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Anxietydisorders are common in family practice. Although not ideal, the DSM 3-R definitions of anxietydisorders provide a framework for diagnostic precision that assists physicians in choosing the best treatment. Assessing functional status helps determine the need for psychotherapeutic or pharmacologic intervention. We evaluate specific interventions and suggest the risks and benefits for each disorder.
Accurate diagnosis and assessment of anxietydisorders in children and adolescents is important for both treatment and research. In this paper, we review research related to the discriminant validity of the childhood anxietydisorders, and outline methods of assessment for children, including diagnostic interviews, self-report instruments, and behavioural, cognitive, and psychophysiological measures. Particular attention is given to psychometric and developmental
Carolyn A Schniering; Jennifer L Hudson; Ronald M Rapee
Anxietydisorder (AD) often is under diagnosed and under treated in older adults, especially when the clinical presentation of anxiety. Symptoms often overlap with medical conditions. Of all the anxietydisorders in later life, generalized anxietydisorder (GAD) is one of the most frequently diagnosed. AD is often comorbid with depression. AD is associated with excess disability. Anxiety in older adults has traditionally been treated pharmacology, often with benzodiazepine. However, the clinical recommendations for pharmacologic treatment actually have been much broader, including suggestions to consider serotonergic antidepressants. Selective serotonin reuptake inhibitors (SSRIs) and serotonin nor epinephrine reuptake inhibitors (SNRIs) generally are safe and procedure fewer side effects compared with tricyclic antidepressants (TCAs), in older patients. Effective treatment includes pharmacotherapy and psychotherapy, and complementary and alternative therapies. Late life AD is associated with substantial impairments in quality of life. Effective treatment for AD may be one of the most predictors of improvement of QOL. PMID:24261208
There is considerable evidence that genetic determinants play a major role in the etiology of anxiety. Investigations into\\u000a susceptibility genes for anxiety are well underway, particularly for panic disorder and obsessive-compulsive disorder and\\u000a more broadly defined anxiety-related traits, such as neuroticism and harm avoidance. This review will discuss some of the\\u000a core issues related to diagnosis and molecular genetic methodology,
Anxiety sensitivity refers to fears of anxiety-related sensations. Most often measured by the Anxiety Sensitivity Index (ASI), anxiety sensitivity is a dispositional variable especially elevated in people with panic disorder. Regardless of diagnosis, ASI scores often predict panic symptoms in response to biological challenges (e.g., carbon dioxide inhalation) that provoke feared bodily sensations. Prospective longitudinal studies indicate that scores on
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
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
... trigger a fear or anxiety response. The emotional memories stored in the central part of the amygdala ... of the brain that encodes threatening events into memories. Studies have shown that the hippocampus appears to ...
Despite longstanding debate over the nature of the boundary between social anxietydisorder (SAD) and less severe social anxiety, no study has tested directly whether the defining features of the disorder correspond to a latent category or dimension. The present study examined this question using data from the National Comorbidity Survey Replication (NCS-R), a nationally representative survey of the U.S.
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
Although clinical observations suggest that health-related anxiety is present, to some extent, in a number of anxietydisorders, this relationship has not been examined empirically. The present study therefore utilized the Short Health Anxiety Inventory (SHAI) to elucidate the structure of such symptoms among patients with anxietydisorders and to…
Abramowitz, Jonathan S.; Olatunji, Bunmi O.; Deacon, Brett J.
Social anxietydisorder is a persistent and irrational fear of situations that may involve scrutiny or judgment by others, ... People with social anxietydisorder fear and avoid situations in which they may be judged by others. It may begin in adolescence and ...
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.
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
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
Attentional bias toward negative social cues is thought to serve an etiological and\\/or maintaining role in social anxietydisorder (SAD). The current study tested whether training patients to disengage from negative social cues may ameliorate social anxiety in patients (N = 36) with a primary diagnosis of generalized SAD. Patients were randomly assigned to either an attention training condition (n
Norman B. Schmidt; J. Anthony Richey; Julia D. Buckner; Kiara R. Timpano
Mood disorders and anxietydisorders contribute significantly to morbidity and mortality during adolescence. These disorders often persist or recur in adulthood. Clinical presentations in the primary care setting are myriad and often confusing. Early recognition, differentiation from physical and other psychiatric disorders, and accurate diagnosis lead to more appropriate treatment and improved outcome. Collaboration among primary care providers and mental health professionals is key to reducing the suffering from these disorders for adolescents and their families. PMID:16473294
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
This article provides a brief review of the current available data concerning present treatment and potential new treatment advances for pediatric anxietydisorders, such as generalized anxietydisorder, separation anxietydisorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder. Disorder-specific treatment methods and innovations, particularly computer-assisted methods of delivery for cognitive behavioral therapy (CBT) will be reviewed. Additionally, the paper will discuss novel psychopharmacological compounds (e.g., D-cycloserine, riluzole, memantine, and anticonvulsant medications). Available evidence for the efficacy of novel medication strategies in adult studies and implications for their use in pediatrics will be discussed. PMID:24279893
Rapp, Amy; Dodds, Alice; Walkup, John T; Rynn, Moira
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.
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. PMID:22392595
What is Social Phobia (Social AnxietyDisorder) Social phobia is a strong fear of being judged by others and of being embarrassed. This ... with social phobia. Share Science News About Social Phobia Bullying Exerts Psychiatric Effects Into Adulthood Brain Imaging ...
Cognitive behavioral therapy is an effective intervention for anxietydisorders. However, a significant number of people do not respond or only show partial response even after an adequate course of the treatment. Recent research has shown that the efficacy of the intervention can be improved by the use of cognitive enhancers that augment the core learning processes of cognitive-behavior therapy. This manuscript provides a review of the current state of cognitive enhancers for the treatment of anxietydisorders.
Hofmann, Stefan G.; Smits, Jasper A. J.; Asnaani, Anu; Gutner, Cassidy A.; Otto, Michael W.
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 &
\\u000a Generalized anxietydisorder (GAD) first appeared as a diagnosis in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association (APA), 1980). Since that time, programmatic research on the nature of worry and GAD has\\u000a led to advancements both in its diagnostic criteria and in its treatment. With the publication of DSM-III-R (APA, 1987),
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,…
MacNeil, Bonnie M.; Lopes, Vicki A.; Minnes, Patricia M.
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
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
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
Reviews studies of cognitive-behavioral therapy (CBT) for generalized anxietydisorder, panic disorder with and without agoraphobia, and social phobia. Sees CBT as consistently more effective than waiting-list and placebo control groups. Notes that cognitive change may be strong predictor of treatment outcome but that such change may be produced…
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.
The fifth edition of Diagnostic and Statistical Manual, the DSM-5 appeared officially in May 2013 during the development of the 166th Annual Meetingof the American Psychiatric Association (APA) in San Francisco. The drafting process was long and complex; much of the debate became public so that the expectations were great. And it must be said that the new edition did not disappoint, as many changes were made in relation to their predecessors. In Chapter of AnxietyDisorders, which is reviewed in this article, the changes were significant. Obsessive-compulsive disorder and Stress-related disorders were excluded and new clinical pictures, such as separation anxietydisorder and selective mutism, were included. And took place was the long awaited split between panic disorder and agoraphobia, now two separate disorders. PMID:24887371
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.
Cognitive hypnotherapy, also known as cognitive-behavioral hypnotherapy (CBH), is applied to the treatment of anxietydisorders. Specific techniques are described and illustrated. The research on CBH is discussed. CBH seems to be at least as effective as behavior therapy (BT) and cognitive-behavior therapy (CBT) treatments that employ imagery and relaxation techniques for anxietydisorders. However, more research is needed because of the lack of adequate studies comparing CBH with BT and CBT. Clinical implications and suggestions for future research are offered. PMID:22655330
Forty-three patients with generalized anxietydisorder (GAD) and 44 patients with panic disorder (PD) were given a standardized interview about thoughts and images during times of anxiety. The two groups differed significantly regarding the ideational content of anxiety. GAD patients experienced more thoughts focusing on themes of mental catastrophes and other catastrophes when suffering from anxiety or anxiety attacks, while
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…
Health anxiety is a persistent fear of illness or disease that often involves the misinterpretation of bodily symptoms as signs of serious illness. Evidence shows that health anxiety affects a proportion of women following a diagnosis of breast cancer, but there are some limitations to how health anxiety has been measured. The objectives of this study were to (1) provide an estimate of clinically elevated health anxiety in women after a diagnosis of breast cancer using a validated measure appropriate for medical populations and (2) understand patient, disease, and anxiety/vulnerability variables that predict health anxiety in this group. Canadian women (n = 137) diagnosed with breast cancer within the past five years completed an online survey measuring health anxiety, along with patient, disease, and anxiety/vulnerability variables. Clinically significant health anxiety was reported by 23.4% of the sample. The regression model revealed that younger age, more advanced stage of breast cancer, increased cognitive anxiety sensitivity, and greater body vigilance were significant unique predictors of health anxiety. These findings highlight that a proportion of women report substantial health anxiety following breast cancer diagnosis, with a combination of patient, disease, and anxiety/vulnerability variables associated with the experience. Further research is needed to better understand the impact of health anxiety in this population. PMID:24102547
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.
Social anxiety is defined as a “marked and persistent fear of social or performance situations” and includes such symptoms as sweating, palpitations, shaking, and respiratory distress. Social anxiety is fairly common, occurring in as much as 13% of the population, and can be extremely disabling. It can be either specific (confined to 1 or 2 performance situations) or generalized, and can be diagnosed with a scale-based questionnaire. Social anxiety may coexist with other disorders, such as depression and dysthymia. The differential diagnosis for social anxiety includes panic disorder, agoraphobia, atypical depression, and body dysmorphic disorder. Treatment for social anxiety can be quite effective and consists of psychotherapy, pharmacotherapy (including such medications as ?-blockers, anxiolytics, antidepressants, and anticonvulsants), or a combination. This article details the prevalence, onset, disease impact, and etiology of social anxiety. Specific treatments, including both psychotherapy and pharmacotherapy, are presented in detail, along with other treatment considerations, such as comorbidity.
Background Our aim was to examine whether comorbid mood and anxietydisorders influence patterns of treatment or the perceived unmet need for treatment among those not receiving treatment for illegal drug use disorders. Methods Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, 2001–2002 and 2004–2005, n?=?34,653). Lifetime DSM-IV illegal drug use disorder (abuse and dependence), as well as comorbid mood (major depression, dysthymia, manic disorder, hypomanic disorder) and anxietydisorders (panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety) were ascertained by a standardized psychiatric interview. Treatment for illegal drug use disorders and perceived unmet need for treatment were assessed among individuals with illegal drug use disorder. Odds of treatment and odds of perceived unmet need for treatment were assessed using logistic regression, adjusting for socio-demographic characteristics, treatment for mood and anxietydisorders, and comorbid alcohol use disorder. Results Out of 34,653 participants, 1114 (3.2%) had a diagnosis of lifetime illegal drug use disorder: 21.2% had a comorbid mood disorder only, 11.8% a comorbid anxietydisorder only, and 45.9% comorbid mood and anxietydisorders. Comorbid mood and anxietydisorders were not related to treatment for illegal drug use disorders but were associated with an elevated likelihood of unmet need for treatment: compared to participants with no comorbidities, multivariate ORs were 2.21 (95% CI: 1.23- 4.10) for mood disorder only, 2.38 (95% CI: 1.27-4.45) for anxietydisorder only, and 2.90 (95% CI: 1.71-4.94) for both mood and anxietydisorders. Conclusions Individuals with an illegal drug use disorder and comorbid mood or anxietydisorders are disproportionately likely to report unmet need for treatment. Integrated mental health and substance use programs could prove effective in addressing their treatment needs.
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
The present study investigated differences in cognitive coping strategies between anxiety-disordered and non-anxious adolescents. In addition, the interaction effect with gender as well as differences between specific anxiety diagnoses was examined. A clinical sample of 159 anxiety-disordered adolescents and a general community sample of 370…
Legerstee, Jeroen S.; Garnefski, Nadia; Verhulst, Frank C.; Utens, Elisabeth M. W. J.
Synopsis Cognitive behavioral therapies (CBTs) have been shown to be efficacious for the treatment of anxietydisorders in children and adolescents. Randomized clinical trials indicate that approximately two-thirds of children treated with CBT will be free of their primary diagnosis at posttreatment. Although several CBT treatment packages have been investigated in youth with diverse anxietydisorders, common core components have been identified. A comprehensive assessment, development of a good therapeutic relationship and working alliance, cognitive restructuring, repeated exposure with reduction of avoidance behavior, and skills training comprise the core procedures for the treatment of anxietydisorders in youth.
... and not really knowing myself, I started attending AA meetings. For the first year I couldn’t ... social anxietydisorder symptoms through therapy. Find an AA meeting near you . Some people with social anxiety, ...
Objective: This study compared scores on the Anxious Thoughts & Tendencies (AT&T) questionnaire, a putative measure of a general anxiety-prone cognitive style, among patients with panic disorder without agoraphobia (PD, n=62), panic disorder with agoraphobia (PDA, n=29), generalized anxietydisorder (GAD, n=43), limited social phobia (LSP, n=34), generalized social phobia (GSP, n=33), and community residents (n=319). Method: Candidates for treatment
E. H Uhlenhuth; Vladan Starcevic; Teddy D Warner; William Matuzas; Teresita McCarty; Brian Roberts; Steven Jenkusky
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.
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. PMID:22034470
Powerful behavioural treatments for many patients with anxietydisorders have been widely available since the 1970s. Despite this, the majority of such patients have continued to be treated with psychotrophic drugs. Recent litigation against the manufacturers of benzodiazepine drugs has made the public increasingly concerned about the prescription of anxiolytic agents. In parallel with the fall in popularity of drug treatment, advances have been made which increase the availability and applicability of behavioural treatments for these patients. This paper examines the impact of the development of self-exposure and cognitive methods on a number of common anxiety syndromes. Clinical examples of self-exposure are given to demonstrate the simplicity of the technique.
With the publication of DSM-5, the diagnostic criteria for social anxietydisorder (SAD, also known as social phobia) have undergone several changes, which have important conceptual and clinical implications. In this paper, we first provide a brief history of the diagnosis. We then review a number of these changes, including (1) the primary name of the disorder, (2) the increased emphasis on fear of negative evaluation, (3) the importance of sociocultural context in determining whether an anxious response to a social situation is out of proportion to the actual threat, (4) the diagnosis of SAD in the context of a medical condition, and (5) the way in which we think about variations in the presentation of SAD (the specifier issue). We then consider the clinical implications of changes in DSM-5 related to these issues. PMID:24395386
Heimberg, Richard G; Hofmann, Stefan G; Liebowitz, Michael R; Schneier, Franklin R; Smits, Jasper A J; Stein, Murray B; Hinton, Devon E; Craske, Michelle G
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.
AIM: To investigate the prevalence and physicians’ detection rate of depressive and anxietydisorders in gastrointestinal (GI) outpatients across China. METHODS: A hospital-based cross-sectional survey was conducted in the GI outpatient departments of 13 general hospitals. A total of 1995 GI outpatients were recruited and screened with the Hospital Anxiety and Depression Scale (HADS). The physicians of the GI departments performed routine clinical diagnosis and management without knowing the HADS score results. Subjects with HADS scores ? 8 were subsequently interviewed by psychiatrists using the Mini International Neuropsychiatric Interview (MINI) to make further diagnoses. RESULTS: There were 1059 patients with HADS score ? 8 and 674 (63.64%) of them undertook the MINI interview by psychiatrists. Based on the criteria of Diagnostic and Statistical Manual of Mental Disorders (4th edition), the adjusted current prevalence for depressive disorders, anxietydisorders, and comorbidity of both disorders in the GI outpatients was 14.39%, 9.42% and 4.66%, respectively. Prevalence of depressive disorders with suicidal problems [suicide attempt or suicide-related ideation prior or current; module C (suicide) of MINI score ? 1] was 5.84% in women and 1.64% in men. The GI physicians’ detection rate of depressive and anxietydisorders accounted for 4.14%. CONCLUSION: While the prevalence of depressive and anxietydisorders is high in Chinese GI outpatients, the detection rate of depressive and anxietydisorders by physicians is low.
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…
Method: History of anxietydisorders was assessed by using a structured diag- nostic instrument in 182 depressed sub- jects aged 60 and older seen in primary care and psychiatric settings. Associa- tions between comorbid anxiety disor- ders and baseline characteristics were measured. The modified structured in- strument allowed detection of symp- toms that met inclusion criteria for gen- eralized anxiety
Eric J. Lenze; Benoit H. Mulsant; Herbert C. Schulberg; D. Mary Amanda Dew; Amy E. Begley; Bruce G. Pollock; Charles F. Reynolds III
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
Sanne M. Hogendoorn; Pier J. M. Prins; Leentje Vervoort; Lidewij H. Wolters; Maaike H. Nauta; Catharina A. Hartman; Harma Moorlag; Else de Haan; Frits Boer
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.
To examine cultural aspects in social anxiety and social anxietydisorder (SAD), we reviewed the literature on the prevalence rates, expressions, and treatments of social anxiety/SAD as they relate to culture, race, and ethnicity. We further reviewed factors that contribute to the differences in social anxiety/SAD between different cultures, including individualism/collectivism, perception of social norms, self-construal, gender roles, and gender role identification. Our review suggests that the prevalence and expression of social anxiety/SAD depends on the particular culture. Asian cultures typically show the lowest rates, whereas Russian and US samples show the highest rates, of SAD. Taijin kyofusho is discussed as a possible culture-specific expression of social anxiety, although the empirical evidence concerning the validity of this syndrome has been mixed. It is concluded that the individual's social concerns need to be examined in the context of the person's cultural, racial, and ethnic background in order to adequately assess the degree and expression of social anxiety and social anxietydisorder. This has direct relevance for the upcoming DSM-V.
Hofmann, Stefan G.; Asnaani, Anu; Hinton, Devon E.
A significant association between anxiety and depersonalization has been found in healthy controls and psychiatric patients irrespective of underlying conditions. Although patients with depersonalization disorder (DPD) often have a history of severe anxiety symptoms, clinical observations suggest that the relation between anxiety and depersonalization is complex and poorly understood. Using relevant rating scales, levels of anxiety and depersonalization were assessed in 291 consecutive DPD cases. 'High' and 'low' depersonalization groups, were compared according to anxiety severity. Correlation and multivariate regression analyses were also used to assessed the contribution of anxiety to the phenomenology and natural course of depersonalization. A low but significant association between depersonalization and anxiety (as measured by Beck's Anxiety Inventory) was only apparent in those patients with low intensity depersonalization, but not in those with severe depersonalization. Levels of anxiety did not seem to make specific contributions to the clinical features of depersonalization itself, although DPD patients with high anxiety seem characterised by additional non-specific perceptual symptoms. The presence of a 'statistical dissociation' between depersonalization and anxiety adds further evidence in favour of depersonalization disorder being an independent condition and suggests that its association with anxiety has been overemphasized. PMID:22414660
Sierra, Mauricio; Medford, Nick; Wyatt, Geddes; David, Anthony S
... be afraid to leave home. These people have anxietydisorders. Types include Panic disorder Obsessive-compulsive disorder Post-traumatic stress disorder Phobias Generalized anxietydisorder Treatment can involve medicines, therapy or both. NIH: ...
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.
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
To examine cultural aspects in social anxiety and social anxietydisorder (SAD), we reviewed the literature on the prevalence rates, expressions, and treatments of social anxiety/SAD as they relate to culture, race, and ethnicity. We further reviewed factors that contribute to the differences in social anxiety/SAD between different cultures, including individualism/collectivism, perception of social norms, self-construal, gender roles, and gender role identification. Our review suggests that the prevalence and expression of social anxiety/SAD depends on the particular culture. Asian cultures typically show the lowest rates, whereas Russian and US samples show the highest rates, of SAD. Taijin kyofusho is discussed as a possible culture-specific expression of social anxiety, although the empirical evidence concerning the validity of this syndrome has been mixed. It is concluded that the individual's social concerns need to be examined in the context of the person's cultural, racial, and ethnic background in order to adequately assess the degree and expression of social anxiety and SAD. This has direct relevance for the upcoming DSM-V. PMID:21132847
Hofmann, Stefan G; Anu Asnaani, M A; Hinton, Devon E
To make a dimensional assessment of personality in individuals with pathological anxiety, the Tridimensional Personality Questionnaire (TPQ) was administered to 32 patients with panic disorder (PD) and 49 patients with generalized anxietydisorder (GAD). The most striking findings were a substantially increased score on the harm avoidance dimension in both groups of patients, and a lack of significant differences between
Vladan Starcevic; E. H. Uhlenhuth; Stephanie Fallon; Dorothy Pathak
A study to examine sleep problems encountered in anxiety and depressive disorders among children and adolescents is conducted. Results indicated subjective and objective sleep problems in children and adolescents with anxietydisorders and need to be kept in mind when treating young anxious people.
Forbes, Erika E.; Bertocci, Michele A.; Gregory, Alice M.; Ryan, Neal D.; Axelson, David A.; Birmaher, Boris; Dahl, Ronald E.
... other involved adults can help provide a clearer picture. Locating a mental health professional with experience assessing and treating young people with an anxietydisorder is best. The American Academy of Child & Adolescent Psychiatry , other ...
Disorders of sexual libido are seldom organic, in general they are of psychological origin. It is, however, difficult to obtain a differential diagnosis. One of the first diagnostic considerations must be the establishment of primary or secondary libidinal dificit, or indeed, whether there is no libido at all. In cases of libido disorders with primary libido dificit, depression, organic disease, or side effects of pharmaca may be the cause. Libido disorders in the presence of functional libido, however, must be regarded as primarily psychologically caused. An exception are libido problems in the presence of diabetes mellitus and peripheral vasculatory defeciencies. In these cases libido is either totally absent or appears only secondarily. The symptomatology of libido disorders in the presence of depression, diabetes melitus, and peripheral vasculatory disturbancies, as well as psychologically caused erectile and ejaculatory difficulties are discussed in detail. These groups are compared with respect to libido and behavior involving erection, ejaculation, anxiety and avoidance. PMID:1002099
We review the available treatments for social anxietydisorder, focusing primarily on psychotherapeutic interventions for adults, but also giving briefer summaries of pharmacological treatments and treatments for children and adolescents. The most well-researched psychosocial treatments for social anxietydisorder are cognitive-behavioral therapies (CBTs), and meta-analyses indicate that all forms of CBT appear likely to provide some benefit for adults. In
Thomas L. Rodebaugh; Robert M. Holaway; Richard G. Heimberg
A person's cultural background influences the experience and expression of emotions. In reviewing the recent literature on cross-cultural aspects of anxietydisorders, we identified some culturally related ethnopsychology/ethnophysiology factors (the culture's conceptualizations of how the mind and body function) and contextual factors that influence anxietydisorders. Ethnopsychology/ethnophysiology factors include the person's ideas about the mental and bodily processes (and their interaction), whereas contextual factors are associated with the social norms and rules that may contribute to anxiety, including individualism vs. collectivism and self-construals. From the perspective of ethnopsychology/ethnophysiology and contextual factors, we will discuss "khyâl cap" ("wind attacks"), taijin kyofusho, and ataques de nervios, three prominent examples of culture-specific expressions of anxietydisorders that have all been included in the DSM-5 list of cultural concepts of distress. PMID:24744049
Questionnaire data were obtained from 5867 participants attending a national anxiety screening program. These participants were selected from more than 15,000 respondents on the basis of never having received treatment for a mental health problem. A screening instrument was designed to assess five anxietydisorders (obsessive-compulsive disorder, posttraumatic stress disorder, social phobia, generalized anxietydisorder, and panic disorder). The present
Lawrence A Welkowitz; Elmer L Struening; John Pittman; Mary Guardino; Joan Welkowitz
Anxietydisorders are the most prevalent mental health concern facing adolescents today, yet they are largely undertreated. This is especially concerning given that there are fairly good data to support an evidence-based approach to the diagnosis and treatment of anxiety, and also that untreated, these problems can continue into adulthood, growing in severity. Thus, knowing how to recognize and respond to anxiety in adolescents is of the utmost importance in primary care settings. To that end, this article provides an up-to-date review of the diagnosis and treatment of anxietydisorders geared towards professionals in primary care settings. Topics covered include subtypes, clinical presentation, the etiology and biology, effective screening instruments, evidence-based treatments (both medication and therapy), and the long-term prognosis for adolescents with anxiety. Importantly, we focus on the most common types of anxietydisorders, often known as phobias, which include generalized anxietydisorder, social anxiety/social phobia, separation anxietydisorder, panic disorder, and specific phobias. In summary, anxiety is a common psychiatric problem for adolescents, but armed with the right tools, primary care providers can make a major impact.
The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) "anxiety, obsessive-compulsive spectrum, posttraumatic, and dissociative disorders" work group addressed reconceptualization issues regarding all anxiety-related disorders. Based on systematic literature reviews, reanalyses of available data and evaluation of results following the DSM-5 principles it was decided to rearrange the disorder spectrum into separate groupings for the classical anxietydisorders, trauma- and stressor-related disorders, obsessive-compulsive and related disorders, and dissociative disorders. Among the classical anxietydisorders DSM-5 now also includes selective mutism and separation anxietydisorder. A major change from DSM-IV is a drastically simplified classification of panic disorder and agoraphobia. Both conditions can be separately coded in DSM-5 and the overlap is disclosed by a comorbid double diagnosis. The anxietydisorder criteria have been generally harmonized regarding content and order. It was assured that criteria are applicable to all age, gender and cultural groups. Furthermore, diagnosis-specific and cross-cutting dimensional anxiety scales have been developed to supplement categorical diagnosis which appears to facilitate assessment of severity and course of treatment. PMID:24737036
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.
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…
Objective: This research examined the validity of criteria for diagnosing social phobia (SOC) and generalized anxietydisorder (GAD), where the "DSM-IV" criteria were modified to better identify toddlers who could have these disorders. Method: Diagnoses were made with a semistructured clinical interview that included child observations. Parents…
Warren, Susan L.; Umylny, Polina; Aron, Emily; Simmens, Samuel J.
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
Objective and subjective sleep and awakening quality as well as daytime vigilance of insomniac patients with generalized anxietydisorder (GAD) were investigated, as compared with normal controls. Forty-four outpatients (25 females, 19 males), aged 24–65 (mean 43) years, diagnosed with non-organic insomnia (ICD-10: F 51.0), related to mild GAD (F 41.1), with a Hamilton anxiety (HAMA) score of 22 ±
Gerda Saletu-Zyhlarz; Bernd Saletu; Peter Anderer; Nadja Brandstätter; Richard Frey; Georg Gruber; Gerhard Klösch; Magdalene Mandl; Josef Grünberger; Leopold Linzmayer
Generalized anxietydisorder (GAD) was defined relatively recently, and the diagnostic criteria are still being refined. The essential feature of the disorder has changed from persistent anxiety to excessive worry, and the required symptom duration has changed from 1 month to 6 months. Additionally, exclusion criteria involving permissibility of the diagnosis in children and wording regarding the relationship of GAD with mood disorders have changed. Nosologic controversies still surround the criteria for excessive worry, symptom duration, the relationship between GAD and major depressive disorder, and the required number of associated symptoms. Alterations in the criteria have been suggested, but more research is needed on the validity of these proposed changes. Generalized anxietydisorder appears to be highly prevalent. In the United States, the lifetime prevalence of DSM-IV GAD is estimated to be about 5% and the current prevalence to be about 2% to 3%. The disorder is differentially prevalent across gender and ethnic and social groups. The course of GAD is chronic and can be exacerbated by poor family relationships, comorbid cluster C personality disorders, and comorbid Axis I disorders. Impairment and suicidal ideation are associated with GAD. PMID:19371500
Generalized anxietydisorder (GAD) is a common (lifetime prevalence: 5.1%), recurrent condition, which often heralds other psychiatric disorders, notably depression. As by definition it is a disorder progressing over months, treatment should be designed on a long term basis. And yet, few studies have been conducted beyond the classical 6–8 weeks characterizing the acute treatment phase. This is especially true of
Objectives: Despite evidence of disproportionate underutilization of mental health services by older adults and by individuals with anxietydisorders, little is known specifically about service use by older adults with anxiety. This study examines the prevalence of mental health service use among older adults with anxietydisorders and clinically significant anxiety symptoms, as well as factors associated with service use.Method:
Tiffany Scott; Corey S. Mackenzie; Judith G. Chipperfield; Jitender Sareen
Background: Anxietydisorders increase risk of future cardiovascular disease (CVD) and mortality, even after controlling for confounds including smoking, lifestyle, and socioeconomic status, and irrespective of a history of medical disorders. While impaired vagal function, indicated by reductions in heart rate variability (HRV), may be one mechanism linking anxietydisorders to CVD, prior studies have reported inconsistent findings highlighting the need for meta-analysis. Method: Studies comparing resting-state HRV recordings in patients with an anxietydisorder as a primary diagnosis and healthy controls were considered for meta-analysis. Results: Meta-analyses were based on 36 articles, including 2086 patients with an anxietydisorder and 2294 controls. Overall, anxietydisorders were characterized by lower HRV [high frequency (HF): Hedges’ g?=??0.29. 95% CI: ?0.41 to ?0.17, p?0.001; time domain: Hedges’ g?=??0.45, 95% CI: ?0.57 to ?0.33, p?0.001] than controls. Panic disorder (n?=?447), post-traumatic stress disorder (n?=?192), generalized anxietydisorder (n?=?68), and social anxietydisorder (n?=?90), but not obsessive–compulsive disorder (n?=?40), displayed reductions in HF HRV relative to controls (all ps?0.001). Conclusion: Anxietydisorders are associated with reduced HRV, findings associated with a small-to-moderate effect size. Findings have important implications for future physical health and well-being of patients, highlighting a need for comprehensive cardiovascular risk reduction.
Chalmers, John A.; Quintana, Daniel S.; Abbott, Maree J.-Anne; Kemp, Andrew H.
There has been significant interest in the impact of anxietydisorders on quality of life. In this meta-analytic review, we empirically evaluate differences in quality of life between patients with anxietydisorders and nonclinical controls. Thirty-two patient samples from 23 separate studies (N=2892) were included in the analysis. The results yielded a large effect size indicating poorer quality of life among anxietydisorder patients vs. controls and this effect was observed across all anxietydisorders. Compared to control samples, no anxietydisorderdiagnosis was associated with significantly poorer overall quality of life than was any other anxietydisorderdiagnosis. Examination of specific domains of QOL suggests that impairments may be particularly prominent among patients with post-traumatic stress disorder. QOL domains of mental health and social functioning were associated with the highest levels of impairment among anxietydisorder patients. These findings are discussed in the context of future research on the assessment of quality of life in the anxietydisorders. PMID:17343963
Symptoms of anxiety are a central feature of perinatal mental health, yet the anxietydisorders have received considerably less attention than depression in both perinatal research and practice. The present investigation involved a retrospective review of the clinical records of 334 patients seen at a psychiatric day hospital program serving pregnant and postpartum women. We examined the frequency with which the patients in this setting reported symptoms of anxiety, clinical correlates of elevated anxiety, and patterns of diagnosis in the clinical record. The results suggest that anxiety symptoms are very common in this population and that the presence of anxiety is associated with a more severe clinical profile, including higher rates of suicidality and increased use of psychotropic medications during pregnancy and postpartum. Although anxiety symptom levels were markedly elevated in this sample, anxietydisorders were diagnosed at relatively low rates. Implications for clinical practice, including discharge and treatment planning, are discussed. PMID:24469528
Objective?To compare anxiety symptoms and disorders in children and adolescents with recurrent abdominal pain (RAP), anxietydisorders, and healthy control children.?Methods?Twenty-one children with RAP (nine males, mean age = 11.05) were compared to 21 children with anxietydisorders (11 males, mean age = 12.29), and 21 children without pain or anxiety (nine males, mean age = 11.57) using diagnostic interviews and continuous measures of anxiety and other internalizing symptoms.?Results?Sixty-seven percent of children with RAP met criteria for an anxietydisorder. Children with RAP were higher than well children but not significantly different from children with anxiety on total internalizing and anxiety symptoms.?Conclusions?RAP and anxiety are closely related. Further understanding between these disorders is essential to understanding the development and progression of RAP, and to inform the prevention and treatment of the disorder.
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
Background. This article presents epidemiological data on the prevalence of DSM-IV generalized anxietydisorder (GAD) and sub-threshold GAD (fulfilling three out of four GAD criteria) in young women together with data on co-morbidity and psychosocial functioning. The prevalence of clinically relevant worry and its predictive validity for the diagnosis of GAD were also examined. Method. Young women (N fl 2064),
ObjectiveThere 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.
Bipolar disorder (BD) is a chronic, debilitating disorder with recurrent manic and depressive episodes. Over 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. Effectively treating comorbid anxiety in individuals with BD has been recognized as one of the biggest unmet needs in the field of bipolar disorder. Recently, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) was developed to be applicable to the full range of anxiety and mood disorders, based upon converging evidence from genetics, cognitive and affective neuroscience, and behavioral research suggesting common, core emotion-related pathology. Here, we present a preliminary evaluation of the efficacy of the UP for the treatment of BD with comorbid anxiety, in a clinical replication series consisting of three cases.
Ellard, Kristen K.; Deckersbach, Thilo; Sylvia, Louisa G.; Nierenberg, Andrew A.; Barlow, David H.
Generalized anxietydisorder (GAD) frequently occurs comorbidly with other conditions, including depression and somatic complaints. Comorbid GAD sufferers have increased psychologic and social impairment, request additional treatment, and have an extended course and poorer outcome than those with GAD alone; therapy should alleviate both the psychic and somatic symptoms of GAD without negatively affecting the comorbid condition. The ideal treatment
David Nutt; Spilos Argyropoulos; Sean Hood; John Potokar
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…
The current study was designed to examine diagnostic validity of social anxietydisorder (SOC) and generalized anxietydisorder (GAD) in youth, and implications of comorbidity of the disorders for nosology. Children (n = 130) with SOC, GAD, or both disorders (COMORBID) and their parents were administered diagnostic interviews and self-report measures. Confirmatory factor analyses (CFAs) and ANOVAs were performed for the three groups (SOC, GAD, COMORBID). Second-order CFAs for both parent and child informants suggested that SOC and GAD are two specific facets of a general anxiety factor. ANOVA analyses revealed the two pure groups differed only on parent-reported SOC symptoms and GAD worry symptoms, as hypothesized. COMORBID children had higher scores than SOC group on parent-reported GAD symptoms, worry, and behavioral inhibition, and COMORBID children had higher scores than GAD group on parent-reported SOC symptoms and social anxiety. Results may have implications for assessment of GAD and SOC. PMID:24173615
Whitmore, Maria J; Kim-Spoon, Jungmeen; Ollendick, Thomas H
Interoceptive sensitivity, particularly regarding heartbeat, has been suggested to play a pivotal role in the pathogenesis of anxiety and anxietydisorders. This review provides an overview of methods which are frequently used to assess heartbeat perception in clinical studies and summarizes presently available results referring to interoceptive sensitivity with respect to heartbeat in anxiety-related traits (anxiety sensitivity, state/trait anxiety), panic disorder and other anxietydisorders. In addition, recent neurobiological studies of neuronal activation correlates of heartbeat perception using positron emission tomography (PET), functional magnetic resonance imaging (fMRI) or electroencephalographic (EEG) techniques are presented. Finally, possible clinical and therapeutic implications (e.g., beta-blockers, biofeedback therapy, cognitive interventions and interoceptive exposure) of the effects of heartbeat perception on anxiety and the anxietydisorders and the potential use of interoceptive sensitivity as an intermediate phenotype of anxietydisorders in future neurobiological and genetic studies are discussed. PMID:19751958
Domschke, Katharina; Stevens, Stephan; Pfleiderer, Bettina; Gerlach, Alexander L
Generalized anxietydisorder (GAD) responds only modestly to existing cognitive-behavioural treatments. This study investigated a new treatment based on an empirically supported metacognitive model [Wells, (1995). Metacognition and worry: A cognitive model of generalized anxietydisorder. Behavioural and Cognitive Psychotherapy, 23, 301–320; Wells, (1997). Cognitive therapy of anxietydisorders: A practice manual and conceptual guide. Chichester, UK: Wiley]. Ten consecutive
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
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
Objective: This article reviews the prevalence, diagnosis, and treatment of generalized anxietydisorder (GAD).Background: Patients with GAD often present to primary care physicians; frequently the disorder manifests with somatic symptoms that have no identifiable physiologic foundation. Accurate diagnosis and treatment often prove elusive, and health care resources are inappropriately consumed in the management of a wide array of complaints, including
Clinical observations suggest abnormal gaze perception to be an important indicator of social anxietydisorder (SAD). Experimental research has yet paid relatively little attention to the study of gaze perception in SAD. In this article we first discuss gaze perception in healthy human beings before reviewing self-referential and threat-related biases of gaze perception in clinical and non-clinical socially anxious samples. Relative to controls, socially anxious individuals exhibit an enhanced self-directed perception of gaze directions and demonstrate a pronounced fear of direct eye contact, though findings are less consistent regarding the avoidance of mutual gaze in SAD. Prospects for future research and clinical implications are discussed.
Schulze, Lars; Renneberg, Babette; Lobmaier, Janek S.
Attentional bias for angry and happy faces in 7-12 year old children with general anxietydisorder (GAD) is examined. Results suggest that an attentional bias toward threat faces depends on a certain degree of clinical severity and/or the type of anxietydiagnosis in children.
Waters, Allison M.; Mogg, Karin; Bradley, Brendan P.; Pine, Daniel S.
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.
Brumariu, Laura E.; Obsuth, Ingrid; Lyons-Ruth, Karlen
Anxiety is one of the most widely observed and extensively studied psychological concomitants of stuttering. Research conducted prior to the turn of the century produced evidence of heightened anxiety in people who stutter, yet findings were inconsistent and ambiguous. Failure to detect a clear and systematic relationship between anxiety and stuttering was attributed to methodological flaws, including use of small sample sizes and unidimensional measures of anxiety. More recent research, however, has generated far less equivocal findings when using social anxiety questionnaires and psychiatric diagnostic assessments in larger samples of people who stutter. In particular, a growing body of research has demonstrated an alarmingly high rate of social anxietydisorder among adults who stutter. Social anxietydisorder is a prevalent and chronic anxietydisorder characterised by significant fear of humiliation, embarrassment, and negative evaluation in social or performance-based situations. In light of the debilitating nature of social anxietydisorder, and the impact of stuttering on quality of life and personal functioning, collaboration between speech pathologists and psychologists is required to develop and implement comprehensive assessment and treatment programmes for social anxiety among people who stutter. This comprehensive approach has the potential to improve quality of life and engagement in everyday activities for people who stutter. Determining the prevalence of social anxietydisorder among children and adolescents who stutter is a critical line of future research. Further studies are also required to confirm the efficacy of Cognitive Behaviour Therapy in treating social anxietydisorder in stuttering. Educational Objectives: The reader will be able to: (a) describe the nature and course of social anxietydisorder; (b) outline previous research regarding anxiety and stuttering, including features of social anxietydisorder; (c) summarise research findings regarding the diagnostic assessment of social anxietydisorder among people who stutter; (d) describe approaches for the assessment and treatment of social anxiety in stuttering, including the efficacy of Cognitive Behaviour Therapy; and (e) outline clinical implications and future directions associated with heightened social anxiety in stuttering. PMID:24929468
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 these…
Background Anxietydisorders are prevalent and associated with poor prognosis in patients with coronary artery disease (CAD). However, studies examining screening of anxietydisorders in CAD patients are lacking. In the present study we evaluated the prevalence of anxietydisorders in patients with CAD and diagnostic utility of self-rating scales for screening of anxietydisorders. Methods Five-hundred and twenty-three CAD patients not receiving psychotropic treatments at initiation of rehabilitation program completed self-rating scales (Hospital Anxiety and Depression Scale or HADS; Spielberger State-Anxiety Inventory or SSAI; and Spielberger Trait-Anxiety Inventory or STAI) and were interviewed for generalized anxietydisorder (GAD), social phobia, panic disorder and agoraphobia (Mini-International Neuropsychiatric Interview or MINI). Results Thirty-eight (7%) patients were diagnosed with anxietydisorder(s), including GAD (5%), social phobia (2%), agoraphobia (1%) and panic disorder (1%). Areas under the ROC curve of the HADS Anxiety subscale (HADS-A), STAI and SSAI for screening of any anxietydisorder were .81, .80 and .72, respectively. Optimal cut-off values for screening of any anxietydisorders were ?8 for the HADS-A (sensitivity?=?82%; specificity?=?76%; and positive predictive value (PPV)?=?21%); ?45 for the STAI (sensitivity?=?89%; specificity?=?56%; and PPV?=?14%); and ?40 for the SSAI (sensitivity?=?84%; specificity?=?55%; PPV?=?13%). In a subgroup of patients (n?=?340) scoring below the optimal major depressive disorder screening cut-off value of HADS-Depression subscale (score <5), the HADS-A, STAI and SSAI had moderate-high sensitivity (range from 69% to 89%) and low PPVs (?22%) for GAD and any anxietydisorders. Conclusions Anxietydisorders are prevalent in CAD patients but can be reliably identified using self-rating scales. Anxiety self-rating scales had comparable sensitivities but the HADS-A had greater specificity and PPV when compared to the STAI and SSAI for screening of anxietydisorders. However, false positive rates were high, suggesting that patients with positive screening results should undergo psychiatric interview prior to initiating treatment for anxietydisorders and that routine use of anxiety self-rating scales for screening purposes can increase healthcare costs. Anxiety screening has incremental value to depression screening for identifying 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.
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 no 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. PMID:22858684
Teachman, Bethany A; Joormann, Jutta; Steinman, Shari A; Gotlib, Ian H
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.
Research has begun to implicate the role of disgust in the etiology of specific phobias and obsessive-compulsive disorder (OCD). However, it remains unclear if the association between disgust and specific anxietydisorder symptoms is an artifact of trait anxiety or a potential mechanism through which trait anxiety effects specific anxietydisorder symptoms. The present study employed structural equation modeling to differentiate disgust from trait anxiety in the prediction of four types of specific anxietydisorder symptoms in a non-clinical sample (N=352). Results indicate that disgust and trait anxiety latent factors were independently related to spider fears, blood-injection-injury (BII) fears, general OCD symptoms, and OCD washing concerns. However, when both variables were simultaneously modeled as predictors, latent disgust remained significantly associated with the anxietydisorder symptoms, whereas the association between latent trait anxiety and the anxietydisorder symptoms became non-significant or was substantially reduced. Statistical tests of intervening variable effects converged in support of disgust as a significant intervening variable between trait anxiety and spider fears, BII fears, and OCD symptoms (particularly washing concerns). The relevance of these findings for future research investigating the role of disgust in specific anxietydisorders is discussed. PMID:17888397
Olatunji, Bunmi O; Williams, Nathan L; Lohr, Jeffrey M; Connolly, Kevin M; Cisler, Josh; Meunier, Suzanne A
A developmental-evolutionary perspective is used to synthesize basic research from the neurosciences, ethology, genetics, and developmental psychology into a unified framework for understanding the nature and origins of social anxiety and avoidant personality disorder. Evidence is presented that social anxietydisorder (social phobia) and avoidant personality disorder may be alternate conceptualizations of the same disorder because they have virtually the
Generalized anxietydisorder (GAD) is the anxietydisorder with the highest prevalence rate in mental health centers. Empirical\\u000a researches concerning its diagnosis and treatment have not yet explored the potential implications of deficits in emotional\\u000a intelligence (EI) as a vulnerability factor in its development. The present study aimed to investigate the relationship between\\u000a EI and clinical symptoms in a group
This study examines the prevalence of anxietydisorders in children with Williams syndrome (WS), their sibling closest in\\u000a age, and their mothers as well as the predictors of anxiety in these groups. The prevalence of anxietydisorders was assessed\\u000a and compared to that in the general population. Children with WS had a significantly higher prevalence of specific phobia,\\u000a generalized anxiety
Ovsanna Leyfer; Janet Woodruff-Borden; Carolyn B. Mervis
Abstract Somatic or emotional experience that has not been symbolically represented, referred to as unmentalized experience, has been given an increasingly prominent role in understanding psychopathology. Panic and anxietydisorders provide a useful model for exploring these factors, as the affective and bodily symptoms can be understood in part as unmentalized experience. The authors explore models of Freud's actual neurosis, Marty and DeM'uzan's pensee operatoire, Klein's unconscious fantasy, Bion's alpha function, Bucci's multiple code system, and relational models to describe how somatic and affective experiences can be translated into symbolic representations, and what factors can interfere with these processes. Approaches to unmentalized aspects of panic and anxiety include symbolizing somatic symptoms, identifying emotional states, and identifying contextual and traumatic links to symptoms. PMID:24828589
Parental emotional distress, particularly high maternal anxiety, is one of the most consistent predictors of child anxiety treatment outcome. In order to identify the cognitive, affective, and behavioral parenting characteristics of mothers of children with anxietydisorders who themselves have an anxietydisorder, we assessed the expectations, appraisals, and behaviors of 88 mothers of anxious children (44 mothers who were not anxious [NONANX] and 44 mothers with a current anxietydisorder [ANX]) when interacting with their 7-12-year-old children. There were no observed differences in anxiety and avoidance among children of ANX and NONANX mothers, but, compared with NONANX mothers, ANX mothers held more negative expectations, and they differed on observations of intrusiveness, expressed anxiety, warmth, and the quality of the relationship. Associations were moderated by the degree to which children expressed anxiety during the tasks. Maternal-reported negative emotions during the task significantly mediated the association between maternal anxiety status and the observed quality of the relationship. These findings suggest that maternal anxietydisorder is associated with reduced tolerance of children's negative emotions. This may interfere with the maintenance of a positive, supportive mother-child interaction under conditions of stress and, as such, this may impede optimum treatment outcomes. The findings identify potential cognitive, affective, and behavioral targets to improve treatment outcomes for children with anxietydisorders in the context of a current maternal anxietydisorder. PMID:22905861
Creswell, Cathy; Apetroaia, Adela; Murray, Lynne; Cooper, Peter
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…
Anxietydisorders typically have an age of onset in childhood and adolescence, resulting in significant disability in social and occupational functioning. Epidemiological evidence suggests that persons with psychiatric disorders and perhaps especially social phobia are at increased risk for premature withdrawal from school [Am. J. Psychiatry 157 (2000) 1606]. In order to further determine the impact of anxietydisorders on
Michael Van Ameringen; Catherine Mancini; Peter Farvolden
Although mental disorders are frequent among dermato- logical patients, little is known about their recognition by dermatologists. This study aimed to assess dermato- logists' ability to recognize depressive and anxietydisorders. All adult outpatients who visited four dermatologists on predetermined days (n~317) com- pleted the 12-item General Health Questionnaire (GHQ- 12) and the section on depressive and anxietydisorders of
Angelo Picardi; Paolo Amerio; Giannandrea Baliva; Claudio Barbieri; Patrizia Teofoli; Simone Bolli; Valentina Salvatori; Eva Mazzotti; Paolo Pasquini; Damiano Abeni
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
Anxietydisorders in childhood and adolescence are extremely common and are often associated with lifelong psychiatric disturbance. Consistent with DSM-5 and the extant literature, this review concerns the assessment and treatment of specific phobias, separation anxietydisorder, generalised anxietydisorder, social anxietydisorder, panic disorder and agoraphobia. Evidence-based psychological treatments (cognitive behaviour therapy; CBT) for these disorders have been developed and investigated, and in recent years promising low-intensity versions of CBT interventions have been proposed that offer a means to increase access to evidence-based treatments. There is some evidence of effectiveness of pharmacological treatments for anxietydisorders in children and young people, however, routine prescription is not recommended due to concerns about potential harm.
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.
Research suggests that individuals with generalized anxietydisorder (GAD) show an attention bias for threat-relevant information. However, few studies have examined the causal role of attention bias in the maintenance of anxiety and whether modification of such biases may reduce pathological anxiety symptoms. In the present article, the authors tested the hypothesis that an 8-session attention modification program would (a)
Nader Amir; Courtney Beard; Michelle Burns; Jessica Bomyea
There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk of anxiety and anxietydisorders. However, it is less clear which of the specific DSM-IV anxietydisorders occur most in this population. The present study used meta-analytic techniques to help clarify this issue. A systematic…
van Steensel, Francisca J. A.; Bogels, Susan M.; Perrin, Sean
BackgroundAnxiety symptoms are associated with elevated coronary heart disease (CHD) risk, but it is not known whether such associations extend to anxietydisorders or if they are independent of depression. We sought to determine if generalized anxietydisorder is associated with elevated CHD risk, and whether this association is independent of or interacts with major depressive disorder.
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 this review is to summarize research on the emerging role of episodic memories in the context of anxietydisorders (AD). The available literature on explicit, autobiographical, and episodic memory function in AD including neuroimaging studies is critically discussed. We describe the methodological diversity of episodic memory research in AD and discuss the need for novel tests to measure episodic memory in a clinical setting. We argue that alterations in episodic memory functions might contribute to the etiology of AD. We further explain why future research on the interplay between episodic memory function and emotional disorders as well as its neuroanatomical foundations offers the promise to increase the effectiveness of modern psychological treatments. We conclude that one major task is to develop methods and training programs that might help patients suffering from AD to better understand, interpret, and possibly actively use their episodic memories in a way that would support therapeutic interventions and counteract the occurrence of symptoms.
Introduction: Generalized anxietydisorder (GAD) is a chronic and disabling disorder with a lifetime prevalence of 4.3 - 5.9% in the general population. Many drug and non-drug treatments have been shown to be effective in the treatment of GAD, including benzodiazepines, antidepressants (selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors and tricyclic antidepressants), anticonvulsants, azapirones, antihistamines, atypical antipsychotics, complementary/alternative medicine, psychotherapy and Internet-based services. Agomelatine is an antidepressant approved by the European Agency; it is a melatonergic agonist (MT1 and MT2 receptors) and a 5-HT2C antagonist indicated in the treatment of major depressive episodes. Areas covered: The present article looks at the short-term efficacy of Agomelatine assessed in two short-term placebo-controlled studies. It also looks at the long-term efficacy evaluated in one relapse prevention study. Expert opinion: Agomelatine is an effective treatment option for both GAD and somatic anxiety. The trial, which includes an escitalopram arm, shows comparable efficacy in GAD between both antidepressants, whereas the restoration of sleep was significantly better with agomelatine. The low discontinuation rate illustrates the good tolerability and lab results show a low incidence of transient elevations in liver enzymes. Whereas uptitrated patients on a 50 mg dose have a lower chance of reaching the desired outcome than the lower 25 mg dose, those reaching this outcome have a better chance of treatment continuation. PMID:24766542
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
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.
Underserved populations often utilize the emergency room in place of primary care, particularly for short term behavioral health services. This study examined emergency department (ED) utilization rates for rurality, insurance, sex, and ethnicity in a large sample of adult patients in Hawai'i hospitals from 2000-2010 with a diagnosis of post-traumatic stress disorder (PTSD), mood disorder, or other anxietydisorder. Findings showed a higher rate of use by rural and suburban residents with a diagnosis of PTSD or other anxiety than by urban residents. Utilization of EDs by African Americans and Other Pacific Islanders with PTSD was proportionally higher than for those with mood disorders or other anxietydisorders. Military ED visits were also proportionally higher for individuals with PTSD than for those with mood or other anxietydisorders. Limited economic resources and increasingly costly mental health disorders such as PTSD highlight the importance of better understanding the needs for behavioral health services for underserved populations. PMID:23728057
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,…
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…
Comorbid diagnoses were examined in 55 principal generalized anxietydisorder (GAD) clients, and the effects of treatment for the anxietydisorder on the other conditions were examined. Although high rates of comorbidity were present at pretherapy, the presence of comorbid conditions declined dramatically after treatment in those for whom the GAD…
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
MICHELLE G. NEWMAN; LOUIS G. CASTONGUAY; THOMAS D. BORKOVEC; AARON J. FISHER; SAMUEL S. NORDBERG
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…
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…
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
For 38 anxiety patients, exposure to phobic imagery resulted in significantly larger heart rate and skin conductance increases than control imagery. Results suggest that simple phobia is avoidance disposition, social phobia involves multiple problems of interpersonal dominance, and agoraphobia may be more similar to generalized anxietydisorder…
Background The societal burden caused by anxietydisorders has likely been underestimated, while those for schizophrenia and depression have received more attention. Anxietydisorders represent a significant illness category that occurs at a high prevalence and poses a considerable burden. However, the cost of anxietydisorders in Japan has not yet been well researched. The goal of the present study was to estimate the total cost of anxietydisorders in Japan and to clarify the characteristics of this burden. Method A prevalence-based approach was adopted to measure the total cost of anxietydisorders. Anxietydisorders were defined as diagnosis code F40.0-F41.9 according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. The cost was comprised of the following components: medical treatment costs and social service costs as direct costs, and morbidity and mortality costs as indirect costs. Data were collected from publicly available statistics. Results The total cost of anxietydisorders in Japan in 2008 was JPY 2.4 trillion (US$ 20.5 billion at the current exchange rate of US$1?=?JPY 116.8). The direct cost was JPY 50 billion. The morbidity cost was JPY 2.1 trillion, while the mortality cost was JPY 0.24 trillion. Conclusions The social burden caused by anxietydisorders in Japan is tremendous and is similar to that of other mental disorders. Productivity loss in the workplace represents the largest portion of all the cost components. Because the medical examination rate is quite low, the improvement of healthcare access might contribute to cost mitigation.
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
Selection of appropriate treatment for generalized anxietydisorder (GAD) is influenced by several considerations, including psychiatric comorbidity. Emerging data suggest that GAD has a chronic course and a high comorbidity with depression. Successful treatment can be facilitated by first establishing treatment goals, which include managing acute anxiety and following through to remission. Prevention of GAD recurrence should be the ultimate objective. Many treatments exist to aid in the realization of treatment goals, including benzodiazepines, hydroxyzine, buspirone, selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs). Some SSRIs and an SNRI have been demonstrated effective in both acute and long-term trials, establishing them as first-line therapies. Benzodiazepines are helpful because of their rapid onset of action and efficacy in somatic and autonomic symptoms of GAD. Other medications in the pipeline include gamma-aminobutyric acid (GABA) modulators, which may have lower abuse potential than currently available agents that act at the GABA receptor; corticotropin-releasing hormone (CRH) antagonists; and pregabalin. The recent realization of the chronic nature of GAD and the recognition of its frequent comorbidity with depression, coupled with data from randomized clinical trials of newer generation agents, should help physicians better diagnose GAD and achieve the goal of bringing patients to full remission. PMID:15384931
Comorbid anxietydisorders are observed in many patients with attention deficit hyperactivity disorder (ADHD): 25-33% compared to 6-10% in pediatric population. Therapeutic effects of Adaptol have been studied, indicated for children and adolescents with ADHD as monotherapy, in dosages of 25-35 mg/kg for 1-3 months. The positive influence of Adaptol on the core symptoms of ADHD was confirmed: reduction of hyperactivity and impulsivity was registered after 1st month, while clinical manifestations of the attention deficit were decreased on the 2nd-3rd months of the treatment. Anxiolytic activity became apparent from the 1st month and continued to increase on the 2nd-3rd months of the treatment. Simultaneously significant reduction of the oppositional-defiant disorder manifestations were observed. PMID:23096041
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.
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.
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
Generalized anxietydisorder (GAD) and major depressive disorder (MDD) are the most common type of anxiety-mood comorbidity. Up to 80% of subjects with lifetime GAD also have a comorbid mood disorder during their lifetime. Many hypotheses have been raised to explain such high comorbidity. Pleiotropy, i.e. a single genetic mutation explains (apparently) different disorders, is one of them and is
Research indicates that posttraumatic stress disorder (PTSD) is associated with high rates of comorbid psychiatric diagnoses. Yet, it remains unknown whether PTSD is associated with greater comorbidity relative to patients with other anxietydisorders. This study examined prevalence of comorbid anxietydisorders with PTSD relative to other disorders among a treatment-seeking population. Patients with PTSD (n = 83) evidenced greater
Claudia Zayfert; Carolyn B. Becker; Danielle L. Unger; Deirdre K. Shearer
Investigated the psychometric properties of the Social Anxiety Scale for children-Revised (SASC-R) as well as relations between social anxiety and children's social and emotional functioning. Participants were a clinic sample of children, ages 6–11 with anxietydisorders (N = 154) who completed the SASC-R. For a subset of these children, parent ratings of social skills, and self-ratings of perceived competence
Golda S. Ginsburg; Annette M. La Greca; Wendy K. Silverman
The present study assesses the prevalence of subclinical eating disorders and examines their comorbidity with mood and anxietydisorders in a sample of adolescent girls. A DSM-III-R computerized self-reported interview was administered to 833 adolescent girls (mean age=15.7±0.5years) from a population sample to assess the prevalence of subclinical eating disorders, major depression, dysthymia, separation anxiety, and generalized anxietydisorders. The
Evelyne Touchette; Adina Henegar; Nathalie T. Godart; Laura Pryor; Bruno Falissard; Richard E. Tremblay; Sylvana M. Côté
Anxiety is a source of concern to the clinicians as it is co morbid with other mental disorders, particularly depression and learning disabilities, and it causes low self-esteem. The aim of this research was to evaluate the prevalence of anxietydisorder amongst secondary school children in Port Harcourt. A two-staged stratified sampling method was used to select the schools. Structured questionnaire based on Vanderbilt ADHD Diagnostic Teacher Rating Scale for anxiety and depression symptoms was used in evaluating the students. The questionnaires administered to the students were filled with the assistance of the researchers and the classroom teachers. Direct verbal interview was conducted for those noted to have symptoms of any of the various types of anxietydisorders and fears. Out of 885 students, 91 met the criteria for the diagnosis of anxiety/ depression disorder; prevalence was 10.28%, age range was 9-18 years. There were 37 males and 54 females giving a male: female ratio of 0.69:1. Majority 52 (57.14%) of the children lived with their parents, 28 (30.77%) of them lived with family relations and 11 (12.09%) of them were working as house helps to other families. The reasons given for being anxious were poor self image, fear of death, repeated physical and sexual abuses by their care givers and other adults. Learning disability was the major associated co morbid disorder (18.68%). Generalized anxiety was the most common type of anxietydisorder identified (32.97%). Anxietydisorders are debilitating chronic conditions. When it affects school aged children it contributes significantly to poor academic performance.
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
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.
We present an integrative review of the development of child anxiety, drawing on a number of strands of research. Family aggregation and genetic studies indicate raised vulnerability to anxiety in offspring of adults with the disorder (e.g. the temperamental style of behavioural inhibition, or information processing biases). Environmental factors are also important; these include adverse life events and exposure to negative information or modelling. Parents are likely to be key, although not unique, sources of such influences, particularly if they are anxious themselves. Some parenting behaviours associated with child anxiety, such as overprotection, may be elicited by child characteristics, especially in the context of parental anxiety, and these may serve to maintain child disorder. Emerging evidence emphasizes the importance of taking the nature of child and parental anxiety into account, of constructing assessments and interventions that are both disorder specific, and of considering bidirectional influences. PMID:19215631
Cognitive theories of emotion try to explain how anxious people attend to the world. Despite the increase in empirical research in this field, the specific or general attentional impairments of patients with anxietydisorder is not well defined. We decided to investigate the relationship between pathological anxiety and attentional mechanisms from the broader perspective of the attentional networks. In our study, patients with anxietydisorders and control participants carried out a task to assess efficiency of three attentional networks: orienting, alerting, and executive control. The main result was that anxietydisorders are related to both reduced effectiveness of the executive control network and difficulties in disengaging attention from invalid cues, even when using emotionally neutral information. This relationship between these attentional networks and anxiety may in part explain the problems in the day-to-day functioning of these patients. PMID:21641180
Pacheco-Unguetti, Antonia Pilar; Acosta, Alberto; Marqués, Erika; Lupiáñez, Juan
Comorbid conditions pose a serious risk to patients with bipolar disorder, but anxiety comorbidity poses a specific hazard due to the increased negative impact of anxiety on illness course and treatment. Anxiety comorbidity appears to be highly prevalent and is associated with intensified symptoms of bipolar disorder and additional comorbid disorders, resulting in a negative impact on the patient and on the course of the illness. The presence of anxiety in bipolar patients is also associated with a lowered age at onset, hampered patient response to treatment such as lithium, increased rates of suicide and substance abuse, and decreased quality of life. Patients can experience work, family, and social impairment and be made to contend with increased health care costs and strains on family support. Studies are few and have a limited scope, and many have failed to consider the clinical significance of comorbid anxiety and bipolar disorder. Because the degree to which anxiety impacts patients with bipolar disorder is not fully known, more information is needed about the relationship between bipolar disorder and anxiety. PMID:16426110
Background: No studies have been found that compared the psychopathology features, including personality disorders, of Panic Disorder (PD) and Panic Disorder with Agoraphobia (PDA), and a nonclinical sample with anxiety vulnerability. Method: The total sample included 152 participants, 52 in the PD/PDA, 45 in the high anxiety sensitivity (AS) sample, and 55 in the nonclinical sample. The participants in PD/PDA sample were evaluated with the structured interview ADIS-IV. The Brief Symptom Inventory and the MCMI-III were used in all three samples. Results: Statistically significant differences were found between the PD/PDA and the nonclinical sample in all MCMI-III scales except for antisocial and compulsive. No significant differences were found between PD/PDA and the sample with high scores in AS. Phobic Anxiety and Paranoid Ideation were the only scales where there were significant differences between the PD/PDA sample and the high AS sample. Conclusions: Our findings showed that people who scored high on AS, despite not having a diagnosis of PD/PDA, were similar in regard to psychopathology features and personality to individuals with PD/PDA. PMID:24755015
Osma, Jorge; García-Palacios, Azucena; Botella, Cristina; Barrada, Juan R
Recent research has revealed that a large number of highly worried individuals do not qualify for a diagnosis of generalized anxietydisorder (GAD). This raises the intriguing question of why some high worriers are more impaired and distressed by their worrying than others, particularly when the severity of their worry is the same. The present investigation sought to address this
Studies of individuals with an increased tendency to experience negative emotions such as fear, sadness, and anger have documented links between this temperamental trait and anxietydisorders. There exists debate, however, concerning the degree to which high levels of a temperamental trait are a necessary and\\/or sufficient component of a DSM diagnosis. In this study, receiver operating characteristic (ROC) analyses
David C. Rettew; Alicia C. Doyle; Monica Kwan; Catherine Stanger; James J. Hudziak
Family variables are thought to play a key role in a wide variety of psychopathology according to many theories. Yet, specific models of the development of anxietydisorders place little emphasis on general family factors despite clear evidence that anxiety runs in families. The current review examines evidence for the involvement of a number of…
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…
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).…
van Steensel, Francisca J. A.; Deutschman, Amber A. C. G.; Bögels, Susan M.
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
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.
Separation, generalized, and social anxietydisorders are common and impairing for children and adolescents. Childhood-onset anxietydisorders frequently persist into adulthood and place youths at risk for future psychiatric disorders, including mood and substance use disorders. Comorbidity is common in childhood anxietydisorders, and studies increasingly take this into account when assessing potential treatments. Existing studies support a number of pharmacological and psychotherapeutic treatments for childhood anxietydisorders. The strongest evidence supports use of selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT). Combination treatment with SSRIs and CBT has been found to be more effective than either treatment alone. Early detection and treatment of childhood anxietydisorders can prevent substantial impairment over the course of a child's development and accumulation of functional disability. Early treatment also may prevent later development of adult psychiatric illness. The authors review the treatment literature and present the case of an adolescent who is brought in for evaluation after years of untreated anxiety. PMID:24874020
Mohatt, Justin; Bennett, Shannon M; Walkup, John T
Anxiety and poor stress management are common concerns in clinical samples of children with autism spectrum disorders (ASD). Anxiety may worsen during adolescence, as young people face an increasingly complex social milieu and often become more aware of their differences and interpersonal difficulties. This review summarizes the state of research on the prevalence, phenomenology, and treatment of anxiety in youth with autism and related conditions such as Asperger’s disorder. Using search words autism, asperger(s), or pervasive developmental disorder and anxiety or anxious to find reports published between 1990 and 2008, this review identified 40 papers. The results of the review suggest that anxiety, whether measured categorically or dimensionally, is indeed common in children and adolescents with autism spectrum disorders and may be a source of additional morbidity. The assessment of anxietydisorders in ASD should be conducted using multiple informants and modalities, as children with ASD often do not display age-typical symptoms of anxiety. To date, relatively few controlled intervention studies using well-characterized samples have been conducted despite preliminary evidence for efficacy of select pharmacological and psychosocial approaches. Recommendations for future applied research are presented and clinical implications are explored.
White, Susan W.; Oswald, Donald; Ollendick, Thomas; Scahill, Lawrence
Anxietydisorders are common, typically have an early onset, run a chronic or relapsing course, cause substantial personal distress, impair social and occupational function, reduce quality of life, and impose a substantial economic burden: they are often comorbid with major depression, bipolar disorder, schizophrenia, substance misuse and physical illness, and are associated with increased risks of suicidal behaviour. As such, anxietydisorders should be regarded as a significant public health problem. However the causes of anxietydisorders remain largely unknown, which hinders accurate diagnosis, the prediction of prognosis, and the development of refined treatment approaches. In clinical practice, many patients with anxietydisorders do not present or are not recognised, the standard of care they receive is often sub-optimal, and the effectiveness of pharmacological and psychological treatment interventions in real-world clinical practice can be disappointing. The current substantial unmet public health, clinical and research needs in anxietydisorders could be addressed in part by developing independent collaborative European networks. PMID:23313646
Baldwin, David S; Pallanti, Stefano; Zwanzger, Peter
This invention provides a method for treating a subject afflicted with an anxietydisorder whose symptoms are exacerbated by the subject's exposure to a predetermined eliciting event, which method comprises administering to the subject a therapeutically e...
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
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
A study compares the scores on autism spectrum disorder (ASD) symptom scales in healthy children and in children with mood or anxietydisorders. It is observed that children with mood or anxietydisorders obtained higher scores on ASD symptom scales than healthy children.
Pine, Daniel S.; Guyer, Amanda E.; Goldwin, Michelle; Towbin, Kenneth A.; Leibenluft, Ellen
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
The DSM-IV-TR definition of nightmares-extremely frightening dreams from which the person wakes up directly-is unnecessarily narrow. Other emotions (anger, grief) have also been reported in nightmares, and direct awakening from a bad dream seems to be unrelated to increased distress. In addition, assessment of nightmares is problematic. Polysomnographic recordings have an ameliorating effect on nightmare frequency, retrospective measurements tend to underestimate nightmare frequency, and persons with frequent nightmares may feel reluctant to fill out (daily) prospective measurements. For studying nightmares, it is necessary to distinguish idiopathic nightmares from posttraumatic nightmares, which are part of a posttraumatic stress reaction or disorder that may result from experiencing a traumatic event. Both types of nightmares have been associated with an elevated level of periodic limb movements, although only posttraumatic nightmares seem to be related to more and longer nocturnal awakenings. Nightmares have also been repeatedly associated with the general level of psychopathology, or the so-called personality factor neuroticism. Nightmare distress, the impact on daily functioning caused by nightmares, may function as a mediating variable. Several studies in the last decades have shown that nightmares can be treated with several cognitive-behavioral techniques. The cognitive-restructuring technique imagery rehearsal therapy is the treatment of choice for nightmares, although a randomized controlled trial with an attention control-group has not yet been carried out. Nightmares are more than a symptom of a larger (anxiety) syndrome and need to be viewed from a sleep medicine perspective: nightmares are a highly prevalent and separate sleep disorder that can and should receive specific treatment. PMID:16377217
Spoormaker, Victor I; Schredl, Michael; van den Bout, Jan
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.
To investigate the physiological symptom constellation of Generalized AnxietyDisorder (GAD)\\/Overanxious Disorder (OAD) in children, the present study examined parent and child reports. Children (N=47; aged 9–13) were evaluated to meet criteria for a diagnosis of GAD. Child physiological symptoms were assessed including: (a) inability to sit still\\/relax, (b) difficulty paying attention\\/concentrating, (c) irritability\\/getting upset easily, (d) muscle aches, and
Background Comorbid anxiety symptoms,in patients with a primary anxietydisorder or a mood disorder, leads to poor patient outcomes and burdens the healthcare system. This pilot study evaluated the feasibility of extended-release quetiapine fumarate (quetiapine XR) for the treatment of patients with either a primary anxietydisorder or a mood disorder with comorbid anxiety symptoms compared to a placebo, as an adjunct to antidepressant therapy. Methods Thirty-nine patients with a diagnosis of a primary anxietydisorder or a mood disorder with comorbid anxiety symptoms were enrolled in this study. Patients with a stable dose of antidepressant therapy were randomized according to a 2:1 probability of receiving either quetiapine XR or a placebo adjunctive treatment for 8 weeks. The efficacy was assessed by the Hamilton Anxiety Rating Scale (HAM-A) and the Clinical Global Impression of severity (CGI-S) score at baseline, week 1, 4, and 8. Results A total of 35 patients were included in this intention-to treat (ITT) population for the efficacy analysis (quetiapine XR: 22 patients; placebo: 13 patients). At week 4, statistically significant differences were observed on both the HAM-A score (p?=?0.003) and the CGI-S score (p?=?0.025), favouring the quetiapine XR (?13.00?±?4.14) compared to placebo (?6.63?±?5.42). However, no statistically significant difference was observed between the two groups with regard to changes from the baseline to week 8 on the HAM-A score (p?=?0.332) or the CGI-S score (p?=?0.833). Conclusions Augmentation of antidepressant treatment with quetiapine XR did not result in clinical improvement according to the outcome measure of anxiety using the HAM-A and CGI-S scores at week 8, among the patients with either a primary anxietydisorder or a mood disorder with comorbid anxiety symptoms. However, treatment with quetiapine XR as an adjunct to antidepressant therapy appeared to provide a short-term benefit at 4 weeks. Further study is needed with a larger sample size, randomized controlled design and control of the dosage prescribed. Trial registration Clinicaltrials.gov identifier: NCT00912535
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
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. PMID:20622981
Cisler, Josh M; Olatunji, Bunmi O; Feldner, Matthew T; Forsyth, Jphn P
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.
Objective To examine attention bias towards threat faces in a large sample of anxiety-disordered youths using a well-established visual probe task. Method Study participants included 101 children and adolescents (ages 7- 18 years) with generalized anxietydisorder, social phobia and/or separation anxietydisorder enrolled in a multi-site anxiety treatment study. Non-anxious youths (n = 51; ages 9 - 18 years) were recruited separately. Participants were administered a computerized visual probe task that presents pairs of faces portraying threat (angry), positive (happy) and neutral expressions. They pressed a response-key to indicate the spatial location of a probe that replaced one of the faces on each trial. Attention bias scores were calculated from response times to probes for each emotional face type. Results Compared to healthy youths, anxious participants demonstrated a greater attention bias towards threat faces. This threat bias in anxious patients did not significantly vary across the anxietydisorders. There was no group difference in attention bias towards happy faces. Conclusions These results suggest that pediatric anxietydisorders are associated with an attention bias towards threat. Future research might examine the manner in which cognitive bias in anxious youth changes with treatment.
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.
Although several psychological and pharmacological treatment options are available for anxietydisorders, not all patients respond well to each option. Furthermore, given the relatively long duration of adequate treatment trials, finding a good treatment fit can take many months or longer. Thus, both clinicians and patients would benefit from the identification of objective pre-treatment measures that predict which patients will best respond to a given treatment. Recent studies have begun to use biological measures to help predict symptomatic change after treatment in anxietydisorders. In this review, we summarize studies that have used structural and functional neuroimaging measures to predict treatment response in obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), generalized anxietydisorder (GAD), and social anxietydisorder (SAD). We note the limitations of the current studies and offer suggestions for future research. Although the literature is currently small, we conclude that pre-treatment neuroimaging measures do appear to predict treatment response in anxietydisorders, and future research will be needed to determine the relative predictive power of neuroimaging measures as compared to clinical and demographic measures. PMID:23915782
Shin, Lisa M; Davis, F Caroline; Vanelzakker, Michael B; Dahlgren, Mary K; Dubois, Stacey J
Two case reports are described in which patients presented for the treatment of multiple comorbid anxietydisorders, all of which appeared to derive from prolonged separation anxietydisorder. In particular, these adults had effectively altered their lifestyles to avoid separation, thereby displaying only ambiguous separation anxiety symptoms that…
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.
Sharma, Mahendra P.; Mao, Angelina; Sudhir, Paulomi M.
The role of the serotonin transporter gene-linked polymorphic region (5-HTTLPR) in anxietydisorder and anxiety-related traits is controversial. Besides this study, few studies have evaluated the triallelic genotype in adolescents. The aim of this study was to investigate whether anxietydisorders and anxiety-related traits are associated with 5-HTTLPR (biallelic and triallelic) in adolescents, integrating both case-control-based and family-based designs in a community sample. This is a cross-sectional community study of 504 individuals and their families: 225 adolescents (129 adolescents with anxietydisorder and 96 controls) and their biological families. We assessed psychiatric diagnosis using the Kiddie Schedule for Affective Disorders and Schizophrenia. The Temperament and Character Inventory and the Resnick Behavioral Inhibition Scale were used to evaluate harm avoidance and behavioral inhibition. DNA was extracted from saliva and genotyped, including biallelic and triallelic 5-HTTLPR classification, by PCR-RFLP followed by agarose gel electrophoresis. We were not able to find any associations between 5-HTTLPR and anxiety-related phenotypes in both case-control and trio analyses. Further investigation and meta-analytic studies are needed to better clarify the inconsistent results with regard to the association between 5-HTTLPR and anxiety-related phenotypes in adolescents. PMID:24842237
Bortoluzzi, Andressa; Blaya, Carolina; Salum, Giovanni A; Cappi, Carolina; Leistner-Segal, Sandra; Manfro, Gisele G
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 intensive, cognitive-behavioral intervention for girls with SAD provided within the novel context of a one-week camp-like setting, the Child Anxiety Multi-Day Program (CAMP). Twenty-nine female children aged 7 to 12 with a principal diagnosis of SAD were randomized to immediate CAMP treatment (n = 15) or waitlist (i.e., delayed treatment; n = 14) condition during the course of this randomized controlled trial. Children in the immediate treatment group evidenced significant reductions in SAD severity, functional impairment, and parent report of child anxiety symptoms relative to the waitlist condition. The intervention’s positive therapeutic response suggests one possible delivery model for surmounting difficulties faced in the dissemination of weekly treatments for SAD.
Anxietydisorders are among the most common of all mental disorders and their pathogenesis is a major topic in psychiatry, both for prevention and treatment. Early stressful life events and alterations of hypothalamic pituitary adrenal (HPA) axis function seem to have a significant role in the onset of anxiety. Existing data appear to support the mediating effect of the HPA axis between childhood traumata and posttraumatic stress disorder. Findings on the HPA axis activity at baseline and after stimuli in panic disordered patients are inconclusive, even if stressful life events may have a triggering function in the development of this disorder. Data on the relationship between stress, HPA axis functioning and obsessive-compulsive disorder (OCD) are scarce and discordant, but an increased activity of the HPA axis is reported in OCD patients. Moreover, normal basal cortisol levels and hyper-responsiveness of the adrenal cortex during a psychosocial stressor are observed in social phobics. Finally, abnormal HPA axis activity has also been observed in generalized anxietydisordered patients. While several hypothesis have attempted to explain these findings over time, currently the most widely accepted theory is that early stressful life events may provoke alterations of the stress response and thus of the HPA axis, that can endure during adulthood, predisposing individuals to develop psychopathology. All theories are reviewed and the authors conclude that childhood life events and HPA abnormalities may be specifically and transnosographically related to all anxietydisorders, as well as, more broadly, to all psychiatric disorders.
... and Research Hoarding: The Basics Staging an Intervention Panic Disorder & Agoraphobia Symptoms Treatment News and Research Posttraumatic ... Screening for Obsessive-Compulsive Disorder (OCD) Screening for Panic Disorder Screening for Posttraumatic Stress Disorder (PTSD) Screening ...
Until now there are few data in the literature describing psychiatric comorbidity in patients waiting for renal transplantation. We have conducted a cross sectional study estimating the prevalence of anxiety and depressive disorders in three groups of renal transplant patients, before transplantation, six months and one year after. The MINI was used to estimate the prevalence of anxiety and depressive disorders. Anxiety and depressive symptoms were assessed using the HAD. Patients' quality of life was also assessed using the SF-36. This study did not find any major impact of renal transplantation on the prevalence of structured psychiatric disorders. Indeed, the prevalence of depressive and anxietydisorders did not differ significantly between the three groups. The mean scores of anxiety did not differ significantly between the three groups in contrast to the mean scores of depression, which differed significantly between the group "before transplantation" and the group "one year after transplantation". We did not find any significant difference concerning the scores of patient's quality of life between the three groups, except for the item "health perceived by the patients themselves". Health perceived by the patients was greater in the group "after transplantation". The quality of life of dialysed or transplant patients was strongly correlated with anxiety and depressive symptoms scores, emphasizing the major interest of a multidisciplinary approach for these patients. PMID:19853715
Baguelin-Pinaud, A; Moinier, D; Fouldrin, G; Le Roy, F; Etienne, I; Godin, M; Thibaut, F
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
Objective Mindfulness meditation has met increasing interest as a therapeutic strategy for anxietydisorders, but prior studies have been limited by methodological concerns, including a lack of an active comparison group. This is the first randomized, controlled trial comparing the manualized Mindfulness-Based Stress Reduction (MBSR) program with an active control for Generalized AnxietyDisorder, a disorder characterized by chronic worry and physiological hyperarousal symptoms. Method Ninety-three individuals with DSM-IV-diagnosed GAD were randomized to an 8-week group intervention with MBSR or to an attention control, Stress Management Education (SME) between 2009 and 2011. Anxiety symptoms were measured with the Hamilton Anxiety Scale (HAM-A, primary outcome measure), the Clinical Global Impression of Severity and Improvement (CGI-S and CGI-I), and the Beck Anxiety Inventory (BAI). Stress reactivity was assessed by comparing anxiety and distress during pre- and post-treatment Trier Social Stress Tests (TSST). Results A modified intent-to-treat analysis including participants who completed at least one session of MBSR (N=48) or SME (N=41) showed that both interventions led to significant reductions in HAM-A scores at endpoint, but did not significantly differ. MBSR, however, was associated with a significantly greater reduction in anxiety as measured by the CGI-S, the CGI-I, and the BAI (all Ps<0.05). MBSR was also associated with greater reductions than SME in anxiety and distress ratings in response to the TSST stress challenge (P<0.05), and a greater increase in positive self-statements (P=0.004). Conclusions These results suggest that MBSR may have a beneficial effect on anxiety symptoms in GAD, and may also improve stress reactivity and coping as measured in a laboratory stress challenge.
Hoge, Elizabeth A.; Bui, Eric; Marques, Luana; Metcalf, Christina A.; Morris, Laura K.; Robinaugh, Donald J.; Worthington, John J.; Pollack, Mark H.; Simon, Naomi M.
Comorbid diagnoses were examined in 55 principal generalized anxietydisorder (GAD) clients, and the effect of treatment for the principal disorder on those conditions was evaluated. High rates of comorbid diagnoses were present at pretherapy, with social and simple phobia being most common. The presence of additional diagnoses declined dramatically from pretherapy to follow-up and was significantly greater among clients
Improving the quality of life is an important goal in the treatment of psychiatric disorders. The current study described subjective quality of life, or life satisfaction, in a sample of older adults with generalized anxietydisorder (GAD). Patients with GAD were compared to other anxious and nonpsychiatric samples on measures of life satisfaction. Older adults with GAD reported lower quality
S. L. Bourland; M. A. Stanley; A. G. Snyder; D. M. Novy; J. G. Beck; P. M. Averill; A. C. Swann
Comorbid diagnoses were examined in 55 principal generalized anxietydisorder (GAD) clients, and the effect of treatment for the principal disorder on those conditions was evaluated. High rates of comorbid diagnoses were present at pretherapy, with social and simple phobia being most common. The presence of additional diagnoses declined dramatically from pretherapy to follow-up and was significantly greater among clients
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
Objective: Pharmacologic prescriptions for anxietydisorders have changed significantly in the last decade. This article investigates whether psychosocial treatments, as reported by 362 subjects in the Harvard\\/Brown AnxietyDisorders Research Program from 1991 to 1996, changed as well. Method: Subjects were interviewed in 1991 and 1995-1996 to de- termine which psychosocial treatments (behavioral, cognitive, dynamic, or relaxation or meditation) they
Robert M. Goisman; Meredith G. Warshaw; Martin B. Keller
Intolerance of uncertainty has been defined as the unwillingness to tolerate the possibility that negative events may occur in the future, no matter how low the probability [Personality Individual Differences 17 (1994), 791–802]. Previous research suggests that intolerance of uncertainty may be more specific to worry and generalized anxietydisorder (GAD) than to other anxietydisorders [e.g., Dugas, M. J.,
Robert M. Holaway; Richard G. Heimberg; Meredith E. Coles
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…
Objective: Research suggests 25% to 35% of children with attention-deficit/hyperactivity disorder (ADHD) have comorbid anxietydisorders. This double-blind study compared atomoxetine with placebo for treating pediatric ADHD with comorbid anxiety, as measured by the ADHD Rating Scale-IV-Parent Version: Investigator Administered and Scored…
Epidemiological studies have demonstrated a significant co-morbidity between social anxietydisorder (SAD) and alcohol use disorders (AUDs). Despite the fact that many studies have demonstrated strong relationships between SAD and AUD diagnoses, there has been much inconsistency in demonstrating causality or even directionality of the relationship between social anxiety and alcohol-related variables. For example, some studies have showed a positive
Summary Clinically significant anxiety occurs frequently among individuals with autism spectrum disorders (ASDs) and is linked to increased psychosocial, familial, behavioral and academic impairment beyond the core autism symptoms when present. Although efforts are underway to establish empirically supported treatments for anxiety among individuals with ASDs, this remains an emerging research area. This literature review summarizes available information on the efficacy of pharmacological and psychosocial approaches for treating anxiety and repetitive behaviors in children, adolescents and adults with ASDs. Specifically, we evaluate evidence for the use of cognitive–behavioral therapy and selective serotonin-reuptake inhibitors. Evidence is growing in support of using cognitive–behavioral therapy to treat anxiety in youths with ASDs; however, mixed evidence exists for its application in treating repetitive behaviors, as well as the use of selective serotonin-reuptake inhibitors for anxiety in youths with ASDs. We conclude the article with a discussion of the strength of current information and next steps in research.
Nadeau, Joshua; Sulkowski, Michael L; Ung, Danielle; Wood, Jeffrey J; Lewin, Adam B; Murphy, Tanya K; May, Jill Ehrenreich; Storch, Eric A
Translating findings from basic science, several compounds have been identified that may enhance therapeutic outcomes and/or expedite treatment gains when administered alongside exposure-based treatments. Four of these compounds (referred to as cognitive enhancers) have been evaluated in the context of randomized controlled trials for anxietydisorders (e.g., specific phobias, panic disorder, social anxietydisorder), obsessive-compulsive disorder and post-traumatic stress disorder. These cognitive enhancers include d-cycloserine, yohimbine hydrochloride, glucocorticoids and cortisol and brain-derived neurotrophic factor. There is consistent evidence that cognitive enhancers can enhance therapeutic outcomes and/or expedite treatment gains across anxietydisorders, obsessive-compulsive disorder and post-traumatic stress disorder. Emerging evidence has highlighted the importance of within-session fear habituation and between-session fear learning, which can either enhance fear extinction or reconsolidate of fear responses. Although findings from these trials are promising, there are several considerations that warrant further evaluation prior to widespread use of cognitive enhancers in exposure-based treatments. Consistent trial design and large sample sizes are important in future studies of cognitive enhancers. PMID:24972729
The two preeminent cognitive behavioral models of social anxiety [Clark, D.M., & Wells, A., (1995). A cognitive model of social phobia. In Heimberg, R.G., Liebowitz, M., Hope, D.A., and Schneier, F.R. (Eds.), Social phobia: Diagnosis, assessment and treatment (pp. 69–93). New York: Guilford Press.; Rapee, R.M., & Heimberg, R.G., (1997). A cognitive behavioral model of anxiety in social phobia. Behaviour
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
Women with polycystic ovary syndrome have gynecologic, reproductive and metabolic co-morbidities that span their entire lifespan. More recently a higher risk of mood and anxietydisorders has been reported in women with PCOS. Women with PCOS have higher depression scores and a higher risk of depression independent of BMI. Although clinical features of hyperandrogenism affect health related quality of life, the association between hirsutism, acne, body image and depression is currently unclear. Similarly there is limited data on the association between variables such as biochemical hyperandrogenism or infertility and depression. Women with PCOS are also at risk for symptoms of generalized anxietydisorder. There is insufficient data examining the risk of other anxietydisorders such as social phobia, obsessive compulsive disorders and panic disorder. In a number of patients some of these disorders coexist increasing the health burden. These data underscore the need to screen all women with PCOS for mood and anxietydisorders and adequately treat women who are diagnosed with these conditions. PMID:22178257
Schmidt's syndrome or autoimmune polyglandurar syndrome type 2 represents an uncommon endocrine disorder composed by Addison's disease with autoimmune thyroid disease and/or type 1 diabetes mellitus. The syndrome usually affects women in the fourth decade of their lives. Prompt diagnosis and treatment can prevent serious complications. We present the case of a 64-year-old woman with generalised anxiety, facing socio-economic problems. Her symptoms attributed to stress led to a late diagnosis. Physicians involved have to be aware about endocrine disorders of which first manifestations may have atypical components mimicking mental health problems. PMID:24868260
Anyfantakis, D; Symvoulakis, E K; Vourliotaki, I; Kastanakis, S
Abstract Schmidt’s syndrome or autoimmune polyglandurar syndrome type 2 represents an uncommon endocrine disorder composed by Addison’s disease with autoimmune thyroid disease and/or type 1 diabetes mellitus. The syndrome usually affects women in the fourth decade of their lives. Prompt diagnosis and treatment can prevent serious complications. We present the case of a 64-year-old woman with generalised anxiety, facing socio-economic problems. Her symptoms attributed to stress led to a late diagnosis. Physicians involved have to be aware about endocrine disorders of which first manifestations may have atypical components mimicking mental health problems.
Anyfantakis, D; Symvoulakis, EK; Vourliotaki, I; Kastanakis, S
Mood disorders in general, and bipolar disorder in particular, are unique among the psychiatric conditions in that they are\\u000a associated with extraordinarily high rates of comorbidity with a multitude of psychiatric and medical conditions. Among all\\u000a the potential cormobidities, co-occurring anxietydisorders stand out due to their very high prevalence. Outcome in bipolar\\u000a illness is worse in the presence of
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
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.
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
Approach-avoidance conflict is an important psychological concept that has been used extensively to better understand cognition and emotion. This review focuses on neural systems involved in approach, avoidance, and conflict decision making, and how these systems overlap with implicated neural substrates of anxietydisorders. In particular, the role of amygdala, insula, ventral striatal, and prefrontal regions are discussed with respect to approach and avoidance behaviors. Three specific hypotheses underlying the dysfunction in anxietydisorders are proposed, including: (i) over-representation of avoidance valuation related to limbic overactivation; (ii) under- or over-representation of approach valuation related to attenuated or exaggerated striatal activation respectively; and (iii) insufficient integration and arbitration of approach and avoidance valuations related to attenuated orbitofrontal cortex activation. These dysfunctions can be examined experimentally using versions of existing decision-making paradigms, but may also require new translational and innovative approaches to probe approach-avoidance conflict and related neural systems in anxietydisorders.
Introduction: Generalized anxietydisorder (GAD) is a prevalent and very disabling anxietydisorder. First-line medications are antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and noradrenalin reuptake inhibitors (SNRIs). However, a substantial number of patients do not reach remission while on antidepressants and they may develop troublesome side effects, which highlights the necessity of new therapeutic options for GAD. Methods: The purpose of this review is to discuss all non-antidepressant treatments studied in GAD. We searched MedLine for English articles published between 1980 and 2012, containing the following keywords: "generalized (or generalised) anxietydisorder" OR "anxietydisorder", AND "drug therapy" OR "herbal medicine". 76 articles were finally selected. Results: Pregabalin is the anticonvulsant with the most robust level of evidence in GAD. It rapidly reduces anxiety, have a safe side effect profile and presents a low potential for abuse. Among antipsychotics, quetiapine is the one of choice in GAD, with similar efficacy to SSRIs in low dosages, yet with lower overall tolerability. Benzodiazepines, buspirone and hydroxyzine are Food and Drugs administration (FDA) approved for GAD and have relatively good evidence of efficacy. Other drugs (betablockers, zolpidem, riluzole, etc…) and natural remedies (e.g. Piper methysticum) could be potential treatment options, yet additional research is warranted. Conclusion: Pregabalin and quetiapine are the two most promising non-antidepressant treatments for GAD. PMID:23438725
Background: The aim of this study was to evaluate whether an eight-week group mindfulness-based stress reduction program would be an acceptable and effective treatment for patients suffering from GAD. Methods: Eligible subjects with generalized anxietydisorder were recruited to Parsa Hospital and Shahid Rajaee Counseling and Social Work Center from June 2009 to October 2011. An experienced psychiatrist diagnosed these patients with a structured clinical interview for axis I disorders and a clinical psychologist conducted a clinical interview for in order to confirm the diagnosis. Subjects were randomized to an eight week course of group mindfulness based stress reduction program (16 subjects) or a control group (15 subjects). Subjects completed measures of anxiety, depressive symptoms and worry at baseline and end of treatment. To investigate the relationship between anxiety, depression and worry symptoms and mindfulness based stress reduction as well as controlling pretest effect, data were analyzed with analysis of covariance. Results: There were significant reductions in anxiety (P<0/001), depressive (P<0/001) and worry symptoms (P<0/001) from baseline to end of treatment. Conclusion: Mindfulness- based stress reduction may be an acceptable intervention in the improvement of generalized anxietydisorder symptoms. Future trials include development of randomized clinical trials of MBSR for GAD.
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 Liebowitz Social Anxiety Scale (LSAS) is one of the most commonly used measures of social anxiety symptoms. To date, no study has examined its psychometric properties in a Latino sample. The authors examined the reliability, temporal stability, and convergent validity of the LSAS in 73 Latinos diagnosed with an anxietydisorder. The original…
Beard, Courtney; Rodriguez, Benjamin F.; Weisberg, Risa B.; Perry, Ashley; Keller, Martin B.
Objective: Population-based surveys have confirmed that psychotic-like experiences are prevalent in the community. However, it is unclear if these experiences are associated with common mental disorders. The aim of this study was to examine the prevalence of psychotic-like experiences in those with affective and anxietydisorders. Methods: Subjects were drawn from the Mater-University of Queensland Study of Pregnancy. Delusion-like experiences were assessed with the Peters Delusional Inventory (PDI). The Composite International Diagnostic Interview (CIDI) was used to identify individuals with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) lifetime diagnoses of major depression, anxietydisorder, substance use/dependence, and psychotic disorders. The influence of affective and anxietydisorders on PDI and CIDI psychosis-related items’ scores were assessed with logistic regression, with adjustments for age, sex, and the presence of the other comorbid psychiatric diagnoses. Results: Having either a lifetime diagnosis of major depressive disorder or an anxietydisorder was associated with significantly higher PDI total scores (highest vs lowest quartile adjusted odds ratios [ORs] and 95% confidence intervals [CIs]?=?4.43, 3.09–6.36; 3.08, 2.26–4.20, respectively). The odds of endorsing any CIDI hallucination or delusion item was increased in those with a major depressive or anxietydisorder. The presence of current anxietydisorder symptoms was significantly associated with PDI score (OR = 5.81, 95% CI = 3.68–9.16). Conclusion: While psychotic-like experiences are usually associated with psychotic disorders, individuals with depression and anxiety are also more likely to report these symptoms compared with well individuals. Psychotic-like experiences are associated with a range of common mental disorders.
Varghese, Daniel; Scott, James; Welham, Joy; Bor, William; Najman, Jake; O'Callaghan, Michael; Williams, Gail; McGrath, John
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.
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, doubts of child competency, over-control, and granting of autonomy) in anxious parents with (n = 21) and without (n = 45) social anxietydisorder (SAD) during a five-minute task with their non-anxious child (aged 7-12 years, M = 9.14). Parents with SAD demonstrated less warmth/positive affect and more criticism and doubts of child competency than did those without SAD. There were no group differences in over-control or granting of autonomy. Findings help clarify inconsistent results in the literature, inform models of familial transmission, and suggest intervention targets for parents with SAD.
Budinger, Meghan Crosby; Drazdowski, Tess K.; Ginsburg, Golda S.
Alternative therapies and therapy modalities for SAD are needed because: Established treatments (CBT and pharmacologic) do not help everyone who seeks help. Established treatments provide only partial decrease in symptoms for many patients. Patients may experience recurrence of symptoms in long-term follow-up. CBT does not reach enough patients in need. Alternative treatment approaches and modalities may also be needed to address the successful outcomes of CBT. Success in overcoming social anxiety symptoms can generate a whole new set of challenges. For example, a 31-year-old man who overcomes his fear of dating and begins his first romantic relationship may need a less symptomatically focused therapy to deal with issues that arise in this relationship. Likewise, a woman whose decreased social anxiety enables her to get a long-awaited promotion may need to deal with the stress of adjusting to her new responsibilities. An individual who overcomes phobia of public speaking and still has mild anxiety may need to graduate to a forum such as Toastmasters to provide continued exposure to further develop confidence and skills in public speaking. PMID:11723635
Previous work has highlighted that children diagnosed with DCD may be at risk of greater problems related to emotional wellbeing. However, to date much work has relied on population based samples, and anxiety has not been examined within a group of children given a clinical diagnosis of DCD. Additionally, the profile of individual differences has…
Depressive and anxietydisorders are often first diagnosed during adolescence and it is known that they persist into adulthood. Previous studies often tried to dissociate depressive and anxietydisorders, but high comorbidity makes this difficult and maybe even impossible. The goal of this study was to use neuroimaging to test what the unique contribution is of depression and anxiety symptomatology on emotional processing and amygdala activation, and to compare the results with a healthy control group. We included 25 adolescents with depressive and/or anxietydisorders and 26 healthy adolescents. Participants performed an emotional face processing task while in the MRI scanner. We were particularly interested in the relation between depression/anxiety symptomatology and patterns of amygdala activation. There were no significant differences in activation patterns between the control group and the clinical group on whole brain level and ROI level. However, we found that dimensional scores on an anxiety but not a depression subscale significantly predicted brain activation in the right amygdala when processing fearful, happy and neutral faces. These results suggest that anxiety symptoms are a better predictor for differentiating activation patterns in the amygdala than depression symptoms. Although the current study includes a relatively large sample of treatment naïve adolescents with depression/anxietydisorders, results might be influenced by differences between studies in recruitment strategies or methodology. Future research should include larger samples with a more equal distribution of adolescents with a clinical diagnosis of depression and/or anxiety. To conclude, this study shows that abnormal amygdala responses to emotional faces in depression and anxiety seems to be more dependent on anxiety symptoms than on depression symptoms, and thereby highlights the need for more research to better characterize clinical groups in future studies. PMID:24926249
van den Bulk, Bianca G; Meens, Paul H F; van Lang, Natasja D J; de Voogd, E L; van der Wee, Nic J A; Rombouts, Serge A R B; Crone, Eveline A; Vermeiren, Robert R J M
Depressive and anxietydisorders are often first diagnosed during adolescence and it is known that they persist into adulthood. Previous studies often tried to dissociate depressive and anxietydisorders, but high comorbidity makes this difficult and maybe even impossible. The goal of this study was to use neuroimaging to test what the unique contribution is of depression and anxiety symptomatology on emotional processing and amygdala activation, and to compare the results with a healthy control group. We included 25 adolescents with depressive and/or anxietydisorders and 26 healthy adolescents. Participants performed an emotional face processing task while in the MRI scanner. We were particularly interested in the relation between depression/anxiety symptomatology and patterns of amygdala activation. There were no significant differences in activation patterns between the control group and the clinical group on whole brain level and ROI level. However, we found that dimensional scores on an anxiety but not a depression subscale significantly predicted brain activation in the right amygdala when processing fearful, happy and neutral faces. These results suggest that anxiety symptoms are a better predictor for differentiating activation patterns in the amygdala than depression symptoms. Although the current study includes a relatively large sample of treatment naïve adolescents with depression/anxietydisorders, results might be influenced by differences between studies in recruitment strategies or methodology. Future research should include larger samples with a more equal distribution of adolescents with a clinical diagnosis of depression and/or anxiety. To conclude, this study shows that abnormal amygdala responses to emotional faces in depression and anxiety seems to be more dependent on anxiety symptoms than on depression symptoms, and thereby highlights the need for more research to better characterize clinical groups in future studies.
van den Bulk, Bianca G.; Meens, Paul H. F.; van Lang, Natasja D. J.; de Voogd, E. L.; van der Wee, Nic J. A.; Rombouts, Serge A. R. B.; Crone, Eveline A.; Vermeiren, Robert R. J. M.
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
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…
Older adults with generalized anxietydisorder (GAD; N = 75; M age = 67.1 years) were randomly assigned to cognitive-behavioral therapy (CBT), a discussion group (DG) organized around worry-provoking topics, or a waiting period. Participants in both active conditions improved relative to the waiting list. Although CBT participants improved on more measures than DG participants, the authors found only 1
Julie Loebach Wetherell; Margaret Gatz; Michelle G. Craske
Although worry is the central feature of Generalised AnxietyDisorder (GAD), little is known about the factors that contribute to pathological or problematic worry. In a recent cognitive model of GAD, Wells, A. (1995) proposed that negative appraisal of worrying itself (meta-worry or type 2 worry) should be distinguished from other types of worrying (type 1 worry). A central feature
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
The present study’s main objective is to examine whether problem orientation and problem-solving skills differ according to generalized anxietydisorder (GAD) symptom level or clinical status (seeking help for GAD). Its secondary goal is to examine whether two cognitive variables (intolerance of uncertainty and beliefs about worry) vary according to GAD symptom level or clinical status. Three groups of subjects
Robert Ladouceur; France Blais; Mark H. Freeston; Michel J. Dugas
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
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.
Background: Anxietydisorders are often present at preschool age. Research on older children and studies contrasting preschoolers with high versus low behavioral inhibition (BI) highlight several risk factors, but these have not been investigated in community samples of young children. Child, parent, and peer factors at age 4 were therefore…
Background Few studies have simultaneously compared the impacts of pharmacotherapy and mental diagnoses on metabolic syndrome (MetS) among psychiatric outpatients with mood and anxietydisorders. This study aimed to investigate the impacts of pharmacotherapy and mental diagnoses on MetS and the prevalence of MetS among these patients. Methods Two-hundred and twenty-nine outpatients (men/women?=?85/144) were enrolled from 1147 outpatients with mood and anxietydisorders by systematic sampling. Psychiatric disorders and MetS were diagnosed using the Structured Clinical Interview for DSM-IV-TR and the new International Diabetics Federation definition, respectively. The numbers of antipsychotics, mood stabilizers, and antidepressants being taken were recorded. Logistic regression was used to investigate the impacts of pharmacotherapy and psychiatric diagnoses on MetS. Results Among 229 subjects, 51 (22.3%) fulfilled the criteria for MetS. The prevalence of MetS was highest in the bipolar I disorder (46.7%) patients, followed by bipolar II disorder (25.0%), major depressive disorder (22.0%), anxiety-only disorders (16.7%), and no mood and/or anxietydisorders (14.3%). The percentages of MetS among the five categories were correlated with those of the patients being treated with antipsychotics and mood stabilizers. Use of antipsychotics and/or mood stabilizers independently predicted a higher risk of MetS after controlling for demographic variables and psychiatric diagnoses. When adding body mass index (BMI) as an independent variable in the regression model, BMI became the most significant factor to predict MetS. Conclusion BMI was found to be an important factor related to MetS. Pharmacotherapy might be one of underlying causes of elevated BMI. The interactions among MetS, BMI, pharmacotherapy, and psychiatric diagnoses might need further research.
This study examined diagnostic agreement between children and their parents for seventy 9- to 13-year-olds (45 boys and 25 girls) who had received cognitive?behavioral treatment for anxietydisorders. Parent-child diagnostic rates and agreements for generalized anxietydisorder, separation anxietydisorder, and social phobia were evaluated at 3…
Safford, Scott M.; Kendall, Philip C.; Flannery-Schroeder, Ellen; Webb, Alicia; Sommer, Heath
A representative general population sample (n = 7,076) was used to study retrospectively and prospectively the nature of the relationship between co-morbid alcohol dependence and anxietydisorders. Four different models were tested: (1) anxietydisorders increase the risk of alcohol dependence; (2) alcohol dependence increases the risk of anxietydisorders; (3) family history or childhood traumatisation increase the risk of
Loes A. Marquenie; Annemiek Schadé; Hannie C. Comijs; Ron de Graaf; Wilma Vollebergh; Richard van Dyck; Wim van den Brink
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).…
Anxietydisorders are common, yet under diagnosed, in primary care settings. Many patients with anxiety and other psychiatric disorders do not seek care in mental health care settings. An integrated primary care\\/mental health model offers one approach to improving outcomes for patients with anxietydisorders. This model has been researched for the treatment of depression with positive results but has
David Price; Arne Beck; Carolee Nimmer; Stephen Bensen
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.
We examined 336 children, aged 7-14 years, with signs of school maladaptation (SM). Anxietydisorders were found in 167 (49.7%), including generalized anxietydisorder - 87 children (25.9%), phobic disorder - 40 children (11.3%), anxietydisorder - 14 (4.2%), social anxietydisorder - 26 (7.7%). These indices differed significantly from those in the comparison group of children without SM. The children with generalized anxietydisorder were treated with adaptol (1000 mg/d during 30 days). The clinical and psychological examination revealed the high efficacy of this drug. Adaptol was well-tolerated, with no side-effects observed. PMID:20436449
Chutko, L S; Surushkina, S Iu; Nikishena, I S; Iakovenko, E A; Anisimova, T I; Livinskaia, A M; Sidorova, Iu I; Kuzovenkova, M P; A?tbekov, K A; Mamaeva, Iu V
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). PMID:18977061
Cisler, Josh M; Olatunji, Bunmi O; Lohr, Jeffrey M
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.
This review examines recent functional neuroimaging research of resting-state regional connectivity between brain regions in anxietydisorders. Studies compiled in the PubMed- National Center for Biotechnology Information database targeting resting-state functional connectivity in anxietydisorders were reviewed. Diagnoses included posttraumatic stress disorder (PTSD), generalized anxietydisorder (GAD), social anxietydisorder (SAD), obsessive-compulsive disorder (OCD), panic disorder (PD), and specific phobia (SP). Alterations to network connectivity were demonstrated in PTSD, GAD, SAD, OCD, and PD in several resting-state investigations. Differences from control subjects were primarily observed in the default mode network within PTSD, SAD, and OCD. Alterations within the salience network were observed primarily in PTSD, GAD, and SAD. Alterations in corticostriatal networks were uniquely observed in OCD. Finally, alterations within somatosensory networks were observed in SAD and PD investigations. Resting-state studies involving SPs as a primary diagnosis (with or without comorbidities) were not generated during the literature search. The emerging use of resting-state paradigms may be an effective method for understanding associations between anxietydisorders. Targeted studies of PD and SPs, meta-analyses of the studies conducted to date, and studies of the impact of specific comorbid presentations, are recommended future research directions. PMID:25007403
Peterson, Andrew; Thome, Janine; Frewen, Paul; Lanius, Ruth A
The study investigates whether a putative diagnosis of separation anxietydisorder can be identified in adulthood and whether there are continuities between juvenile and adult forms of the disorder. Seventy patients with conventional adult diagnoses of panic disorder and generalized anxietydisorder attending an anxiety clinic were administered an interview and checklist to assess separation anxiety (SA) symptoms in adulthood.
Low levels of end-tidal partial pressure of carbon dioxide (pCO2)-the amount of carbon dioxide measured from expired air-are commonly found in individuals with anxietydisorders but have not been examined as predictors of outcome from anxiety treatment. The current study examined pre-treatment baseline pCO2 as a predictor of outcome from cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for anxietydisorders. Sixty-one individuals with a Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defined principal anxietydisorderdiagnosis completed 12 sessions of either CBT or ACT. Baseline pCO2 was measured prior to entering treatment. Self-reported anxiety symptoms and quality of life were assessed at pre-treatment, post-treatment, and 6- and 12-month follow-up from baseline. Low baseline pCO2 was associated with higher anxiety symptoms and lower quality of life across follow-up timepoints, above and beyond baseline symptom severity. These results suggest that low baseline pCO2 predicts poorer outcome from CBT and ACT for anxiety and may warrant treatment that directly addresses respiratory dysregulation. PMID:24953422
Social anxietydisorder (SAD), the 3rd most common psychiatric disorder in the United States, follows a chronic and unremitting course, often resulting in severe im- pairments in multiple areas of functioning. Despite a typical age of onset in early ado- lescence, the disorder is rarely recognized and treated in adolescent populations. Given its early age of onset, school professionals are
James D. Herbert; Kia Crittenden; Kristy L. Dalrymple
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
Background: The present study's aim was to examine the long-term effects (8 to 13 years post-treatment; M = 9.83 years; SD = 1.71) of the most widely used treatment approaches of exposure-based cognitive behavioral treatment for phobic and anxietydisorders in children and adolescents (i.e., group treatment and two variants of individual…
Saavedra, Lissette M.; Silverman, Wendy K.; Morgan-Lopez, Antonio A.; Kurtines, William M.
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
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.
... by something unrelated to school, such as a divorce, illness, or a death in the family. Some ... complications associated with the disorder, and minimizing the effects on the teen's social, school, and developmental progress. ...
What have these studies revealed about SAD? First, few studies have been performed so far, with even fewer replications. Most of the work has been exploratory in nature and follows the paradigms used in PD. This approach has been justifiably criticized. The use of psychological (naturalistic) challenges may be more appropriate in SP than chemical challenges. The paradigms of public speaking, autobiographical scripts, or similar behavioral challenges merit further use, exploration, and validation if symptoms resembling those of the condition proper are to be induced in experimental circumstances. However, some tentative conclusions can be drawn from the research performed so far. There is no enough evidence to support the presence of structural brain abnormality in SAD. Admittedly, such a finding would have been very unlikely. On the other hand, evidence of subtle functional abnormalities is accumulating. On the nosologic question, there appear to be differences from PD. While in some challenges (e.g., CO2 and pentagastrin) the two conditions differ only in degree, in others (e.g., lactate, caffeine, and flumazenil), the separation is clearer. Equally, there is a strong argument to differentiate the generalized from the specific form of social anxiety on the basis of substantial (albeit accidental) findings outlined earlier. More sophisticated neuroimaging techniques, directly comparing patients from both groups before and after pharmacologic or psychological treatment, should provide more conclusive evidence on this issue. What might also help future research is the integration of biological investigations with specific personality profiles. In one study, SAD patients scored low in novelty seeking, self-directedness and cooperativeness and high in harm avoidance. It has been hypothesized that such results indicate serotonergic and dopaminergic dysregulation, which is consistent with the findings described earlier. The best evidence for neurotransmitter abnormality so far is for altered dopamine function at the level of the basal ganglia, either pre- or postsynaptic, which may result in reduced basal ganglia function so that the normal fluidity of social motor functions (e.g., smiling, eye movements, and speech) are impaired, thus leading to the cognitive symptoms of social anxiety and the subsequent generation of avoidance behavior. Such patients should respond poorly to antipsychotics, and additional challenges with these drugs could be used to test this theory. Furthermore, more research needs to be done to elucidate the mechanism by which SSRIs work in SAD. Neuroanatomical models of social anxiety (Fig. 4) [see structure: Text], explaining the site of action of drugs and psychological treatments, have been proposed in recent years. Central to these models is the notion of an innate anxiety circuit, which could be tentatively identified with the behavioral inhibition system, the septohippocampal system. This area receives 5-HT, NE, and dopamine input and has connections with the cortex and limbic structures. The relevance of these models remains to be assessed in experiments that are specifically designed to test them. PMID:11723629
Anxietydisorders are common, costly and debilitating, and yet often unrecognized or inadequately treated in real world, primary care settings. Our group has been researching ways of delivering evidence-based treatment for anxiety in primary care settings, with special interest to preserving the fidelity of the treatment while at the same time promoting its sustainability once the research is over. In this paper, we describe the programs we have developed and our directions for future research. Our first study evaluated the efficacy of CBT and expert pharmacotherapy recommendations for panic disorder in primary care, using a collaborative care model of service delivery (CCAP). Symptom, disability and mental health functioning measures were superior for the intervention group compared to treatment as usual both in the short term and the long term, although also more costly. In our ongoing CALM study, we have extended our population to include panic disorder, social anxietydisorder, generalized anxietydisorder and posttraumatic disorder, while at the same time utilizing clinicians with limited mental health care experience. In addition to pharmacotherapy management, we developed a computer-assisted CBT that guides both novice clinician and patient, thereby contributing to sustainability once the research is over. We have also incorporated a measurement based approach to treatment planning, using a web-based tracking system of patient status. To date, the computer-assisted CBT program has been shown to be acceptable to clinicians and patients. Clinicians rated the program highly, and patients engaged in the program. Future directions for our research include dissemination and implementation of the CALM program, testing potential alternations to the CALM program, and distance delivery of CALM.
Craske, Michelle G.; Roy-Byrne, Peter P.; Stein, Murray B.; Sullivan, Greer; Sherbourne, Cathy; Bystritsky, Alexander
Background To inform early intervention practice, the present research examines how child anxiety, behavioural inhibition, maternal overinvolvement, maternal negativity, mother-child attachment and maternal anxiety, as assessed at age four, predict anxiety at age nine. Method 202 children (102 behaviourally inhibited and 100 behaviourally uninhibited) aged 3–4 years were initially recruited and the predictors outlined above were assessed. Diagnostic assessments, using the AnxietyDisorders Interview Schedule, were then conducted five years later. Results Behavioural inhibition, maternal anxiety, and maternal overinvolvement were significant predictors of clinical anxiety, even after controlling for baseline anxiety (p<.05). No significant effect of negativity or attachment security was found over and above baseline anxiety (p>.1). Conclusions Preschool children who show anxiety, are inhibited, have overinvolved mothers and mothers with anxietydisorders are at increased risk for anxiety in middle childhood. These factors can be used to identify suitable participants for early intervention and can be targeted within intervention programs.
Background Anxiety scales may help primary care physicians to detect specific anxietydisorders among the many emotionally distressed patients presenting in primary care. The anxiety scale of the Four-Dimensional Symptom Questionnaire (4DSQ) consists of an admixture of symptoms of specific anxietydisorders. The research questions were: (1) Is the anxiety scale unidimensional or multidimensional? (2) To what extent does the anxiety scale detect specific DSM-IV anxietydisorders? (3) Which cut-off points are suitable to rule out or to rule in (which) anxietydisorders? Methods We analyzed 5 primary care datasets with standardized psychiatric diagnoses and 4DSQ scores. Unidimensionality was assessed through confirmatory factor analysis (CFA). We examined mean scores and anxiety score distributions per disorder. Receiver operating characteristic (ROC) analysis was used to determine optimal cut-off points. Results Total n was 969. CFA supported unidimensionality. The anxiety scale performed slightly better in detecting patients with panic disorder, agoraphobia, social phobia, obsessive compulsive disorder (OCD) and post traumatic stress disorder (PTSD) than patients with generalized anxietydisorder (GAD) and specific phobia. ROC-analysis suggested that ?4 was the optimal cut-off point to rule out and ?10 the cut-off point to rule in anxietydisorders. Conclusions The 4DSQ anxiety scale measures a common trait of pathological anxiety that is characteristic of anxietydisorders, in particular panic disorder, agoraphobia, social phobia, OCD and PTSD. The anxiety score detects the latter anxietydisorders to a slightly greater extent than GAD and specific phobia, without being able to distinguish between the different anxietydisorder types. The cut-off points ?4 and ?10 can be used to separate distressed patients in three groups with a relatively low, moderate and high probability of having one or more anxietydisorders.
The efficacy of early intervention for preschool-aged children at risk of anxietydisorders is investigated. Brief early intervention delivered through parents can reduce anxiety and associated risk and may alter the developmental trajectory of anxiety in some young children.
Kennedy, Susan J.; Rapee, Ronald M.; Edwards, Susan L.
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 presence of myotonia and paramyotonia on clinical examination and of myotonic discharges during electrodiagnostic (EDX) studies are important for the diagnosis of certain neuromuscular conditions. The increased muscle activity of myotonia produces muscle stiffness that improves with repeated activity. Paramyotonia produces a similar symptom, but the stiffness paradoxically increases with activity. Myotonic discharges are easily recognized on EDX testing because of the waxing and waning discharges. Myotonic dystrophy and myotonia congenita share both clinical and electrodiagnostic myotonia. Paramyotonia congenita and hyperkalemic periodic paralysis are associated with clinical paramyotonia and electrical myotonia. Acid maltase deficiency often produces myotonic potentials without clinical evidence of myotonia or paramyotonia. The differential diagnosis of these myotonic disorders is discussed. PMID:18067134
Background Anxietydisorders are highly prevalent in primary care and cause a substantial burden of disease. Screening on risk status, followed by preventive interventions in those at risk may prevent the onset of anxietydisorders, and thereby reduce the disease burden. The willingness to participate in screening and interventions is crucial for the scope of preventive strategies, but unknown. This feasibility study, therefore, investigated participation rates of screening and preventive services for anxietydisorders in primary care, and explored reasons to refrain from screening. Methods In three general practices, screening was offered to individuals visiting their general practitioner (total n?=?2454). To assess risk status, a 10-item questionnaire was followed by a telephone interview (including the CIDI) when scoring above a predefined threshold. Preventive services were offered to those at risk. Participation rates for screening and preventive services for anxietydisorders were assessed. Those not willing to be screened were asked for their main reason to refrain from screening. Results Of all individuals, 17.3% participated in initial screening, and of those with a possible risk status, 56.0% continued screening. In 30.1% of those assessed, a risk status to develop an anxietydisorder was verified. Of these, 22.6% already received some form of mental health treatment and 38.7% of them agreed to participate in a preventive intervention and were referred. The most frequently mentioned reasons to refrain from screening were the emotional burden associated with elevated risk status, the assumption not to be at risk, and a lack of motivation to act upon an elevated risk status by using preventive services. Conclusions Screening in general practice, followed by offering services to prevent anxietydisorders in those at risk did not appear to be a feasible strategy due to low participation rates. To enable the development of feasible and cost-effective preventive strategies, exploring the reasons of low participation rates, considering involving general practitioners in preventive strategies, and looking at preventive strategies in somatic health care with proven feasibility may be helpful.
Adolescents with high-functioning autism spectrum disorders (ASDs) are at high risk for developing psychiatric symptoms, with anxietydisorders among the most commonly cooccurring. Cognitive behavior therapies (CBTs) are considered the best practice for treating anxiety in the general population. Modified CBT approaches for youth with high-functioning ASD and anxiety have resulted in significant reductions in anxiety following intervention. The purpose of the present study was to develop an intervention for treating anxiety in adolescents with ASD based on a CBT program designed for school-aged children. The Facing Your Fears-Adolescent Version (FYF-A) program was developed; feasibility and acceptability data were obtained, along with initial efficacy of the intervention. Twenty-four adolescents, aged 13-18, completed the FYF-A intervention. Results indicated significant reductions in anxiety severity and interference posttreatment, with low rates of anxiety maintained at 3-month follow-up. In addition, nearly 46% of teen participants met criteria for a positive treatment response on primary diagnosis following the intervention. Initial findings from the current study are encouraging and suggest that modified group CBT for adolescents with high-functioning ASD may be effective in reducing anxiety symptoms. Limitations include small sample size and lack of control group. Future directions are discussed. PMID:23091719
Reaven, Judy; Blakeley-Smith, Audrey; Leuthe, Eileen; Moody, Eric; Hepburn, Susan
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.
Anxietydisorders are the most common psychiatric disorders. They are frequently treated with benzodiazepines, which are fast acting highly effective anxiolytic agents. However, their long-term use is impaired by tolerance development and abuse liability. In contrast, antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are considered as first-line treatment but have a slow onset of action. Neurosteroids are powerful allosteric modulators of GABAA and glutamate receptors. However, they also modulate sigma receptors and they are modulated themselves by SSRIs. Both pre-clinical and clinical studies have shown that neurosteroid homeostasis is altered in depression and anxietydisorders and antidepressants may act in part through restoring neurosteroid disbalance. Moreover, novel drugs interfering with neurosteroidogenesis such as ligands of the translocator protein (18?kDa) may represent an attractive pharmacological option for novel anxiolytics which lack the unwarranted side effects of benzodiazepines. Thus, neurosteroids are important endogenous neuromodulators for the physiology and pathophysiology of anxiety and they may constitute a novel therapeutic approach in the treatment of these disorders.
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
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. PMID:19337457
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
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…
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…
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
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…
Research has shown that Generalized AnxietyDisorder is one of the most common anxietydisorders found in adolescents today. Its main symptoms are disproportionate fear and anxiety (worrying) about work-related or school-related events or activities and social relations. Adolescents suffering from GAD symptoms have difficulty keeping fear and worries in check. This causes mounting stress and impairs their functioning. GAD
The present study tested the reliability of a self-report diagnostic measure of generalized anxietydisorder (GAD) based on DSM criteria. Among two samples of undergraduate students, 47–80% of the GAD diagnoses by questionnaire were confirmed by diagnostic interview, with the higher rate being associated with DSM-IV criteria. Categorization of a participant as Non-GAD by questionnaire was found to be 100%
Lizabeth Roemer; Mary Borkovec; Sharon Posa; T. D. Borkovec
Cognitive-behavioral therapy (CBT) can be successfully used to treat generalized anxietydisorder (GAD), with or without the inclusion of anxiolytics. The treatment of GAD using cognitive-behavioral techniques involves cognitive restructuring, relaxation, worry exposure, behavior modification, and problem solving. This article will review the principles used in CBT for the treatment of GAD and will discuss recent modifications of CBTs and how they may be employed. The simultaneous use of CBT and antidepressants will also be reviewed. PMID:15384932
Numerous clinical trials have supported the efficacy of cognitive behavioral therapy (CBT) for the treatment of anxietydisorders. Accordingly, CBT has been formally recognized as an empirically supported treatment for anxiety-related conditions. This article reviews the evidence supporting the efficacy of CBT for anxietydisorders. Specifically, contemporary meta-analytic studies on the treatment of anxietydisorders are reviewed and the efficacy of CBT is examined. Although the specific components of CBT differ depending on the study design and the anxietydisorder treated, meta-analyses suggest that CBT procedures (particularly exposure-based approaches) are highly efficacious. CBT generally outperforms wait-list and placebo controls. Thus, CBT provides incremental efficacy above and beyond nonspecific factors. For some anxietydisorders, CBT also tends to outperform other psychosocial treatment modalities. The implications of available meta-analytic findings in further delineating the efficacy and dissemination of CBT for anxietydisorders are discussed. PMID:20599133
Olatunji, Bunmi O; Cisler, Josh M; Deacon, Brett J
This study aimed to determine the prevalence of long-term anxietydisorder in burn-injured youth. It is well documented that inpatient pediatric burn patients experience heightened anxiety. However, the prevalence of anxietydisorder in pediatric burn survivors warrants further investigation. Participants completed the Screen for Anxiety Related Disorders, a 41-item self-report measuring anxietydisorder symptomatology. Respondents included 197 pediatric burn survivors, 105 boys, 92 girls, who were between 8 and 18 years of age; the mean age was 12.4 ± 2.4 years. Mean age at time of injury was 5.8 ± 3.7 years, with 79% of youth reporting visible scars. There were 77 participants (39%) who screened positive for a possible anxietydisorder with a total anxiety score ?25, and 28% with a total mean score of ?30, more specific to the likely presence of anxietydisorder. Nearly half of the participants (44%) reported symptoms indicating the presence of separation anxiety with a mean score of ?5, and 28% had symptoms indicating the presence of panic disorder and school avoidance disorder. Significant sex differences were observed for anxiety, with girls scoring significantly higher than boys on total anxiety P ? .001 and on all four subscales. Youth attending burn camps for ?5 years reported significantly lower anxiety scores. This study supports the screening of burn-injured youth for anxietydisorder and highlights the importance of educating parents and burn care professionals regarding the symptoms of anxietydisorders. This can help to ensure that pediatric burn survivors receive treatment when anxietydisorder symptoms are present. Screening appears to be especially important for girls. PMID:24165666
Rimmer, Ruth Brubaker; Bay, R Curtis; Alam, Now Bahar; Sadler, Ian J; Hansen, Linda; Foster, Kevin N; Caruso, Daniel M
Generalized anxietydisorder (GAD) is characterized by excessive and persistent worrying. Neural substrates of this disorder are insufficiently understood, which relates to functional as well as to structural brain abnormalities. Especially, findings on the neuroanatomy of GAD have been inconsistent and were predominantly derived from pediatric samples. Therefore, we studied adult patients. Thirty-one women (16 patients with GAD and 15 healthy control participants) underwent structural MRI scanning. Gray matter volumes for specific brain regions involved in worrying, anticipatory anxiety, and emotion regulation were analyzed by means of voxel-based morphometry. Relative to controls, patients with GAD had larger volumes of the amygdala and the dorsomedial prefrontal cortex (DMPFC). Moreover, patients' self-reports on symptom severity were positively correlated with volumes of the DMPFC and the anterior cingulate cortex. Patients with GAD show localized gray matter volume differences in brain regions associated with anticipatory anxiety and emotion regulation. This abnormality may represent either a predisposition for GAD or a consequence of disorder-specific behavior, such as chronic worrying. This issue should be addressed in future MRI studies. PMID:20820793
Body stability is controlled by the postural system and can be affected by fear and anxiety. Few studies have addressed freezing posture in psychiatric disorders. The purpose of the present study was to assess posturographic behavior in 30 patients with social anxietydisorder (SAD) and 35 without SAD during presentation of blocks of pictures with different valences. Neutral images consisted of objects taken from a catalog of pictures, negative images were mutilation pictures and anxiogenic images were related to situations regarding SAD fears. While participants were standing on a force platform, similar to a balance, displacement of the center of pressure in the mediolateral and anteroposterior directions was measured. We found that the SAD group exhibited a lower sway area and a lower velocity of sway throughout the experiment independent of the visual stimuli, in which the phobic pictures, a stimulus associated with a defense response, were unable to evoke a significantly more rigid posture than the others. We hypothesize that patients with SAD when entering in a situation of exposure, from the moment the pictures are presented, tend to move less than controls, remaining this way until the experiment ends. This discrete body manifestation can provide additional data to the characterization of SAD and its differentiation from other anxietydisorders, especially in situations regarding facing fear.
The study investigated biases in selective attention to emotional face stimuli in generalized anxietydisorder (GAD) and depressive disorder, using a modified probe detection task. There were 4 face types: threatening, sad, happy, and neutral. Measures of attentional bias included (a) the direction and latency of the initial eye movement in response to the faces and (b) manual reaction time
Objective: To assess from a health sector perspective the incremental cost-effectiveness of interventions for generalized anxietydisorder (cognitive behavioural therapy (CBT) and serotonin and noradrenaline reuptake inhibitors (SNRIs)) and panic disorder (CBT, selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs)). Method: The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations
Louise Heuzenroeder; Marie Donnelly; Michelle M. Haby; Cathrine Mihalopoulos; Ruth Rossell; Rob Carter; Gavin Andrews; Theo Vos
The objective of the present study was to examine the relationship between sluggish cognitive tempo (SCT), subtypes of attention-deficit/hyperactivity disorder (ADHD), and anxietydisorders (AnxDs). One hundred and forty-one children (90 males, 51 females) aged 7-13 years were assigned to four groups, i.e., referred children with comorbid AnxDs…
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 with…
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
Despite high rates of clinically elevated anxiety difficulties in children and adolescents with autism spectrum disorders (ASDs), very few studies have systematically examined the usefulness of commonly used caregiver report anxiety screening tools with this population. This study investigated the use of the Spence Children's Anxiety Scale-Parent version (SCAS-P) as a screening tool for anxietydisorders when compared to a standardized DSM-IV-TR-based clinical interview, the Kiddie-Schedule for Schizophrenia and Affective Disorders-Present and Lifetime version (K-SADS-PL). Thirty-two caregivers of youth with a clinical diagnosis of ASD (mean age 10.3 years) attending a specialist autism school participated in this study. They first completed the SCAS-P, a measure of adaptive functioning and a checklist of other emotional and behavioral difficulties. They were then interviewed with the K-SADS-PL. Internal consistency for the SCAS Total score was .88, but Cronbach's alphas were <.70 in three of the six SCAS-P subscales. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the SCAS-P against K-SADS diagnosis were .75, .71, .27, and .95, respectively. All values were >.70, except for the PPV. Evidence of convergent validity between the SCAS-P, K-SADS-PL and DBC anxiety subscale was also found. The high false positive rates notwithstanding, the preliminary data of acceptable to excellent sensitivity, specificity and NPV values tentatively suggest that the SCAS-P may be useful for screening non-help seeking young people with ASD for elevated anxiety symptoms. Further replication in larger studies is needed and ways in which the SCAS-P could be further developed and investigated for use with youth with ASD are discussed. PMID:24573336
Zainal, Hani; Magiati, Iliana; Tan, Julianne Wen-Li; Sung, Min; Fung, Daniel S S; Howlin, Patricia
Background Recognition of the significance of anxietydisorders in older adults is growing. The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a timely opportunity to consider potential improvements to diagnostic criteria for psychiatric disorders for use with older people. The authors of this paper comprise the Advisory Committee to the DSM5 Lifespan Disorders Work Group, the purpose of which was to generate informative responses from individuals with clinical and research expertise in the field of late-life anxietydisorders. Methods This paper reviews the unique features of anxiety in later life and synthesizes the work of the Advisory Committee. Results Suggestions are offered for refining our understanding of the effects of aging on anxiety and other disorders (e.g., mood disorders) and changes to the DSM5 criteria and text that could facilitate more accurate recognition and diagnosis of anxietydisorders in older adults. Several of the recommendations are not limited to the study of anxiety but rather are applicable across the broader field of geriatric mental health. Conclusions DSM5 should provide guidelines for the thorough assessment of avoidance, excessiveness, and comorbid conditions (e.g., depression, medical illness, cognitive impairment) in anxious older adults.
Mohlman, Jan; Bryant, Christina; Lenze, Eric J.; Stanley, Melinda A.; Gum, Amber; Flint, Alastair; Beekman, Aartjan T. F.; Wetherell, Julie Loebach; Thorp, Steven R.; Craske, Michelle G.
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.
Transdiagnostic approaches to cognitive behaviour therapy (TCBT) of anxietydisorders have drawn increasing interest and empirical testing over the past decade. In this paper, we review evidence of the overall efficacy of TCBT for anxietydisorders, as well as TCBT efficacy compared with wait-list, treatment-as-usual, and diagnosis-specific cognitive behaviour therapy (CBT) controls. A total of 11 studies reporting 12 trials (n = 1933) were included in the systematic review. Results from the meta-analysis of 11 trials suggest that TCBT was generally associated with positive outcome; TCBT patients did better than wait-list and treatment-as-usual patients, and treatment gains were maintained through follow-up. The pooled estimate showed a moderate treatment effect, however with large heterogeneity suggesting differences in treatment effects between the studies. Also, all the included trials, apart from one, were judged to be associated with a high risk of bias. Only one study compared TCBT with diagnosis-specific CBT suggesting treatment effect of TCBT to be as strong as diagnosis-specific CBT. This study not only cautiously supports evidence for the efficacy of TCBT, but also suggests the need for more high-quality, large-scaled studies in this area. Transdiagnostic treatments offer great clinical promise as an affordable and pragmatic treatment for anxietydisorders and as a specialized treatment for co-morbid and other-specified anxietydisorders. PMID:24646219
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
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
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
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
Anxietydisorders in childhood are common, disabling and run a chronic course. Cognitive behaviour therapy (CBT) is effective but expensive and trained therapists are scarce. Guided self?help treatments may be a means of widening access to treatment. This study aimed to examine the feasibility of guided CBT self?help in primary care for childhood anxietydisorders, specifically in terms of therapist adherence, patient and therapist satisfaction and clinical gain. Participants were children aged between five and 12 years referred to two primary child and adolescent mental health services (PCAMHSs) in Oxfordshire, UK, who met diagnostic criteria for a primary anxietydisorder. Of the 52 eligible children, 41 anxious children were assessed for anxiety severity and interference before and after receiving CBT self?help delivered via a parent (total therapy time = five hours) by primary mental health workers (PMHWs). Therapy sessions were rated for treatment adherence and parents and PMHWs completed satisfaction questionnaires after treatment completion. Over 80% of therapy sessions were rated at a high level of treatment adherence. Parents and PMHWs reported high satisfaction with the treatment. Sixty?one percent of the children assessed no longer met the criteria for their primary anxietydisorderdiagnosis following treatment, and 76% were rated as ‘much’/‘very much’ improved on the Clinical Global Impression–Improvement (CGI–I) scale. There were significant reductions on parent and child report measures of anxiety symptoms, interference and depression. Preliminary exploration indicated that parental anxiety was associated with child treatment outcome. The findings suggest that guided CBT self?help represents a promising treatment for childhood anxiety in primary care.
Anxietydisorders in childhood are common, disabling and run a chronic course. Cognitive behaviour therapy (CBT) is effective but expensive and trained therapists are scarce. Guided self-help treatments may be a means of widening access to treatment. This study aimed to examine the feasibility of guided CBT self-help in primary care for childhood anxietydisorders, specifically in terms of therapist adherence, patient and therapist satisfaction and clinical gain.Participants were children aged between five and 12 years referred to two primary child and adolescent mental health services (PCAMHSs) in Oxfordshire, UK, who met diagnostic criteria for a primary anxietydisorder. Of the 52 eligible children, 41 anxious children were assessed for anxiety severity and interference before and after receiving CBT self-help delivered via a parent (total therapy time = five hours) by primary mental health workers (PMHWs). Therapy sessions were rated for treatment adherence and parents and PMHWs completed satisfaction questionnaires after treatment completion. Over 80% of therapy sessions were rated at a high level of treatment adherence. Parents and PMHWs reported high satisfaction with the treatment. Sixty-one percent of the children assessed no longer met the criteria for their primary anxietydisorderdiagnosis following treatment, and 76% were rated as 'much'/'very much' improved on the Clinical Global Impression-Improvement (CGI-I) scale. There were significant reductions on parent and child report measures of anxiety symptoms, interference and depression. Preliminary exploration indicated that parental anxiety was associated with child treatment outcome. The findings suggest that guided CBT self-help represents a promising treatment for childhood anxiety in primary care. PMID:22477922
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
Background The aim of the study was to determine in a clinical setting the risk factors for current anxietydisorder (AD) comorbidity among Thai patients with bipolar disorder (BD), being treated under the Thai Bipolar Disorder Registry Project (TBDR). Methods The TBDR was a multisite naturalistic study conducted at 24 psychiatric units (ie, at university, provincial mental, and government general hospitals) between February 2009 and January 2011. Participants were in- or out-patients over 18 years of age who were diagnosed with BD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Instruments used in this study included the Thai Mini International Neuropsychiatric Interview version 5; Thai Montgomery–Åsberg Depression Rating Scale (MADRS); Thai Young Mania Rating Scale; Clinical Global Impression of Bipolar Disorder-Severity (CGI-BP-S), CGI-BP-S-mania, CGI-BPS-depression, and CGI-BP-S-overall BP illness; and the Thai SF-36 quality of life questionnaire. Results Among the 424 BD patients, 404 (95.3%) had BD type I. The respective mean ± standard deviation of age of onset of mood disturbance, first diagnosis of BD, and first treatment of BD was 32.0±11.9, 36.1±12.2, and 36.2±12.2 years. The duration of illness was 10.7±9.0 years. Fifty-three (12.5%) of the 424 participants had a current AD while 38 (9%) had a substance use disorder (SUD). The univariate analysis revealed 13 significant risks for current AD comorbidity, which the multivariate analysis narrowed to age at first diagnosis of BD (odds ratio =0.95, P<0.01), family history of SUD (odds ratio =2.18, P=0.02), and having a higher current MADRS score (odds ratio =1.11, P<0.01). Conclusion A diagnosis of AD comorbid with BD is suggested by early-age onset of BD together with a higher MADRS score and a family history of SUD. The likelihood of AD comorbidity decreases by 5% with each passing year; early-age onset of BD is a risk while later age onset is protective. Our results underscore how SUD within the family significantly contributes to the risk of an AD comorbidity.
Diagnosis of autism spectrum disorder (ASD) is often delayed in high-functioning children with milder and more varied forms of ASD. The substantial overlap between ASD and other psychiatric disorders is thought to contribute to this delay. This study examined the endorsement of DSM-IV-TR diagnostic criteria for ASD based on semi-structured parent interviews across three groups of older children referred to an ASD clinic: 55 children diagnosed with high-functioning ASD, 27 children diagnosed with attention-deficit/hyperactivity disorder (ADHD), and 23 children diagnosed with anxietydisorder. Results indicate that the criteria within the domains of communication and social relatedness were largely able to discriminate the high-functioning ASD group from the ADHD and anxietydisorder groups, but criteria within the domain of restricted/repetitive/stereotyped patterns were not.
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…
We studied the association between dental fear and anxiety or depressive disorders, as well as the comorbidity of dental fear with anxiety and depressive disorders, controlling for socio-demographic characteristics, dental attendance, and dental health. Nationally representative data on Finnish adults, ? 30 yr of age (n = 5,953), were gathered through interviews and clinical examination. Dental fear was measured using the question: 'How afraid are you of visiting a dentist?' Anxiety and/or depressive disorders were assessed using a standardized structured psychiatric interview according to criteria presented in the Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV).Those with depressive disorders, generalized anxietydisorder or social phobia more commonly reported high dental fear than did those without these disorders. When age, gender, education, dental attendance, and the number of decayed, missing, and restored teeth were considered, those with generalized anxietydisorder were more likely to have high dental fear than were participants with neither anxiety nor depressive disorders. The comorbidity of depressive and anxietydisorders also remained statistically significantly associated with dental fear; those with both depressive and anxietydisorders were more likely to have high dental fear than were those without these disorders. Our findings support the suggestion that some individuals may have a personality that is vulnerable to dental fear. PMID:21244512
Pohjola, Vesa; Mattila, Aino K; Joukamaa, Matti; Lahti, Satu
Introduction: Anxietydisorders are relatively common psychiatric illnesses in children and adolescents. In young people, such disorders are likely to show severe outcomes and adversely impact on multiple aspects of personality and social integration. Area covered: This article aims to analyze systematically the efficacy of both old- and new-generation antidepressants in children and adolescents diagnosed with non-obsessive-compulsive disorderanxietydisorders. Expert opinion: Reviewed data demonstrate that social phobia is the only pediatric anxietydisorder whose response to antidepressant medications has been investigated in an adequate number of studies. In this clinical condition, venlafaxine and fluoxetine (and fluvoxamine as second choice) are the only antidepressants that have shown convincing reports on efficacy. In contrast, apart from preliminary observations suggesting the efficacy of sertraline in pediatric generalized anxietydisorder, no evidence-based information definitively supports the use of antidepressants for managing other juvenile anxietydisorders. PMID:24845944
Objective: This paper aims to describe some of the challenges in psychiatric classification, using generalized anxietydisorder (GAD) as an example. A range of different conceptualizations of GAD are presented. Some are based on theoretical formulations, while others draw on epidemiological data. Each has merit, but also deficiencies. The evolution of diagnostic criteria is not simply a theoretical exercise, but reflects assumptions about the nature of the underlying pathology and the relationships between different disorders. Furthermore, these criteria determine which subjects are included in research and in clinical trials, so they shape the further development of psychiatric classification systems. Conclusion: The controversies about the classification of GAD illustrate the complexities and challenges of developing a valid classification system for psychiatric disorders. PMID:20001372
Social anxietydisorder (SAD) is a common psychiatric disorder characterized by a persistent, excessive fear and avoidance of social and performance situations. Research on cognitive biases indicates individuals with SAD may lack an accurate view of how they are perceived by others, especially in social situations when they allocate important attentional resources to monitoring their own actions as well as external threat. In the present study, we explored whether socially anxious individuals also have impairments in theory of mind (ToM), or the ability to comprehend others' mental states, including emotions, beliefs, and intentions. Forty socially anxious and 40 non-socially-anxious comparison participants completed two ToM tasks: the Reading the Mind in the Eyes and the Movie for the Assessment of Social Cognition. Participants with SAD performed worse on ToM tasks than did non-socially-anxious participants. Relative to comparison participants, those with SAD were more likely to attribute more intense emotions and greater meaning to what others were thinking and feeling. These group differences were not due to interpretation bias. The ToM impairments in people with SAD are in the opposite direction of those in people with autism spectrum conditions whose inferences about the mental states of other people are absent or very limited. This association between SAD and ToM may have important implications for our understanding of both the maintenance and treatment of social anxietydisorder. PMID:24912465
There is considerable controversy about the role of child sexual abuse in the etiology of anxietydisorders. Although a growing number of research studies have been published, these have produced inconsistent results and conclusions regarding the nature of the associations between child sexual abuse and the various forms of anxiety problems as well as the potential effects of third variables, such as moderators, mediators, or confounders. This article provides a systematic review of the several reviews that have investigated the literature on the role of child sexual abuse in the etiology of anxietydisorders. Seven databases were searched, supplemented with hand search of reference lists from retrieved papers. Four meta-analyses, including 3,214,482 subjects from 171 studies, were analyzed. There is evidence that child sexual abuse is a significant, although general and nonspecific, risk factor for anxietydisorders, especially posttraumatic stress disorder, regardless of gender of the victim and severity of abuse. Additional biological or psychosocial risk factors (such as alterations in brain structure or function, information processing biases, parental anxietydisorders, family dysfunction, and other forms of child abuse) may interact with child sexual abuse or act independently to cause anxietydisorders in victims in abuse survivors. However, child sexual abuse may sometimes confer additional risk of developing anxietydisorders either as a distal and indirect cause or as a proximal and direct cause. Child sexual abuse should be considered one of the several risk factors for anxietydisorders and included in multifactorial etiological models for anxietydisorders. PMID:23262751
Background: Anxiety and depression form commonest stress-induced psychiatric disorders. To combat the biochemical changes which occur as a result of stress, there is antioxidant defence in the biological system. Secondary defence is by the nonenzymatic antioxidants like vitamins E (alphatocopherol), C (ascorbic acid), and ?-carotene. Therefore, the authors interest was aroused to examine the status of these antioxidants in the biological system of patients suffering from stress-induced psychiatric disorders. Aims: This study was carried out to find out whether patients with generalized anxietydisorder (GAD) and depression have any difference in blood serum levels of vitamins A (?-carotene), C, and E in comparison to the normal healthy control group and whether supplementation of adequate doses of vitamins A (?-carotene), C, and E leads to improvement in anxiety and depression and reduction in scores of the patients. Materials and Methods: Eighty subjects in the age group of 20–60 years, who attended a psychiatric clinic of a private hospital and who met inclusion and exclusion criteria of the study and consented for psychological evaluation and blood screening to find out the serum levels of vitamins A, C, and E, were included in the study. Approval was sought from the institutional ethics committee for collecting the blood sample of these subjects before and after vitamins A, C, and E supplements given for a period of 6 weeks. Statistics Analysis: It was observed that patients with GAD and depression had significantly lower levels of vitamins A, C, and E in comparison to healthy controls. After dietary supplementation of these vitamins for a period of 6 weeks, a significant reduction in anxiety and depression scores of patients was observed (P<0.001). A significant increase in the blood levels of antioxidants was observed in patients (P<0.05) except that of vitamin E in the group of depressed patients. Results and Conclusion: The findings suggest that antioxidant supplement therapy as an adjuvant therapy is useful in patients with stress-induced psychiatric disorders and the results have been discussed.
Psychosomatic presentations of generalized anxietydisorder (GAD) and an estimation of efficacy of adaptol in the treatment of patients with this pathology have been studied. The results of clinical examination of 67 patients with GAD , aged from 18 to 45 years, are presented. Adaptol was administered in dose 1500 mg daily during 60 days in 35 patients. The improvement was noted in 68,6% of cases. The high clinical efficacy of adaptol and the absence of side-effects are reported. PMID:22678674
Chutko, L S; Rozhkova, A V; Sidorenko, V A; Surushkina, S Iu; Tursunova, K B
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…
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.
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 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
Objective The objective of this study was to examine medical illness and anxiety, depressive, and somatic symptoms in older medical patients with generalized anxietydisorder (GAD). Method A case-control study was designed and conducted in the University of California, San Diego (UCSD) Geriatrics Clinics. A total of fifty-four older medical patients with GAD and 54 matched controls participated. Measurements The measurements used for this study include: Brief Symptom Inventory – 18, Mini International Neuropsychiatric Interview, and the AnxietyDisorders Interview Schedule. Results Older medical patients with GAD reported higher levels of somatic symptoms, anxiety, and depression than other older adults, as well as higher rates of diabetes and gastrointestinal conditions. In a multivariate model that included somatic symptoms, medical conditions, and depressive and anxiety symptoms, anxiety symptoms were the only significant predictors of GAD. Conclusion These results suggest first, that older medical patients with GAD do not primarily express distress as somatic symptoms; second, that anxiety symptoms in geriatric patients should not be discounted as a byproduct of medical illness or depression; and third, that older adults with diabetes and gastrointestinal conditions may benefit from screening for anxiety.
Wetherell, Julie Loebach; Ayers, Catherine R.; Nuevo, Roberto; Stein, Murray B.; Ramsdell, Joe; Patterson, Thomas L.
Regular physical exercise has been shown to favorably influence mood and anxiety; however, there are few studies regarding psychiatric aspects of physically active patients with coronary artery disease (CAD). The objective of the present study was to compare the prevalence of psychiatric disorders and cardiac anxiety in sedentary and exercising CAD patients. A total sample of 119 CAD patients (74 men) were enrolled in a case-control study. The subjects were interviewed to identify psychiatric disorders and responded to the Cardiac Anxiety Questionnaire. In the exercise group (N = 60), there was a lower prevalence (45 vs 81%; P < 0.001) of at least one psychiatric diagnosis, as well as multiple comorbidities, when compared to the sedentary group (N = 59). Considering the Cardiac Anxiety Questionnaire, sedentary patients presented higher scores compared to exercisers (mean ± SEM = 55.8 ± 1.9 vs 37.3 ± 1.6; P < 0.001). In a regression model, to be attending a medically supervised exercise program presented a relevant potential for a 35% reduction in cardiac anxiety. CAD patients regularly attending an exercise program presented less current psychiatric diagnoses and multiple mental-related comorbidities and lower scores of cardiac anxiety. These salutary mental effects add to the already known health benefits of exercise for CAD patients.
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
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
It remains unclear if patients with different types of common mental disorders, such as adjustment, anxiety and depressive disorders, have the same irrational ideas. The aim of this prospective cohort study (n = 190) is to investigate differences in level and type of irrational beliefs among these groups and to examine whether a change in irrational beliefs is related to symptom recovery. Irrational beliefs (IBI) and symptoms were measured at four points in time: at baseline, after 3, 6 and 12 months. Results showed that diagnostic groups differed in their level of irrational beliefs and this effect remained over time. Highest levels of irrationality were observed in the double diagnosis group, followed by the anxietydisorder group and the depression group. Participants with adjustment disorders showed the lowest levels of irrationality, comparable to a community sample. We did not find differences in the type of irrational beliefs between diagnostic groups. The level of irrationality declined over time for all diagnostic groups. No differences in decrease were observed between diagnostic groups. The magnitude and direction of change in irrational beliefs were related to the magnitude of recovery of depressive, anxiety and stress symptoms over time. These results support the application of general cognitive interventions, especially for patients with a depressive or an anxietydisorder.
Verbeek, Jos H. A. M.; de Boer, Angela G. E. M.; Blonk, Roland W. B.; van Dijk, Frank J. H.
This study examined the association between cognitive impairment and anxietydisorders following traumatic brain injury (TBI). Sixty-six participants recruited from a rehabilitation hospital completed the Structured Clinical Interview for the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition) and cognitive tests at one year post injury. Prevalence of anxietydisorder was 27.3%. Logistic regression analyses revealed that the attention/working memory, information processing, and executive functions models were significantly associated with anxietydisorder. The memory model was not significant. Processing speed emerged as the strongest model associated with anxietydisorder. The role of cognitive impairment in the etiology of anxietydisorders after TBI is discussed, and treatment implications are explored. PMID:24303952
Gould, Kate Rachel; Ponsford, Jennie Louise; Spitz, Gershon
A group randomized trial of adding a home-based walking program to a standard group cognitive behavioral therapy (GCBT+EX) was compared with groups receiving GCBT and educational sessions (GCBT+ED). The study was implemented in an outpatient clinic providing GCBT for clients diagnosed with panic disorder, generalized anxietydisorder or social phobia. Pre- and post-treatment measures included the self-report depression, anxiety, and stress scale (DASS-21) and measures of physical activity. From January 2004 to May 2005, six groups were allocated to GCBT+EX (n=38) and five to GCBT+ED (n=36). Analysis of covariance for completed cases (GCBT+EX, n=21; GCBT+ED, n=20), adjusting for the group design, baseline DASS-21 scores, and anxietydiagnosis showed significant effect for GCBT+EX on depression, anxiety, and stress (regression coefficients=-6.21, -3.41, and -5.14, respectively, p<0.05) compared to the GCBT+ED. The potential of exercise interventions as adjunct to GCBT for anxietydisorder needs to be further explored. PMID:17988832
Generalized anxietydisorder (GAD), panic disorder (PD) and post-traumatic stress disorder (PTSD) often co-occur. We investigated whether and to what degree genetic and environmental contributions overlap among symptoms of GAD, symptoms of PD and PTSD. Subjects were 3327 monozygotic and dizygotic male–male twin pair members of the Vietnam Era Twin Registry who participated in a 1992 telephone administration of the
Sunanta I Chantarujikapong; Jeffrey F Scherrer; Hong Xian; Seth A Eisen; Michael J Lyons; Jack Goldberg; Ming Tsuang; William R True
Background: The current diagnostic system for subjects at enhanced clinical risk of psychosis allows concurrent comorbid diagnoses of anxiety and depressive disorders. Their impact on the presenting high-risk psychopathology, functioning, and transition outcomes has not been widely researched. Methods: In a large sample of subjects with an At-Risk Mental State (ARMS, n = 509), we estimated the prevalence of DSM/SCID anxiety or depressive disorders and their impact on psychopathology, functioning, and psychosis transition. A meta-analytical review of the literature complemented the analysis. Results: About 73% of ARMS subjects had a comorbid axis I diagnosis in addition to the “at-risk” signs and symptoms. About 40% of ARMS subjects had a comorbid diagnosis of depressive disorder while anxietydisorders were less frequent (8%). The meta-analysis conducted in 1683 high-risk subjects confirmed that baseline prevalence of comorbid depressive and anxietydisorders is respectively 41% and 15%. At a psychopathological level, comorbid diagnoses of anxiety or depression were associated with higher suicidality or self-harm behaviors, disorganized/odd/stigmatizing behavior, and avolition/apathy. Comorbid anxiety and depressive diagnoses were also associated with impaired global functioning but had no effect on risk of transition to frank psychosis. Meta-regression analyses confirmed no effect of baseline anxiety and/or depressive comorbid diagnoses on transition to psychosis. Conclusions: The ARMS patients are characterized by high prevalence of anxiety and depressive disorders in addition to their attenuated psychotic symptoms. These symptoms may reflect core emotional dysregulation processes and delusional mood in prodromal psychosis. Anxiety and depressive symptoms are likely to impact the ongoing psychopathology, the global functioning, and the overall longitudinal outcome of these patients.
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.
This study examined whether individuals with social anxietydisorder have a memory bias for bodily sensations associated with\\u000a anxiety. Using a false feedback paradigm, 33 individuals with social anxietydisorder (SAD) and 34 non-anxious control (NAC)\\u000a participants completed a performance task while monitoring stimuli they were told provided feedback on whether their physiological\\u000a response was changing or stable. On measures
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.
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
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…
Background: The neurodevelopment of childhood anxietydisorders is not well understood. Basic research has implicated the amygdala and circuits related to these nuclei as being central to several aspects of fear and fear-related behaviors in animals.Methods: Magnetic resonance imaging was used to measure amygdala volumes and comparison brain regions in 12 child and adolescent subjects with generalized anxietydisorder and
Michael D. De Bellis; B. J. Casey; Ronald E. Dahl; Boris Birmaher; Douglas E. Williamson; Kathleen M. Thomas; David A. Axelson; Karin Frustaci; Amy M. Boring; Julie Hall; Neal D. Ryan
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.
The current study examined the temporal stability of threat perception abnormalities and anxietydisorder symptoms in non-clinical children. One-hundred-and-thirteen primary school children aged 9 to 13 years completed a self-report measure of anxietydisorder symptoms, and were interviewed individually using an ambiguous story paradigm from which…
Background: Affective disorders are associated with comorbidity of depression and anxiety symptoms. Positron emission tomography resting-state studies in affective disorders have generally failed to isolate specific symptom effects. Emotion provocation studies in healthy volunteers have produced variable results, due to differences in experimental paradigm and instructions.Methods: To better delineate the neural correlates of sad mood and anxiety, this study used
Mario Liotti; Helen S Mayberg; Stephan K Brannan; Scott McGinnis; Paul Jerabek; Peter T Fox
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…
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 a…
Santucci, Lauren C.; Ehrenreich, Jill T.; Trosper, Sarah E.; Bennett, Shannon M.; Pincus, Donna B.
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
Background Interpersonal psychotherapy (IPT) has demonstrated efficacy in treating mood and eating disorders. This article critically reviews outcome research testing IPT for anxietydisorders, a diagnostic area where cognitive behavioral therapy (CBT) has dominated research and treatment. Methods A literature search identified six open and five controlled trials of IPT for social anxietydisorder (SAD), panic disorder, and posttraumatic stress disorder. Results Studies were generally small, underpowered, and sometimes methodologically compromised. Nonetheless, minimally adapted from its standard depression strategies, IPT for anxietydisorders yielded positive results in open trials for the three diagnoses. In controlled trials, IPT fared better than waiting list (N = 2), was equipotent to supportive psychodynamic psychotherapy (N = 1), but less efficacious than CBT for SAD (N = 1), and CBT for panic disorder (N = 1) in a methodologically complicated study. IPT equaled CBT in a group residential format (N = 1). Conclusions IPT shows some promise for anxietydisorders but has thus far shown no advantages in controlled trials relative to other therapies. Methodological and ecological issues have complicated testing of IPT for anxietydisorders, clouding some findings. The authors discuss difficulties of conducting non-CBT research in a CBT-dominated area, investigator bias, and the probable need to further modify IPT for anxietydisorders. Untested therapies deserve the fairest possible testing. Depression and Anxiety 00:1–10, 2014.
Markowitz, John C.; Lipsitz, Joshua; Milrod, Barbara L.
In a double-blind controlled study lasting 8 weeks, 50 anxious psychoneurotic outpatients with a primary diagnosis of generalized anxiety or panic disorder were randomly assigned to alprazolam (n=30), a new benzodiazepine, or placebo (n=20), after a washout period of 1 week. Alprazolam at dosages between 0.25 and 3 mg\\/day was found to be significantly better than placebo in the treatment
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 1755 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.
Shivers, Carolyn M.; Deisenroth, Lauren K.; Taylor, Julie Lounds
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 aim of this study was to investigate familial influences and their dependence on sex for panic disorder and/or agoraphobia, social phobia, generalized anxietydisorder and major depression. Data from Australian (N = 2287) and Dutch (N = 1185) twins and siblings who were selected for a linkage study and participated in clinical interviews to obtain lifetime Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) diagnoses were used. In a liability model, tetrachoric correlations were estimated in sibling pairs and sex differences between sibling correlations were tested. For each diagnosis, the sibling correlations could be constrained to be equal across the Australian and Dutch samples. With the exception of panic disorder and/or agoraphobia, all sibling correlations were the same for brother, sister and opposite-sex sibling pairs and were around .20. For panic disorder and/or agoraphobia, the correlation was .23 in brother and sister pairs, but absent in opposite-sex sibling pairs. From these results it can be concluded that upper heritability estimates, based on twice the correlations in the sibling pairs, vary between 36% (major depression) and 50% (social phobia). Furthermore, different genetic risk factors appear to contribute to the vulnerability for panic disorder and/or agoraphobia in men and women. No other sex differences were found. PMID:16354503
Middeldorp, Christel M; Birley, Andrew J; Cath, Danielle C; Gillespie, Nathan A; Willemsen, Gonneke; Statham, Dixie J; de Geus, Eco J C; Andrews, J Gavin; van Dyck, Richard; Beem, A Leo; Sullivan, Patrick F; Martin, Nicholas G; Boomsma, Dorret I
A previous review summarized what was then known about the potential role of pregabalin in the treatment of patients with generalized anxietydisorder (GAD): this review provides an update on its pharmacological properties and presumed mechanism of action, the liability for abuse, and efficacy and tolerability in patients with GAD. Pregabalin has a similar molecular structure to the inhibitory neurotransmitter gamma amino butyric acid (GABA) but its mechanism of action does not appear to be mediated through effects on GABA. Instead, its anxiolytic effects may arise through high-affinity binding to the alpha-2-delta sub-unit of the P/Q type voltage-gated calcium channel in “over-excited” presynaptic neurons, thereby reducing the release of excitatory neurotransmitters such as glutamate. The findings of randomized controlled trials and meta-analyses together indicate that pregabalin is efficacious in both acute treatment and relapse prevention in GAD, with some evidence of an early onset of effect, and broad efficacy in reducing the severity of psychological and physical symptoms of anxiety. It also has efficacy as an augmenting agent after non-response to antidepressant treatment in GAD. Continuing vigilance is needed in assessing its potential abuse liability but the tolerability profile of pregabalin may confer some advantages over other pharmacological treatments in the short term for treatment in patients with GAD.
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.
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…
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.
Research suggested that maternal anxietydisorders might be related to infants' behavioral inhibition. This study investigated whether maternal postpartum anxietydisorder is associated with infant temperament, more precisely, infant distress to novelty, an early predictor of behavioral inhibition. Differences in the latter were analyzed in a German sample by comparing n = 38 healthy mother-infant dyads to n=44 dyads comprised of mothers diagnosed with a DSM-IV anxietydisorders. Infant age ranged from 2.83 to 7.97 months. Infant temperament was measured by means of the Infant Behavior Questionnaire. Mothers were screened for postpartum anxietydisorder using the Structured Clinical Interview for DSM-IV Disorders. Severity of anxiety was measured by self-reported questionnaires (Anxiety Cognition Questionnaire, Body Sensations Questionnaire and Mobility Inventory). Infant salivary cortisol reaction when being confronted with a socio-emotional stressor (Face-to-Face-Still-Face paradigm) was assessed to validate infant distress. A Mann-Whitney-U analysis suggested that infants of mothers with an anxietydisorder show more distress to novelty than infants of healthy mothers. Furthermore, data reveal a positive Spearman's ?-correlation between infant distress to novelty and maternal avoidance behavior (Mobility Inventory). A strong correlation between infant cortisol reactivity and reported distress to novelty validated the maternal evaluation of infant temperament in our sample. Results suggest a possible approach to promote infant development by encouraging mothers with anxiety symptoms to encounter feared stimuli. PMID:23746492
Reck, Corinna; Müller, Mitho; Tietz, Alexandra; Möhler, Eva
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
Objective. As most of the previous studies were done to study depressive disorders and \\/or symptoms in patients with rheumatoid arthritis, this study was performed to investigate whether anxietydisorder is as common as depressive disorder in these patients and to look for the socio-demographic as well as the clinical characteristics of the patients developing these disorders. Methods. A detailed physical
Frequent assessment during therapy can improve treatments and provide accountability. However, clinicians often do not monitor progress because of the time it takes to administer and score assessments. In response, the Social Anxiety Session Change Index (SASCI) was developed. The SASCI is a short, easily administered rating of subjective improvement that asks clients with social anxietydisorder how much they have changed since the beginning of therapy. Change on the SASCI was related to change in fear of negative evaluation, a core aspect of social anxiety, and to clinician-rated improvement, but not to ratings of anxiety sensitivity or depression. Because it is brief and easily interpretable, the SASCI can be used in a variety of clinical settings to monitor change across therapy. The SASCI is presented along with examples of how the information gathered from frequent administration can inform clinical practice.
Hayes, Sarah A.; Miller, Nathan A.; Hope, Debra A.; Heimberg, Richard G.; Juster, Harlan R.
This study investigated the relation between generalized anxietydisorder (GAD) and frequency of bad dreams in older adults. A secondary analysis from a randomized clinical trial comparing cognitive behavioral therapy (CBT) for anxiety to enhanced usual care (EUC) assessed bad dream frequency at baseline, post treatment (3 months), and at 6, 9, 12, and 15 months. Of 227 participants (mean age = 67.4), 134 met GAD diagnostic criteria (CBT = 70, EUC = 64), with the remaining 93 serving as a comparison group. Patients with GAD had significantly more bad dreams than those without, and bad dream frequency was significantly associated with depression, anxiety, worry, and poor quality of life. CBT for anxiety significantly reduced bad dream frequency at post treatment and throughout follow up compared to EUC. PMID:23470116
Nadorff, Michael R; Porter, Ben; Rhoades, Howard M; Greisinger, Anthony J; Kunik, Mark E; Stanley, Melinda A
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. 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
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.
Generalized anxietydisorder (GAD) is identified as a discrete disorder in the DSM-5, but evidence suggests that GAD and the related construct of pathological worry possesses a dimensional latent structure. The objective of this study was to ascertain the latent structure of GAD using taxometric methods. A subsample of adults (N=2061) from the Midlife in the United States Study, a national sample of Americans, provided the data. Additional data from individuals who were re-interviewed 10 year later (n=1228) were also analyzed. Items corresponding to the DSM-IV-TR diagnostic criteria for GAD were used to generate indicators for the taxometric analyses. Multiple taxometric procedures provided no evidence that GAD has a categorical or taxonic latent structure. Instead, the results were more consistent with the proposition that GAD exists on a continuum. Evidence that GAD is dimensional suggests that dichotomizing individuals into GAD versus non-GAD groups will typically result in decreased statistical power. They also suggest that any diagnostic thresholds for identifying GAD are likely to be arbitrary. The findings are consistent with models that locate GAD within the framework of extant dimensional models of personality and with research that emphasizes a multifactorial etiology for GAD. PMID:24377439
To examine the relationship between attention and anxiety and the response to methylphenidate in children with attention deficit hyperactivity disorder (ADHD), a total of 57 boys, between the ages of 7-12 years, were assessed for their attention and level of anxiety. Methylphenidate was administered for a week in a randomized double-blind drug/placebo-drug cross-over design. The levels of anxiety were evenly distributed between the inattentive and hyperactive/impulsive types. Anxiety was significantly correlated with the attention as reported by both teachers and parents. The response to methylphenidate was inversely correlated with the reported anxiety level only in boys with the hyperactive/impulsive and combined types. The higher the level of anxiety, the lower level of response to methylphenidate was observed. In the assessment and treatment of children with ADHD, the level of anxiety should be evaluated and taken into account while planning and monitoring treatment regiment. PMID:22622628
Recent evidence indicates that the propensity towards experiencing disgust may contribute to the development and maintenance of some anxietydisorders. This article summarizes the empirical evidence with emphasis on illuminating potential mediators, moderators, and mechanisms of the disgust-anxietydisorder association that may inform the development of an integrative conceptual model. Early research using neuroimaging methods suggest that disgust processing is associated with activation of the insula. This research has the potential to facilitate progress in developing an empirically informed psychobiological theory on the causal role of disgust in the anxietydisorders. PMID:19969378
Olatunji, Bunmi O; Cisler, Josh; McKay, Dean; Phillips, Mary L
The aim of the study was to evaluate the efficacy and safety of combined usage of Vazonat and Adaptol in patients with coronary heart disease (CHD) and anxietydisorders. It was shown that the use of a modulator metabolism Vasonat in addition to conventional therapy promotes CHD clinical improvement and increased myocardial contractility. The therapy in most patients there was a significant reduction in the intensity of anxiety symptoms, improve general health and mood. In addition to improved parameters of psychiatric sphere yhere was positive dynamics for somatisation disorders and autonomic manifestations of pain in patients with CHD and anxietydisorders. PMID:23786022
\\u000a Perhaps no condition better illustrates the intimate relationship between brain and behavior – mind and body – as the inner\\u000a experience of fear. In this chapter, we present an integrative scientific view of anxiety and clinical anxietydisorders,\\u000a with an emphasis on awareness and acceptance as a foundation for mind\\/body health. Whereas anxiety-related psychopathology\\u000a is characterized by a desire to
The aim of this study was to evaluate the relationship between alexithymia and social anxiety symptoms in female outpatients\\u000a with dermatological disorder. Fifty consecutive patients sent to a psychiatry outpatient clinic for consultation from a dermatology\\u000a outpatient clinic were included in the study. Social anxiety symptoms showed significant correlations with depression, trait\\u000a anxiety, alexithymia and global psychiatric symptom severity. A
A variety of agents are currently used to treat the different anxietydisorders. Benzodiazepines, such as diazepam, are still preferred by some for the treatment of acute anxiety, with the advantage of a rapid onset of action, but they are less suitable for long-term treatment due to their potential for memory disturbances, sleepiness, lethargy, physical dependence and withdrawal. Compounds acting on monoamine neurotransmission are more suitable in the treatment of long-term or chronic anxietydisorders. Tricyclic antidepressants, such as imipramine, and monoamine oxidase inhibitors have been shown to be effective anxiolytics, but their side effects and safety concerns have limited their use. The probable role of disturbed serotonergic neurotransmission in anxiety is widely accepted and is the theoretical basis for the use of serotonergic agents such as the 5-HT1A receptor partial agonist, buspirone, and the selective serotonin reuptake inhibitors (SSRI), such as sertraline and paroxetine, which have largely replaced the earlier antidepressants. There is clear evidence for decreased serotonergic function in anxiety as well as in depression. Studies of patients with anxietydisorders show reduced levels of serotonin in cerebrospinal fluid (CSF) as well as reduced serotonin transporter binding. The role of noradrenaline in the control of anxiety is less well understood, although there is considerable evidence to suggest that a disturbance of noradrenergic neurotransmission may also contribute to the symptoms of anxiety. Noradrenaline modulates the activity of brain regions such as the amygdala which are associated with anxiety. In addition, anxiety states are associated with increases in the metabolite of noradrenaline, 3-methoxy-4-hydrophenylglycol (MHPG), and hypersecretion of noradrenaline in plasma and CSF. It appears likely that modulation of both serotonin and noradrenaline systems by dual-reuptake inhibitors may prove to be an advantage in the treatment of anxietydisorders. The serotonin-noradrenaline reuptake inhibitors (SNRI), venlafaxine, milnacipran and duloxetine are efficacious in relieving anxiety symptoms within depression, and some have proven efficacy in certain anxietydisorders. Initial studies suggest that dual acting agents may have an advantage over selective reuptake inhibitors in certain anxietydisorders, such as post-traumatic stress disorder (PTSD), and in patients with comorbid anxiety and depression. PMID:24921677
Body dysmorphic disorder is a psychiatric disease that can be frequently encountered in an aesthetic practice. Body dysmorphic disorder is characterized by a preoccupation with a minimal or nonexistent appearance defect and causes significant distress and interferes with the social life of the patient. The perceived physical anomaly may involve the shape and size of the whole body or may be centered around single units. Body dysmorphic disorder patients are known to request multiple aesthetic procedures that leave them unsatisfied. Only a timely diagnosis will enable the surgeon and staff to adequately address the patient's needs. Body dysmorphic disorder patients cannot be cured with surgery. Diagnostic techniques such as patient interview and observation are presented in this article. With this, the plastic surgeon should be able to diagnose body dysmorphic disorder preoperatively. Using the presented algorithm to approach body dysmorphic disorder patients will avoid disappointment for patients and surgeons alike. PMID:17440376
This article synthesizes the concept of "wounded self" in the understanding and psychological treatment of anxietydisorders. The focal point of this concept is the notion of self-wounds or early unresolved emotional injuries. According to this conceptualization, anxiety represents an unconscious fear of unbearable insult to the wounded self, which is protected by maladaptive conscious strategies such as avoidance, cognitive distortions, or emotional constriction. This perspective provides a theoretical basis for blending elements of psychodynamic, behavioral, cognitive, and experiential therapies in the psychological management of anxietydisorders. As cognitive hypnotherapy embodies all of these therapeutic elements, its application to anxietydisorders is described in this article. Various hypnotherapeutic techniques for symptomatic relief and for eliciting and healing the wounded self are discussed and exemplified by a case. This case illustrates that symptom-focused treatment is necessary, but not sufficient. A more durable treatment requires resolution of underlying conflicts that drive the anxiety. PMID:24938077
Background: Obsessive-compulsive disorder (OCD) and social anxietydisorder (SAD) frequently co-occur in persons with autism spectrum disorder (ASD). We studied which features distinguish ‘pure’ anxietydisordered patients from those with co-morbid ASD. Method: In a case-controlled design in which groups were matched for age, sex and educational level, patients with OCD or SAD and co-morbid ASD were compared with patients
Danielle C. Cath; Natalie Ran; Johannes H. Smit; Hannie C. Comijs
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.
The relationship between the functional somatic syndromes, anxietydisorders and the upper airway (particularly, sleep disordered breathing) remains ambiguous. This ambiguity, despite a growing body of research supporting a relationship, may result from the absence of a paradigm to explain how upper airway dysfunction can promote disorders commonly associated with one's mental health. This review models the functional somatic syndromes and anxietydisorders as consequences of chronically increased hypothalamic-pituitary-adrenal axis activity. It then examines the literature supporting a relationship between these disorders and upper airway dysfunction during wakefulness and sleep. Finally, building upon an existing paradigm of neural sensitization, sleep disordered breathing is linked to functional somatic syndromes and anxietydisorders through chronic activation of the hypothalamic-pituitary-adrenal axis. PMID:21295503
Objective: To report on remission rates in anxious youth who participated in the Child/Adolescent Anxiety Multimodal Study (CAMS). The CAMS, a multisite clinical trial, randomized 488 children and adolescents (ages 7-17 years; 79% Caucasian; 50% female) with separation, social, and/or generalized anxietydisorder to a 12-week treatment of…
Ginsburg, Golda S.; Kendall, Philip C.; Sakolsky, Dara; Compton, Scott N.; Piacentini, John; Albano, Anne Marie; Walkup, John T.; Sherrill, Joel; Coffey, Kimberly A.; Rynn, Moira A.; Keeton, Courtney P.; McCracken, James T.; Bergman, Lindsey; Iyengar, Satish; Birmaher, Boris; March, John
Background: Comorbidity between adult social anxietydisorder and major depression is extensive. Considerably less information about this relationship is available among youth. Methods: A randomly selected (from enrollees in a pediatric primary care clinic) sample of 190 families with children between the ages of 8 and 17 responded by mail to questionnaires assessing social anxiety, depression, and social functioning. Parents
Denise A Chavira; Murray B Stein; Kelly Bailey; Martin T Stein
The effects of auditory statements describing a personal worry on brain activation as measured by functional magnetic resonance imaging were examined in patients with generalized anxietydisorder (GAD) before and after anxiety reduction with citalopram. Six patients were imaged while listening to verbal descriptions of a personal worry or a neutral statement before treatment with citalopram and after 7 weeks
Rudolf Hoehn-Saric; Michael W Schlund; Steven H. Y Wong
Objective: This study compared the effects of direct child-parent interventions to the effects of child-focused interventions on anxiety outcomes for children with anxietydisorders. Method: Systematic review methods and meta-analytic techniques were employed. Eight randomized controlled trials examining effects of family cognitive behavior…
Children with autism spectrum disorders (ASD) experience high rates of anxiety, sensory processing problems, and gastrointestinal (GI) problems; however, the associations among these symptoms in children with ASD have not been previously examined. The current study examined bivariate and multivariate relations among anxiety, sensory…
Mazurek, Micah O.; Vasa, Roma A.; Kalb, Luther G.; Kanne, Stephen M.; Rosenberg, Daniel; Keefer, Amy; Murray, Donna S.; Freedman, Brian; Lowery, Lea Ann
We tested the factor structure of the National AnxietyDisorder Screening Day instrument (n=14860) within five ethnic groups (White, Black, Hispanic, Asian, Native American). Conducted yearly across the US, the screening is meant to detect five common anxiety syndromes. Factor analyses often fail to confirm the validity of assessment tools’ structures, and this is especially likely for minority ethnic groups.
Jennifer Boyd Ritsher; Elmer L Struening; Fred Hellman; Mary Guardino
Although there is evidence for the efficacy of psychodynamic therapy (PDT) in anxietydisorders, results are not yet satisfactory, for example, if rates of remission and response are considered. To address this problem, a unified psychodynamic protocol for anxietydisorders (UPP-ANXIETY) is proposed that integrates the treatment principles of those methods of PDT that have proven to be efficacious in anxietydisorders. In addition, this protocol is transdiagnostic, implying that it is applicable to various forms of anxietydisorders and related disorders (generalized anxietydisorder, social phobia, panic disorders, avoidant personality disorder). Based on supportive-expressive therapy, the UPP-ANXIETY represents an integrated form of psychodynamic therapy that allows for a flexible use of empirically supported treatment principles. UPP-ANXIETY encompasses the following 9 treatment principles (modules): (1) socializing the patient for psychotherapy, (2) motivating and setting treatment goals, (3) establishing a secure helping alliance, (4) identifying the core conflict underlying anxiety, (5) focusing on the warded-off wish/affect, (6) modifying underlying internalized object relations, (7) changing underlying defenses and avoidance, (8) modifying underlying response of self, and (9) termination and relapse prevention. Some principles are regarded as core components to be used in every treatment (principles 3-8). A unified protocol for the psychodynamic treatment of anxietydisorders has several advantages, that is (1) integrating the most effective treatment principles of empirically supported psychodynamic treatments for anxietydisorders can be expected to further improve the efficacy of PDT; (2) using a unified protocol in efficacy studies has the potential to enhance the evidence-based status of PDT by aggregating the evidence; (3) a unified protocol will facilitate both training in PDT and transfer of research to clinical practice; and (4) thus, a unified protocol can be expected to have a significant impact on the health care system. We are planning to test the UPP-ANXIETY in a multicenter randomized controlled trial. (PsycINFO Database Record (c) 2014 APA, all rights reserved). PMID:24377407
Objectives To assess the available evidence on the prevalence, aetiology, treatment, and prevention of anxiety and depressive disorders in Pakistan. Design Systematic review of published literature. Studies reviewed 20 studies, of which 17 gave prevalence estimates and 11 discussed risk factors. Main outcome measures Prevalence of anxiety and depressive disorders, risk factors, effects of treatment. Results Factors positively associated with anxiety and depressive disorders were female sex, middle age, low level of education, financial difficulty, being a housewife, and relationship problems. Arguments with husbands and relational problems with in-laws were positively associated in 3/11 studies. Those who had close confiding relationships were less likely to have anxiety and depressive disorders. Mean overall prevalence of anxiety and depressive disorders in the community population was 34% (range 29-66% for women and 10-33% for men). There were no rigorously controlled trials of treatments for these disorders. Conclusions Available evidence suggests a major social cause for anxiety and depressive disorders in Pakistan. This evidence is limited because of methodological problems, so caution must be exercised in generalising this to the whole of the population of Pakistan.
Objective: To assemble expert clinical experience and judgement in the treatment of anxiety and related disorders in a systematic, quantitative manner. Methods: A panel of internationally recognized Experts in treating anxiety and depression was constituted by multistage peer nomination. 90% completed a questionnaire. This report focuses on case vignettes of 7 anxietydisorders followed by questions about relevant therapeutic options.
E. H. Uhlenhuth; Mitchell B. Balter; Thomas A. Ban; Kenneth Yang
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,…
Hamlyn-Wright, Sarah; Draghi-Lorenz, Riccardo; Ellis, Jason
Objective:To compare the efficacy of group and individual cognitive-behavioral therapy (CBT) in children with Axis I anxietydisorders. It was hypothesized that certain subgroups would respond preferentially to one modality.
KATHARINA MANASSIS; SANDRA L. MENDLOWITZ; DONNA SCAPILLATO; DAVID AVERY; LISA FIKSENBAUM; MARLINDA FREIRE; SUNEETA MONGA; MARY OWENS
ObjectiveThis study compared anxiety and depression in patients presenting with psychogenic non-epileptic seizures (PNES) with those suffering from psychogenic movement disorders (PMD) to assess the link between these psychiatric pathologies and neurological symptoms.
I. Grimaldi; M. Dubuc; P. Kahane; T. Bougerol; L. Vercueil
Summary In clinical daily practice the definition of a bleeding tendency is rather subjective. Clinical manifestations usually include hematoma, epistaxis, menorrhagia, and severe bleeding episodes after surgery or injuries. The most common causes are disorders of primary hemostasis that occur sometimes due to platelet function disorders. Inherited thrombocytopathies are much less frequent in comparison to acquired platelet function disorders. However, congenital disorders can lead to severe bleeding tendency and are often not diagnosed. They are induced by different platelet defects based on disorders of platelet adhesion, receptors, secretion, and signal transduction. In some cases, they are associated with thrombocytopenias, giant platelets, and various comorbidities. This article gives an overview of the different defects, their diagnosis, and treatment options.
Anxietydisorders (ADs) are common in youths with bipolar disorder (BD). We examine psychiatric comorbidity, hospitalization, and treatment in youths with versus without AD and rapid cycling (four or more cycles per year). Data from the Integrated Healthcare Information Services cohort were used and included 8129 youths (ages ?18 years). Prevalence of AD, demographic, type of AD, hospitalization, and use of psychotropics were compared between rapid and nonrapid cycling. Overall, 51% of the youths met criteria for at least one comorbid AD; they were predominantly female and were between 12 and 17 years of age. The most common comorbid ADs were generalized ADs and separation ADs. In the patients with rapid cycling, 65.5%met criteria for comorbid AD. The BD youths with AD were more likely to have major depressive disorders and other comorbid ADs, to be given more psychotropics, and to be hospitalized for depression and medical conditions more often than were those without AD.
Castilla-Puentes, Ruby; Sala, Regina; Ng, Bernardo; Galvez, Juan; Camacho, Alvaro
Objective The authors studied the lifetime prevalence of DSM-IV-TR psychiatric disorders in a population of adults with the fragile X premutation. Methods Structured Clinical Interview for DSM-IV (SCID) were conducted on 85 individuals with the fragile X premutation, 47 with the fragile X-associated tremor/ataxia syndrome (FXTAS; 33 male, 14 female, mean age 66) and 38 without FXTAS (16 male, 22 female, mean age 52). Lifetime prevalence for mood and anxietydisorders among carriers with and without FXTAS was compared to available age-specific population estimates from the National Comorbidity Survey Replication (NCS-R). Results Among subjects with FXTAS, 30 cases (65%) met lifetime DSM-IV-TR criteria for mood disorder; 24 cases (52%) met lifetime DSM-IV-TR criteria for anxietydisorder. Among the non-FXTAS subjects, there were 15 cases (42%) of lifetime mood disorder and 18 cases (47%) of lifetime anxietydisorder. When compared to age-specific NCS-R data, the lifetime prevalence of any mood disorder, major depressive disorder, any anxietydisorder, panic disorder, specific phobia, and PTSD were significantly higher in subjects with FXTAS. The lifetime rates of social phobia in individuals with the premutation without FXTAS were significantly higher than NCS-R data. Conclusions This sample of carriers of the fragile X premutation had a notably high lifetime risk of mood and anxietydisorders. Mood and anxietydisorders may be part of the clinical phenotype of the fragile X premutation conditions, especially in carriers with FXTAS. Clinicians encountering these patients are advised to consider FXTAS as a neuropsychiatric syndrome as well as a neurological disorder.
Bourgeois, James A.; Seritan, Andreea L.; Casillas, E. Melina; Hessl, David; Schneider, Andrea; Yang, Ying; Kaur, Inderjeet; Cogswell, Jennifer B.; Nguyen, Danh V.; Hagerman, Randi J.
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
Mauro Carta; Matteo Balestrieri; Andrea Murru; Maria Hardoy
This paper was designed to provide professional counselors with a comprehensive but concise method of accurately evaluting, interviewing, and planning for treatment of eating disorder clients. The paper is organized in five sections. The first section, Diagnosis, compares, contrasts, and offers clear explanations of the diagnostic criteria for…
The definition of Generalized AnxietyDisorder (GAD) has been narrowed in successive editions of DSM by emphasizing intrusive worry and deemphasizing somatic symptoms of hyperarousal. We tried to determine the clinical characteristics of more broadly defined chronically anxious patients, and whether they would show physiological signs of sympathetic activation. A group whose chief complaint was frequent, unpleasant tension over at least the last six weeks for which they desired treatment, was compared with a group who described themselves as calm. Participants were assessed with structured interviews and questionnaires. Finger skin conductance, motor activity, and ambient temperature were measured for 24 hours. Results show that during waking and in bed at night, runs of continuous minute-by-minute skin conductance level (SCL) declines were skewed towards being shorter in the tense group than in the calm group. In addition, during waking, distributions of minute SCLs were skewed towards higher levels in the tense group, although overall mean SCL did not differ. Thus, the tense group showed a failure to periodically reduce sympathetic tone, presumably a corollary of failure to relax. We conclude that broader GAD criteria include a substantial number of chronically anxious and hyperaroused patients who do not fall within standard criteria. Such patients deserve attention by clinicians and researchers.
BACKGROUND Although social anxietydisorder (SAD) is classified in DSM-IV into generalized and non-generalized subtypes, community surveys in Western countries find no evidence of disjunctions in the dose-response relationship between number of social fears and outcomes to support this distinction. We aimed to determine whether this holds across a broader set of developed and developing countries and whether subtyping according to number of performance versus interactional fears would be more useful. METHODS The WHO World Mental Health (WMH) Survey Initiative undertook population epidemiological surveys in 11 developing and 9 developed countries using the Composite International Diagnostic Interview (CIDI) to assess DSM-IV disorders. Fourteen performance and interactional fears were assessed. Associations between number of social fears in SAD and numerous outcomes (age-of-onset, persistence, severity, comorbidity, treatment) were examined. Additional analyses examined associations with number of performance fears versus number of interactional fears. RESULTS Lifetime social fears are quite common in both developed (15.9%) and developing (14.3%) countries, but lifetime SAD is much more common in the former (6.1%) than latter (2.1%) countries. Among those with SAD, persistence, severity, comorbidity, and treatment all have dose-response relationships with number of social fears, with no clear nonlinearity in relationships that would support a distinction between generalized and non-generalized SAD. The distinction between performance fears and interactional fears is generally not important in predicting these same outcomes. CONCLUSION No evidence is found to support subtyping SAD on the basis of either number of social fears or number of performance fears versus number of interactional fears.
Stein, Dan J.; Ruscio, Ayelet Meron; Lee, Sing; Petukhova, Maria; Alonso, Jordi; Andrade, Laura Helena S.G.; Benjet, Corina; Bromet, Evelyn; Demyttenaere, Koen; Florescu, Silvia; de Girolamo, Giovanni; de Graaf, Ron; Gureje, Oye; He, Yanling; Hinkov, Hristo; Hu, Chiyi; Iwata, Noboru; Karam, Elie G; Lepine, Jean-Pierre; Matschinger, Herbert; Browne, Mark Oakley; Posada-Villa, Jose; Sagar, Rajesh; Williams, David R.; Kessler, Ronald C.
Alterations of regional brain activity in the prefrontal cortex and in limbic areas have been reported in humans with anxiety\\u000a disorders. This animal study reports the results of brain perfusion imaging with single photon emission computed tomography\\u000a (SPECT) in dogs with anxietydisorders. Based on the human literature, we hypothesized altered prefrontal and higher temporal\\u000a brain perfusion. SPECT acquisitions were
Simon Vermeire; Kurt Audenaert; André Dobbeleir; Rudy De Meester; Eva Vandermeulen; Tim Waelbers; Kathelijne Peremans
\\u000a Neuropeptide systems have been considered a major opportunity for the development of novel treatment approaches for anxiety\\u000a disorders based on preclinical evidence and neurochemical alterations seen in anxietydisorders. This excitement was further\\u000a facilitated by the fact that drugs acting at these systems, such as CRF1 antagonists, NK1 antagonists, NK3 antagonists or\\u000a CCK2 antagonists, may have unique properties not seen
Research suggests that experiential avoidance may play an important role in generalized anxietydisorder (GAD; see Roemer, L., & Orsillo, S.M. (2002). Expanding our conceptualization of and treatment for generalized anxietydisorder: Integrating mindfulness\\/acceptance-based approaches with existing cognitive-behavioral models. Clinical Psychology: Science and Practice, 9, 54–68, for a review). Therefore, a treatment that emphasizes experiential acceptance, as well as intentional
BackgroundCurrent pathophysiological concepts of generalized anxietydisorder (GAD) assume a disturbed exteroceptive sensory system. Furthermore, central serotonergic neurotransmission has been shown to play an important role in anxietydisorder. Cortical signal processing as measured by auditory evoked potentials (AEPs) may reflect the integrity of the exteroceptive sensory system. Because a special aspect of AEP, the loudness dependence of the N1\\/P2-component
Daniel Senkowski; Michael Linden; Doris Zubrägel; Thomas Bär; Jürgen Gallinat
\\u000a In the past 10 years virtual reality exposure therapy (VRET) has become a viable alternative for exposure in vivo, the gold\\u000a standard for the treatment of anxietydisorders. VRET is often regarded as a natural extension of the systematic exposure\\u000a component of (cognitive) behavior therapy. The objective of this chapter is to discuss the treatment of anxietydisorders\\u000a with VRET
Both temperament and parental child-rearing style are found to be associated with childhood anxietydisorders in population\\u000a studies. This study investigates the contribution of not only temperament but also parental child-rearing to clinical childhood\\u000a anxietydisorders. It also investigates whether the contribution of temperament is moderated by child-rearing style, as is\\u000a suggested by some studies in the general population. Fifty
Ingeborg E. Lindhout; Monica Th. Markus; Thea H. G. Hoogendijk; Frits Boer
Blushing is considered to be one of the prime pathophysiological markers of social anxietydisorder, potentially mediated\\u000a by serotonergic function. Therefore, in the present study 62 patients with social anxietydisorder and 62 age- and sex-matched\\u000a healthy controls were investigated for the influence of serotonin transporter (5-HTT) gene variation (5-HTTLPR, rs25531) on\\u000a blushing propensity as measured by the blushing propensity
Katharina Domschke; Stephan Stevens; Beate Beck; Anna Baffa; Christa Hohoff; Jürgen Deckert; Alexander L. Gerlach
Social anxietydisorder, whose onset peaks in adolescence, is associated with significant impairment. Despite the availability\\u000a of effective treatments, few affected youth receive services. Transporting interventions into schools may circumvent barriers\\u000a to treatment. The efficacy of a school-based intervention for social anxietydisorder was examined in a randomized wait-list\\u000a control trial of 35 adolescents (26 females). Independent evaluators, blind to
Carrie Masia-Warner; Rachel G. Klein; Heather C. Dent; Paige H. Fisher; Jose Alvir; Anne Marie Albano; Mary Guardino
The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the AnxietyDisorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with
Timothy A. Brown; Laura A. Campbell; Cassandra L. Lehman; Jessica R. Grisham; Richard B. Mancill
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 to both active (CBT, dynamic therapy, drug treatment, CBT+drug treatment, mindfulness) and inactive treatments (placebo/attention control, wait-list). All treatments were associated with significant improvement at post-treatment, and active treatments were associated with greater effects than were inactive treatments. However, overall comorbidity was generally unrelated to effect size at post-treatment or at follow-up. A significant negative relationship between overall comorbidity and treatment outcome was found for mixed or "neurotic" anxiety samples when examining associations between comorbidity and specific diagnoses. Conversely, there was a significant positive relationship between overall comorbidity and treatment outcome for panic disorder and/or agoraphobia and PTSD or sexual abuse survivors. These findings suggest that while diagnostic comorbidity may not impact the effects of specific anxietydisorder treatments, it appears to differentially impact outcome for specific anxietydisorder diagnoses. PMID:20510492
It has been proposed that social anxietydisorder (SAD) is associated with automatic information processing biases resulting in hypersensitivity to signals of social threat such as negative facial expressions. However, the nature and extent of automatic processes in SAD on the behavioral and neural level is not entirely clear yet. The present review summarizes neuroscientific findings on automatic processing of facial threat but also other disorder-related stimuli such as emotional prosody or negative words in SAD. We review initial evidence for automatic activation of the amygdala, insula, and sensory cortices as well as for automatic early electrophysiological components. However, findings vary depending on tasks, stimuli, and neuroscientific methods. Only few studies set out to examine automatic neural processes directly and systematic attempts are as yet lacking. We suggest that future studies should: (1) use different stimulus modalities, (2) examine different emotional expressions, (3) compare findings in SAD with other anxietydisorders, (4) use more sophisticated experimental designs to investigate features of automaticity systematically, and (5) combine different neuroscientific methods (such as functional neuroimaging and electrophysiology). Finally, the understanding of neural automatic processes could also provide hints for therapeutic approaches.
Schulz, Claudia; Mothes-Lasch, Martin; Straube, Thomas
Despite the high rate of anxiety in individuals with autism spectrum disorder (ASD), measuring anxiety in ASD is fraught with uncertainty. This is due, in part, to incomplete consensus on the manifestations of anxiety in this population. Autism Speaks assembled a panel of experts to conduct a systematic review of available measures for anxiety in youth with ASD. To complete the review, the panel held monthly conference calls and two face-to-face meetings over a fourteen-month period. Thirty eight published studies were reviewed and ten assessment measures were examined: four were deemed appropriate for use in clinical trials, although with conditions; three were judged to be potentially appropriate, while three were considered not useful for clinical trials assessing anxiety. Despite recent advances, additional relevant, reliable and valid outcome measures are needed to evaluate treatments for anxiety in ASD. PMID:24158679
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 school-age range of children and adolescents (age 6-18) with ASDs and IQs ? 70 (n=95), we also observed elevated rates of depression/anxiety symptoms, but we did not find higher IQ or fewer ASD symptoms among individuals with ASDs and depression or anxiety symptoms. These findings indicate an increased risk for depression/anxiety symptoms in children and adolescents with ASDs without intellectual disability, regardless of age, IQ, or ASD symptoms.
Strang, John F.; Kenworthy, Lauren; Daniolos, Peter; Case, Laura; Wills, Meagan C.; Martin, Alex; Wallace, Gregory L.
The past three decades have witnessed an increase in the number of empirical investigations examining the phenomenology of anxiety and related conditions. There has also been an increase in efforts to understand differences that may exist between ethnic groups in the expression of the anxietydisorders. In addition, there is now substantial evidence that a variety of treatment approaches (most notably behavioral and cognitive behavioral) are efficacious in remediating anxiety. However, there continues to be comparatively few treatment outcome studies investigating the efficacy of anxiety treatments among minority populations. In this paper, we review the extant treatment outcome research for African American, Hispanic/Latino[a] American, Asian American, and Native Americans suffering with one of the anxietydisorders. We discuss some of the specific problems with the research in this area, and then provide specific recommendations for conducting treatment outcome research with minority populations in the future.
Carter, Michele M; Mitchell, Frances E.; Sbrocco, Tracy
Anxietydisorders constitute a significant public health problem. Current gold standard treatments are limited in their effectiveness, prompting the consideration of alternative approaches. In this review, we examine the evidence for exercise as an intervention for anxietydisorders. This evidence comes from population studies, studies of nonclinical anxiety reduction, as well as a limited number of studies of clinically anxious individuals. All of these studies provide converging evidence for consistent beneficial effects of exercise on anxiety, and are consistent with a variety of accounts of the mechanism of anxiety reduction with exercise. Further study of clinical populations is encouraged, as are studies of the mechanism of change of exercise interventions, which have the potential to help refine exercise intervention strategies. Likewise, studies that identify moderators of treatment efficacy will assist clinicians in deciding how and for whom to prescribe exercise.
DeBoer, Lindsey B; Powers, Mark B; Utschig, Angela C; Otto, Michael W; Smits, Jasper AJ
Etiological models of social anxietydisorder (SAD) suggest that early childhood trauma contributes to the development of this disorder. However, surprisingly little is known about the link between different forms of childhood trauma and adult clinical symptoms in SAD. This study (1) compared levels of childhood trauma in adults with generalized SAD versus healthy controls (HCs), and (2) examined the relationship between specific types of childhood trauma and adult clinical symptoms in SAD. Participants were 102 individuals with generalized SAD and 30 HCs who completed measures of childhood trauma, social anxiety, trait anxiety, depression, and self-esteem. Compared to HCs, individuals with SAD reported greater childhood emotional abuse and emotional neglect. Within the SAD group, childhood emotional abuse and neglect, but not sexual abuse, physical abuse, or physical neglect, were associated with the severity of social anxiety, trait anxiety, depression, and self-esteem.
Kuo, Janice R.; Goldin, Philippe R.; Werner, Kelly; Heimberg, Richard G.; Gross, James J.
Objective: The authors sought to ob- serve the long-term clinical course of anx- iety disorders over 12 years and to exam- ine the influence of comorbid psychiatric disorders on recovery from or recurrence of panic disorder, generalized anxiety dis- order, and social phobia. Method: Data were drawn from the Har- vard\\/Brown AnxietyDisorders Research Program, a prospective, naturalistic, lon- gitudinal,
Steven E. Bruce; Kimberly A. Yonkers; Michael W. Otto; Jane L. Eisen; Risa B. Weisberg; Maria Pagano; Martin B. Keller
1. The present study evaluated the safety and efficacy of two dosages of SC 48,274 (1mg and 25mg) as compared to placebo in subjects with Generalized AnxietyDisorder (GAD). 2. This was a randomized, double-blind, placebo-controlled, parallel-group study which was part of one of three large multicenter trials which evaluated a total of 5 doses of SC 48,274 (.25, 1, 5, 25, and 100mg bid). Following a 7-day placebo baseline period, patients entered 4 weeks of double-blind treatment and a 7-day placebo follow-up period. 3. Efficacy was assessed weekly throughout the study with the Hamilton Anxiety Rating Scale (HAM-A), and Clinical Global Impression (CGI), and at treatment endpoint with the Covi Anxiety Scale, Raskin Depression Scale and Hamilton Depression Rating Scale (HAM-D). A diagnosis of GAD according to DSM-III-R criteria (with the exception that a GAD minimum duration of 3 months was allowed), a HAM-A score > or = 20 (anxious mood and tension items > or = 2), HAM-D less than HAM-A, Covi Anxiety Score > or = 8, Raskin Depression Scale less than the Covi Anxiety, and age of 18 to 65 years were necessary for inclusion in the study. 4. Patients received one of two dosages of SC 48,274, either 1mg (n = 28), 25mg (n = 9), or placebo (n = 28) bid, during the 4-week randomized portion of the trial. 5. Mean changes from baseline in HAM-A scores for the 1mg, 25mg, and placebo groups after 4 weeks treatment were -5.1, -4.2, and -1.9, respectively. Changes were significant for the 1mg group vs. placebo (F = 8.93, p = 0.004), but not for the 25mg group (F = 2.26, p = 0.138). 6. CGI severity of illness scores were also significant for the 1mg group versus placebo at the end of treatment (X2 = 3.8, p = 0.05), but not for the 25mg group (X2 = 0.90, p = 0.343). Neither group showed significant CGI improvement scores by end of treatment. 7. The most frequent adverse events associated with the study drug (n = 37) were headache (n = 7), nausea (n = 3), palpitations (n = 4) and chest pains (n = 2). There was, however, no apparent pattern of adverse events distinguishing SC 48,274 from placebo. PMID:7938559
Cutler, N R; Sramek, J J; Macpherson, A E; Doss, M G; Benes, C O; Howard, S F
Momentary intervention has been proposed as a cost-effective, generalizable, and ecologically valid method to increase the efficiency of face-to-face cognitive-behavioral therapy (CBT). The purpose of the current pilot study was to evaluate the efficacy of a six-session palmtop computer-assisted Group CBT for generalized anxietydisorder (GAD) (CAGT6) in comparison with a six-session Group CBT for GAD without the computer (CBGT6) and typical (12 session) Group CBT for GAD (CBGT12) in a randomized controlled trial. Thirty-four individuals with a primary diagnosis of GAD were randomized to one of the three conditions and completed measures of GAD and anxiety before therapy, after therapy, and at 6-, and 12-month follow-ups. Results indicated that CAGT6 was superior to CBGT6 at posttreatment, but not significantly different from CBGT12. At 6- and 12-month follow-ups, CAGT6 was neither significantly different from CBGT6, nor from CBGT12. Percentages of individuals achieving reliable change on two of the three GAD measures favored CAGT6 over CBGT6 at posttreatment, suggesting promise for the added value of the mobile technology. PMID:24059730
Background The early contributions of childhood trauma (emotional, physical, sexual, and general) have been hypothesized to play a significant role in the development of anxietydisorders, such as posttraumatic stress disorder (PTSD) and social anxietydisorder (SAD). The aim of this study was to assess childhood trauma differences between PTSD and SAD patients and healthy controls, as measured by the Early Trauma Inventory. Methods We examined individuals (N?=?109) with SAD with moderate/severe early developmental trauma (EDT) (n?=?32), individuals with SAD with low/no EDT (n?=?29), individuals with PTSD with EDT (n?=?17), and healthy controls (n?=?31). The mean age was 34 years (SD?=?11). Subjects were screened with the Mini-International Neuropsychiatric Interview (MINI), Liebowitz Social Anxiety Scale (LSAS), Clinician-Administered PTSD Scale (CAPS), and Childhood Trauma Questionnaire (CTQ). Analysis of variance was performed to assess group differences. Correlations were calculated between childhood traumas. Results Although not statistically significant, individuals with PTSD endorsed more physical and sexual childhood trauma compared with individuals with SAD with moderate/severe EDT who endorsed more emotional trauma. For all groups, physical and emotional abuse occurred between ages 6 and 11, while the occurrence of sexual abuse in individuals with PTSD was at 6–11 years and later (13–18 years) in individuals with SAD with moderate/severe EDT. For emotional abuse in all groups, the perpetrator was mostly a primary female caregiver; for sexual abuse, it was mostly a nonfamilial adult male, while for physical abuse, it was mostly a caregiver (male in PTSD and female in SAD with moderate/severe EDT). Conclusions The contribution of childhood abuse to the development of PTSD and SAD and the differences between these groups and other anxietydisorders should not be ignored and attention should be given to the frequency and severity of these events. The relationship of the perpetrator(s) and the age of onset of childhood abuse are also important considerations as they provide a useful starting point to assess impact over the life course. This can, in turn, guide clinicians on the optimal timing for the delivery of interventions for the prevention of PTSD and SAD.
In the absence of data, pharmacotherapy with benzodiazepines has become the mainstay of anxiety management in the elderly population. However, the use of benzodiazepines in the elderly has many problems. Elderly persons are more sensitive to anti-anxiety medications and are subject to a variety of increased risks, including cognitive impairment,…
In virtual reality exposure therapy (VRET) for anxietydisorders, sense of presence in the virtual environment is considered the principal mechanism that enables anxiety to be felt. Existing studies on the relation between sense of presence and level of anxiety, however, have yielded mixed results on the correlation between the two. In this meta-analysis, we reviewed publications on VRET for anxiety that included self-reported presence and anxiety. The comprehensive search of the literature identified 33 publications with a total of 1196 participants. The correlation between self-reported sense of presence and anxiety was extracted and meta-analyzed. Potential moderators such as technology characteristics, sample characteristics including age, gender and clinical status, disorder characteristics and study design characteristics such as measurements were also examined. The random effects analysis showed a medium effect size for the correlation between sense of presence and anxiety (r?=?.28; 95% CI: 0.18-0.38). Moderation analyses revealed that the effect size of the correlation differed across different anxietydisorders, with a large effect size for fear of animals (r?=?.50; 95% CI: 0.30-0.66) and a no to small effect size for social anxietydisorder (r?=?.001; 95% CI: -0.19-0.19). Further, the correlation between anxiety and presence was stronger in studies with participants who met criteria for an anxietydisorder than in studies with a non-clinical population. Trackers with six degrees of freedom and displays with a larger field of view resulted in higher effect sizes, compared to trackers with three degrees of freedom and displays with a smaller field of view. In addition, no difference in effect size was found for the type of presence measurement and the type of anxiety measurement. This meta-analysis confirms the positive relation between sense of presence and anxiety and demonstrates that this relation can be affected by various moderating factors. PMID:24801324
In virtual reality exposure therapy (VRET) for anxietydisorders, sense of presence in the virtual environment is considered the principal mechanism that enables anxiety to be felt. Existing studies on the relation between sense of presence and level of anxiety, however, have yielded mixed results on the correlation between the two. In this meta-analysis, we reviewed publications on VRET for anxiety that included self-reported presence and anxiety. The comprehensive search of the literature identified 33 publications with a total of 1196 participants. The correlation between self-reported sense of presence and anxiety was extracted and meta-analyzed. Potential moderators such as technology characteristics, sample characteristics including age, gender and clinical status, disorder characteristics and study design characteristics such as measurements were also examined. The random effects analysis showed a medium effect size for the correlation between sense of presence and anxiety (r?=?.28; 95% CI: 0.18–0.38). Moderation analyses revealed that the effect size of the correlation differed across different anxietydisorders, with a large effect size for fear of animals (r?=?.50; 95% CI: 0.30–0.66) and a no to small effect size for social anxietydisorder (r?=?.001; 95% CI: ?0.19–0.19). Further, the correlation between anxiety and presence was stronger in studies with participants who met criteria for an anxietydisorder than in studies with a non-clinical population. Trackers with six degrees of freedom and displays with a larger field of view resulted in higher effect sizes, compared to trackers with three degrees of freedom and displays with a smaller field of view. In addition, no difference in effect size was found for the type of presence measurement and the type of anxiety measurement. This meta-analysis confirms the positive relation between sense of presence and anxiety and demonstrates that this relation can be affected by various moderating factors.
Although separation anxietydisorder appears to be common among children exposed to disasters, there are no data focusing on the impact of trauma on adult separation anxietydisorder. The present exploratory study examined the relationship of adult separation anxietydisorder with other psychological reactions (posttraumatic stress disorder [PTSD], complicated grief, depression) and dimensions of trauma among 126 war-affected Bosnian refugees resettled in Australia. Adult separation anxietydisorder was associated with PTSD, but not with complicated grief or depression. Although adult separation anxietydisorder was weakly linked with traumatic losses, this association was nonspecific. Further research is needed to clarify the pathogenic pathways leading to the comorbid PTSD-adult separation anxietydisorder pattern and its clinical implications. PMID:20135680
Background To determine the use of antidepressants (ADs) in people with sub-threshold depression (SD); the lifetime prevalence of mania and hypomania in SD and the link between ADs use, bipolarity and anxietydisorders in SD. Methods Study design: community survey. Study population: samples randomly drawn, after stratification from the adult population of municipal records. Sample size: 4999 people from seven areas within six Italian regions. Tools: Questionnaire on psychotropic drug consumption, prescription; Structured Clinical Interview NP for DSM-IV modified (ANTAS); Hamilton Depression Rating Scale (HAM-D); Mood Disorder Questionnaire (MDQ); Short Form Health Survey (SF-12). SD definition: HAM-D > 10 without lifetime diagnosis of Depressive Episode (DE). Results SD point prevalence is 5.0%. The lifetime prevalence of mania and hypomania episodes in SD is 7.3%. Benzodiazepines (BDZ) consumption in SD is 24.1%, followed by ADs (19.7%). In SD, positive for MDQ and comorbidity with Panic Disorder (PD) or Generalized AnxietyDisorders (GAD) are associated with ADs use, whereas the association between a positive MDQ and ADs use, without a diagnosis of PD or GAD, is not significant. Only in people with DE the well-being (SF-12) is higher among those using first-line antidepressants compared to those not using any medication. In people with SD no significant differences were found in terms of SF-12 score according to drug use. Conclusions This study suggests caution in prescribing ADs to people with SD. In people with concomitant anxietydisorders and SD, it should be mandatory to perform a well-designed assessment and evaluate the presence of previous manic or hypomanic symptoms prior to prescribing ADs.
Previous studies of cognitive alterations in borderline personality disorder (BPD) have yielded conflicting results. Given that a core feature of BPD is affective instability, which is characterized by emotional hyperreactivity and deficits in emotion regulation, it seems conceivable that short-lasting emotional distress might exert temporary detrimental effects on cognitive performance. Here we used functional magnetic resonance imaging (fMRI) to investigate how task-irrelevant emotional stimuli (fearful faces) affect performance and fronto-limbic neural activity patterns during attention-demanding cognitive processing in 16 female, unmedicated BPD patients relative to 24 age-matched healthy controls. In a modified flanker task, emotionally negative, socially salient pictures (fearful vs. neutral faces) were presented as distracters in the background. Patients, but not controls, showed an atypical response pattern of the right amygdala with increased activation during emotional interference in the (difficult) incongruent flanker condition, but emotion-related amygdala deactivation in the congruent condition. A direct comparison of the emotional conditions between the two groups revealed that the strongest diagnosis-related differences could be observed in the dorsal and, to a lesser extent, also in the rostral anterior cingulate cortex (dACC, rACC) where patients exhibited an increased neural response to emotional relative to neutral distracters. Moreover, in the incongruent condition, both the dACC and rACC fMRI responses during emotional interference were negatively correlated with trait anxiety in the patients, but not in the healthy controls. As higher trait anxiety was also associated with longer reaction times (RTs) in the BPD patients, we suggest that in BPD patients the ACC might mediate compensatory cognitive processes during emotional interference and that such neurocognitive compensation that can be adversely affected by high levels of anxiety.
Previous studies of cognitive alterations in borderline personality disorder (BPD) have yielded conflicting results. Given that a core feature of BPD is affective instability, which is characterized by emotional hyperreactivity and deficits in emotion regulation, it seems conceivable that short-lasting emotional distress might exert temporary detrimental effects on cognitive performance. Here we used functional magnetic resonance imaging (fMRI) to investigate how task-irrelevant emotional stimuli (fearful faces) affect performance and fronto-limbic neural activity patterns during attention-demanding cognitive processing in 16 female, unmedicated BPD patients relative to 24 age-matched healthy controls. In a modified flanker task, emotionally negative, socially salient pictures (fearful vs. neutral faces) were presented as distracters in the background. Patients, but not controls, showed an atypical response pattern of the right amygdala with increased activation during emotional interference in the (difficult) incongruent flanker condition, but emotion-related amygdala deactivation in the congruent condition. A direct comparison of the emotional conditions between the two groups revealed that the strongest diagnosis-related differences could be observed in the dorsal and, to a lesser extent, also in the rostral anterior cingulate cortex (dACC, rACC) where patients exhibited an increased neural response to emotional relative to neutral distracters. Moreover, in the incongruent condition, both the dACC and rACC fMRI responses during emotional interference were negatively correlated with trait anxiety in the patients, but not in the healthy controls. As higher trait anxiety was also associated with longer reaction times (RTs) in the BPD patients, we suggest that in BPD patients the ACC might mediate compensatory cognitive processes during emotional interference and that such neurocognitive compensation that can be adversely affected by high levels of anxiety. PMID:23459637
Holtmann, Jana; Herbort, Maike C; Wüstenberg, Torsten; Soch, Joram; Richter, Sylvia; Walter, Henrik; Roepke, Stefan; Schott, Björn H
Clinical question What treatment improves social interactions and reduces reports of anxiety symptoms in individuals with autism spectrum disorders (ASD) and a co-occurring anxietydisorder? Results Systematic reviews and randomized clinical trials suggest that cognitive behavior therapy in tandem with direct instruction of social skills using applied behavior analysis intervention components may be effective for treating anxiety in individuals with high functioning ASD. For individuals with ASD, an anxietydisorder, and an intellectual disability, systematic desensitization may be effective. Implementation Intervention should emphasize teaching social skills. Reinforcers (ie, rewards based upon the client’s interests) should be used to encourage participation in therapy. Treatment should incorporate visual aides and family involvement. Intervention components involving abstract concepts, visualization, and discussions of emotions are less useful given difficulties in abstract reasoning and communication inherent to ASD.
The treatment of anxiety is on the edge of a new era of combinations of pharmacologic and psychosocial interventions. A new wave of translational research has focused on the use of pharmacological agents as psychotherapy adjuvants using neurobiological insights into the mechanism of the action of certain psychological treatments such as exposure therapy. Recently, d-cycloserine (DCS) an antibiotic used to treat tuberculosis has been applied to enhance exposure-based treatment for anxiety and has proved to be a promising, but as yet unproven intervention. The present study aimed to evaluate the efficacy of DCS in the enhancement of exposure therapy in anxietydisorders. A systematic review/meta-analysis was conducted. Electronic searches were conducted in the databases ISI-Web of Science, Pubmed and PsycINFO. We included only randomized, double-blind, placebo-controlled trials with humans, focusing on the role of DCS in enhancing the action of exposure therapy for anxietydisorders. We identified 328 references, 13 studies were included in our final sample: 4 on obsessive-compulsive disorder, 2 on panic disorder, 2 on social anxietydisorder, 2 on posttraumatic stress disorder, one on acrophobia, and 2 on snake phobia. The results of the present meta-analysis show that DCS enhances exposure therapy in the treatment of anxietydisorders (Cohen d?=? ?0.34; CI: ?0.54 to ?0.14), facilitating the specific process of extinction of fear. DCS seems to be effective when administered at a time close to the exposure therapy, at low doses and a limited number of times. DCS emerges as a potential new therapeutic approach for patients with refractory anxietydisorders that are unresponsive to the conventional treatments available. When administered correctly, DCS is a promising strategy for augmentation of CBT and could reduce health care costs, drop-out rates and bring faster relief to patients.
Presently most adolescent anxietydisorder screening instruments make their determination of running a high risk for an anxietydisorder on the basis of a cut-off score measured by a single screening which can lead to false positives. Therefore, the goal of this study is to examine whether a repeated administration of the SCARED screening instrument for DSM-5 anxietydisorder symptoms could help in the detection of true positives while also avoiding false positives. Participants were 923 early adolescents from the general community. The adolescents' ages at the first annual screening ranged from 10 to 15 with an average of 12.5 years. In a prospective five-year longitudinal design, the adolescents completed the SCARED screening instrument for anxietydisorder symptoms on a yearly basis. To detect true positives and avoid false positives, the data were analyzed with Receiver Operating Characteristics (ROC) cut-off score analyses. ROC cut-off score analyses revealed that the sensitivity and specificity of high risk were greatly improved for repeated screenings above those of a single screening. The findings of this study demonstrate that a screening instrument (such as the SCARED) should be administered not just once but several times in order to better determine true positives and avoid false positives.
Hale III, William W.; Raaijmakers, Quinten A. W.; Meeus, Wim H. J.
New techniques of DNA analysis have been applied to the prenatal diagnosis of the common haemoglobin disorders. Currently, it is possible to provide a comprehensive programme for the prevention of these conditions, although this entails the use of several different techniques including globin chain synthesis analysis, direct identification of mutations with restriction enzymes, linkage analysis of restriction fragment length polymorphisms, and the use of oligonucleotide probes. At present, the best combination of these approaches has to be worked out for individual populations, but as the techniques of chorion villus sampling and DNA analysis improve it should be possible to rationalise these prenatal diagnosis programmes and thus make them simpler and less expensive. Images
Weatherall, D J; Old, J M; Thein, S L; Wainscoat, J S; Clegg, J B
A multicenter, randomized, placebo-controlled, double-blind study was conducted to evaluate the efficacy of pregabalin in preventing relapse of generalized anxietydisorder (GAD) after response to short-term treatment. Outpatients (n=624) with GAD for > or =1 year received open-label pregabalin (450 mg/day) for 8 weeks and, if a clinical response was observed, were randomized to receive either pregabalin (450 mg/day; n=168) or placebo (n=170) for 24 weeks. The primary efficacy parameter was time to relapse. Among responders to open-label acute treatment with pregabalin, time to relapse of GAD was significantly longer for patients treated with pregabalin compared with placebo (P<0.0001). Fifty per cent of the placebo group had relapsed by day 23, and at study endpoint, 65% had relapsed. In the pregabalin group, only 42% had relapsed by study end. Total attrition during double-blind treatment was somewhat higher on pregabalin compared with placebo (21.4 vs. 15.3%); attrition owing to adverse events (AEs) was also somewhat higher on pregabalin (6.0 vs. 2.4%). AEs were relatively low in the double-blind phase; only three AEs occurred with an incidence of more than 5% on pregabalin and placebo, respectively: infection (14.9 vs. 11.2%), headache (10.1 vs. 11.2%), and somnolence (6.0 vs. 0%). No safety concerns were identified with long-term treatment. The study indicates that pregabalin is an effective treatment for the prevention of relapse in patients with GAD. PMID:18090504
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. As hypothesized, children with ADHD demonstrated poorer selective and sustained attention, whereas youth with anxietydisorders demonstrated greater attentional bias toward threatening faces on a visual probe task. Findings suggest the neuropsychological differentiation of attention problems in anxious and ADHD children, despite potentially similar phenotypes. PMID:22417186
Weissman, Adam S; Chu, Brian C; Reddy, Linda A; Mohlman, Jan
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 Rwandan genocide. The syndromes were strongly linked to each other with a high comorbidity. Principal axis factoring resulted in the emergence of 4 different factors. The symptoms of depression, along with the cognitive, emotional, and behavioral symptoms of PGD, loaded on the first factor, symptoms of anxiety on the second factor, symptoms of PTSD on the third factor, and the separation distress symptoms of PGD on the fourth factor. This indicates that the concept of PGD includes symptoms that are conceptually related to depression. However, the symptom cluster of separation distress presents a grief-specific dimension that may surface unrelated to depressive symptoms. PMID:24567983
Schaal, Susanne; Dusingizemungu, Jean-Pierre; Jacob, Nadja; Neuner, Frank; Elbert, Thomas
This study examined the role of comorbid depressive disorders (major depressive disorder or dysthymic disorder) and co-occurring depressive symptoms in treatment outcome and maintenance for youth (N = 72, aged 7-14) treated with cognitive-behavioral therapy for a principal anxietydisorder (generalized anxietydisorder, separation anxiety…
Objective It is unclear why late-life mood and anxietydisorders are highly undertreated, despite being common in older adults. Thus, this study determined the prevalence and key factors associated with non-use of mental health services among older community-dwelling adults with mood and anxietydisorders. Methods The study examined 348 participants aged 55 years and older who met criteria for prevalent DSM-IV mood and anxietydisorders from the National Comorbidity Survey Replication (NCS-R), a population-based probability sample. Analyses included frequency measures and logistic regression using weights and complex design-corrected statistical tests. Key factors associated with not using mental health services were determined in a final multivariable model using a systematic approach accounting for a comprehensive list of potential predictors. Results Approximately 70% of older adults with prevalent mood and anxietydisorders did not use services. Those who were from minority race/ethnic groups, not comfortable with discussing personal problems, who were married or cohabitating, and middle versus high income status had increased odds of not using mental health services. In addition, respondents with mild versus serious disorders, no chronic pain complaints, and low versus high perceived cognitive impairment had greater odds of non-use. Conclusions The results support improving perception of need and comfort to seek help, as well as increased screening and other prevention efforts, in order to combat the very high number of mood and anxietydisorders that go untreated in older Americans.
The present study examines the construct validity of separation anxietydisorder (SAD), social phobia (SoP), panic disorder (PD), and generalized anxietydisorder (GAD) in a clinical sample of children. Participants were 174 children, 6 to 17 years old (94 boys) who had undergone a diagnostic evaluation at a university hospital based clinic.…
Langer, David A.; Wood, Jeffrey J.; Bergman, R. Lindsey; Piacentini, John C.
It was hypothesized that children identified by their peers at school as anxious solitary would report more symptoms of social\\u000a anxietydisorder on a self report questionnaire and, on the basis of child and parent clinical interviews, receive more diagnoses\\u000a of social anxietydisorder and additional anxiety and mood disorders. Participants were 192 children drawn from a community\\u000a sample of
Bipolar disorder is a common, complex, and severe psychiatric disorder with cyclical disturbances of mood and a high suicide rate. Here, we describe a family with four siblings, three affected females and one unaffected male. The disease course was characterized by early-onset bipolar disorder and co-morbid anxiety spectrum disorders that followed the onset of bipolar disorder. Genetic risk factors were suggested by the early onset of the disease, the severe disease course, including multiple suicide attempts, and lack of adverse prenatal or early life events. In particular, drug and alcohol abuse did not contribute to the disease onset. Exome sequencing identified very rare, heterozygous, and likely protein-damaging variants in eight brain-expressed genes: IQUB, JMJD1C, GADD45A, GOLGB1, PLSCR5, VRK2, MESDC2, and FGGY. The variants were shared among all three affected family members but absent in the unaffected sibling and in more than 200 controls. The genes encode proteins with significant regulatory roles in the ERK/MAPK and CREB-regulated intracellular signaling pathways. These pathways are central to neuronal and synaptic plasticity, cognition, affect regulation and response to chronic stress. In addition, proteins in these pathways are the target of commonly used mood-stabilizing drugs, such as tricyclic antidepressants, lithium, and valproic acid. The combination of multiple rare, damaging mutations in these central pathways could lead to reduced resilience and increased vulnerability to stressful life events. Our results support a new model for psychiatric disorders, in which multiple rare, damaging mutations in genes functionally related to a common signaling pathway contribute to the manifestation of bipolar disorder.
Kerner, Berit; Rao, Aliz R.; Christensen, Bryce; Dandekar, Sugandha; Yourshaw, Michael; Nelson, Stanley F.
Bipolar disorder is a common, complex, and severe psychiatric disorder with cyclical disturbances of mood and a high suicide rate. Here, we describe a family with four siblings, three affected females and one unaffected male. The disease course was characterized by early-onset bipolar disorder and co-morbid anxiety spectrum disorders that followed the onset of bipolar disorder. Genetic risk factors were suggested by the early onset of the disease, the severe disease course, including multiple suicide attempts, and lack of adverse prenatal or early life events. In particular, drug and alcohol abuse did not contribute to the disease onset. Exome sequencing identified very rare, heterozygous, and likely protein-damaging variants in eight brain-expressed genes: IQUB, JMJD1C, GADD45A, GOLGB1, PLSCR5, VRK2, MESDC2, and FGGY. The variants were shared among all three affected family members but absent in the unaffected sibling and in more than 200 controls. The genes encode proteins with significant regulatory roles in the ERK/MAPK and CREB-regulated intracellular signaling pathways. These pathways are central to neuronal and synaptic plasticity, cognition, affect regulation and response to chronic stress. In addition, proteins in these pathways are the target of commonly used mood-stabilizing drugs, such as tricyclic antidepressants, lithium, and valproic acid. The combination of multiple rare, damaging mutations in these central pathways could lead to reduced resilience and increased vulnerability to stressful life events. Our results support a new model for psychiatric disorders, in which multiple rare, damaging mutations in genes functionally related to a common signaling pathway contribute to the manifestation of bipolar disorder. PMID:24348429
Kerner, Berit; Rao, Aliz R; Christensen, Bryce; Dandekar, Sugandha; Yourshaw, Michael; Nelson, Stanley F
A study to examine the association between childhood separation anxietydisorder (SAD) and the risk of the development of psychopathology during young adulthood was conducted. Results showed that SAD contributed to the risk for the development of internalizing disorders, which are panic and depression, but decreased the risk for externalizing…
Lewinsohn, Peter M.; Holm-Denoma, Jill M.; Small, Jason W.; Seeley, John R.; Joiner, Thomas E.
There is abundant evidence for abnormalities of the norepinephrine (NE) and serotonin (5HT) neurotransmitter systems in depression and anxietydisorders. The majority of evidence supports underactivation of serotonergic function and complex dysregulation of noradrenergic function, most consistent with overactivation of this system. Treatment for these disorders requires perturba- tion of these systems. Reproducible increases in serotonergic function and de- creases