the development and maintenance of childhood anxietydisorders is still in its infancy. Recently, research has begun to investigate the influence of emotion regulation on anxietydisorders. Although a relation between anxiety…
Esbjorn, B. H.; Bender, P. K.; Reinholdt-Dunne, M. L.; Munck, L. A.; Ollendick, T. H.
Data from the Children in the Community Study, a prospective longitudinal investigation, were used to investigate the association of personality disorder (PD) traits, evident by early adulthood, with risk for development of anxietydisorders by middle adulthood. Individuals without a history of anxietydisorders who met diagnostic criteria for ?1 PD by early adulthood were at markedly elevated risk for
Jeffrey G. Johnson; Patricia Cohen; Stephanie Kasen; Judith S. Brook
ObjectiveThis study compared family-focused cognitive behavioral therapy (CBT; the Building Confidence Program) with traditional child-focused CBT with minimal family involvement for children with anxietydisorders.
JEFFREY J. WOOD; JOHN C. PIACENTINI; MICHAEL SOUTHAM-GEROW; BRIAN C. CHU; MARIAN SIGMAN
This article presents a brief conceptual overview of acceptance-based behavioral therapies (ABBTs) for anxietydisorders, followed by a review and summary of the recent efficacy studies of ABBTs for anxiety and comorbid disorders. We discuss clinical implications, including the importance of targeting reactivity and experiential avoidance in interventions for anxietydisorders through the use of mindfulness and other acceptance-based strategies, as well the encouragement of engagement in meaningful activities or valued action. We also address future directions for research, such as expanding research to include more randomized control trials comparing ABBTs for specific anxietydisorders to other active treatments, examining mechanisms of change, exploring adaptations in different care-delivery contexts, as well as determining the applicability of these approaches to clients from marginalized or non-dominant statuses. PMID:24078067
Roemer, Lizabeth; Williston, Sarah K; Eustis, Elizabeth H; Orsillo, Susan M
Cannabinoid agents modulate anxiety, although their effects vary and depend on regional endogenous tone, basal anxiety levels,\\u000a environmental context, species differences, type of anxiety, prior exposure, and dose. Cannabinoid receptors are densely located\\u000a in brain areas that are involved in the regulation of emotional states and induce neurochemical responses that are congruent\\u000a with anxiolyt ic\\/anxiogenic effects. The effects on emotion
There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk\\u000a of anxiety and anxietydisorders. However, it is less clear which of the specific DSM-IV anxietydisorders occur most in this\\u000a population. The present study used meta-analytic techniques to help clarify this issue. A systematic review of the literature\\u000a identified 31 studies involving
Francisca J. A. van Steensel; Susan M. Bögels; Sean Perrin
Although anxietydisorders and headaches are comorbid conditions, there have been no studies evaluating the prevalence of\\u000a primary headaches in patients with generalized anxietydisorder (GAD). The aim of this study was to analyze the lifetime prevalence\\u000a of primary headaches in individuals with and without GAD. A total of 60 individuals were evaluated: 30 GAD patients and 30\\u000a controls without
Juliane P. P. MercanteMario; Mario F. P. Peres; Márcio A. Bernik
Objective Research has consistently shown that anxietydisorders are common among individuals with eating disorders. Although social phobia has been found to be highly associated with eating disorders, less is known about social anxiety in individuals with binge eating disorder (BED). The present study examined associations between social anxiety and self-consciousness with BMI and eating-disorder psychopathology in BED. Methods Participants were 113 overweight or obese treatment seeking men and women with BED. Participants were administered semi-structural diagnostic clinical interviews and completed a battery of self-report measures. Results Social anxiety was positively and significantly correlated with shape- and weight-concerns, and binge eating frequency. After accounting for depressive levels, social anxiety and self-consciousness accounted for significant variance in eating-, shape-, and weight-concerns and overall eating-disorder global severity scores (Eating Disorder Examination). Social anxiety also accounted for significant variance in binge eating frequency after co-varying for depressive levels. Social anxiety and self-consciousness were not significantly associated with BMI or dietary restraint. Discussion Our findings suggest that greater social anxiety and heightened self-consciousness are associated with greater eating disorder psychopathology, most notably with greater shape- and weight-concerns and binge eating frequency in patients with BED. Social anxiety and self-consciousness do not appear to be merely functions of excess weight, and future research should examine whether they contribute to the maintenance of binge eating and associated eating-disorder psychopathology.
Sawaoka, Takuya; Barnes, Rachel D.; Blomquist, Kerstin K.; Masheb, Robin M.; Grilo, Carlos M.
Sampling of amniotic fluid, visualization of the fetus, fetal blood sampling, and screening of maternal blood represent successive approaches to the diagnosis of specific genetic disorders in the second trimester of pregnancy. Clinical and ethical concerns about the appropriateness, safety, and efficacy of the techniques have led to multidisciplinary assessments at an early stage. A major growth in demand for
Techniques for the diagnosis of copper transport disorders are increasingly important due to recent recognition of previously unappreciated clinical phenotypes and emerging advances in the treatment of these conditions. Here, we collate the diagnostic approaches and techniques currently employed for biochemical and molecular assessment of at-risk individuals in whom abnormal copper metabolism is suspected.
M?ller, Lisbeth B.; Hicks, Julia D.; Holmes, Courtney S.; Goldstein, David S.; Brendl, Cornelia; Huppke, Peter; Kaler, Stephen G.
Much of the research on the neurobiology of human anxietydisorders has focused on psychopaihological abnormalities in patients with anxietydisorders. While this line of research is obviously important, more investigation is needed to elucidate the psychobiology of resilience to extreme stress. Study of the psychobiology of resilience has the potential to identify neurochemical, neuropeptide, and hormonal mediators of vulnerability and resilience to severe stress. In addition, the relevance of neural mechanisms of reward and motivation, fear responsiveness, and social behavior to character traits associated with risk and resistance to anxietydisorders may be clarified. These areas of investigation should lead to improved methods of diagnosis, novel approaches to prevention, and new targets for antianxiety drug discovery.
Clinician-guided Internet-based cognitive behavioural therapy (iCBT) programs are clinically effective at treating specific anxietydisorders. The present study examined the efficacy of a transdiagnostic Internet-based cognitive behavioural treatment (iCBT) program to treat more than one anxietydisorder within the same program (the Anxiety Program). Eighty six individuals meeting diagnostic criteria for generalized anxietydisorder (GAD), panic disorder, and/or social phobia were randomly assigned to a treatment group, or to a waitlist control group. Treatment consisted of CBT based online educational lessons and homework assignments, weekly email or telephone contact from a clinical psychologist, access to a moderated online discussion forum, and automated emails. An intention-to-treat model using the baseline-observation-carried-forward principle was employed for data analyses. Seventy-five percent of treatment group participants completed all 6 lessons within the 8 week program. Post-treatment data was collected from 38/40 treatment group and 38/38 control group participants, and 3-month follow-up data was collected from 32/40 treatment group participants. Relative to controls, treatment group participants reported significantly reduced symptoms of anxiety as measured by the Generalized AnxietyDisorder - 7 Item, Social Phobia Screening Questionnaire, and the Panic Disorder Severity Rating Scale - Self Report Scale, but not on the Penn State Worry Questionnaire, with corresponding between-groups effect sizes (Cohen's d) at post-treatment of 0.78, 0.43, 0.43, and 0.20, respectively. The clinician spent a total mean time of 46min per person over the program, participants rated the procedure as moderately acceptable, and gains were sustained at follow-up. Modifications to the Anxiety program, based on post-treatment feedback from treatment group participants, were associated with improved outcomes in the control group. These results indicate that transdiagnostic programs for anxietydisorders may be successfully administered via the Internet. PMID:20561606
Titov, Nickolai; Andrews, Gavin; Johnston, Luke; Robinson, Emma; Spence, Jay
This randomized clinical trial compared the relative efficacy of individual (child) cognitive–behavioral therapy (ICBT), family cognitive–behavioral therapy (FCBT), and a family-based education\\/support\\/attention (FESA) active control for treating anxietydisordered youth ages 7–14 years (M = 10.27). Youth (N = 161; 44% female; 85% Caucasian, 9% African American, 3% Hispanic, 3% other\\/mixed) with a principal diagnosis of separation anxietydisorder, social
Philip C. Kendall; Jennifer L. Hudson; Elizabeth Gosch; Ellen Flannery-Schroeder; Cynthia Suveg
This is a study of comorbid anxietydisorders and how they affect the clinical picture of comorbid cases. The sample consisted\\u000a of 576 Spanish children aged 8 to 17 years receiving psychiatric outpatient consultation that were evaluated using a semi-structured\\u000a diagnostic interview for both parents and children. A specific association of homotypic comorbidity among anxietydisorders\\u000a that was independent of the
This study was designed to explore the role of perceived parenting behavior in the relationship between parent and offspring anxietydisorders in a high-risk sample of adolescents. We examined the relationship between parental and child anxietydisorders and tested whether perceived parenting behavior acted as a mediator between these variables. Analyses were performed on a high-risk sample of 816 fifteen-year-olds
Erin B. McClure; Patricia A. Brennan; Constance Hammen; Robyne M. Le Brocque
The construct of emotion regulation has been increasingly investigated in the last decade, and this work has important implications for advancing anxietydisorder theory. This paper reviews research demonstrating that: 1) emotion (i.e., fear and anxiety) and emotion regulation are distinct, non-redundant, constructs that can be differentiated at the conceptual, behavioral, and neural levels of analysis; 2) emotion regulation can augment or diminish fear, depending on the emotion regulation strategy employed; and 3) measures of emotion regulation explain incremental variance in anxietydisorder symptoms above and beyond the variance explained by measures of emotional reactivity. The authors propose a model by which emotion regulation may function in the etiology of anxietydisorders. The paper concludes with suggestions for future research.
Cisler, Josh M.; Olatunji, Bunmi O.; Feldner, Matthew T.; Forsyth, Jphn P.
Fear–anxiety–avoidance models posit pain-related anxiety and anxiety sensitivity as important contributing variables in the development and maintenance of chronic musculoskeletal pain [Asmundson, G. J. G, Vlaeyen, J. W. S., & Crombez, G. (Eds.). (2004). Understanding and treating fear of pain. New York: Oxford University Press]. Emerging evidence also suggests that pain-related anxiety may be a diathesis for many other emotional
R. Nicholas Carleton; Murray P. Abrams; Gordon J. G. Asmundson; Martin M. Antony; Randi E. McCabe
Anxietydisorders are highly prevalent among individuals with borderline personality disorder, with comorbidity rates of up to 90%. Anxietydisorders have been found to reduce the likelihood of achieving remission from borderline personality disorder over time and to increase the risk of suicide and self-injury in this population. Evidence-based treatments for borderline personality disorder have not sufficiently focused on targeting anxietydisorders, and their effects on these disorders are either limited or unknown. Conversely, evidence-based treatments for anxietydisorders typically exclude suicidal, self-injuring, and seriously comorbid patients, thereby limiting their generalizability to individuals with borderline personality disorder. To address these limitations, recent research has begun to emerge focused on developing and evaluating treatments for individuals with co-occurring borderline personality disorder and anxietydisorders, specifically posttraumatic stress disorder (PTSD), with promising initial results. However, there is a need for additional research in this area, particularly studies evaluating the treatment of anxietydisorders among high-risk and complex borderline personality disorder patients.
Anxietydisorders are highly prevalent among individuals with borderline personality disorder, with comorbidity rates of up to 90%. Anxietydisorders have been found to reduce the likelihood of achieving remission from borderline personality disorder over time and to increase the risk of suicide and self-injury in this population. Evidence-based treatments for borderline personality disorder have not sufficiently focused on targeting anxietydisorders, and their effects on these disorders are either limited or unknown. Conversely, evidence-based treatments for anxietydisorders typically exclude suicidal, self-injuring, and seriously comorbid patients, thereby limiting their generalizability to individuals with borderline personality disorder. To address these limitations, recent research has begun to emerge focused on developing and evaluating treatments for individuals with co-occurring borderline personality disorder and anxietydisorders, specifically posttraumatic stress disorder (PTSD), with promising initial results. However, there is a need for additional research in this area, particularly studies evaluating the treatment of anxietydisorders among high-risk and complex borderline personality disorder patients. PMID:23710329
Objective: The study of human anxietydisorders has benefited greatly from func- tional neuroimaging approaches. Individ- ual studies, however, vary greatly in their findings. The authors searched for com- mon and disorder-specific functional neu- robiological deficits in several anxiety dis- orders. The authors also compared these deficits to the neural systems engaged during anticipatory anxiety in healthy subjects. Method: Functional
The present study is aimed at evaluating the effectiveness of a Mindfulness-Based Cognitive Behavior Therapy (MBCBT) for reducing cognitive and somatic anxiety and modifying dysfunctional cognitions in patients with anxietydisorders. A single case design with pre- and post-assessment was adopted. Four patients meeting the specified inclusion and exclusion criteria were recruited for the study. Three patients received a primary diagnosis of generalized anxietydisorder (GAD), while the fourth patient was diagnosed with Panic Disorder. Patients were assessed on the Cognitive and Somatic Anxiety Questionnaire (CSAQ), Penn State Worry Questionnaire (PSWQ), Hamilton's Anxiety Inventory (HAM-A), and Dysfunctional Attitudes Scale. The therapeutic program consisted of education regarding nature of anxiety, training in different versions of mindfulness meditation, cognitive restructuring, and strategies to handle worry, such as, worry postponement, worry exposure, and problem solving. A total of 23 sessions over four to six weeks were conducted for each patient. The findings of the study are discussed in light of the available research, and implications and limitations are highlighted along with suggestions for future research. PMID:23439854
Sharma, Mahendra P; Mao, Angelina; Sudhir, Paulomi M
The present study is aimed at evaluating the effectiveness of a Mindfulness-Based Cognitive Behavior Therapy (MBCBT) for reducing cognitive and somatic anxiety and modifying dysfunctional cognitions in patients with anxietydisorders. A single case design with pre- and post-assessment was adopted. Four patients meeting the specified inclusion and exclusion criteria were recruited for the study. Three patients received a primary diagnosis of generalized anxietydisorder (GAD), while the fourth patient was diagnosed with Panic Disorder. Patients were assessed on the Cognitive and Somatic Anxiety Questionnaire (CSAQ), Penn State Worry Questionnaire (PSWQ), Hamilton's Anxiety Inventory (HAM-A), and Dysfunctional Attitudes Scale. The therapeutic program consisted of education regarding nature of anxiety, training in different versions of mindfulness meditation, cognitive restructuring, and strategies to handle worry, such as, worry postponement, worry exposure, and problem solving. A total of 23 sessions over four to six weeks were conducted for each patient. The findings of the study are discussed in light of the available research, and implications and limitations are highlighted along with suggestions for future research.
Sharma, Mahendra P.; Mao, Angelina; Sudhir, Paulomi M.
|It is now widely accepted that anxietydisorders run in families, and current etiological models have proposed both genetic and environmental pathways to anxiety development. In this paper, the familial role in the development, treatment, and prevention of anxietydisorders in children is reviewed. We focus on three anxietydisorders in youth,…
In order to test the hypothesis that anxiety is a risk factor for cardiovascular disease, specifically stroke, we simultaneously measured anxiety and cerebral vascular alternation, using a computer-based system, "Cerberus." Sixty nine psychiatric patients (including an alcoholic subgroup) were selected as subjects for measurements conducted in Kecskemet, Hungary. The five-item short form of anxiety test (STAI) was administered twice during the same session. Between each test, brain pulse waves were recorded by rheoencephalogram (REG). A REG peak time above 180 milliseconds was considered a cerebrovascular alteration (modified after Jenkner). Data were sorted into two groups: low anxiety (N=10) and high anxiety (N=10). Significant differences were found between cardiovascular risk factors (p< 0.001), REG peak time (p<0.043), and heart rate (p< 0.045). Six subjects showed cerebrovascular alteration in the high anxiety group, and two in the low anxiety group. For the two anxiety groups, there were no significant differences in body mass index, cardiovascular sympathetic-parasympathetic balance, age and symptoms of transient ischemic attack. The correlation of REG and age was significantly different only for the alcoholic subgroup (Szalay et al, 2007). These data support the hypothesis that a correlation exists between cerebrovascular disorder and anxiety in the studied population.
Sipos, Kornel; Bodo, Michael; Szalay, Piroska; Szucs, Attila
There is a general belief that physical activity and exercise have positive effects on mood and anxiety and a great number\\u000a of studies describe an association of physical activity and general well-being, mood and anxiety. In line, intervention studies\\u000a describe an anxiolytic and antidepressive activity of exercise in healthy subjects and patients. However, the majority of\\u000a published studies have substantial
Comorbid anxiety is common among children with Autism Spectrum Disorder (ASD), and parents of children with ASD are more likely to have anxietydisorders. This study investigated the relationship between parents' state and trait anxiety and parent-reported internalizing and externalizing symptoms among adolescents (n = 30) with ASD, as well as the relationship of parents' anxiety symptoms and adolescent treatment response in the context of a randomized controlled trial. Parental state anxiety correlated with severity of adolescent anxiety, and trait anxiety in parents correlated with parent-reported adolescent internalizing and externalizing symptoms. Also, parents of adolescent treatment responders experienced a decrease in their own trait anxiety. Findings highlight the importance of considering parental anxiety when targeting anxiety among youth with ASD. PMID:23224592
Conner, Caitlin M; Maddox, Brenna B; White, Susan W
Background: Generalized anxietydisorders (GAD) are amongst the most prevalent mental disorders. Recent studies have suggested that cognitive behaviour therapy (CBT) is an effective treatment for GAD. A controlled clinical trial was done to evaluate the efficacy of CBT treatment in outpatients with pure GAD who were treated by a therapist working in routine care. Methods: Seventy-two outpatients, fulfilling GAD
M. Linden; D. Zubraegel; T. Baer; U. Franke; P. Schlattmann
Objective Growing evidence suggests high levels of comorbidity between hypertension and mental illness but there are few data from low- and middle-income countries. We examined the association between hypertension and depression and anxiety in South Africa. Methods Data come from a nationally-representative survey of adults (n?=?4351). The Composite International Diagnostic Interview was used to measure DSM-IV mental disorders during the previous 12-months. The relationships between self-reported hypertension and anxietydisorders, depressive disorders and comorbid anxiety-depression were assessed after adjustment for participant characteristics including experience of trauma and other chronic physical conditions. Results Overall 16.7% reported a previous medical diagnosis of hypertension, and 8.1% and 4.9% were found to have a 12-month anxiety or depressive disorder, respectively. In adjusted analyses, hypertension diagnosis was associated with 12-month anxietydisorders [Odds ratio (OR)?=?1.55, 95% Confidence interval (CI)?=?1.10–2.18] but not 12-month depressive disorders or 12-month comorbid anxiety-depression. Hypertension in the absence of other chronic physical conditions was not associated with any of the 12-month mental health outcomes (p-values all <0.05), while being diagnosed with both hypertension and another chronic physical condition were associated with 12-month anxietydisorders (OR?=?2.25, 95% CI?=?1.46–3.45), but not 12-month depressive disorders or comorbid anxiety-depression. Conclusions These are the first population-based estimates to demonstrate an association between hypertension and mental disorders in sub-Saharan Africa. Further investigation is needed into role of traumatic life events in the aetiology of hypertension as well as the temporality of the association between hypertension and mental disorders.
The association between lifetime anxietydisorders, conduct disorder (CD), and antisocial personality disorder (ASPD) among adults in the community was explored. Data were drawn from the National Comorbidity Survey (n=5,877), a representative community sample of adults aged 15–54 in the 48 contiguous US states. Multiple logistic regression analyses were used to determine the association between anxietydisorders, CD and ASPD,
There is a paucity of knowledge on the role of sibling relationships in internalizing disorders. Research in nonclinical populations suggests an association between internalizing problems in children and negative sibling interactions. Further, an association is reported between internalizing problems and actual or perceived parental differential treatment. This study examines sibling relationship qualities and perceived parental differential treatment in a clinical sample. Participants included 24 anxietydisordered children (ages 8-13 years) and 25 nondisordered control children (ages 7-13 years). Anxietydisordered and nondisordered children do not differ with regard to perceived affection or hostility from a sibling. Anxietydisordered children, however, report significantly more parental differential treatment than do nondisordered children. PMID:12941369
Lindhout, Ingeborg E; Boer, Frits; Markus, Monica T; Hoogendijk, Thea H G; Maingay, Ragna; Borst, Sophie R
|A family-based, cognitive behavioural treatment for anxiety in 47 children with comorbid anxietydisorders and High Functioning Autism Spectrum Disorder (HFA) was evaluated. Treatment involved 12 weekly group sessions and was compared with a waiting list condition. Changes between pre- and post-treatment were examined using clinical interviews as…
In this study we examined for the first time the difference between patients with an anxietydisorder and healthy controls in their attachment representation and facial affective behavior during the activation of the attachment system. 13 female patients und 14 healthy women were administered with the Adult Attachment Interview (AAI). Facial affective behavior during 6 selected questions of the AAI was coded using the Emotional-Facial-Action-Coding-System (EMFACS). As expected patients with an anxietydisorder, especially panic disorders, were classified significantly more often as insecure-preoccupied with a high proportion of unresolved loss. Against our assumption anxiety patients, independent of their attachment category, did not differ in their facial affective behavior from the control group. A group comparison taking into account diagnosis and attachment status showed that duchenne smile (happiness) was significantly predominant in control subjects classified as secure. Attachment security in healthy subjects, characterized by an overall valuing of positive or negative attachment experiences and coherent discourse in the AAI, was associated with positive facial affectivity. In contrast insecure anxiety patients could be characterized by showing social smile when talking e. g. about former separation experiences from their attachment figures mostly in an incoherent manner. This could be interpreted as a self-regulating defense. Limitations of the study are the small sample size and the heterogeneous clinical group of anxietydisorders. PMID:17377891
This review puts forth a transdiagnostic lens through which to examine the oft-found comorbidity between anxiety and oppositional defiant disorder in children and adolescents. Children who experience these co-occurring disorders may be at greater risk for adverse outcomes. Our review begins with a broad examination of the comorbidity between anxiety and oppositionality and then highlights three underlying processes that characterize both anxiety and oppositionality: emotion regulation difficulties, information processing biases, and specific parenting practices. These underlying processes are then discussed within the context of developing a treatment to target these transdiagnostic processes for families with a child who experiences comorbid anxiety and oppositionality. Our review concludes with future directions for this emerging area of research. PMID:23313760
This study investigated the relationship between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) and comorbid anxiety, depressive, and substance use disorders over the first 12-month period following a cancer diagnosis. Individuals recently diagnosed with 1st onset head and neck or lung malignancy were assessed for ASD within…
|This study investigated the relationship between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) and comorbid anxiety, depressive, and substance use disorders over the first 12-month period following a cancer diagnosis. Individuals recently diagnosed with 1st onset head and neck or lung malignancy were assessed for ASD within…
The construct of emotion regulation has been increasingly investigated in the last decade, and this work has important implications\\u000a for advancing anxietydisorder theory. This paper reviews research demonstrating that: 1) emotion (i.e., fear and anxiety)\\u000a and emotion regulation are distinct, non-redundant, constructs that can be differentiated at the conceptual, behavioral, and\\u000a neural levels of analysis; 2) emotion regulation can
Josh M. Cisler; Bunmi O. Olatunji; Matthew T. Feldner; John P. Forsyth
Anxietydisorders are characterised by distorted beliefs about the dangerousness of certain situations and\\/or internal stimuli. Why do such beliefs persist? Six processes (safety-seeking behaviours, attentional deployment, spontaneous imagery, emotional reasoning, memory processes and the nature of the threat representation) that could maintain anxiety-related negative beliefs are outlined and their empirical status is reviewed. Ways in which knowledge about maintenance
While anxiety and mild-moderate depression (the so-called neuroses) are the commonest mental disorders, they receive scant attention. They should be considered together, because they commonly occur together, are typically chronic, and respond to the same treatment. This review challenges traditional notions about the neuroses, by examining the reasons for their co-morbidity, the effectiveness of SSRIs in anxiety, and the biological
The binding characteristics of the pBR (peripheral benzodiazepine receptor) inverse agonist, [3H]-Ro 5-4864, were examined in patients diagnosed as generalized anxietydisorder. As compared to normal healthy controls,\\u000a the anxious subjects demonstrated a statistically significant (p < 0.001) increase in the density of pBR in platelets. The\\u000a enhanced pBR binding correlated significantly with the severity of global anxiety symptom of
Simon Chiu; Amarendra N. Singh; Pauline Chiu; Ram K. Mishra
Background: The present study compared the efficacy of psychotherapy for childhood anxietydisorders (excluding trials solely treating post-traumatic stress disorder or obsessive-compulsive disorder). Methods: The meta-analysis included studies that met the basic CONSORT (consolidated standards of reporting trials) criteria. Several outcome variables (e.g. effect sizes, percentage of recovery) were analyzed using completer and intent-to-treat analyses during post-treatment and follow-up assessment.
Generalized anxietydisorder (GAD) is a disorder characterized by chronic, pervasive, uncontrollable worry (as well as associated\\u000a somatic complaints; American Psychiatric Association, 1994) for which we have yet to develop sufficiently successful interventions.\\u000a The National Comorbidity Study yielded a lifetime prevalence estimate of 5.1% for GAD, and revealed, contrary to the common\\u000a assumption that it is a mild disorder, that
Social anxiety and eating disorders are highly comorbid. However, it is unknown how specific domains of social anxiety relate to disordered eating. We provide data on these relationships and investigate social appearance anxiety and fear of negative evaluation as potential vulnerabilities linking social anxiety with eating disorders. Specifically, we examined five domains of social anxiety: Social interaction anxiety, fear of scrutiny, fear of positive evaluation, fear of negative evaluation, and social appearance anxiety. Results indicated that social appearance anxiety predicted body dissatisfaction, bulimia symptoms, shape concern, weight concern, and eating concern over and above fear of scrutiny, social interaction anxiety, and fear of positive evaluation. Fear of negative evaluation uniquely predicted drive for thinness and restraint. Structural equation modeling supported a model in which social appearance anxiety and fear of negative evaluation are vulnerabilities for both social anxiety and eating disorder symptoms. Interventions that target these negative social evaluation fears may help prevent development of eating disorders.
Anxietydisorders are among the most common psychiatric disorders in childhood. Nonetheless, theoretical knowledge of the development and maintenance of childhood anxietydisorders is still in its infancy. Recently, research has begun to investigate the influence of emotion regulation on anxietydisorders. Although a relation between anxietydisorders and emotion regulation difficulties has been demonstrated, little attention has been given to the question of why anxious individuals have difficulties regulating their emotions. The present review examines the evidence of the link between emotion regulation and anxiety. It also explores the unique contributions of attachment style and dysfunctional emotion regulation to the development of anxietydisorders. PMID:22116623
Esbjørn, B H; Bender, P K; Reinholdt-Dunne, M L; Munck, L A; Ollendick, T H
Separation AnxietyDisorder (SAD) is the most commonly diagnosed and impairing childhood anxietydisorder, accounting for approximately 50% of the referrals for mental health treatment of anxietydisorders. While considered a normative phenomenon in early childhood, SAD has the potential to negatively impact a child’s social and emotional functioning when it leads to avoidance of certain places, activities and experiences that are necessary for healthy development. Amongst those with severe symptoms, SAD may result in school refusal and a disruption in educational attainment. This paper provides a comprehensive review of the current literature on SAD etiology, assessment strategies, and empirically supported treatment approaches. New and innovative approaches to the treatment of SAD that also employ empirically supported techniques are highlighted. In addition, future directions and challenges in the assessment and treatment of SAD are addressed.
Ehrenreich, Jill T.; Santucci, Lauren C.; Weiner, Courtney L.
Traditional treatments for anxietydisorders include cognitive-behavioral therapy and anxiolytic medications. Although these treatments are more effective than placebo, there is still considerable room for further improvement. Unfortunately, combining these different modalities is generally not substantially better than monotherapies. Recently, researchers have turned their attention toward translating preclinical research on the neural circuitry underlying fear extinction to clinical applications for the treatment of anxietydisorders with the goal to augment the learning process during exposure-based procedures with cognitive enhancers. This review examines d-cycloserine, cortisol, catecholamines, yohimbine, oxytocin, modafinil, as well as nutrients and botanicals as agents to augment treatment for anxietydisorders. D-cycloserine shows the most empirical support. Other promising agents include cortisol, catecholamines, yohimbine, and possibly oxytocin. Less support comes from studies that examined nutrients and botanicals, such as caffeine, nicotine, and omega-3 fatty acid. Limitations of the exiting literature and future research directions are discussed. PMID:23542909
Hofmann, Stefan G; Fang, Angela; Gutner, Cassidy A
Anxietydisorders affect about 10% of children and adolescents, are often chronic and impair psychological, academic and social functioning. Recent studies have clearly demonstrated the efficacy of selective serotonin reuptake inhibitors in young people with obsessive-compulsive disorder and mixed or generalized anxietydisorders. Evidence is emerging for effectiveness in social phobia and its variant, selective mutism. Since the effect size for selective serotonin reuptake inhibitors in anxiety greatly exceeds that in depression, studies with small numbers readily show superiority of medication over placebo. Hence, further positive studies are predicted in the next few years. As a result, the rate of prescription of selective serotonin reuptake inhibitors in young people has been rising and will continue to do so. These medications are well-tolerated, but motor and behavioral side effects are more common in young people. Long-term research and postmarketing surveillance are needed. PMID:19811001
This case study of combined anxiety with both alcohol and benzodiazepine dependence illustrates key issues in presentation, differential diagnosis and management. The case is discussed from a biopsychosocial perspective with each of the discussants focusing on their particular area of experience and expertise, then the treatment package is presented in an integrated fashion. Of particular interest is how social anxietydisorder may become a significant barrier to engagement and retention, and thus outcome in persons presenting for addiction treatment, and how a treatment plan for such patients can be built. PMID:22042217
Ries, Richard; Wolitzky-Taylor, Kate B; Operskalski, Joachim T; Craske, Michelle G; Roy-Byrne, Peter
Objective Behaviorally inhibited children face increased risk for anxietydisorders, although factors that predict which children develop a disorder remain poorly specified. The current study examines whether the startle reflex response may be used to differentiate between behaviorally inhibited adolescents with and without a history of anxiety. Method Participants were assessed for behavioral inhibition during toddlerhood and early childhood. They returned to the laboratory as adolescents and completed a fear-potentiated startle paradigm and a clinical diagnostic interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version). Magnitude of the startle reflex was examined at baseline and during cues associated with safety and threat. Results Only adolescents who showed high levels of behavioral inhibition and had a lifetime occurrence of anxietydisorders showed increased startle reactivity in the presence of safety cues. Neither behavioral inhibition nor diagnosis was related to startle reactivity during threat cues. Conclusions These results suggest that neurobiological measures, such as the startle reflex, may be a potential risk marker for the development of anxietydisorders among behaviorally inhibited adolescents. These methods may enhance our ability to identify vulnerable individuals before the development of anxious psychopathology.
REEB-SUTHERLAND, BETHANY C.; HELFINSTEIN, SARAH M.; DEGNAN, KATHRYN A.; PEREZ-EDGAR, KORALY; HENDERSON, HEATHER A.; LISSEK, SHMUEL; CHRONIS-TUSCANO, ANDREA; GRILLON, CHRISTIAN; PINE, DANIEL S.; FOX, NATHAN A.
Many anxietydisorders are not treated to remission (symptom-free state); however, this should be the minimum goal of therapy. Antidepressant therapies have shown significant beneficial effects in the management of anxietydisorders, with some variability in results in specific disorders. In social anxietydisorder, selective serotonin reuptake inhibitors and venlafaxine extended release (XR) have demonstrated efficacy, with response rates varying
The objectives of the study were to assess lifetime prevalence of specific anxietydisorders, and their age of onset relative to that of eating disorders (ED), in a French sample of patients with anorexia nervosa (AN) or bulimia nervosa (BN). We assessed frequencies of seven anxietydisorders and childhood histories of separation anxietydisorder among 63 subjects with a current
N. T. Godart; M. F. Flament; Y. Lecrubier; P. Jeammet
Exposure techniques have now been used in the treatment of anxietydisorders for several decades. Although such techniques are a dominant feature of current therapies for disorders such as posttraumatic stress disorder and acute stress disorder, examination of their relative merits has been less studied. The purpose of this review is to suggest the usefulness of in vivo flooding in
Background Adjustment Disorder is a condition strongly tied to acute and chronic stress. Despite clinical suggestion of a large prevalence in the general population and the high frequency of its diagnosis in the clinical settings, there has been relatively little research reported and, consequently, very few hints about its treatments. Methods the authors gathered old and current information on the epidemiology, clinical features, comorbidity, treatment and outcome of adjustment disorder by a systematic review of essays published on PUBMED. Results After a first glance at its historical definition and its definition in the DSM and ICD systems, the problem of distinguishing AD from other mood and anxietydisorders, the difficulty in the definition of stress and the implied concept of 'vulnerability' are considered. Comorbidity of AD with other conditions, and outcome of AD are then analyzed. This review also highlights recent data about trends in the use of antidepressant drugs, evidence on their efficacy and the use of psychotherapies. Conclusion AD is a very common diagnosis in clinical practice, but we still lack data about its rightful clinical entity. This may be caused by a difficulty in facing, with a purely descriptive methods, a "pathogenic label", based on a stressful event, for which a subjective impact has to be considered. We lack efficacy surveys concerning treatment. The use of psychotropic drugs such as antidepressants, in AD with anxious or depressed mood is not properly supported and should be avoided, while the usefulness of psychotherapies is more solidly supported by clinical evidence. To better determine the correct course of therapy, randomized-controlled trials, even for the combined use of drugs and psychotherapies, are needed vitally, especially for the resistant forms of AD.
New hybrid models of psychopathology have been proposed that combine the current categorical approach with symptom dimensions that are common across various disorders. The present study investigated the new hybrid model of social anxiety in a large sample of participants with anxietydisorders and unipolar mood disorders to improve understanding of the comorbidity and symptom overlap between social phobia (SOC) and the other anxietydisorders and unipolar mood disorders. Six hundred and eighty two participants from a specialized outpatient clinic for anxiety treatment completed a semi-structured diagnostic interview and the Multidimensional Assessment of Social Anxiety (MASA). A hybrid model symptom profile was identified for SOC and compared with each of the other principal diagnoses. Significant group differences were identified on each of the MASA scales. Differences also were identified when common sets of comorbidities were compared within participants diagnosed with SOC. The findings demonstrated the influence of both the principal diagnosis of SOC and other anxietydisorders and unipolar mood disorders as well as the influence of comorbid diagnoses with SOC on the six symptom dimensions. These findings highlight the need to shift to transdiagnostic assessment and treatment practices that go beyond the disorder-specific focus of the current categorical diagnostic systems. PMID:23809463
A computer programme (DPAX) was constructed for a longitudinal study of psychiatric epidemiology in Stirling County (Canada). It identifies disorders involving the syndromes of depression and anxiety based on responses given in structured questionnaire interviews. The programme follows a diagnostic algorithm that uses criteria for: (1) essential features; (2) number, frequency, and pattern of associated symptoms; (3) impairment; and (4) duration. The programme reproduces case evaluations provided by psychiatrists, as conveyed by a sensitivity of 92% and a specificity of 98%. PMID:3887448
Murphy, J M; Neff, R K; Sobol, A M; Rice, J X; Olivier, D C
|This study examined relations between anxiety, aggression, social understanding, IQ, and diagnosis in a sample of 231 children (ages 2-9) diagnosed with Autism Spectrum Disorders (ASDs; Autistic Disorder, Asperger's Disorder, Pervasive Developmental Disorder Not Otherwise Specified) in a hospital setting. Children were administered tests of IQ,…
Niditch, Laura A.; Varela, R. Enrique; Kamps, Jodi L.; Hill, Trenesha
Anxiety sensitivity (AS), the fear of sensations of anxious arousal based on beliefs about their harmful consequences, is increasingly recognized as a multidimensional construct. The recently developed Anxiety Sensitivity Index-3 [ASI-3; Taylor, S., Zvolensky, M., Cox, B., Deacon, B., Heimberg, R., Ledley, D. R., et al. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3 (ASI-3). Psychological Assessment, 19, 176-188] measures three dimensions of AS: physical concerns, social concerns, and cognitive concerns. The ASI-3 shows promise, although further evaluation of its psychometric properties and validity in independent samples is needed. We evaluated the ASI-3 in a mixed sample of anxietydisorder patients (N=506) and undergraduate student controls (N=315). The measure demonstrated a stable 3-factor structure and sound psychometric properties, with the three factors showing theoretically consistent patterns of associations with anxiety symptoms and diagnoses. ASI-3 total scores were less discriminative. Implications for conceptual models of anxiety are discussed. PMID:22306133
Wheaton, Michael G; Deacon, Brett J; McGrath, Patrick B; Berman, Noah C; Abramowitz, Jonathan S
Abstract Objective The purpose of this study was to examine child, parent, and clinician's consensus agreement on the AnxietyDisorders Interview Schedule, Child and Parent versions (ADIS-C/P) in a sample of children and adolescents with autism spectrum disorders (ASD). Method Youth with ASD (n=85; age range=7–17 years) and their parents were each administered the ADIS-C/P by a trained clinician. Consensus diagnoses were determined in a clinical conference using best estimate procedures that incorporated all available information. Results Children and youth with ASD diagnoses generally showed poor diagnostic agreement with parents and clinical consensus, whereas parents showed good-to-excellent diagnostic agreement with clinical consensus diagnoses. Diagnostic agreement between parents and consensus was moderated by the specific ASD diagnosis. Otherwise, the pattern of relationships did not systematically differ as a function of age or externalizing comorbidity. Conclusions These data suggest that parent and youth agreement regarding the presence of clinical levels of anxiety is markedly poor among youth with ASD. Additionally, clinicians are likely to base their diagnostic impressions on parent report, placing minimal emphasis on child report.
Ehrenreich May, Jill; Wood, Jeffrey J.; Jones, Anna M.; De Nadai, Alessandro S.; Lewin, Adam B.; Arnold, Elysse B.; Murphy, Tanya K.
The differential diagnosis of dissociative disorders includes many psychiatric disorders, such as schizophrenia, bipolar disorders (especially bipolar II disorder), depressive disorder (especially atypical depression), epilepsy, Asperger syndrome, and borderline personality disorder. The theme of this paper is the differential diagnosis between dissociative disorders and schizophrenia. Schneiderian first-rank symptoms in schizophrenia are common in dissociative disorders, especially in dissociative identity disorder (DID). Many DID patients have been misdiagnosed as schizophrenics and treated with neuroleptics. We compared and examined Schneiderian symptoms of schizophrenia and those of dissociative disorders from a structural viewpoint. In dissociative disorders, delusional perception and somatic passivity are not seen. "Lateness" and "Precedence of the Other" originated from the concept of "Pattern Reversal" (H. Yasunaga)" is characteristic of schizophrenia. It is important to check these basic structure of schizophrenia in subjective experiences in differential diagnosis between dissociative disorders and schizophrenia. PMID:22117396
Summary Objective: To examine sex- and age-related differences of treatment outcome in a cohort of outpatients with major depressive disorder (MDD), with and without comorbid anxiety, treated with fluoxetine. Methods: Outpatients with a SCID-diagnosis of MDD aged 18 to 65 years were treated openly with fluoxetine (20?mg\\/day) for 8 weeks. The 17-item Hamilton Depression Rating Scale (HAM-D-17) was administered at
P. Cassano; C. N. Soares; L. S. Cohen; A. K. Lyster; M. Fava
Purpose The vast majority of studies investigating the association between social and psychological factors and anxietydisorders\\u000a have been cross-sectional, making it difficult to draw causal conclusions. The purpose of the study was to investigate in\\u000a a prospective longitudinal study whether social and psychological factors are associated with the later risk of being admitted\\u000a to a hospital and receive a diagnosis
Trine Flensborg-Madsen; Janne Tolstrup; Holger Jelling Sørensen; Erik Lykke Mortensen
There is limited information about the nature of anxiety among youth with symptoms of autism spectrum disorder (ASD). The present study examined (a) differences in the clinical characteristics of anxious youth with and without symptoms of ASD and (b) the symptoms of anxiety that best distinguish between these groups. Results indicated that anxious youth with elevated ASD symptoms had significantly more diagnoses (e.g., specific phobias), and were more likely to meet diagnostic criteria for social phobia (and list social concerns among their top fears) than youth without elevated ASD symptoms. At the symptom level, severity of interpersonal worry based on parent report and severity of fear of medical (doctor/dentist) visits based on youth report best differentiated ASD status. The findings inform diagnostic evaluations, case conceptualization, and treatment planning for youth with anxietydisorders and ASD symptoms.
Settipani, Cara A.; Puleo, Connor M.; Conner, Bradley T.; Kendall, Philip C.
To evaluate the theoretical underpinnings of current categorical approaches to classify childhood psychopathological conditions, this dissertation examined whether children with a single diagnosis of an anxietydisorder (ANX only) and children with an anxietydiagnosis comorbid with other diagnoses (i.e., anxiety + anxietydisorder [ANX + ANX], anxiety + depressive disorder [ANX + DEP], and anxiety + disruptive disorder [ANX
Background There is evidence that negative affect (NA) and anxiety sensitivity (AS) predict the development of anxietydisorders, particularly panic disorder (PD). The main purpose of this study was to examine whether NA and AS will also predict the clinical course of PD. Methods Participants were 136 individuals with a DSM-III-R diagnosis of PD (with or without agoraphobia) enrolled in a naturalistic and longitudinal study of anxietydisorders, the Harvard/Brown Anxiety Research Project (HARP). Participants were administered the Anxiety Sensitivity Index and the Negative Affect Scales of the Positive and Negative Affect Schedule-Expanded Form (PANAS-X-NA) and their percentage of time in PD episode was followed for 1 year after the administration of the measures. Results Multiple regression analyses indicated that AS, but not NA, was a significant predictor of percentage of time in PD episode after controlling for previous time in PD episodes, comorbid depression, other anxietydisorders, and exposure to psychopharmacological and behavioral treatments. As expected, the Physical Concerns subscale of the Anxiety Sensitivity Index had a significant independent contribution in predicting the course of the disorder. Conclusions Overall, these findings suggest that AS, as a unique construct, may be predictive of the amount of time patients are in episode of PD.
Benitez, Carlos Israel Perez; Shea, M. Tracie; Raffa, Susan; Rende, Richard; Dyck, Ingrid R.; Ramsawh, Holly J.; Edelen, Maria Orlando; Keller, Martin B.
ObjectiveTo replicate and extend work on the psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED), a child and parent self-report instrument used to screen for children with anxietydisorders.
BORIS BIRMAHER; DAVID A. BRENT; LAUREL CHIAPPETTA; JEFFREY BRIDGE; SUNEETA MONGA; MARIANNE BAUGHER
Objective: The present study seeks to extend research on the etiology of separation anxietydisorder (SAD) in a German-speaking sample by examining differences between children with SAD and healthy comparisons, using a retrospective-reporting paradigm. Method: The sample included 106 children with SAD and 44 healthy children between the ages of 4 and 14 years. Parents completed questionnaires and structured clinical
Kristen Lavallee; Chantal Herren; Judith Blatter-Meunier; Carmen Adornetto; Tina In-Albon; Silvia Schneider
In this concluding chapter to the volume, we first provide a theoretical integration of the material contained in the initial two sections of the book. We review models, theories, and mechanisms to account for the high co-morbidity of anxiety and substance use disorders including notions involving self-medication, substance-induced anxiety, and third variable (e.g., anxiety sensitivity) explanations. Which particular pathway is
We attempted to identify factors differentiating Agoraphobia with Panic Attacks (AG) from Panic Disorder (PD) patients. Twenty-three AG and 27 PD patients were compared. No significant difference in severity of illness was found. As predicted, the groups differed on a measure of anxiety-relevant cognitions developed for this study, the Anxious Thoughts and Tendencies scale (AT&T) (P less than 0.02). We suggest that differences in interpretation of panic attacks account for the development of of phobic avoidance behavior in some but not all PD patients. The intercorrelations among measures suggest that Panic Disorder may be conceptualized as having several independent although related components (panic attacks, general anxiety, phobic anxiety, and cognitive distortions). PMID:2951409
Ganellen, R J; Matuzas, W; Uhlenhuth, E H; Glass, R; Easton, C R
Fear and anxiety are debilitating conditions that affect a significant number of individuals in their lifetimes. Understanding underlying mechanisms of these disorders affords us the possibility of therapeutic intervention. Such clarity in terms of mechanism and intervention can only come from an amalgamation of research from human to animal studies that attempt to mimic the human condition, both of which are discussed in this review. We begin by presenting an outline of our current understanding of the neurobiological basis of fear and anxiety. This outline spans various levels of organization that include the circuitry, molecular pathways, genetic and epigenetic components of fear and anxiety. Using these organizational levels as a scaffold, we then discuss strategies that are currently used to ameliorate these disorders, and forecast future interventions that hold therapeutic promise. Among these newer promising treatments, we include, optogenetic, pharmacological, and extinction-based approaches, as well as lifestyle modifications, with combinatorial treatment regimens of these holding the most promise. PMID:23402950
Dias, Brian G; Banerjee, Sunayana B; Goodman, Jared V; Ressler, Kerry J
Context Generalized anxietydisorder (GAD) is one of the most common psychiatric disorders in older adults; however, few data exist to guide clinicians in efficacious and safe treatment. Selective serotonin reuptake inhibitors (SSRIs) are efficacious for younger adults with GAD, but benefits and risks may be different in older adults. Objective To examine the efficacy, safety, and tolerability of the SSRI escitalopram in older adults with GAD. Design, Setting, and Participants A randomized controlled trial in primary care practices and related specialty clinics in Pittsburgh, Pennsylvania, of 177 participants aged 60 years or older with a principal diagnosis of GAD randomized to receive either escitalopram or placebo and conducted between January 2005 and January 2008. Interventions Twelve weeks of 10 to 20 mg/d of escitalopram (n=85) or matching placebo (n=92). Main Outcome Measures Cumulative response defined by Clinical Global Impressions-Improvement score of much or very much improved; time to response; and anxiety and role functioning changes measured by the Clinical Global Impressions-Improvement scale, Hamilton Anxiety Rating Scale, Penn State Worry Questionnaire, Late-Life Function and Disability Instrument activity limitations subscale, and the role-emotional impairment and social function subscales of the Medical Outcome Survey 36-item Short Form. Results In the primary analytic strategy in which participants (n=33) were censored at the time of dropout, mean cumulative response rate for escitalopram was 69% (95% confidence interval [CI], 58%-80%) vs 51% (95% CI, 40%-62%) for placebo (P=.03). A conservative intention-to-treat analysis showed no difference in mean cumulative response rate between escitalopram and placebo (57%; 95% CI, 46%-67%; vs 45%; 95% CI, 35%-55%; P=.11). Participants treated with escitalopram showed greater improvement than with placebo in anxiety symptoms and role functioning (Clinical Global Impressions-Improvement scale: effect size, 0.93; 95% CI, 0.50-1.36; P<.001; Penn State Worry Questionnaire: 0.30; 95% CI, 0.23-0.48; P=.01; activity limitations: 0.32; 95% CI, 0.01-0.63; P=.04; and the role-emotional impairment and social function: 0.96; 95% CI, 0.03-1.90; P=.04). Adverse effects of escitalopram (P<.05 vs placebo) were fatigue or somnolence (35 patients [41.1%]), sleep disturbance (12 [14.1%]), and urinary symptoms (8 [9.4%]). Conclusions Older adults with GAD randomized to escitalopram had a higher cumulative response rate for improvement vs placebo over 12 weeks; however, response rates were not significantly different using an intention-to-treat analysis. Further study is required to assess efficacy and safety over longer treatment durations. Trial Registration clinicaltrials.gov Identifier: NCT00105586
Lenze, Eric J.; Rollman, Bruce L.; Shear, M. Katherine; Dew, Mary Amanda; Pollock, Bruce G.; Ciliberti, Caroline; Costantino, Michelle; Snyder, Sara; Shi, Peichang; Spitznagel, Edward; Andreescu, Carmen; Butters, Meryl A.; Reynolds, Charles F.
Objective To compare the frequency of anxietydisorders in older and younger persons with major depressive disorder with psychotic features. Design Cross-sectional. Setting University medical centers. Participants Two hundred and fifty nine persons (n= 117 aged 18–59 years and n=142 aged ? 60 years) with major depressive disorder with psychotic features who were enrolled in the Study of the Pharmacotherapy of Psychotic Depression (STOP-PD). Measurements DSM-IV-defined anxietydisorders were determined by SCID interview at baseline assessment. Younger and older participants were compared on the frequencies of any current anxietydisorder and any lifetime anxietydisorder, as well as the frequencies of individual anxietydisorders. Results Older persons had significantly lower frequencies of any current anxietydisorder and any lifetime anxietydisorder, even after controlling for relevant demographic and clinical variables. With respect to specific anxietydisorders, older persons had significantly lower frequencies of current and lifetime panic disorder, current and lifetime social anxietydisorder, and current and lifetime posttraumatic stress disorder. Conclusion The findings of this study are consistent with those of community-based epidemiologic surveys, that anxietydisorders are less prevalent in older than younger adults. Because of the rigorous assessment used in STOP-PD, our findings suggest that the age-related decline in the prevalence of anxietydisorders is not simply due to a failure to detect cases in older people, as has been previously suggested.
Flint, Alastair J.; Peasley-Miklus, Catherine; Papademetriou, Eros; Meyers, Barnett S.; Mulsant, Benoit H.; Rothschild, Anthony J.; Whyte, Ellen M.
Despite the demonstrated efficacy of cognitive-behavior therapy (CBT) for social anxietydisorder (SAD), many individuals do not respond to treatment or demonstrate residual symptoms and impairment posttreatment. Preliminary evidence indicates that acceptance-based approaches (e.g., acceptance and commitment therapy; ACT) can be helpful for a variety of disorders and emphasize exposure-based strategies and processes. Nineteen individuals diagnosed with SAD participated in
While cognitive behavior therapy has been found to be effective in the treatment of generalized anxietydisorder (GAD), a significant percentage of patients struggle with residual symptoms. There is some conceptual basis for suggesting that cultivation of mindfulness may be helpful for people with GAD. Mindfulness-based cognitive therapy (MBCT) is a group treatment derived from mindfulness-based stress reduction (MBSR) developed
Susan Evans; Stephen Ferrando; Marianne Findler; Charles Stowell; Colette Smart; Dean Haglin
The present study investigated differences between individuals with and without social anxietydisorder (SAD) in instrumentality and expressiveness, personality traits traditionally linked to the male and female gender roles, respectively. Based on evolutionary and self-discrepancy theories, it was hypothesized that individuals with SAD would score lower on instrumentality and report a discrepancy between their perceived and ideal level of instrumentality
Karen E. Roberts; Trevor A. Hart; Adina Coroiu; Richard G. Heimberg
|Attention bias towards threat faces is examined for a large sample of anxiety-disordered youths using visual probe task. The results showed that anxious individuals showed a selective bias towards threat due to perturbation in neural mechanisms that control vigilance.|
Roy, Amy Krain; Vasa, Roma A.; Bruck, Maggie; Mogg, Karin; Bradley, Brendan P.; Sweeney, Michael; Bergman, R. Lindsey; McClure-Tone, Erin B.; Pine, Daniel S.
This article identifies and addresses three methodological domains relevant to the treatment of anxietydisorders in youth: (a) procedural matters, (b) the assessment of anxious distress, and (c) the analysis of treatment-produced change. Procedural topics include the need to manualize treatment, have diversity among participants and comparability of the duration of treatment and control conditions, and control for medication status.
Background: There is increasing awareness that the goal of treatment in generalized anxietydisorder (GAD) should not simply be a response, but restoration of normal function. The aim of this study was to apply a novel psychotherapeutic approach for increasing the level of remission in GAD. Methods: Twenty patients with DSM-IV GAD devoid of comorbid conditions were randomly assigned to
Giovanni A. Fava; Chiara Ruini; Chiara Rafanelli; Livio Finos; Luigi Salmaso; Lara Mangelli; Saulo Sirigatti
In this article, the authors discuss the role of homework in behavior therapy for the anxietydisorders. First, the authors describe the essential components of behavior therapy that include exposure to feared consequences and cessation of all avoidance behaviors. Then, the authors briefly review the literature on the relationship between homework compliance and treatment outcome. Next, the authors discuss the
Jonathan D. Huppert; Deborah Roth Ledley; Edna B. Foa
Virtual reality exposure therapy (VRET) is an altered form of behavioral therapy and may be a possible alternative to standard in vivo exposure. Virtual reality integrates real-time computer graphics, body tracking devices, visual displays, and other sensory input devices to immerse patients in a computer-generated virtual environment. Research on this type of treatment for anxietydisorders is discussed in this
M. Krijn; P. M. G. Emmelkamp; R. P. Olafsson; R. Biemond
The present investigation evaluated the initial efficacy of a modular approach to cog- nitive behavior therapy (CBT) for anxietydisorders in youth. Modular CBT consists of the guided combination of individually scripted techniques that are explicitly matched to the child's individual strengths and needs. Eleven youth primarily of Asian and Pacific Island ethnicity ranging in age from 7 to 13
Bruce F. Chorpita; Alissa A. Taylor; Sarah E. Francis; Catherine Moffitt; Ayda A. Austin
This study presents a preliminary test of a conceptual model of Generalized AnxietyDisorder (GAD) which is theoretically driven and has clear clinical implications. The model's main features are intolerance of uncertainty, beliefs about worry, poor problem orientation and cognitive avoidance. Subjects were 24 GAD patients and 20 non clinical control subjects. The results show that all main components of
Michel J. Dugas; Fabien Gagnon; Robert Ladouceur; Mark H. Freeston
Background: The essential symptoms of generalized anxietydisorder (GAD) are intrusive worry about everyday life circumstances and social competence, and associated autonomic hyperarousal. The amygdala, a brain region involved in fear and fear-related behaviors in animals, and its projections to the superior temporal gyrus (STG), thalamus, and to the prefrontal cortex are thought to comprise the neural basis of our
Michael D De Bellis; Matcheri S Keshavan; Heather Shifflett; Satish Iyengar; Ronald E Dahl; David A Axelson; Boris Birmaher; Julie Hall; Grace Moritz; Neal D Ryan
Previous research examining hypothalamic–pituitary–adrenal (HPA) axis activity in generalised anxietydisorder (GAD) has suggested a general hypercortisolism. These studies have mostly relied on salivary, plasma or urinary assessments, reflecting cortisol secretion over short time periods. The current study utilised the novel method of cortisol assessment in hair to obtain a retrospective index of cortisol secretion over a prolonged period of
Susann Steudte; Tobias Stalder; Lucia Dettenborn; Elisabeth Klumbies; Paul Foley; Katja Beesdo-Baum; Clemens Kirschbaum
Anxietydisorders and sensory over-responsivity (SOR) are common in children with autism spectrum disorders (ASD), and there\\u000a is evidence for an association between these two conditions. Currently, it is unclear what causal mechanisms may exist between\\u000a SOR and anxiety. We propose three possible theories to explain the association between anxiety and SOR: (a) SOR is caused\\u000a by anxiety; (b) Anxiety
Anxietydisorders have traditionally been conceptualized as reflecting the emotions of fear and anxiety. A developing program of research demonstrates a relation between disgust and three specific anxietydisorders: blood-injection-injury (BII) phobia, spider phobia, and contamination-related obsessive-compulsive disorder (OCD). This review serves three purposes. First, the authors review the response patterns predicted to be observed if the emotional response in these disorders involved disgust versus fear. The review suggests specific response patterns that characterize disgust and fear in the domains of heart rate, facial expression, neural activity, and cognitive processes. Second, the authors review extant research employing measures of these domains in spider phobia, BII phobia, and contamination-related OCD. The evidence suggests that both fear and disgust characterize each of these disorders, but the magnitude at which the emotions characterize the disorders may depend on the response domain measured. For example, disgust may be more involved in spider phobia in appraisals and facial expression, but less involved in neural correlates or heart rate domains. Third, the authors suggest guidelines for future research, including concurrent use of specific measures as well as examining whether the different emotions in different response domains respond to similar interventions (e.g., exposure).
Cisler, Josh M.; Olatunji, Bunmi O.; Lohr, Jeffrey M.
Research into the possible relationship between anxietydisorders and suicidal ideation has yielded mixed results, leading some to suggest that the positive findings between anxiety and suicidal ideation might simply be a by-product of comorbid depression. Recent work has suggested that having an anxietydisorder without history of mood disorder does convey increased risk for suicidal ideation, although the study
Peter J. Norton; Samuel R. Temple; Jeremy W. Pettit
|Comorbid anxietydisorders are common in children with autism spectrum disorders (ASD). However, studies comparing children with ASD to clinically anxious children are rare. This study investigated anxiety problems and health-related quality of life in children with high-functioning ASD and comorbid anxietydisorders (referred to as the ASD…
van Steensel, Francisca J. A.; Bogels, Susan M.; Dirksen, Carmen D.
|A common assumption is that all youth with anxietydisorders (AD) experience impaired peer relationships relative to healthy control children. Social impairments have been identified among youth with certain AD (e.g., social anxietydisorder; SAD), but less is known about the peer relationships of children with generalized anxietydisorder (GAD).…
|Background: The present study compares an individual versus a group format in the delivery of manualised cognitive-behavioural therapy (FRIENDS) for children with anxietydisorders. Clinically referred children (aged 8 to 12) diagnosed with Separation AnxietyDisorder (n = 52), Generalised AnxietyDisorder (n = 37), Social Phobia (n = 22) or…
Liber, Juliette M.; Van Widenfelt, Brigit M.; Utens, Elisabeth M. W. J.; Ferdinand, Robert F.; Van Der Leeden, Adelinde J. M.; Van Gastel, Willemijn; Treffers, Philip D. A.
Background: The present study compares an individual versus a group format in the delivery of manualised cognitive-behavioural therapy (FRIENDS) for children with anxietydisorders. Clinically referred children (aged 8 to 12) diagnosed with Separation AnxietyDisorder (n ¼ 52), Generalised AnxietyDisorder (n ¼ 37), Social Phobia (n ¼ 22) or Specific Phobia (n ¼ 16) were randomly assigned to
Juliette M. Liber; Brigit M. Van Widenfelt; Elisabeth M. W. J. Utens; Robert F. Ferdinand; Willemijn Van Gastel; Philip D. A. Treffers
Research suggests that children with autism spectrum disorders (ASDs) and their relatives have high rates of depression and anxiety. However, relatively few studies have looked at both factors concurrently. This study examined the potential relationship between maternal mood symptoms and depression and anxiety in their children with ASD. Participants were 31 10- to 17-year-old children with an ASD diagnosis that was supported by gold-standard measures and their biological mothers. Mothers completed the Autism Comorbidity Interview to determine whether the child with ASD met criteria for any depressive or anxiety diagnoses and a questionnaire of their own current mood symptoms. As expected, many children with ASD met criteria for lifetime diagnoses of depressive (32%) and anxietydisorders (39%). Mothers' report of their own current mood symptoms revealed averages within the normal range, though there was significant variability. Approximately 75% of children with ASD could be correctly classified as having a depressive or anxietydisorder history or not based on maternal symptoms of interpersonal sensitivity, hostility, phobic anxiety, depression, and anxiety. The results provide preliminary evidence that maternal mood symptoms may be related to depression and anxiety in their children with ASD. Although the design did not allow for testing of heritability per se, the familial transmission patterns were generally consistent with research in typical populations. While larger follow-up studies are needed, this research has implications for prevention and intervention efforts. PMID:20578069
Mazefsky, Carla A; Conner, Caitlin M; Oswald, Donald P
|The goal of this study was to evaluate the efficacy of cognitive-behavioral therapy for comorbid panic disorder with agoraphobia (PDA) and generalized anxietydisorder (GAD) by combining treatment strategies for both disorders. A single-case, multiple-baseline design across participants was used. Three participants with primary PDA and secondary…
Labrecque, Joane; Marchand, Andre; Dugas, Michel J.; Letarte, Andree
Objective: To determine whether panic disorder is associated with elevated serum choles- terol levels. Serum cholesterol levels of panic disorder patients are reported to be elevated. This could explain the higher-than-expected cardiovascular mortality in this population. Some evidence exists wherein cholesterol levels are also increased in patients with general anxietydisorder and phobias. To date, there are only 2 reports
Helmut Peter; Iver Hand; Fritz Hohagen; Anne Koenig; Olaf Mindermann; Frank Oeder; Markus Wittich
|While the efficacy of cognitive behavior therapy for childhood anxietydisorders, including separation anxietydisorder (SAD), has been established, tailoring such treatments to particular interests and needs may enhance uptake of evidence-based interventions. The current investigation evaluates the feasibility and preliminary efficacy of an…
While the efficacy of cognitive behavior therapy for childhood anxietydisorders, including separation anxietydisorder (SAD), has been established, tailoring such treatments to particular interests and needs may enhance uptake of evidence-based interventions. The current investigation evaluates the feasibility and preliminary efficacy of an…
|Social functioning was assessed using the Child Behavior Checklist and Teacher Report Form for children with anxietydisorders who participated in a randomized clinical trial (N = 161, aged 7-14). Significant relationships were found between severity of children's principal anxietydisorder and most measures of social functioning, such that…
This study examines the degree to which untreated anxietydisorders and major depressive disorder, occurring either singly or in combination, reduce functioning and well-being among primary care patients. Adult patients were screened using the SCL-52 to identify those with clinically significant anxiety symptoms. They also completed the Rand Short-Form (SF-36) to measure self-reported patient functioning and well-being. Patients with untreated
Warren H Schonfeld; Carol J Verboncoeur; Sheila K Fifer; Ruth C Lipschutz; Deborah P Lubeck; Don P Buesching
A family-based, cognitive behavioural treatment for anxiety in 47 children with comorbid anxietydisorders and High Functioning\\u000a Autism Spectrum Disorder (HFA) was evaluated. Treatment involved 12 weekly group sessions and was compared with a waiting\\u000a list condition. Changes between pre- and post-treatment were examined using clinical interviews as well as child-, parent-\\u000a and teacher-report measures. Following treatment, 71.4% of the treated
Social anxietydisorder is a debilitating mental illness with eventually serious comorbidities such as major depression and alcohol or substance abuse and dependence. Those comorbidities are much more common when social phobia is left neglected and untreated. It is characterized by excessive fears to one or most social situations (circumscribed versus generalized type). Social phobia has its onset typically in childhood or early adolescence and it is associated with significant functional impairment. Although cognitive behavioral therapy and the selective serotonin reuptake inhibitors are considered the mainstay treatment of this disorder, other psychotropic agents can be of value in the management of this condition. This review discusses the efficacy of beta-bockers, benzodiazepines, anticonvulsants, D-cycloserine, buspirone and atypical antipsychotics in the treatment of social anxietydisorder. PMID:23438729
This study examines the persistence of sleep problems over 18 months in 76 referred children with anxietydisorders and/or attention deficit hyperactivity disorders (ADHD) and 31 nonreferred controls, and explores predictors of sleep problems at follow-up (T2) in the referred children. Diagnoses were assessed at initial assessment (T1) using the semi-structured interview Kaufman Schedule for Affective Disorders and Schizophrenia. Sleep problems were assessed using the Children's Sleep Habit Questionnaire at T1 and at T2. Persistence rate of total sleep problems in the clinical range was 72.4 % in referred children, and did not differ significantly between children with a T1 diagnosis of anxietydisorder (76.0 %), ADHD (70.6 %), anxietydisorder and ADHD (68.8 %) or nonreferred controls (50.0 %) The total sleep problems score at T1 significantly predicted the total sleep problems score at T2, whereas age, sex, parent education level and total number of life events did not. PMID:22833310
Worryingly low levels of parent–child agreement on child psychiatric diagnosis are reported. This study examined parent–child\\u000a agreement on diagnostic categories and severity ratings with the AnxietyDisorders Interview Schedule, Child and Parents versions\\u000a (ADIS-C\\/P). Children’s age, gender, motivation and self-concept and parent’s general psychopathology and diagnoses were examined.\\u000a Participants were 110 children (aged 8–14 years) with a principal specific phobia diagnosis,
Lena Reuterskiöld; Lars-Göran Öst; Thomas Ollendick
Social anxiety and eating disorders are highly comorbid. Social appearance anxiety (i.e., fear of negative evaluation of one's appearance), general fear of negative evaluation, and perfectionism have each been proposed as risk factors for both social anxietydisorder and the eating disorders. However, no research to date has examined all three factors simultaneously. Using structural equation modeling in two diverse samples (N=236; N=136) we tested a model in which each of these risk factors were uniquely associated with social anxiety and eating disorder symptoms. We found support for social appearance anxiety as a shared risk factor between social anxiety and eating disorder symptoms, whereas fear of negative evaluation was a risk factor only for social anxiety symptoms. Despite significant zero-order relationships, two facets of perfectionism (high standards and maladaptive perfectionism) did not emerge as a risk factor for either disorder when all constructs were considered. These results were maintained when gender, body mass index, trait negative affect, and depression were included in the model. It is possible that treating negative appearance evaluation fears may reduce both eating disorder and social anxiety symptoms. PMID:23583741
Levinson, Cheri A; Rodebaugh, Thomas L; White, Emily K; Menatti, Andrew R; Weeks, Justin W; Iacovino, Juliette M; Warren, Cortney S
|Anxietydisorders and sensory over-responsivity (SOR) are common in children with autism spectrum disorders (ASD), and there is evidence for an association between these two conditions. Currently, it is unclear what causal mechanisms may exist between SOR and anxiety. We propose three possible theories to explain the association between anxiety…
|The objective of this study was to examine (a) anxiety and depression symptoms in children with Asperger syndrome (AS) compared to children with attention-deficit/hyperactivity disorder (ADHD) and children with depressive disorder; (b) parental anxiety and depressive symptoms in the three groups; and (c) the association between the anxiety and…
Park, Subin; Park, Min-Hyeon; Kim, Hyo Jin; Yoo, Hee Jeong
The relationship between obsessive-compulsive disorder (OCD) and obsessive-compulsive personality disorder (OCPD) has not yet been fully clarified. The aim of the present study was to analyze DSM-IV OCPD prevalence rates in OCD and panic disorder (PD) patients to test for the specificity of the OCPD-OCD link, and to compare them to OCPD prevalence in a control group of subjects without any psychiatric disorder. A total of 109 patients with a principal diagnosis of DSM-IV (SCID-I) OCD and 82 with PD were interviewed using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) in order to assess the prevalence of OCPD. All patients with a coexisting axis I diagnosis were excluded from the study to eliminate confounding factors when evaluating the association between prevalence rates of OCPD and anxietydisorder diagnoses. An exclusion criteria was also a Hamilton Depression Rating Scale (HAM-D) score >/=16. A sample of comparison subjects (age 18 to 65 years) without any psychiatric disorder was recruited from people registered with two general practitioners (GPs), whether or not they consulted the doctor, in order to evaluate OCPD prevalence rate in the community. A significant difference was found between the prevalence of OCPD in OCD (22.9%) and in PD (17.1%) on one hand, and that in the comparison sample (3.0%) on the other. No differences were found between the two psychiatric groups, even when splitting the samples according to gender. Our study failed to support the hypothesis of a specific relationship between OCPD and OCD; we confirmed the higher prevalence rate of this personality disorder in OCD subjects with regard to the general population, but we also confirmed the higher rate of OCPD in another anxietydisorder which is phenomenologically well characterized and different from OCD, such as PD. PMID:15332194
Response to treatment of late-life generalized anxietydisorder has been defined by a variety of methods, all based on statistically significant reductions in symptom severity. However, it is unknown whether these improvements in symptom severity are associated with meaningful differences in everyday functioning. The current study used four methods to define response to treatment for 115 primary-care patients 60 years and older, with a principal or coprincipal diagnosis of generalized anxietydisorder. The methods examined included percentage of improvement, reliable change index, and minimal clinically significant differences. Agreement among classification methods and their associations with general and mental health-related quality of life were assessed. Results indicated moderate agreement among symptom-based classification methods and significant associations with measures of quality of life. PMID:21964278
Roseman, Ashley S; Cully, Jeffrey A; Kunik, Mark E; Novy, Diane M; Rhoades, Howard M; Wilson, Nancy L; Bush, Amber L; Stanley, Melinda A
Background Over the past several decades, complementary and alternative medications have increasingly become a part of everyday treatment. With the rising cost of prescription medications and their production of unwanted side effects, patients are exploring herbal and other natural remedies for the management and treatment of psychological conditions. Psychological disorders are one of the most frequent conditions seen by clinicians, and often require a long-term regimen of prescription medications. Approximately 6.8 million Americans suffer from generalized anxietydisorder. Many also suffer from the spectrum of behavioural and physical side effects that often accompany its treatment. It is not surprising that there is universal interest in finding effective natural anxiolytic (anti-anxiety) treatments with a lower risk of adverse effects or withdrawal. Methods An electronic and manual search was performed through MEDLINE/PubMed and EBSCO. Articles were not discriminated by date of publication. Available clinical studies published in English that used human participants and examined the anxiolytic potential of dietary and herbal supplements were included. Data were extracted and compiled into tables that included the study design, sample population, intervention, control, length of treatment, outcomes, direction of evidence, and reported adverse events. Results A total of 24 studies that investigated five different CAM monotherapies and eight different combination treatments and involved 2619 participants met the inclusion criteria and were analyzed. There were 21 randomized controlled trials and three open-label, uncontrolled observational studies. Most studies involved patients who had been diagnosed with either an anxietydisorder or depression (n = 1786). However, eight studies used healthy volunteers (n = 877) who had normal levels of anxiety, were undergoing surgery, tested at the upper limit of the normal range of a trait anxiety scale, had adverse premenstrual symptoms or were peri-menopausal, reported anxiety and insomnia, or had one month or more of elevated generalized anxiety. Heterogeneity and the small number of studies for each supplement or combination therapy prevented a formal meta-analysis. Of the randomized controlled trials reviewed, 71% (15 out of 21) showed a positive direction of evidence. Any reported side effects were mild to moderate. Conclusions Based on the available evidence, it appears that nutritional and herbal supplementation is an effective method for treating anxiety and anxiety-related conditions without the risk of serious side effects. There is the possibility that any positive effects seen could be due to a placebo effect, which may have a significant psychological impact on participants with mental disorders. However, based on this systematic review, strong evidence exists for the use of herbal supplements containing extracts of passionflower or kava and combinations of L-lysine and L-arginine as treatments for anxiety symptoms and disorders. Magnesium-containing supplements and other herbal combinations may hold promise, but more research is needed before these products can be recommended to patients. St. John's wort monotherapy has insufficient evidence for use as an effective anxiolytic treatment.
Converging evidence from epidemiologic and treatment studies indicate that anxietydisorders and substance use disorders commonly co-occur, and the interaction is multifaceted and variable. Epidemiological studies and investigations within clinical substance abuse populations have found an association between anxietydisorders and substance use disorders. Specific anxietydisorders including generalized anxietydisorder, panic disorder, and post traumatic stress disorder have all been associated with substance use. The association with obsessive–compulsive disorder is less robust, and some research has found a negative association. The risk of nicotine dependence is significantly higher among individuals with an anxietydisorder, and conversely, smoking has been found to be associated with trait anxiety and anxietydisorders. A review of the current literature and the relationship between specific anxietydisorders and alcohol and substance use disorders is discussed in detail. This article, written for social workers in a variety of practice settings, reviews the prevalence, diagnostic, and treatment issues at the interface of substance use disorders and anxietydisorders.
Brady, Kathleen T.; Haynes, Louise F.; Hartwell, Karen J.; Killeen, Therese K.
This study examined whether children with attention-deficit\\/hyperactivity disorder (ADHD) have lower autonomic nervous system\\u000a (ANS) activity and show less stress reactivity than children with an anxietydisorder. It also explored whether such a difference\\u000a was accounted for by comorbid oppositional defiant disorder (ODD) or conduct disorder (CD) in some of the ADHD children. Forty-three\\u000a referred children performed a stress task,
Natasja D. J. van Lang; Joke H. M. Tulen; Victor L. Kallen; Bianca Rosbergen; Gwen Dieleman; Robert F. Ferdinand
A comparative analysis was carried out of depressive and anxietydisorders in accordance to ICD-10 criteria in the group of patients with pain variant of somatization disorder (SD), vegetative dysfunction (VD) with monolocal pathological body sensations (PBS) and VD with be- and polylocal PBS (analogous of somatoform vegetative dysfunction without of an accent on disturbances of physiological functioning of any organs or system). Results of this analysis compared with frequency of depressive and anxiety symptomatic in the group of patients with depressive episode (DE). As a result of discriminative analysis 20 depressive and anxiety symptoms were established with possibility of determination of mutual distant/near of 4 clinical groups in feature's space. The SD and VD with monolocal PBS groups take place extreme position in the continuum of 4 clinical groups, DE and VD with be- and polylocal PBS - middle position. Pain variant of SD with primary light (rare middle) severe of depressive episode, as a rule, anxiety modality of low mood can be qualified as masked (somatization) depression. VD patients with be- and polylocal PBS were attributed to atypical monopolar depression; depressive episode without pathological body sensations (to the exclusion of possible vitalization of verbalization/no verbalization melancholy affect) occupied middle position in the continuum of monopolar depression as an affective psychosis. PMID:18379493
Duloxetine, a medication with effects on both serotonin and noradrenaline transporter molecules, has recently been approved for the treatment of generalized anxietydisorder. The evidence for its efficacy lies in a limited number of double blind, placebo controlled comparisons. Statistically significant improvements in the Hamilton Anxiety Rating Scale from baseline were demonstrated in all studies at doses of 60 to 120 mg per day. The significance of such changes in terms of clinical improvements compared to placebo is less certain, particularly when the effect size of the change is calculated. In comparative trials with venlafaxine, duloxetine was as effective in providing relief of anxiety symptoms. In addition to improvements in clinical symptoms duloxetine has also been associated with restitution of role function as measured by disability scales. Duloxetine use is associated with nausea, dizziness, dry mouth, constipation, insomnia, somnolence, hyperhidrosis, decreased libido and vomiting. These treatment emergent side effects were generally of mild to moderate severity and were tolerated over time. Using a tapered withdrawal schedule over two weeks in the clinical trials, duloxetine was associated with only a mild withdrawal syndrome in up to about 30% of patients compared to about 17% in placebo treated patients. Duloxetine in doses of up to 200 mg twice daily did not prolong the QTc interval in healthy volunteers. Like other agents with dual neurotransmitter actions duloxetine reduces the symptoms of generalized anxietydisorder in short term treatments. Further evidence for its efficacy and safety in long term treatment is required.
\\u000a The occupational disability associated with mood and anxietydisorders has been receiving increasing attention from mental\\u000a health and occupational researchers and practitioners, leading to the development of several work-focused interventions for\\u000a these conditions. This is clearly an emerging area of research that has yet to define the critical intervention to remedy\\u000a this substantial problem. This chapter describes the existing interventions
The objectives of this study were to evaluate perceived unmet need for mental healthcare, determinants of unmet need, and\\u000a barriers to care in individuals with social anxiety (SA) or panic disorder with agoraphobia (PDA) in Quebec. Data from 206\\u000a participants diagnosed with SA or PDA were collected using an online questionnaire. Correlational analyses and binary stepwise\\u000a logistic regressions were conducted
Mariko Chartier-OtisMichel; Michel Perreault; Claude Bélanger
|The current study aimed to examine the relation between experiential avoidance and anxietydisorders, as well as the usefulness of the Avoidance and Fusion Questionnaire for Youth (AFQ-Y; Greco, Lambert, & Baer, 2008) in detecting anxietydisorder in a sample of adolescent inpatients. First, the relation between experiential avoidance and anxiety…
|Background: Anxietydisorders are known to be common in the general population. Previous studies with adults with intellectual disabilities (IDs) report a prevalence of general anxietydisorder ranging from less than 2% to 17.4%. Little is known about associated factors in this population. This study investigates point prevalence of anxiety…
Anxietydisorders share high comorbidity with schizophrenia spectrum disorders. This study examined the outcomes of a transdiagnostic education and support group for people with schizophrenia spectrum diagnoses and problematic anxiety. Results suggest that transdiagnostic education and support may be effective in reducing anxiety for people with schizophrenia spectrum diagnoses.
Anxietydisorders have been found to be highly comorbid with autism spectrum disorders (ASDs). Even so, the identification and dissemination of empirically supported treatments for anxiety in adults or children who have ASD has lagged behind the larger evidence-based trend. This review examines the efficacy of cognitive-behavioral therapy as a treatment for anxiety in children who have an ASD and
Fifteen children with selective mutism (SM), 15 children with anxietydisorders (AD) without selective mutism, and 15 children without anxietydisorders or selective mutism (CN) were compared to examine the relationship between selective mutism and anxiety. Data were collected from children (age 4–10 years), parents, teachers, and clinicians. Results indicated that children with SM closely resemble children with AD. All
Objective: The present study examined sleep-related problems (SRPs) among a large sample (n = 128) of youth with anxietydisorders (i.e., generalized, separation, and social). The frequency of eight specific SRPs was examined in relation to age, gender, type of anxietydisorder, anxiety severity, and functional impairment. The impact of…
|Children with Autism Spectrum Disorder or Williams syndrome are vulnerable to anxiety. The factors that contribute to this risk remain unclear. This study compared anxiety in autism spectrum disorder and Williams Syndrome and examined the relationship between repetitive behaviours and anxiety. Thirty-four children with autism and twenty children…
Rodgers, Jacqui; Riby, Deborah M.; Janes, Emily; Connolly, Brenda; McConachie, Helen
Sensory-processing sensitivity is assumed to be a heritable vulnerability factor for shyness. The present study is the first to examine sensory-processing sensitivity among individuals with social anxietydisorder. The results showed that the construct is separate from social anxiety, but it is highly correlated with harm avoidance and agoraphobic avoidance. Individuals with a generalized subtype of social anxietydisorder reported
Acceptance and Commitment Therapy (ACT) is an innovative acceptance-based behavior therapy that has been applied broadly and successfully to treat a variety of clinical problems, including the anxietydisorders. Throughout treatment ACT balances acceptance and mindfulness processes with commitment and behavior change processes. As applied to anxietydisorders, ACT seeks to undermine excessive struggle with anxiety and experiential avoidance––attempts to
Joanna Arch; Emmanuel Espejo; Melody Keller; David Langer
|Objective: The present study examined sleep-related problems (SRPs) among a large sample (n = 128) of youth with anxietydisorders (i.e., generalized, separation, and social). The frequency of eight specific SRPs was examined in relation to age, gender, type of anxietydisorder, anxiety severity, and functional impairment. The impact of…
The nature of the noradrenergic dysregulation in clinical anxietydisorders remains unclear. In panic disorder, the predominant view has been that central noradrenergic neuronal networks and\\/or the sympathetic nervous system was normal in patients at rest, but hyper-reactive to specific stimuli, for example carbon dioxide. These ideas have been extended to other anxietydisorders, which share with panic disorder characteristic
In recent years, virtual reality exposure therapy (VRET) has become an interesting alternative for the treatment of anxietydisorders. Research has focused on the efficacy of VRET in treating anxietydisorders: phobias, panic disorder, and posttraumatic stress disorder. In this systematic review, strict methodological criteria are used to give an overview of the controlled trials regarding the efficacy of VRET
Orthostatic circulatory disorders are frequently the cause of orthostatic intolerance, syncope or dangerous falls. A sufficient therapy should be based on a differential diagnosis by means of an active standing test or a tilt-table test. Three typical pathological reactions of blood pressure and heart rate can be differentiated. The hypoadrenergic orthostatic hypotension is characterised by an immediate drop in blood pressure (systolic drop > 20 mmHg below base line within 3 min) with or without compensatory tachycardia. It is caused by peripheral or central sympathetic dysfunction. Tachycardia (> 30 beats per minute above base line within 10 min) without significant blood pressure drop but with a fall of cerebral blood flow indicates a postural tachycardia syndrome. In general, there is no further somatic dysfunction. Increased venous pooling is thought to be the assumed pathomechanism. A reflex mechanism evokes the neurocardiogenic syncope after a certain time of standing: sympathetic inhibition yields a strong blood pressure drop and vagal activation bradycardia. Proved therapies include use of the mineralocorticoide fludrocortison (hypoadrenergic orthostatic hypotension), of the alpha-agonist midodrin (postural tachycardia syndrome) and of beta-blockers (neurocardiogenic syncope). PMID:10637809
|The goal of this study was to evaluate the efficacy of a cognitive-behavioral treatment package for comorbid generalized anxietydisorder (GAD) and panic disorder with agoraphobia (PDA). A single-case, multiple-baseline, across-subjects design was used with 3 primary GAD patients with secondary PDA. The efficacy of the treatment was evaluated…
Labrecque, Joane; Dugas, Michel J.; Marchand, Andre; Letarte, Andree
A number of studies have demonstrated that symptoms of prolonged grief disorder (PGD) represent a symptom cluster distinct from bereavement-related depression, anxiety, and posttraumatic stress disorder (PTSD). The aim of the present study was to confirm and extend these findings using the most recent criteria defining PGD. The authors interviewed…
Schaal, Susanne; Dusingizemungu, Jean-Pierre; Jacob, Nadja; Neuner, Frank; Elbert, Thomas
Social AnxietyDisorder (SAD) and Autism Spectrum Disorders (ASD) are fairly common psychiatric conditions that impair the functioning of otherwise healthy young adults. Given that the two conditions frequently co-occur, measurement of the characteristics unique to each condition is critical. This study evaluated the structure and construct…
White, Susan W.; Bray, Bethany C.; Ollendick, Thomas H.
Although the Internet offers information about psychological problems and support resources for behavioral health problems, the quality of this information varies widely. So as to offer guidance in this area, preferred sites pertaining to anxietydisorders, parenting problems, eating disorders, and chemical dependency were analyzed. A total of 365…
|A number of studies have demonstrated that symptoms of prolonged grief disorder (PGD) represent a symptom cluster distinct from bereavement-related depression, anxiety, and posttraumatic stress disorder (PTSD). The aim of the present study was to confirm and extend these findings using the most recent criteria defining PGD. The authors…
Schaal, Susanne; Dusingizemungu, Jean-Pierre; Jacob, Nadja; Neuner, Frank; Elbert, Thomas
A number of studies have demonstrated that symptoms of prolonged grief disorder (PGD) represent a symptom cluster distinct from bereavement-related depression, anxiety, and posttraumatic stress disorder (PTSD). The aim of the present study was to confirm and extend these findings using the most recent criteria defining PGD. The authors interviewed a total of 400 orphaned or widowed survivors of the
Susanne Schaal; Jean-Pierre Dusingizemungu; Nadja Jacob; Frank Neuner; Thomas Elbert
The relationship between selective mutism (SM) and childhood anxietydisorders is illustrated through an examination of their temperamental, environmental, and biological etiologies. SM is also explored as a symptom of the specific anxietydisorders of social phobia, separation anxiety, and posttraumatic stress disorder. The etiology and symptom overlap demonstrates SM as being an anxietydisorder or a variant of a specific anxietydisorder. The conceptualization of SM as an anxietydisorder is helpful in effectively treating afflicted children. There is enough evidence in the current literature to challenge the current classification, from the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders of SM as an Other Disorder of Infancy, Childhood, and Adolescence. PMID:10504110
Background There are limited studies of generalized anxietydisorder (GAD) across pregnancy. Methods Women (n=2793) were enrolled in the Yale Pink and Blue study, a cohort enriched with subjects who suffered from major depressive disorder (MDD) within the past five years or used antidepressants in the past year. Subjects were evaluated with the Composite International Diagnostic Interview at three time points: twice in pregnancy and once after delivery. We defined a generalized anxietydisorder (GAD) episode as per DSM IV but with required duration reduced to one month or longer. Course and correlates of GAD were examined in women who had: 1) no GAD during the 6 months prior or in pregnancy (Group A), 2) GAD in the 6 months prior to but not in pregnancy (Group B), 3) GAD in pregnancy only (Group C) and 4) GAD both in the 6 months prior to and during pregnancy (Group D). Results 9.5% of the cohort suffered from GAD at some point in pregnancy. Anxiety symptoms were highest in the first trimester and decreased across pregnancy. Regression analysis revealed that previous GAD episodes, education, social support and a history of child abuse distinguished between membership in the four groups. Limitations The sample may not be representational, as it was enhanced with those at risk, and had relatively low representation of socio-economically disadvantaged women. Conclusions Identification of anxious patients during pregnancy may provide an opportunity to engage those in need of psychiatric treatment.
Examined the concurrent validity of the attention-deficit\\/hyperactivity disorder (ADHD) module of the AnxietyDisorders Interview\\u000a Schedule for DSM-IV, Child and Parent versions (ADIS-C\\/P). One hundred eighty-four clinic-referred children were categorized into three ADIS-generated\\u000a groups: No diagnosis of ADHD (No ADHD; n = 63), parent-only diagnosis of ADHD (Parent Only; n = 81), and parent plus child diagnosis of ADHD (Parent + Child; n = 40). The
Matthew A. Jarrett; Jennifer C. Wolff; Thomas H. Ollendick
Background Despite advances in neurobiological research on Major Depressive Disorder and Social AnxietyDisorder, little is known about the neural functioning of individuals with comorbid depression/social anxiety. We examined the timing of neural responses to social stress in individuals with major depression and/or social anxiety. We hypothesized that having social anxiety would be associated with earlier responses to stress, having major depression would be associated with sustained responses to stress, and that comorbid participants would exhibit both of these response patterns. Methods Participants were females diagnosed with pure depression (n?=?12), pure social anxiety (n?=?16), comorbid depression/social anxiety (n?=?17), or as never having had any Axis-I disorder (control; n?=?17). Blood oxygenation-level dependent activity (BOLD) was assessed with functional magnetic resonance imaging (fMRI). To induce social stress, participants prepared a speech that was ostensibly to be evaluated by a third party. Results Whereas being diagnosed with depression was associated with a resurgence of activation in the medial frontal cortex late in the stressor, having social anxiety was associated with a vigilance-avoidance activation pattern in the occipital cortex and insula. Comorbid participants exhibited activation patterns that generally overlapped with the non-comorbid groups, with the exception of an intermediate level of activation, between the level of activation of the pure depression and social anxiety groups, in the middle and posterior cingulate cortex. Conclusions These findings advance our understanding of the neural underpinnings of major depression and social anxiety, and of their comorbidity. Future research should elucidate more precisely the behavioral correlates of these patterns of brain activation.
There is a need to explain the high level of comorbidity between separation anxietydisorder (SAD) in adulthood and panic disorder with agoraphobia (Pd-Ag). One possibility is that inadequate specification of symptom domains and/or diagnostic questions accounts for some of the comorbidity. The present anxiety clinic study examined responses of adult patients (n = 646) with SAD and/or Pd-Ag on eight symptom domains based on a previous factor analysis of a commonly used separation anxiety measure, the ASA-27, as well as on the Anxiety Sensitivity Index. We also examined questionnaire items that did not load on the factor structure. All separation anxiety domains distinguished strongly between SAD and Pd-Ag. Comparisons across three groups (SAD alone, Pd-Ag alone and comorbid SAD/Pd-Ag) revealed that two symptom domains (anxiety about embarking on trips, and sleep disturbances) showed some overlap between Pd-Ag and SAD. Two of the items of the ASA-27 that did not load with other items in the factor analysis also showed overlap with Pd-Ag, with both referring to anxieties about leaving home. Patients with SAD (with or without Pd-Ag) returned higher scores on anxiety sensitivity than those with Pd-Ag alone. The findings support the distinctiveness of the construct of SAD and the capacity of the ASA-27 to discriminate between that disorder and Pd-Ag. SAD appears to be a more severe form of anxiety than Pd-Ag. There may be a need to refine items to include the reasons for avoiding leaving home, reluctance to sleep alone and to embark on trips, to ensure accurate discrimination between Pd-Ag and SAD in adulthood. PMID:23247205
The Screen for Child Anxiety Related Emotional Disorders (SCARED) and the Spence Children’s Anxiety Scale (SCAS) are recently developed self-report questionnaires for measuring DSM-IV defined anxietydisorder symptoms in children. The present study examined correlations among these measures in a large sample of Dutch school children (N=1011). Results showed that there was a strong correlation between the total anxiety scores
The present study aimed to examine how video feedback can affect perceived performance and anticipatory anxiety in various naturalistic social anxiety-provoking situations among clinical patients diagnosed with social anxietydisorder (SAD) and to examine predictors that might influence response to video feedback. Participants were 52 consecutive patients with DSM-IV SAD who participated in a group-based CBT program. Our results demonstrated
Junwen Chen; Toshi A. Furukawa; Yumi Nakano; Tetsuji Ietsugu; Sei Ogawa; Tadashi Funayama; Norio Watanabe; Yumiko Noda; Ronald M. Rapee
This study examined secondary outcomes of a randomized clinical trial that evaluated an individual cognitive-behavioral (ICBT), family-based cognitive-behavioral (FCBT), and family-based education, support and attention (FESA) treatment for anxious youth. Participants (161) were between 7 and 14 years (M=10.27) of age and had a principal diagnosis of separation anxietydisorder, social phobia, and\\/or generalized anxietydisorder. Hierarchical linear modeling examined
Cynthia Suveg; Jennifer L. Hudson; Gene Brewer; Ellen Flannery-Schroeder; Elizabeth Gosch; Philip C. Kendall
Background: The serotonin 1A (5-hydroxytryptamine 1A [5-HT1A]) receptor likely plays a critical role in anxiety pathophysiology.Objective: In this proof-of-concept investigation, we tested the short-term tolerability of PRX-00023, a nonazapirone 5-HT1A selective partial agonist, in outpatients with generalized anxietydisorder (GAD).Methods: Patients with a diagnosis of GAD, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and
Sanjay J. Mathew; Amir Garakani; Scott Oshana; Stephen Donahue
OBJECTIVE: To examine unintentional alcohol and drug poisoning in association with substance use disorders (SUDs) and mood and anxietydisorders. METHOD: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) external-cause-of-injury codes on discharge records of patients ages 12+ years from the 2010 Nationwide Inpatient Sample were examined to identify cases with unintentional alcohol poisoning (E860) and/or drug poisoning (E850-E858). ICD-9-CM diagnosis codes were examined to identify comorbid alcohol dependence, drug dependence, tobacco use disorder, and mood/anxietydisorders. Poisson regression was used to derive risk ratios to assess the associations between these comorbid conditions and alcohol/drug poisoning. RESULTS: Estimated numbers of hospitalisations related to unintentional alcohol and drug poisoning were, respectively, 5623 and 60 423 in men, and 3147 and 68 568 in women. For both sexes, the proportion with SUDs or mood/anxietydisorders was significantly higher among inpatients with alcohol and drug poisoning than among all inpatients. Estimated risk ratios indicated strong relationships of SUDs and mood/ anxietydisorders with unintentional poisoning from alcohol and drugs. The strongest association was between alcohol dependence and alcohol poisoning for both sexes. Significant associations also existed between drug dependence and drug poisoning, and mood/anxietydisorders and poisoning from alcohol and drugs. CONCLUSIONS: SUDs and mood/anxietydisorders are key risk factors for unintentional poisoning by alcohol and drugs among inpatients in the USA. Effective treatments of these disorders should be targeted as poisoning prevention efforts. Future studies are needed to clarify a potential bias in the data due to differential inpatient mental condition screening practices. PMID:23710064
The present study examined the prevalence and types of anxiety exhibited by high-functioning adolescents With autism spectrum disorders and factors related to this anxiety. Results suggest that adolescents With autism spectrum disorders exhibit anxiety levels that are significantly higher than those of the general population. The study found a loW negative correlation betWeen assertive social skills and social anxiety. In
Children with Autism Spectrum Disorder or Williams syndrome are vulnerable to anxiety. The factors that contribute to this\\u000a risk remain unclear. This study compared anxiety in autism spectrum disorder and Williams Syndrome and examined the relationship\\u000a between repetitive behaviours and anxiety. Thirty-four children with autism and twenty children with Williams Syndrome were\\u000a assessed with measures of anxiety and repetitive behaviours.
Jacqui RodgersDeborah; Deborah M. Riby; Emily Janes; Brenda Connolly; Helen McConachie
. Background: Little is known about the temporal sequencing of psychiatric disorders. The aim of this study was to obtain insight into\\u000a patterns of co-occurrence of DSM-III-R mood disorders in relation to anxiety and substance use disorders, their temporal sequencing\\u000a and the sociodemographic and long-term vulnerability predictors of this temporal sequencing. Methods: Data are from the Netherlands Mental Health Survey
R. de Graaf; R. V. Bijl; J. Spijker; A. T. F. Beekman; W. A. M. Vollebergh
Anxietydisorders are prevalent in children 7 years and younger; however, these children generally do not possess developmental skills required in cognitive behavior treatment. Recent efforts have adapted parent-child interaction therapy (PCIT), originally developed for disruptive and noncompliant behavior, for young children with anxiety. This article reviews the principles underlying PCIT and the rationale for adapting it to target anxiety symptoms. The authors describe two related treatment approaches that have modified PCIT to treat anxiety: (1) Pincus and colleagues' treatment for separation anxiety, and (2) Puliafico, Comer, and Albano's CALM Program for the range of early child anxietydisorders. PMID:22800997
Puliafico, Anthony C; Comer, Jonathan S; Pincus, Donna B
|Previous research has shown that children with high levels of early anxiety/withdrawal are at increased risk of later anxiety and depression. It has also been found that positive parent-child attachment reduces the risk of these disorders. The aim of this paper was to examine the extent to which positive parent-child attachment acted to mitigate…
Jakobsen, Ida Skytte; Horwood, L. John; Fergusson, David M.
Despite their apparent implications for social functioning, adult attachment styles have never been specifically explored among persons with social anxietydisorder. In the current study, a cluster analysis of the Revised Adult Attachment Scale (N. L. Collins, 1996) revealed that 118 patients with social anxiety were best represented by anxious and secure attachment style clusters. Members of the anxious attachment
Winnie Eng; Richard G. Heimberg; Trevor A. Hart; Franklin R. Schneier; Michael R. Liebowitz
Little is known about the predictors of outcome in anxietydisorders in naturalistic outpatient settings. We analyzed 2-year follow-up data collected through Routine Outcome Monitoring (ROM) in a naturalistic sample of 917 outpatients in psychiatric specialty care in order to identify factors predicting outcome. We included patients with panic disorder with or without agoraphobia, agoraphobia without panic, social phobia, or generalized anxietydisorder. Main findings from Cox regression analyses demonstrated that several socio-demographic variables (having a non-Dutch ethnicity [HR = 0.71)], not having a daily occupation [HR = 0.76]) and clinical factors (having a diagnosis of agoraphobia [HR = 0.67], high affective lability [HR = 0.80] and behavior problems [HR = 0.84]) decreased chances of response (defined as 50% reduction of anxiety severity) over the period of two years. Living with family had a protective predictive value [HR = 1.41]. These results may imply that factors that could be thought to limit societal participation, are associated with elevated risk of poor outcome. A comprehensive ROM screening process at intake may aid clinicians in the identification of patients at risk of chronicity. PMID:24074517
Schat, A; van Noorden, M S; Noom, M J; Giltay, E J; van der Wee, N J A; Vermeiren, R R J M; Zitman, F G
Numerous clinical trials have demonstrated the efficacy of cognitive behavior therapy (CBT) for the treatment of childhood Separation AnxietyDisorder (SAD) and other anxietydisorders (Velting, Setzer, & Albano, 2004), yet additional research may still be needed to better access and engage anxious youth (Kendall, Suveg, & Kingery, 2006). In this study, we investigated the acceptability and preliminary utility of a group cognitive-behavioral intervention for school-aged girls with SAD provided within an intensive, 1-week setting. The development of the proposed treatment strategy, a 1-week summer treatment program, was predicated on evidence supporting the need for childhood treatments that are developmentally sensitive, allow for creative application of intervention components, incorporate a child’s social context, and ultimately establish new pathways for dissemination to the community. The summer treatment program for SAD was pilot-tested using a case-series design with 5 female children, aged 8 to 11, each with a principal diagnosis of SAD. For 4 of the 5 participants, treatment gains were evidenced by changes in diagnostic status, significant reductions in measures of avoidance, and improvements on self- and parent-report measures of anxiety symptomology. Specifically, severity of SAD symptoms decreased substantially at posttreatment for each participant and, 2 months following treatment, none of the participants met diagnostic criteria for the disorder. A fifth participant experienced substantive improvement in diagnostic status prior to the onset of treatment and, though she evidenced continued improvements following treatment, the role of the intervention in such improvements is less clear.
Santucci, Lauren C.; Ehrenreich, Jill T.; Trosper, Sarah E.; Bennett, Shannon M.; Pincus, Donna B.
|Inattention is among the most commonly referred problems for school-aged youth. Research suggests distinct mechanisms may contribute to attention problems in youth with anxietydisorders versus youth with attention deficit hyperactivity disorder (ADHD). This study compared children (8-17 years) with anxietydisorders (n = 24) and children (8-16…
Weissman, Adam S.; Chu, Brian C.; Reddy, Linda A.; Mohlman, Jan
A brief description of the controversies surrounding the diagnosis of dissociative identity disorder is presented, followed by a discussion of the proposed similarities and differences between dissociative identity disorder and borderline personality disorder. The phenomenon of autohypnosis in the context of early childhood sexual trauma and disordered attachment is discussed, as is the meaning of alters or alternate personalities. The author describes recent neurosciences research that may relate the symptoms of dissociative identity disorder to demonstrable disordered attention and memory processes. A clinical description of a typical patient presentation is included, plus some recommendations for approaches to treatment. PMID:19724751
Capsulotomy is an established psychosurgical intervention for anxietydisorders. While the effectiveness of the intervention in reducing target symptoms is undisputed, the issue of negative personality changes following capsulotomy is of great concern. We studied prospectively personality traits in nine consecutive patients undergoing capsulotomy for anxietydisorder, using the Rorschach test and a personality inventory, the Karolinska Scales of Personality (KSP), administered before and one year after operation. The protocols were evaluated under blind conditions by an independent assessor who had access to no data other than the age and sex of the patients. The Rorschach findings were used in two main comparison procedures: between the patients pre- and postoperative scores, and between that group and three reference groups. The KSP data were compared both with an age-stratified non-patient control group and with data obtained from groups of neurotic patients. In summary, the capsulotomy patients' personalities, as expressed in their Rorschach interpretations, remained intact, and significant reductions were noted in scales reflecting anxiety and hospitality. Statistically significant changes were also noted after operation in 10 of the 17 scales included in the KSP. While pathological scores were observed preoperatively in many scales, all the postoperative scores but one (Socialization) were within the normal range. Scores on the Socialization scale remained low, which is often the case in chronic patients. It is concluded that the patients displayed more normal personality features after operation than before and that adverse personality changes are not likely to occur after capsulotomy. PMID:3223360
Mindus, P; Nyman, H; Rosenquist, A; Rydin, E; Meyerson, B A
Background Anxietydisorders are very common and increase risk for suicide attempts. Little is known about predictors of increased risk specifically among individuals with anxietydisorders. The purpose of this study was to investigate whether specific anxietydisorders and other co-morbid psychiatric disorders, physical health, or work or social functioning increased the future likelihood of a suicide attempts among individuals with anxietydisorders. Method In this prospective study, 676 individuals with an anxietydisorder were followed for an average of 12 years. Results As hypothesized, we found that post-traumatic stress disorder, major depressive disorder (MDD), intermittent depressive disorder (IDD), epilepsy, pain, and poor work and social functioning all predicted a shorter time to a suicide attempt in univariate analyses. In multivariate analyses, baseline MDD and IDD were independent predictors of time to suicide attempt, even when controlling for a past history of suicide attempt. No specific anxietydisorder was an independent predictor of time to attempt in this anxiety-disordered sample. Adding baseline physical health variables and social functioning did not improve the ability of the model to predict time to suicide attempt. Conclusions Mood disorders and past history of suicide attempts are the most powerful predictors of a future suicide attempt in this sample of individuals, all of whom have an anxietydisorder.
Uebelacker, L. A.; Weisberg, R.; Millman, M.; Yen, S.; Keller, M.
We compared symptoms of generalized anxietydisorder (GAD) and separation anxietydisorder (SAD) in 5 groups of boys with\\u000a neurobehavioral syndromes: attention-deficit\\/hyperactivity disorder (ADHD) plus autism spectrum disorder (ASD), ADHD plus\\u000a chronic multiple tic disorder (CMTD), ASD only, ADHD only, and community Controls. Anxiety symptoms were assessed using parent\\u000a and teacher versions of a DSM-IV-referenced rating scale. All three groups
Sarit Guttmann-SteinmetzKenneth; Kenneth D. Gadow; Carla J. DeVincent; Judy Crowell
Multiple studies have demonstrated an association between cigarette smoking and increased anxiety symptoms or disorders, with early life exposures potentially predisposing to enhanced anxiety responses in later life. Explanatory models support a potential role for neurotransmitter systems, inflammation, oxidative and nitrosative stress, mitochondrial dysfunction, neurotrophins and neurogenesis, and epigenetic effects, in anxiety pathogenesis. All of these pathways are affected by exposure to cigarette smoke components, including nicotine and free radicals. This review critically examines and summarizes the literature exploring the role of these systems in increased anxiety and how exposure to cigarette smoke may contribute to this pathology at a biological level. Further, this review explores the effects of cigarette smoke on normal neurodevelopment and anxiety control, suggesting how exposure in early life (prenatal, infancy, and adolescence) may predispose to higher anxiety in later life. A large heterogenous literature was reviewed that detailed the association between cigarette smoking and anxiety symptoms and disorders with structural brain changes, inflammation, and cell-mediated immune markers, markers of oxidative and nitrosative stress, mitochondrial function, neurotransmitter systems, neurotrophins and neurogenesis. Some preliminary data were found for potential epigenetic effects. The literature provides some support for a potential interaction between cigarette smoking, anxiety symptoms and disorders, and the above pathways; however, limitations exist particularly in delineating causative effects. The literature also provides insight into potential effects of cigarette smoke, in particular nicotine, on neurodevelopment. The potential treatment implications of these findings are discussed in regards to future therapeutic targets for anxiety. The aforementioned pathways may help mediate increased anxiety seen in people who smoke. Further research into the specific actions of nicotine and other cigarette components on these pathways, and how these pathways interact, may provide insights that lead to new treatment for anxiety and a greater understanding of anxiety pathogenesis. PMID:23785661
Moylan, Steven; Jacka, Felice N; Pasco, Julie A; Berk, Michael
Background Generalized anxietydisorder (GAD) is a common and sometimes disabling condition often associated with stressful life events that involve significant loss or danger. The disorder appears moderately heritable. Polymorphisms in the RGS2 (regulator of G-protein signaling 2) gene were recently associated with anxious behavior in mice and panic disorder and trait anxiety in humans. We examined whether rs4606, a single nucleotide polymorphism (SNP) in the 3’ UTR of RGS2, was associated with GAD in an epidemiologic sample of adults exposed to the 2004 Florida Hurricanes. Methods The sample for the current study is 607 adults from the 2004 Florida Hurricane Study who returned buccal DNA samples via mail. Participants were selected via random digit dial procedures and interviewed via telephone about hurricane exposure, social support, and GAD symptoms. The outcome measure was DSM-IV diagnosis of GAD derived from structured interviews. Results RGS2 SNP rs4606 was significantly associated with GAD in this sample. In logistic regression analyses, each C allele was associated with a 100% (p=.026) increased risk of GAD after controlling for age, sex, ancestry, hurricane exposure and social support. Conclusions These findings are consistent with a previously published study showing a higher prevalence of the C allele among panic disorder patients than controls. This work points toward a relevant polymorphism for GAD at the 3’ end of the RGS2 gene; and suggest that studying a recently disaster-exposed sample is both feasible and may improve power to find gene-disorder associations.
Koenen, Karestan C.; Amstadter, Ananda B.; Ruggiero, Kenneth J.; Acierno, Ron; Galea, Sandro; Kilpatrick, Dean G.; Gelernter, Joel
The present study examined temporal dependencies of change of panic symptoms and two promising mechanisms of change (self-efficacy and anxiety sensitivity) during an 11-session course of cognitive-behavior therapy (CBT) for Panic Disorder (PD). 361 individuals with a principal diagnosis of PD completed measures of self-efficacy, anxiety sensitivity, and PD symptoms at each session during treatment. Effect size analyses indicated that the greatest changes in anxiety sensitivity occurred early in treatment, whereas the greatest changes in self-efficacy occurred later in treatment. Results of parallel process latent growth curve models indicated that changes in self-efficacy and anxiety sensitivity across treatment uniquely predicted changes in PD symptoms. Bivariate and multivariate latent difference score models indicated, as expected, that changes in anxiety sensitivity and self-efficacy temporally preceded changes in panic symptoms, and that intraindividual changes in anxiety sensitivity and self-efficacy independently predicted subsequent intraindividual changes in panic symptoms. These results provide strong evidence that changes in self-efficacy and anxiety sensitivity during CBT influence subsequent changes in panic symptoms, and that self-efficacy and anxiety sensitivity may therefore be two distinct mechanisms of change of CBT for PD that have their greatest impact at different stages of treatment. PMID:24095901
Gallagher, Matthew W; Payne, Laura A; White, Kamila S; Shear, Katherine M; Woods, Scott W; Gorman, Jack M; Barlow, David H
BACKGROUND: Panic disorder (PD) and generalized anxietydisorder (GAD) are two of the most disabling and costly anxietydisorders seen in primary care. However, treatment quality of these disorders in primary care generally falls beneath the standard of international guidelines. Collaborative stepped care is recommended for improving treatment of anxietydisorders, but cost-effectiveness of such an intervention has not yet
Anna DT Muntingh; Christina M van der Feltz-Cornelis; Harm WJ van Marwijk; Philip Spinhoven; Willem JJ Assendelft; Margot WM de Waal; Leona Hakkaart-van Roijen; Herman J Adèr; Anton JLM van Balkom
Anxiety sensitivity (AS) is a dispositional characteristic that predisposes to the development of anxietydisorders (eg, panic and post-traumatic stress disorder) and major depression. AS is subject to genetic and environmental influences, the former as yet unidentified and the latter known to include childhood maltreatment. The serotonin transporter gene (SLC6A4) promoter polymorphism (5-HTTLPR) has been associated with depression, but most
Previous research has shown that children with high levels of early anxiety\\/withdrawal are at increased risk of later anxiety\\u000a and depression. It has also been found that positive parent–child attachment reduces the risk of these disorders. The aim\\u000a of this paper was to examine the extent to which positive parent–child attachment acted to mitigate the risk of later internalising\\u000a disorders
Ida Skytte Jakobsen; L. John Horwood; David M. Fergusson
This study examined correlates of preschoolers' anxietydisorders using a comprehensive, multimethod design. Participants included a community sample of 541 three-year-old children, of whom 106 (19.6%) met criteria for at least 1 anxietydisorder. Child and parental psychopathology and life stress were assessed with clinical interviews. Child temperament and parenting behavior were assessed with laboratory observations. Mothers and fathers reported on their parenting styles. Compared to preschoolers with no anxietydisorder, preschoolers with an anxietydisorder were more likely to meet criteria for comorbid depressive and oppositional defiant disorders and to exhibit greater temperamental behavioral inhibition and lower positive affectivity, and more sleep problems. Children with anxietydisorders also experienced more stressful life events in the previous 6 months, and their mothers had a higher rate of current anxietydisorders. Compared to children with other anxietydisorders, children with only specific phobia exhibited a somewhat different pattern of associations than children with other anxietydisorders. Overall, the findings suggest that many of the correlates observed in older youth with anxietydisorders are also observed in preschoolers. PMID:23368788
Dougherty, Lea R; Tolep, Marissa R; Bufferd, Sara J; Olino, Thomas M; Dyson, Margaret; Traditi, Jennifer; Rose, Suzanne; Carlson, Gabrielle A; Klein, Daniel N
Anxietydisorders (obsessive-compulsive disorder, social phobia/selective mutism, panic disorder, separation anxiety, generalized anxietydisorder, simple phobia and post-traumatic stress disorder) are the most prevalent psychiatric disorders in children and adolescents. The selective serotonin reuptake inhibitors (SSRIs)--citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline--have demonstrated efficacy in treating anxietydisorders in adults. Although less information is available on the use of these agents in the paediatric population, research into the SSRIs for childhood anxietydisorders is increasing. This article reviews current literature, including case reports as well as open and controlled trials, on the effectiveness and tolerability of the SSRIs in the paediatric population. It also discusses developmental differences in children that should be considered in the utilisation of the SSRIs in paediatric patients. PMID:11110019
Murphy, T K; Bengtson, M A; Tan, J Y; Carbonell, E; Levin, G M
The comorbidity of alcoholism with anxiety and depressive disorders was examined in four epidemiologic investigations from diverse geographic sites. Despite variability in lifetime prevalence rates for these disorders, there was strong cross-site consistency in the magnitude and specific patterns of comorbidity. Individuals with alcohol abuse or dependence generally experienced a twofold to threefold increased risk of anxiety and depressive disorders.
Joel D. Swendsen; Kathleen R. Merikangas; Glorisa J. Canino; Ronald C. Kessler; Maritza Rubio-Stipec; Jules Angst
|Anxietydisorders are the most common mental health concerns in the United States and they tend to be among the most frequently reported in college mental health. While efficacious research for the psychotherapy treatment of specific anxietydisorders (e.g., social phobia, panic disorder, etc.) exists, the picture is more complex in clinical…
Pharmacotherapy for anxietydisorders is an active area of research. A variety of drug groups have been shown to be effective in treating many of the anxietydisorders, with selective serotonin reuptake inhibitors (SSRIs) being considered first-line agents for virtually all anxietydisorders. There is a clinical need for alternative drug treatments, as many patients do not achieve a complete response and experience significant adverse effects. The successful use of antiepileptic drugs in mood disorders has led clinicians and researchers to investigate their potential efficacy in other psychiatric disorders, particularly in anxietydisorders. There have been a number of investigations conducted in the form of case reports, case series and open-label trials, suggesting the potential usefulness of antiepileptic drug treatment in a variety of anxietydisorders. More reliable evidence for the use of antiepileptic drugs in anxietydisorders can be gleaned from recent placebo-controlled trials. Thus far, the strongest placebo-controlled evidence has demonstrated the efficacy of pregabalin in treating social phobia and generalised anxietydisorder, while smaller or less robust controlled trials have suggested the potential efficacy of gabapentin in social phobia, lamotrigine in post-traumatic stress disorder, and valproic acid in panic disorder. Antiepileptic drugs may have a place in the treatment of anxietydisorders; however, further investigation is warranted to determine in what circumstances they should be used as monotherapy or as augmenting agents in individuals who are partially or non-responsive to conventional therapy. PMID:15456335
Van Ameringen, Michael; Mancini, Catherine; Pipe, Beth; Bennett, Mark
Objective: Attention deficit hyperactivity disorder, combined type (ADHD-CT), dysthymic disorder, and anxietydisorders frequently co-occur in primary school age children, although there have been no published data describing their association. We investigated the association of anxiety, defined from a parent or child perspective, with primary school-age children with ADHD-CT with and without dysthymic disorder.Method: One hundred and forty-six medication naïve
Alasdair Vance; Katrina Harris; Marilyn Boots; Jessica Talbot; Mary Karamitsios
A common assumption is that all youth with anxietydisorders (AD) experience impaired peer relationships relative to healthy\\u000a control children. Social impairments have been identified among youth with certain AD (e.g., social anxietydisorder; SAD),\\u000a but less is known about the peer relationships of children with generalized anxietydisorder (GAD). We therefore compared\\u000a the interpersonal functioning of youth with GAD,
Lindsay Scharfstein; Candice Alfano; Deborah Beidel; Nina Wong
Although psychiatric comorbidity is common among patients with anxietydisorders, its impact on treatment outcome remains unclear. The present study used meta-analytic techniques to examine the relationship between diagnostic comorbidity and treatment outcome for patients with anxietydisorders. One hundred forty-eight anxiety-disordered treatment samples (combined N=3534) were examined for post-treatment effects from the PsychINFO database. Samples consisted of those exposed
The non-OCD (obsessive-compulsive disorder) anxietydisorders in the pediatric population- separation anxietydisorder, generalized anxietydisorder, and social phobia and others- are arguably the most common psychiatric disorders in this age group. Anxietydisorders, in addition to being common, also significantly impair the affected child at home, school, and with peers. A small developing evidence base suggests the selective serotonin reuptake inhibitors (SSRIs) are the pharmacological treatment of choice for pediatric non-OCD anxietydisorders. In clinical trials, SSRIs are often very effective in reducing symptoms and improving functioning and generally well tolerated. The U.S. Food and Drug Administration's (FDA) review of the safety of antidepressants in the pediatric population suggest a small, but significant, increased relative risk for suicidality adverse events on antidepressant versus placebo. Despite the apparent increased risk, the larger magnitude of benefit of the SSRIs for pediatric non-OCD anxietydisorders compared to depression suggests the benefit/risk ratio for anxietydisorders is more favorable than that for depression. This paper will review available studies on the treatment of non-OCD childhood anxietydisorders with antidepressants, including the SSRIs, and discuss pertinent safety issues. PMID:16553537
Following the recent debates on the discrepancy between the predominant weight of bipolar disorder (BPD) in the clinical reality and its relatively low prevalence figures emerging from epidemiological surveys, the present paper contends the ability of current operational diagnostic system to properly detect the clinical entity of bipolar disorder. As an episode of mania\\/hypomania is the necessary requirement for a
Carlo Faravelli; Silvia Gorini Amedei; Maria Alessandra Scarpato; Luca Faravelli
It has been suggested that an HIV diagnosis may increase the likelihood of mental disorders among infected individuals and that the progression of HIV may be hastened by mental disorders like anxiety and depression. Therefore, a brief screening measure, with good sensitivity/specificity for psychiatric diagnoses that could be given to HIV-infected individuals would be useful. We assessed the validity of the K-10, using the MINI International Neuropsychiatric Interview as the gold standard, in a sample of 429 HIV-infected adults enrolled in HIV care and treatment services near Cape Town, South Africa. There was significant agreement between the K-10 and the MINI-defined depressive and anxietydisorders. A receiver operating characteristic (ROC) curve analysis indicated that the K-10 showed agreeable sensitivity and specificity in detecting depression (area under the ROC curve, 0.77), generalized anxietydisorder (0.78), and posttraumatic stress disorder (PTSD) (0.77). The K-10 may be a useful screening measure for detecting mood and anxietydisorders, including PTSD, in patients with HIV/AIDS. PMID:20024776
Spies, G; Kader, K; Kidd, M; Smit, J; Myer, L; Stein, D J; Seedat, S
|Due to developmental issues and overlapping symptoms with other disorders, diagnosing bipolar disorder in adolescents is often a confusing and complex process. This article highlights diagnostic criteria, symptoms and behaviors, and the differential diagnosis process. Treatment options are also discussed. (Contains 17 references.) (GCP)|
Wilkinson, Great Buyck; Taylor, Priscilla; Holt, Jan R.
The current review describes the phenomenology of several common anxietydisorders in children and adolescents as they present in medical settings. Anxietydisorders and associated features in children are described, along with epidemiology, functional impairment, common somatic complaints, medical comorbidity, health care utilization, and presentation in general and specialty pediatric medical settings. Recommendations for clinical management in pediatric settings are presented, and evidence-based interventions are described along with emerging treatments for pediatric anxietydisorders. The review concludes with a discussion of future research directions that may lead to increased recognition and improved management of anxietydisorders in pediatric medical settings.
Ramsawh, Holly J.; Chavira, Denise A.; Stein, Murray B.
Introduction To explore ethnic differences in psychopathology, this study examined the prevalence of depressive and anxietydisorders among\\u000a different ethnic groups in Amsterdam and determined whether ethnic differences can be explained by socio-demographic differences.\\u000a \\u000a \\u000a \\u000a Methods A population-based sample of 321 Dutch, 231 Turkish, 191 Moroccan, 87 Surinamese\\/Antilleans was interviewed by well-trained\\u000a bilingual interviewers, using the CIDI 2.1. Educational level and income were
Matty A. S. de Wit; Wilco C. Tuinebreijer; Jack Dekker; Aart-Jan T. F. Beekman; Wim H. M. Gorissen; Agnes C. Schrier; Brenda W. J. H. Penninx; Ivan H. Komproe; Arnoud P. Verhoeff
Family and twin studies have indicated that genes influence susceptibility to panic and phobic anxietydisorders, but the location of the genes involved remains unknown. Animal models can simplify gene-mapping efforts by overcoming problems that complicate human pedigree studies including genetic heterogeneity and high phenocopy rates. Homology between rodent and human genomes can be exploited to map human genes underlying complex traits. We used regions identified by quantitative trait locus (QTL)-mapping of anxiety phenotypes in mice to guide a linkage analysis of a large multiplex pedigree (99 members, 75 genotyped) segregating panic disorder/agoraphobia. Two phenotypes were studied: panic disorder/agoraphobia and a phenotype ("D-type") designed to capture early-onset susceptibility to anxietydisorders. A total of 99 markers across 11 chromosomal regions were typed. Parametric lod score analysis provided suggestive evidence of linkage (lod = 2.38) to a locus on chromosome 10q under a dominant model with reduced penetrance for the anxiety-proneness (D-type) phenotype. Nonparametric (NPL) analysis provided evidence of linkage for panic disorder/agoraphobia to a locus on chromosome 12q13 (NPL = 4.96, P = 0.006). Modest evidence of linkage by NPL analysis was also found for the D-type phenotype to a region of chromosome 1q (peak NPL = 2.05, P = 0.035). While these linkage results are merely suggestive, this study illustrates the potential advantages of using mouse gene-mapping results and exploring alternative phenotype definitions in linkage studies of anxietydisorder. PMID:11304837
Smoller, J W; Acierno, J S; Rosenbaum, J F; Biederman, J; Pollack, M H; Meminger, S; Pava, J A; Chadwick, L H; White, C; Bulzacchelli, M; Slaugenhaupt, S A
The psychometric properties of a questionnaire developed to assess symptoms of anxietydisorders (SCARED-71) were compared between two groups of children: children with high-functioning autism spectrum disorder and comorbid anxietydisorders (ASD-group; n = 115), and children with anxietydisorders (AD-group; n = 122). Anxietydisorders were established with a semi-structured interview (ADIS-C/P), using child- as well as parent-report. Internal consistency, construct validity, sensitivity, specificity, and discriminant validity of the SCARED-71 was investigated. Results revealed that the psychometric properties of the SCARED-71 for the ASD-group were quite comparable to the AD-group, however, the discriminant validity of the SCARED-71 child-report was less in the ASD-group. Raising the parental cutoffs of the SCARED-71 resulted in higher specificity rates, which suggests that research should focus more on establishing alternative cutoffs for the ASD-population. PMID:23045220
van Steensel, Francisca Ja; Deutschman, Amber Acg; Bögels, Susan M
This study explored symptoms of social anxiety and multidimensional self-esteem in a clinical, adolescent female eating disorder population. Using self-report measures, data from 344 females revealed significant negative relationships between dimensions of self-esteem and social anxiety. A diagnostic difference emerged, with the restricting subgroup reporting significantly higher perceived physical appearance and global self-worth than those with binge/purge symptoms or bulimia nervosa. No significant age differences or age by diagnosis interaction effects emerged. These findings suggest that in clinical samples of adolescent eating disorders, self-esteem and social anxiety share a significant inverse relationship and seem to remain fairly constant across adolescence. PMID:23421697
|Attention bias modification (ABM) is a newly emerging therapy for anxietydisorders that is rooted in current cognitive models of anxiety and in established experimental data on threat-related attentional biases in anxiety. This review describes the evidence indicating that ABM has the potential to become an enhancing tool for current…
Attention bias modification (ABM) is a newly emerging therapy for anxietydisorders that is rooted in current cognitive models of anxiety and in established experimental data on threat-related attentional biases in anxiety. This review describes the evidence indicating that ABM has the potential to become an enhancing tool for current…
Recent studies have shown that rates of depression and anxiety symptoms are elevated among individuals with autism spectrum disorders (ASDs) of various ages and IQs and that depression/anxiety symptoms are associated with higher IQ and fewer ASD symptoms. In this study which examined correlates of depression and anxiety symptoms in the full…
Strang, John F.; Kenworthy, Lauren; Daniolos, Peter; Case, Laura; Wills, Meagan C.; Martin, Alex; Wallace, Gregory L.
Problems with social anxiety are frequently reported in people with autism spectrum disorders (ASD). It is possible that social anxiety, when present, exacerbates the experience of hostility and other forms of aggression in relation to ASD symptoms. This study sought to determine if social anxiety symptoms mediate the relationship between features…
White, Susan Williams; Kreiser, Nicole L.; Pugliese, Cara; Scarpa, Angela
|Recent studies have shown that rates of depression and anxiety symptoms are elevated among individuals with autism spectrum disorders (ASDs) of various ages and IQs and that depression/anxiety symptoms are associated with higher IQ and fewer ASD symptoms. In this study which examined correlates of depression and anxiety symptoms in the full…
Strang, John F.; Kenworthy, Lauren; Daniolos, Peter; Case, Laura; Wills, Meagan C.; Martin, Alex; Wallace, Gregory L.
We present anxiety buffer disruption theory (ABDT) and provide a review of current evidence regarding the theory. ABDT is an application of terror management theory to explain diverse reactions to traumatic events and the onset and maintenance of posttraumatic stress disorder (PTSD). It posits that PTSD results from a disruption in one's anxiety-buffering mechanisms, which normally provide protection against anxiety
|This article provides an overview of cognitive-behavioural strategies used in the treatment of child-anxiety problems, emphasizing the need for exposure and caregiver involvement. Most of the paper focuses on developments in empirically supported cognitive-behavioral intervention protocols for generalized anxietydisorder, separation anxiety…
King, Neville J.; Heyne, David; Ollendick, Thomas H.
Social AnxietyDisorder (SAD) and Autism Spectrum Disorders (ASD) are fairly common psychiatric conditions that impair the\\u000a functioning of otherwise healthy young adults. Given that the two conditions frequently co-occur, measurement of the characteristics\\u000a unique to each condition is critical. This study evaluated the structure and construct overlap of two screening measures of\\u000a SAD and ASD. Results from 623 young
Susan W. WhiteBethany; Bethany C. Bray; Thomas H. Ollendick
We used psychophysiologic techniques to assess responses to imagery of psychologically stressful past experiences in medication-free Vietnam combat veterans classified, on the basis of DSM-III-R criteria into posttraumatic stress disorder (PTSD; n = 7) or non-PTSD anxietydisorder (anxious; n = 7) groups. Scripts describing each individual's combat experiences were recorded and played back in the laboratory. Ss were instructed
Roger K. Pitman; Scott P. Orr; Dennis F. Forgue; Bruce Altman; Jacob B. de Jong; Lawrence R. Herz
Background Mental disorders in primary care patients are frequently associated with physical complaints that can mask the disorder. There is insufficient knowledge concerning the role of anxiety, depression, and somatoform disorders in patients presenting with physical symptoms. Our primary objective was to determine the prevalence of depression, anxiety, and somatoform disorders among primary care patients with a physical complaint. We also investigated the relationship between cumulated psychosocial stressors and mental disorders. Methods We conducted a multicentre cross-sectional study in twenty-one private practices and in one academic primary care centre in Western Switzerland. Randomly selected patients presenting with a spontaneous physical complaint were asked to complete the self-administered Patient Health Questionnaire (PHQ) between November 2004 and July 2005. The validated French version of the PHQ allowed the diagnosis of mental disorders (DSM-IV criteria) and the analyses of exposure to psychosocial stressors. Results There were 917 patients exhibiting at least one physical symptom included. The rate of depression, anxiety, and somatoform disorders was 20.0% (95% confidence interval [CI] = 17.4% to 22.7%), 15.5% (95% CI = 13.2% to 18.0%), and 15.1% (95% CI = 12.8% to 17.5%), respectively. Psychosocial stressors were significantly associated with mental disorders. Patients with an accumulation of psychosocial stressors were more likely to present anxiety, depression, or somatoform disorders, with an increase of 2.2 fold (95% CI = 2.0 to 2.5) for each additional stressor. Conclusions The investigation of mental disorders and psychosocial stressors among patients with physical complaints is relevant in primary care. Psychosocial stressors should be explored as potential epidemiological causes of mental disorders.
Background Psychiatric disorders have been associated with sleep disorders in men and non-pregnant women, but little is known about sleep complaints and disorders among pregnant women with psychiatric disorders. Methods A cohort of 1,332 women was interviewed during early pregnancy. We ascertained psychiatric diagnosis status and collect information about sleep duration, daytime sleepiness, vital exhaustion and perceived stress. Logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results Approximately 5.1% of the cohort (n=68) reported having a physician-diagnosis of mood or anxietydisorder before interview. Compared with women without a psychiatric diagnosis, the multivariable-adjusted OR (95% CI) for short sleep duration in early pregnancy (?6 hours) were 1.95 (1.03-3.69). The corresponding OR (95%CI) for long sleep duration (?9 hours) during early pregnancy was 1.13 (0.63-2.03). Women with psychiatric disorders had an increased risk of vital exhaustion (OR=2.41; 95%CI 1.46-4.00) and elevated perceived stress (OR=3.33; 95%CI 1.89-5.88). Observed associations were more pronounced among overweight/obese women. Conclusions Women with a psychiatric disorder were more likely to report short sleep durations, vital exhaustion and elevated perceived stress. Prospective studies are needed to more thoroughly explore factors that mediate the apparent mood/anxiety-sleep comorbidity among pregnant women.
We assessed the occurrence of co-morbid psychiatric disorders (i.e., problem drinking, anxiety, and depression) among college students who met the threshold for disordered gambling. The participants included a large sample of undergraduate students (n = 1,430) who were enrolled in an introductory health course at a large, southeastern university in Spring 2011 and completed an online assessment that included scales to assess disordered gambling, problem drinking, anxiety, and depression. We calculated screening scores, computed prevalence rates for each disorder, and calculated Pearson correlations and Chi square tests to examine correlations and co-morbid relationships between the four disorders. Analyses indicated that all disorders were significantly associated (p < .01) except for disordered gambling and anxiety. Because college students who experience disordered gambling (and other psychiatric disorders) are at increased risk of experiencing co-occurring disorders, it might be useful for college health professionals to concurrently screen and intervene for co-occurring disorders. PMID:23430449
Martin, Ryan J; Usdan, Stuart; Cremeens, Jennifer; Vail-Smith, Karen
The current study assessed efficacy of combined cognitive behavioral therapy (CBT) and venlafaxine XR compared to venlafaxine XR alone in the treatment of generalized anxietydisorder (GAD) within settings where medication is typically offered as the treatment for this disorder. Patients with DSM-IV-diagnosed GAD who were recently enrolled in a long-term venlafaxine XR study were randomly offered (n=77), or not offered (n=40), the option of adding 12 sessions of CBT. Of those offered CBT, 33% (n=26) accepted and attended at least one treatment session. There were no differences between the combined treatment group and the medication only group on primary or secondary efficacy measures in any of the sample comparisons. Many patients who present in medical/psychopharmacology settings seeking treatment for GAD decline the opportunity to receive adjunctive treatment. Of those that receive CBT, there appears to be no additional benefit of combined treatment compared to venlafaxine XR alone. PMID:21840164
In recent years some pilot-studies were performed at health centres in Amsterdam, on infants of 8-9 months of age, concerning early detection of visual disorders. The method consisted of a programme of corneal light reflexes, cover test, monocular following movements and inspection of the cornea, the pupil and the pupillary reaction. The aim of the studies was: 1. Is this programme efficient for early detection of organic eye disorders and strabismus at this age? 2. Is the method reliable, if performed by doctors of the health centres? The results of the studies were positive. In at least 1,9% of the 1200 children of the pilot-study a visual disorder was detected. The method can be incorporated in the regular working scheme of the health centres and can be performed on infants from the age of 6 1/2 months. PMID:4035658
Cognitive– behavioral therapy (CBT), although effective, has the lowest average effect size for generalized anxietydisorder (GAD), when compared to effect sizes of CBT for other anxietydisorders. Additional basic and applied research suggests that although interpersonal processes and emotional avoidance may be maintaining GAD symptomatology, CBT has not sufficiently addressed interpersonal issues or emotion avoidance. This study aimed to test the feasibility and preliminary efficacy of an integrative psychotherapy, combining CBT with techniques to address interpersonal problems and emotional avoidance. Eighteen participants received 14 sessions of CBT plus interpersonal emotional processing therapy and three participants (for training and feasibility purposes) received 14 sessions of CBT plus supportive listening. Results showed that the integrative therapy significantly decreased GAD symptomatology, with maintenance of gains up to 1 year following treatment. In addition, comparisons with extant literature suggested that the effect size for this new GAD treatment was higher than the average effect size of CBT for GAD. Results also showed clinically significant change in GAD symptomatology and interpersonal problems with continued gains during the 1-year follow-up. Implications of these results are discussed.
Newman, Michelle G.; Castonguay, Louis G.; Borkovec, Thomas D.; Fisher, Aaron J.; Nordberg, Samuel S.
Four recent, independent, rigorously controlled studies of Eye Movement Desensitization and Reprocessing (EMDR) have reported that 84 to 100% of single-trauma victims no longer maintain the posttraumatic stress disorderdiagnosis after the equivalent of three 90-minute sessions. The rapidity of EMDR treatment effects makes many ancillary research opportunities available. Specifically, the increased number of cases resolved in a relatively short
Objective: The present study evaluated a 10-week psychosocial treatment designed specifically for children with attention-deficit\\/hyperactivity disorder (ADHD) and a comorbid anxietydisorder. Method: Using a nonconcurrent multiple baseline design, the authors treated 8 children ages 8–12 with ADHD, combined type, and at least 1 of 3 major anxietydisorders (separation anxietydisorder, generalized anxietydisorder, social phobia). The integrated treatment
Anxietydisorders and sensory over-responsivity (SOR) are common in children with autism spectrum disorders (ASD), and there is evidence for an association between these two conditions. Currently, it is unclear what causal mechanisms may exist between SOR and anxiety. We propose three possible theories to explain the association between anxiety and SOR: (a) SOR is caused by anxiety; (b) Anxiety is caused by SOR; or (c) SOR and anxiety are causally unrelated but are associated through a common risk factor or diagnostic overlap. In this paper, we examine support for each theory in the existing anxiety, autism, and neuroscience literature, and discuss how each theory informs choice of interventions and implications for future studies. PMID:20383658
Research on comorbidity among psychological disorders is relatively new. Yet, comorbidity data have fundamental significance for classification and treatment. This significance is particularly apparent in the anxietydisorders, which, prior to DSM-III-R, were subsumed under disorders considered more significant (e.g., psychotic and depressive disorders). After considering defini- tional, methodological, and theoretical issues of comorbidity, data on comorbidity among the anxiety
|Numerous clinical trials have demonstrated the efficacy of cognitive behavior therapy (CBT) for the treatment of childhood Separation AnxietyDisorder (SAD) and other anxietydisorders yet additional research may still be needed to better access and engage anxious youth. In this study, we investigated the acceptability and preliminary utility of…
Santucci, Lauren C.; Ehrenreich, Jill T.; Trosper, Sarah E.; Bennett, Shannon M.; Pincus, Donna B.
|Anxietydisorders in children and adolescents are largely undetected and the majority of youth do not receive services. Given the deleterious consequences of anxietydisorders, early identification and intervention have public health implications. In order to increase identification and treatment of anxious youth, expansion to nonpsychiatric…
|Growing recognition of the negative impact of anxietydisorders in the lives of youth has made their identification an important clinical task. Multiple perspective assessment (e.g., parents, children) is generally considered a preferred method in the assessment of anxietydisorder symptoms, although it has been generally thought that…
Weems, Carl F.; Feaster, Daniel J.; Horigian, Viviana E.; Robbins, Michael S.
In this review, we examine the role of emotion regulation in the treatment of children with anxietydisorders. Cognitive-behavioral therapy (CBT) has been shown to "work" for children with anxietydisorders and it has been categorized as an evidence-based treatment. However, most studies have shown that the treatment is effective for about 60-70%…
Hannesdottir, Dagmar Kristin; Ollendick, Thomas H.
The Web site for the AnxietyDisorders Association of America (ADAA) receives more than 5 million visits per month and thus represents a unique medium for the study of anxietydisorders. ADAA Web site users from October 2002 to January 2003 were invited to complete a survey oriented toward trauma history and psychiatric sequelae. A diagnostic approximation of posttraumatic stress
Peter J. Nicholls; Kurian Abraham; Kathryn M. Connor; Jerilyn Ross; Jonathan R. T. Davidson
Separation AnxietyDisorder (SAD) is the most prevalent anxietydisorder experienced by children, and yet empirical treatment studies of SAD in young children are virtually nonexistent. This paper will describe the development and implementation of an innovative treatment for SAD in young children. First, we will highlight the rationale for developing interventions specifically for SAD in young children. Second, we
Donna B. Pincus; Lauren C. Santucci; Jill T. Ehrenreich; Sheila M. Eyberg
Cognitive-behavioral therapy (CBT) is the most thoroughly studied nonpharmacologic approach to the treatment of social anxietydisorder, and its efficacy has been demonstrated in a large number of investigations. This article summarizes the data on the efficacy of CBT for the treatment of the symptoms of social anxietydisorder and impaired quality of life. The relative efficacy of various CBT
|Threat-related selective attention was found to predict the success of the treatment of childhood anxietydisorders through administering a pictorial dot-probe task to 131 children with anxietydisorders prior to cognitive behavioral therapy. The diagnostic status of the subjects was evaluated with a semistructured clinical interview at both pre-…
Legerstee, Jeroen S.; Tulen, Joke H. M.; Kallen, Victor L.; Dieleman, Gwen C.; Treffers, Philip D. A.; Verhulst, Frank C.; Utens, Elisabeth M. W. J.
|There are meager prospective data from nonclinical samples on the link between anxietydisorders and suicide or the extent to which the association varies over time. We examined these issues in a cohort of 309,861 U.S. Air Force service members, with 227 suicides over follow-up. Mental disorder diagnoses including anxiety, mood, and substance-use…
Conner, Kenneth R.; McCarthy, Michael D.; Bajorska, Alina; Caine, Eric D.; Tu, Xin M.; Knox, Kerry L.
Because women in the childbearing years are vulnerable to mood and anxietydisorders, physi- cians in all patient care specialties need to be fa- miliar with the prevalence and course of these disorders, particularly during pregnancy and the postpartum period. Systematic prospective data are limited on the onset of mood and anxiety dis- orders during pregnancy and the postpartum pe-
Lori L. Altshuler; Victoria Hendrick; Lee S. Cohen
Separation AnxietyDisorder (SAD) is currently the most prevalent, yet most under-researched anxietydisorder in childhood. To date, there have been few studies investigating the effi- cacy of interventions for young children with SAD. The primary purpose of this paper is to describe the process of tailoring Parent Child Interaction Therapy (PCIT) for young children aged 4-8 with SAD. The
Donna B. Pincus; Sheila M. Eyberg; Molly L. Choate
The present study aimed to assess the merit of subtyping social anxietydisorder by validating the nongeneralised subtype, differentiating the generalised and nongeneralised subtypes, and determining the role of feared social situations. Data came from the Canadian Community Health Survey Cycle 1.2 (N = 36,984) of adults aged 15 years and older. Social anxietydisorder was assessed with the World
Hayley Chartrand; Brian Cox; Renée El-Gabalawy; Ian Clara
|Objective: Attention-deficit/hyperactivity disorder (ADHD) is often accompanied by clinically significant anxiety, but few empirical data guide treatment of children meeting full DSM-IV criteria for ADHD and anxietydisorders (ADHD/ANX). This study examined the efficacy of sequential pharmacotherapy for ADHD/ANX children. Method: Children, age 6…
|Anxietydisorders are among the most common comorbid conditions in children and adolescents with autism spectrum disorders (ASDs), although assessment presents unique challenges. Many symptoms of anxiety appear to overlap with common presentations of autism. Furthermore, deficits in language and cognitive functioning make it difficult for such…
Research on information processing biases has been motivated by the hope that it would lead to new and more efficient psychotherapeutic interventions. The literature is abundant with empirical data of attentional biases toward threat stimuli in anxietydisorders. This article aims to review the existing literature on the topic of attentional bias in anxietydisorders and discuss important implications for
|Examined intelligence quotient and academic achievement of 76 psychiatrically hospitalized children (mean age 10 years). Found relative deficit in verbal abilities for conduct-disordered children. Depressed children were characterized by underachievement. Children with anxietydisorder had lower intelligence quotient than children without anxiety…
|Anxietydisorders have been found to be highly comorbid with autism spectrum disorders (ASDs). Even so, the identification and dissemination of empirically supported treatments for anxiety in adults or children who have ASD has lagged behind the larger evidence-based trend. This review examines the efficacy of cognitive-behavioral therapy as a…
Introduction: Research has generally found strong associations between smoking and anxietydisorders. The present study sought to examine the role of comorbidity in explaining these relationships. Methods: Participants from the National Comorbidity Survey-Replication (N = 5,692) were included in the present study. Axis I disorders were assessed using the World Mental Health Survey Initiative version of the World Health Organization Composite International Diagnostic Interview. In addition, smoking and mental health treatment history were assessed. Results: Multivariate analyses covarying for demographic variables and psychiatric and substance use comorbidity found that posttraumatic stress disorder was uniquely associated with every smoking outcome of interest, including 12-month and lifetime daily and heavy smoking, nicotine dependence, and cessation failure. Generalized anxietydisorder and social anxietydisorder were associated with fewer smoking-related outcomes, and contrary to predictions, panic disorder was only independently associated with 12-month daily smoking. Panic attack history, however, was uniquely associated with 12-month daily and heavy smoking, nicotine dependence, and lifetime cessation failure. In addition, analyses indicated that greater number of anxietydisorders was associated with greater prevalence of each smoking outcome, and the presence of even one anxietydisorder was associated with elevated smoking prevalence. Discussion: Several specific anxietydisorders were found to be uniquely associated with smoking behavior. Findings suggest that comorbidity may only explain the associations with smoking difficulties for some anxietydisorders.
Zvolensky, Michael J.; Fitch, Kristin E.; Sachs-Ericsson, Natalie
Objective The purpose of this article is to describe the development of the borderline personality disorderdiagnosis, highlighting both the obstacles encountered and the associated achievements. Method On the basis of a review of the literature, the author provides a chronological account of the borderline construct in psychiatry, summarizing progress in decade-long intervals. Results Borderline personality disorder has moved from being a psychoanalytic colloquialism for untreatable neurotics to becoming a valid diagnosis with significant heritability and with specific and effective psychotherapeutic treatments. Nonetheless, patients with this disorder pose a major public health problem while they themselves remain highly stigmatized and largely neglected. Conclusions Despite remarkable changes in our knowledge about borderline personality disorder, increased awareness involving much more education and research is still needed. Psychiatric institutions, professional organizations, public policies, and reimbursement agencies need to prioritize this need.
Anxietydisorders in children and adolescents are largely undetected and the majority of youth do not receive services. Given the deleterious consequences of anxietydisorders, early identification and intervention have public health implications. In order to increase identification and treatment of anxious youth, expansion to nonpsychiatric settings (i.e., pediatric medical settings, schools) is necessary. Pediatric medical offices represent ideal settings for detection and intervention for several reasons: (1) access to large numbers of children, (2) high prevalence of unrecognized anxietydisorders in medical settings, and (3) an association between anxietydisorders and medically unexplained somatic symptoms. This paper describes a cognitive-behavioral intervention for youth who present to pediatric medical settings with nonmedical somatic symptoms and undiagnosed anxietydisorders. We explain the rationale for and focus of our treatment approach, present two case studies illustrating the treatment process, and conclude with a discussion of implementation considerations.
Sleep disturbance is a cardinal symptom in both DSM-IV and ICD-10 criteria for generalized anxietydisorder (GAD). This review summarizes the results of clinical trials and pooled analyses that provide data on pregabalin's effect on sleep disturbance in patients diagnosed with GAD. The hypothesized mechanism of action of pregabalin is distinctly different from other anxiolytics. Pregabalin binds to a membrane ?2? subunit protein to inhibit release in excited central nervous system neurons of neurotransmitters implicated in pathological anxiety. Treatment with pregabalin has been found to be associated with significant improvement in GAD-related sleep disturbance across seven placebo-controlled clinical trials. Treatment with pregabalin is associated with improvement in all forms of insomnia and improvement in sleep has been found to be correlated with reduction in functional impairment and improvement in quality of life on subjective global measures. Results of a mediational analysis suggest that 53% of the effect of pregabalin on sleep disturbance was due to a direct effect and 47% was due to an indirect effect, mediated through prior reduction in anxiety symptom severity. In patients with GAD, improvement in sleep has been found to be associated with a reduction in daytime sleepiness. However, dose-related sedation is reported, typically in the first 2 wk of treatment, in approximately 10-30% of patients, depending on the dose used and the speed of titration. Insomnia is a common component of the clinical presentation of GAD and pregabalin appears to be an efficacious treatment for this often chronic and disabling symptom. PMID:23009881
The purpose of this study was to examine patterns of anxiety among siblings of children with autism spectrum disorders (ASD), and determine the characteristics of the child with ASD and their parents that predicted anxiety. Data was collected from 1,755 siblings of children with ASD whose families participated in the Simons Simplex Collection; siblings ranged in age from 3 to 18 years (M = 9 years). Male siblings were at increased risk for sub-clinical anxiety problems during middle childhood. Parental history of anxietydisorders, higher maternal pragmatic language, and more proband behavior problems predicted higher anxiety. While siblings overall did not show elevated anxiety symptoms, higher rates of sub-clinical anxiety problems among males and siblings in middle childhood are cause for concern. PMID:23076507
Shivers, Carolyn M; Deisenroth, Lauren K; Taylor, Julie Lounds
Most individuals with social anxietydisorder (SAD) do not receive any type of treatment. Reasons include logistical barriers (e.g., geographic location, travel time), fear of stigmatization, and fear of the social interactions associated with seeking treatment. Videoconferencing technology holds great promise in the widespread delivery of evidence-based treatments to those who would otherwise not receive treatment. This pilot study assessed the feasibility, acceptability, and initial efficacy of an acceptance-based behavioral intervention using Skype videoconferencing to treat adults with generalized SAD. Twenty-four participants received 12 sessions of weekly therapy and were assessed at pre-treatment, mid-treatment, post-treatment, and 3-month follow-up. Participants and therapists rated the intervention as acceptable and feasible. Analyses revealed significant pre-treatment to follow-up improvements in social anxiety, depression, disability, quality of life, and experiential avoidance, with effect sizes comparable to or larger than previously published results of studies delivering in-person CBT for SAD. Implications and future directions are discussed. PMID:23764124
Yuen, Erica K; Herbert, James D; Forman, Evan M; Goetter, Elizabeth M; Juarascio, Adrienne S; Rabin, Stephanie; Goodwin, Christina; Bouchard, Stéphane
Inattention is among the most commonly referred problems for school-aged youth. Research suggests distinct mechanisms may contribute to attention problems in youth with anxietydisorders versus youth with attention deficit hyperactivity disorder (ADHD). This study compared children (8–17 years) with anxietydisorders (n = 24) and children (8–16 years) with ADHD (n = 23) on neurocognitive tests of both general and emotion-based attention processes.
Adam S. Weissman; Brian C. Chu; Linda A. Reddy; Jan Mohlman
Social anxietydisorder (SAD) is a debilitating and chronic illness characterized by persistent fear of one or more social or performance situations, with a relatively high lifetime prevalence of 7% to 13% in the general population. Although the last two decades have witnessed enormous growth in the study of biological and dispositional factors underlying SAD, comparatively little attention has been directed towards environmental factors in SAD, even though there has been much ongoing work in the area. In this paper, we provide a recent review and critique of proposed environmental risk factors for SAD, focusing on traditional as well as some understudied and overlooked environmental risk factors: parenting and family environment, adverse life events, cultural and societal factors, and gender roles. We also discuss the need for research design improvements and considerations for future directions. PMID:18728768
Social anxietydisorder (SAD) is a debilitating and chronic illness characterized by persistent fear of one or more social or performance situations, with a relatively high lifetime prevalence of 7% to 13% in the general population. Although the last two decades have witnessed enormous growth in the study of biological and dispositional factors underlying SAD, comparatively little attention has been directed towards environmental factors in SAD, even though there has been much ongoing work in the area. In this paper, we provide a recent review and critique of proposed environmental risk factors for SAD, focusing on traditional as well as some understudied and overlooked environmental risk factors: parenting and family environment, adverse life events, cultural and societal factors, and gender roles. We also discuss the need for research design improvements and considerations for future directions.
Background: Post event processing (PEP) in social anxietydisorder involves rumination about social events after the fact, and is thought to be a crucial feature of the maintenance of the disorder. Aims: The current experiment aimed to manipulate the use of PEP in individuals with social anxietydisorder. Method: Forty-one individuals with social anxietydisorder completed a videotaped speech. Anxiety ratings and degree of PEP were measured after the task as well as the day following the experiment. Results: Individuals in the distract group reported a greater decrease in anxiety from baseline to post-experimental task than those asked to focus. Individuals in the distract group also reported higher PEP about the task than those instructed to complete a focus task, which appeared to be partially accounted for by baseline differences in symptom severity and state anxiety. Degree of PEP was positively correlated with anxiety ratings, both after the experimental task as well as 24 hours later. Conclusions: These findings suggest that naturalistic PEP is problematic for individuals with social anxietydisorder, especially for those with more severe symptoms. A distraction task, even with breakthrough PEP, appears to have useful short-term effects on anxiety reduction as compared to focus instructions. PMID:23507254
Rowa, Karen; Antony, Martin M; Swinson, Richard P; McCabe, Randi E
In this paper, we give an overview of the diagnostic categories of autism and other pervasive developmental disorders (PDDs) and discuss the changes in the DSM classification system over the past 20 years. We describe each subtype of PDD, along with comorbid psychiatric conditions, assessment guidelines, and tools for diagnosis. The epidemiology of autism has generated much discussion and research;
A vast amount of information describing health interventions is available on the Internet. This paper describes the systematic\\u000a retrieval and quality assessment of websites containing information on the treatment of anxietydisorders. Separate searches\\u000a were conducted for information on generalized anxietydisorder, obsessive-compulsive disorder, panic disorder, post-traumatic\\u000a stress disorder, social anxietydisorder, and specific phobia. The Google, Yahoo, and MSN
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) groups disorders into diagnostic classes on the basis of the subjective criterion of "shared phenomenological features." There are now sufficient data to eliminate this rational system and replace it with an empirically based structure that reflects the actual similarities among disorders. The existing structural evidence establishes that the mood and anxietydisorders should be collapsed together into an overarching class of emotional disorders, which can be decomposed into 3 subclasses: the bipolar disorders (bipolar I, bipolar II, cyclothymia), the distress disorders (major depression, dysthymic disorder, generalized anxietydisorder, posttraumatic stress disorder), and the fear disorders (panic disorder, agoraphobia, social phobia, specific phobia). The optimal placement of other syndromes (e.g., obsessive-compulsive disorder) needs to be clarified in future research. PMID:16351375
|It was hypothesized that children identified by their peers at school as anxious solitary would report more symptoms of social anxietydisorder on a self report questionnaire and, on the basis of child and parent clinical interviews, receive more diagnoses of social anxietydisorder and additional anxiety and mood disorders. Participants were 192…
Stress, anxiety and depression are raised amongst parents of children with a developmental disorder. However, the processes by which stress leads to depression and anxiety are poorly understood. In a cross-sectional survey, levels of parental stress, depression and anxiety were compared between parents of children with an autistic disorder, children with Down's syndrome and children with no disorder (N =
Sarah Hamlyn-Wright; Riccardo Draghi-Lorenz; Jason Ellis
|Using a sample of 781 adolescents (ages 13-17, 52.8% male) from a community survey, this study examined gender differences in the co-occurrence of specific anxietydisorders with substance use in adolescents. The associations between anxietydisorders and substance use differed according to the particular anxietydisorders and forms of substance…
Wu, Ping; Goodwin, Renee D.; Fuller, Cordelia; Liu, Xinhua; Comer, Jonathan S.; Cohen, Patricia; Hoven, Christina W.
Eating and anxietydisorders are more prevalent in females, increase during adolescence, and are associated with early pubertal development. This study examined whether timing of puberty onset is associated with disordered eating and anxiety in a large sample of postpubertal male and female undergraduate students. Self-report questionnaires assessed timing of puberty, disordered eating, anxiety, alcohol use, personality, and sensation seeking.
Julia L. Zehr; Kristen M. Culbert; Cheryl L. Sisk; Kelly L. Klump
Previous studies have not compared Health-related Quality of Life (HR-QoL) across all DSM-IV anxietydisorders and comorbid conditions. We compared the effects of each anxietydisorder on HR-QoL, controlling for demographic variables, medical conditions, and comorbid Axis I disorders. Data are obtained from the Primary Care Anxiety Project (PCAP), a naturalistic, longitudinal study of anxietydisorders in 539 primary care patients. Each of the anxietydisorders was associated with worse self-reported physical and mental functioning compared to general population means. While all of the anxietydisorders were univariate predictors of specific domains of HR-QoL, only presence of Posttraumatic Stress and Disorder (PTSD) and comorbid Depressive Disorder (MDD) uniquely predicted worse functioning on both self-report and interview measures. The current study extends previous research by showing that different anxietydisorders and comorbid conditions may be associated with impairment in specific domains of HR-QoL.
Beard, Courtney; Weisberg, Risa B.; Keller, Martin B.
The nature of the noradrenergic dysregulation in clinical anxietydisorders remains unclear. In panic disorder, the predominant view has been that central noradrenergic neuronal networks and/or the sympathetic nervous system was normal in patients at rest, but hyper-reactive to specific stimuli, for example carbon dioxide. These ideas have been extended to other anxietydisorders, which share with panic disorder characteristic subjective anxiety and physiological symptoms of excess sympathetic activity. For example, Generalized AnxietyDisorder is characterized by chronic free-floating anxiety, muscle tension, palpitation and insomnia. It has been proposed that there is chronic central hypersecretion of noradrenaline in Generalized AnxietyDisorder, with consequent hyporesponsiveness of central post-synaptic receptors. With regards to other disorders, it has been suggested that there is noradrenergic involvement or derangement, but a more specific hypothesis has not been enunciated. This paper reviews the evidence for noradrenergic dysfunction in anxietydisorders, derived from indirect measures of noradrenergic function in clinical populations. PMID:20530586
Paroxetine alone is not sufficient to decrease alcohol use in socially anxious alcoholics seeking anxiety treatment. We tested the hypothesis that adding a brief-alcohol-intervention (BI) to paroxetine would decrease alcohol use. All subjects (N = 83) had a diagnosis of social anxietydisorder, endorsed drinking to cope with anxiety, were NIAAA-defined at-risk drinkers, and were randomized to either paroxetine alone, or paroxetine plus BI. Both groups showed significant improvement in both social anxiety severity (F(5,83) = 61.5, p < 0.0001) and drinking to cope (e.g. F(4,79) = 23, p < 0.0001) and these two constructs correlated with each other (B = 3.39, SE = 0.696, t(71) = 4.88, p < 0.001). BI was not effective at decreasing alcohol use (e.g. no main effect of group, all p values >0.3). Paroxetine decreased social anxiety severity in the face of heavy drinking and decreasing the anxiety was related to a concurrent decrease in coping related drinking. BI was not effective at decreasing drinking or drinking to cope.
Book, Sarah W.; Thomas, Suzanne E.; Smith, Joshua P.; Randall, Patrick K.; Kushner, Matt G.; Bernstein, Gail A.; Specker, Sheila M.; Miller, Peter M.; Randall, Carrie L.
Despite considerable comorbidity between mood disorders, binge eating disorder (BED), and obesity, the underlying mechanisms remain unresolved. Therefore, the purpose of this study was to examine models by which internalizing behaviors of depression and anxiety influence food intake in overweight/obese women. Thirty-two women (15 BED, 17 controls) participated in a laboratory eating-episode and completed questionnaires assessing symptoms of anxiety and depression. Path analysis was used to test mediation and moderation models to determine the mechanisms by which internalizing symptoms influenced kilocalorie (kcal) intake. The BED group endorsed significantly more symptoms of depression (10.1 versus 4.8, P = 0.005 ) and anxiety (8.5 versus 2.7, P = 0.003). Linear regression indicated that BED diagnosis and internalizing symptoms accounted for 30% of the variance in kcal intake. Results from path analysis suggested that BED mediates the influence of internalizing symptoms on total kcal intake (empirical P < 0.001 ). The associations between internalizing symptoms and food intake are best described as operating indirectly through a BED diagnosis. This suggests that symptoms of depression and anxiety influence whether one engages in binge eating, which influences kcal intake. Greater understanding of the mechanisms underlying the associations between mood, binge eating, and food intake will facilitate the development of more effective prevention and treatment strategies for both BED and obesity.
Despite considerable comorbidity between mood disorders, binge eating disorder (BED), and obesity, the underlying mechanisms remain unresolved. Therefore, the purpose of this study was to examine models by which internalizing behaviors of depression and anxiety influence food intake in overweight/obese women. Thirty-two women (15 BED, 17 controls) participated in a laboratory eating-episode and completed questionnaires assessing symptoms of anxiety and depression. Path analysis was used to test mediation and moderation models to determine the mechanisms by which internalizing symptoms influenced kilocalorie (kcal) intake. The BED group endorsed significantly more symptoms of depression (10.1 versus 4.8, P = 0.005 ) and anxiety (8.5 versus 2.7, P = 0.003). Linear regression indicated that BED diagnosis and internalizing symptoms accounted for 30% of the variance in kcal intake. Results from path analysis suggested that BED mediates the influence of internalizing symptoms on total kcal intake (empirical P < 0.001 ). The associations between internalizing symptoms and food intake are best described as operating indirectly through a BED diagnosis. This suggests that symptoms of depression and anxiety influence whether one engages in binge eating, which influences kcal intake. Greater understanding of the mechanisms underlying the associations between mood, binge eating, and food intake will facilitate the development of more effective prevention and treatment strategies for both BED and obesity. PMID:22778917
Autism spectrum disorders (ASDs) are life-long developmental disorders characterized by impairments in the development of reciprocal social and communication skills, abnormal language development, and a restricted repertoire of behaviors and interests. While it has been known for some time that children with ASD can evince elevated rates of anxiety symptoms, little research has been conducted on whether deficits in communication skills affect the range of anxiety symptoms in infants and toddlers with ASD. This study represents a first attempt to determine whether deficits in communication skills have an effect on the expression of anxiety in infants and toddlers with autistic disorder and pervasive developmental disorder-not otherwise specified. Seven hundred thirty-five infants were evaluated with respect to the nature and extent of anxiety symptoms and developmental functioning. Both receptive and expressive communication skills appeared to play a significant role in the manifestation of anxiety symptoms. PMID:22304886
Davis, Thompson E; Moree, Brittany N; Dempsey, Timothy; Hess, Julie A; Jenkins, Whitney S; Fodstad, Jill C; Matson, Johnny L
Anxietydisorders (ANX) and attention-deficit/hyperactivity disorder (ADHD) commonly co-occur; this comorbidity is associated with a high degree of impairment and a poor long-term prognosis. In this review, the nature of this comorbidity and its treatment will be described, and an approach to treating children with ANX + ADHD will be presented. The etiology of ANX + ADHD is controversial, with biological, developmental, environmental and cognitive factors examined in various studies. There is increasing evidence that ANX + ADHD may be distinct from each separate disorder, and may represent a neuropsychiatric condition that involves dysregulation in both anxiety and ADHD domains. Treatment usually requires a combination of medication and psychotherapeutic intervention. Stimulant medications have been found most helpful so far compared with other medications, although atomoxetine is also being studied. There is limited evidence for selective serotonin reuptake inhibitors, and their potential for behavioral activation may be problematic in these children. Intensive behavior modification was shown to be beneficial in conjunction with medication for ANX + ADHD in a multimodal treatment study of children with ADHD. Cognitive-behavioral therapy has been used to address anxiety symptoms, but may need to be individualized in ANX + ADHD as cognitive limitations and ADHD behaviors may otherwise interfere. Parental anxious or ADHD traits and the child's developmental level must also be considered to optimize treatment. PMID:17678493
Despite the increased attention that researchers have paid to social anxietydisorder (SAD), compared with other anxiety and mood disorders, relatively little is known about the emotional and social factors that distinguish individuals who meet diagnostic criteria from those who do not. In this study, participants with and without a diagnosis of SAD (generalized subtype) described their daily face-to-face social interactions for 2 weeks using handheld computers. We hypothesized that, compared with healthy controls, individuals diagnosed with SAD would experience fewer positive emotions, rely more on experiential avoidance (of anxiety), and have greater self-control depletion (feeling mentally and physically exhausted after socializing), after accounting for social anxiety, negative emotions, and feelings of belonging during social interactions. We found that compared with healthy controls, individuals with SAD experienced weaker positive emotions and greater experiential avoidance, but there were no differences in self-control depletion between groups. Moreover, the differences we found could not be attributed to comorbid anxiety or depressive disorders. Our results suggest that negative emotions alone do not fully distinguish normal from pathological social anxiety, and that assessing social anxietydisorder should include impairments in positive emotional experiences and dysfunctional emotion regulation (in the form of experiential avoidance) in social situations. (PsycINFO Database Record (c) 2013 APA, all rights reserved). PMID:23815396
Kashdan, Todd B; Farmer, Antonina S; Adams, Leah M; Ferssizidis, Patty; McKnight, Patrick E; Nezlek, John B
This paper is to study auditory event-related potential P300 in patients with anxiety and depressive disorders using dipole\\u000a source analysis. Auditory P300 using 2-stimulus oddball paradigm was collected from 35 patients with anxietydisorder, 32\\u000a patients with depressive disorder, and 30 healthy controls. P300 dipole sources and peak amplitude of dipole activities were\\u000a analyzed. The source analysis resulted in a
Anxiety is highly prevalent in the community, and despite improvements in therapy a significant proportion of people tend to relapse, or remain significantly symptomatic. Theorists have proposed that untreated attachment anxieties and separation conflicts emerge from childhood development to be pervasive problems in adulthood. This study aimed to investigate the influence of juvenile and concurrent adult separation anxiety on psychotherapy
Laura T. Kirsten; Brin F. S. Grenyer; Renate Wagner; Vijaya Manicavasagar
Self-help treatments have the potential to increase the availability and affordability of evidence-based treatments for anxietydisorders. Although promising, previous research results are heterogeneous, indicating a need to identify factors that moderate treatment outcome. The present article reviews the literature on self-help treatment for anxietydisorders among adults, with a total sample of 56 articles with 82 comparisons. When self-help treatment was compared to wait-list or placebo, a meta-analysis indicated a moderate to large effect size (g=0.78). When self-help treatment was compared to face-to-face treatment, results indicated a small effect that favored the latter (g=-0.20). When self-help was compared to wait-list or placebo, subgroup analyses indicated that self-help treatment format, primary anxietydiagnosis and procedures for recruitment of subjects were related to treatment outcome in bivariate analyses, but only recruitment procedures remained significant in a multiple meta-regression analysis. When self-help was compared to face-to-face treatment, a multiple meta-regression indicated that the type of comparison group, treatment format and gender were significantly related to outcome. We conclude that self-help is effective in the treatment of anxietydisorders, and should be offered as part of stepped care treatment models in community services. Implications of the results and future directions are discussed. PMID:22681915
Haug, Thomas; Nordgreen, Tine; Öst, Lars Göran; Havik, Odd E
The role of anxiety has been emphasized in etiological/maintenance models of anorexia nervosa. This study identified daily patterns of anxiety in anorexia nervosa and examined the likelihood of the occurrence of eating disorder behaviors in each trajectory, the daily temporal distribution of eating disorder behaviors in each trajectory, and the extent to which the tendency to exhibit particular anxiety trajectories was associated with baseline diagnostic and trait-level personality variables. Women with full or subthreshold anorexia nervosa (N = 118) completed a 2-week ecological momentary assessment (EMA) protocol during which they reported on a variety of behavioral and affective variables, including anxiety and eating disorder behaviors. Using latent growth mixture modeling to classify EMA days (N = 1,526) based on anxiety ratings, we identified 7 distinct daily anxiety trajectories. Overall differences between trajectories were found for rates of binge eating, self-induced vomiting, body checking, skipping meals, and dietary restriction. Furthermore, distinct daily temporal distributions of eating disorder behaviors were found across the trajectories, with peaks in the probability of behaviors frequently coinciding with high levels of anxiety. Finally, traits of personality pathology (affective lability, self-harm, social avoidance, and oppositionality) and the presence of a co-occurring mood disorder were found to be associated with the tendency to experience particular daily anxiety trajectories (e.g., stable high anxiety). Findings support the presence of within-person variability in daily anxiety patterns in anorexia nervosa and also provide evidence for an association between these anxiety patterns and eating disorder behaviors. (PsycINFO Database Record (c) 2013 APA, all rights reserved). PMID:23647124
Lavender, Jason M; De Young, Kyle P; Wonderlich, Stephen A; Crosby, Ross D; Engel, Scott G; Mitchell, James E; Crow, Scott J; Peterson, Carol B; Le Grange, Daniel
Differences in rates of depression across and between populations can be considerable and are largely determined by psychosocial factors. Such findings have important implications for comorbidity. On the basis of multiplying independent probabilities, the proportion of comorbid conditions increases as base rates of the disorders increase in a population. If such a chance combination has clinical implications, it would appear to be a "fact" of significance irrespective of biological underpinnings. In a recent survey of 404 women living with at least one child in an inner-city area, the rate of both anxiety and depression was highly related to the childhood experiences of neglect and abuse. However, adversity in adult life (e.g. widowhood or divorce), which might be expected to relate to current stressors, was only related to the rate of depression. The two risk factors had a considerable impact on comorbidity by increasing the rate of each disorder and thus the probability of their occurring together. They had a lesser impact as "common antecedents". If both influences are considered, such adversity explains around half of the comorbidity. This is a conservative estimate of the impact of psychosocial factors. PMID:8864149
Previous research examining hypothalamic-pituitary-adrenal (HPA) axis activity in generalised anxietydisorder (GAD) has suggested a general hypercortisolism. These studies have mostly relied on salivary, plasma or urinary assessments, reflecting cortisol secretion over short time periods. The current study utilised the novel method of cortisol assessment in hair to obtain a retrospective index of cortisol secretion over a prolonged period of time. Hair cortisol levels were determined in 15 GAD patients and in 15 age- and gender-matched controls. In addition, participants collected six saliva samples (on awakening, +30 min, 12:00, 16:00, 20:00 h and at bedtime) on two consecutive weekdays for the assessment of the diurnal cortisol profile. Results revealed significantly lower (50-60%) cortisol levels in the first and second 3-cm hair segments of GAD patients compared to those of controls. No significant between-group differences were seen in diurnal cortisol profiles. The hair cortisol findings tentatively suggest that under naturalistic conditions GAD is associated with hypocortisolism. If corroborated by future research, this demonstrates the important qualities of cortisol measurement in hair as an ecologically valid, retrospective index of long-term cortisol secretion and as a marker for psychiatric disorders associated with hypo- or hypercortisolism. PMID:20889215
Context Little is known about prevalence rates of DSM-IV disorders across age strata of older adults, including common conditions such as individual and coexisting mood and anxietydisorders. Objective To determine nationally representative estimates of 12-month prevalence rates of mood, anxiety, and comorbid mood-anxietydisorder across young-old, mid-old, old-old, and oldest old community-dwelling adults. Design and Setting The National Comorbidity Survey Replication (NCS-R) is a population-based probability sample of 9282 participants 18 years and older, conducted between February 2001 and April 2003. The NCS-R survey used the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Participants We studied the 2575 participants 55 years and older who were part of NCS-R (43% 55-64; 32% 65-74; 20% 75-84; 5% ?85 years). This included only non-institutionalized adults, as all NCS-R participants resided in households within the community. Main Outcome Measures Twelve-month prevalence of mood disorders (MDD, dysthymia, bipolar disorder), anxietydisorders (panic disorder, agoraphobia, specific phobia, social phobia, generalized anxietydisorder, posttraumatic stress disorder), and coexisting mood-anxietydisorder were assessed using DSM-IV criteria. Prevalence rates were weighted to adjust for the complex design in order to infer generalizability to the U.S. population. Results The likelihood of having a mood, anxiety, or combined mood-anxietydisorder generally showed a pattern of decline with age (P < .05). Twelve-month disorders showed higher rates in women compared to men; a statistically significant trend with age. In addition, anxietydisorders were as high if not higher than mood disorders across age groups (overall 12-month rates: mood=5% and anxiety=12%). No differences were found between race/ethnicity groups. Conclusions Prevalence rates of DSM-IV mood and anxietydisorders in late life tend to decline with age, but remain very common; especially in women. These results highlight the need for intervention and prevention strategies.
Byers, Amy L.; Yaffe, Kristine; Covinsky, Kenneth E.; Friedman, Michael B.; Bruce, Martha L.
Objective Identifying mediators of therapeutic change is important to the development of interventions and augmentation strategies. Threat reappraisal is considered a key mediator underlying the effects of cognitive-behavioral therapy for anxietydisorders. The present study systematically reviewed the evidence for the threat reappraisal mediation hypothesis. Method In our review we included studies that: (1) investigated the threat reappraisal mediation hypothesis; (2) included adults with an anxietydisorderdiagnosis; (3) employed a longitudinal design; and (4) did not report on previously published findings (to avoid the inclusion of multiple reports of the same data). After data extraction, we made review-specific quality judgments for each study using the following a priori criteria informed by mediation theory: (1) demonstrated statistical mediation; (2) demonstrated that CBT caused threat reappraisal; (3) demonstrated that threat reappraisal caused anxiety reduction; and (4) demonstrated specificity of the threat reappraisal-anxiety reduction relation. Results Of the 2,296 studies we identified, 25 met inclusion criteria. Of these studies, 56% tested and 52% established statistical mediation, 52% tested and 28% established CBT as a cause of threat reappraisal, 28% tested and 24% established threat reappraisal as a cause of anxiety reduction, and 44% tested and 36% established specificity of the threat reappraisal-anxiety reduction relation. Conclusions While threat reappraisal is related to anxiety symptom improvement with CBT, there are few extant studies that meet most of the criteria necessary to conclusively demonstrate that it causes symptom improvement in CBT and that it is not a proxy for other third variables. Recommendations for future research in this area are discussed.
Smits, Jasper A. J.; Julian, Kristin; Rosenfield, David; Powers, Mark B.