Disorder Relevant or Disorder Specific: Fear of Losing Control in OCD and Panic Disorder

Objective: To determine the frequency of dissociation and childhood trauma among obsessive-compulsive patients by comparing with healthy controls. Methods: This study comprises of a group of 50 patients attending to Hamidiye Etfal Training and Research Hospital Psychiatric Outpatients Department who had been diagnosed as obsessive-compulsive disorder according to DSM-5 and a control group of 50 participants with no psychiatric diagnosis. The groups were collected between September 2014 and January 2015. SCID-I, SCID-D, Dissociative Experiences Scale (DES), Childhood Trauma Quetionnaire (CTQ-28) and a short instrument gathering qualitative information about childhood traumatic experiences were administered to all attendees with a sociodemographic form. Results: Mean DES and CTQ-28 total scores were determined as significantly different between OCD and control groups. In the OCD group, the percentage of existence of at least one type of dissociative disorder was 14%. In CTQ-28 subscales scores, there were significant differences between OCD and control groups for emotional neglect, emoti-onal abuse and physical abuse. Moreover, 70% of the OCD group has had at least one type of childhood trauma. In childhood trauma subscales, there were also significant differences between OCD and control groups for at least one type of childhood trauma, emotional neglect, emotional abuse, physical abuse and sexual abuse. Discussion: Findings of significant differences between OCD patients and healthy controls according to dissociation and child-hood trauma, 14% of at least one type of dissociative disorder and 70% of at least one type of childhood trauma in OCD patients are main findings of this study. Our study differentiates from other studies in our country that its having a control group. Considering above findings, it has revealed that because of its probable effects on the diagnosis and treatment, co-existence of OCD with dissociation and childhood trauma is needed to be taken account.

Familial Aggregation of Panic Disturbances in Parkinson's Disease

A cognitive model of aetiology of panic disorder assumes that people who experience frequent panic attacks have tendencies to catastrophically interpret normal and benign somatic sensations--as signs of serious illness. This arise the question: is this cognition specific for patients with panic disorder and in what intensity it is present in patients with serious somatic illness and in healthy subjects. The aim of the study was to ascertain the differences in the frequency and intensity of "catastrophic" cognitions related to body sensations, and to ascertain the differences in the frequency and intensity of anxiety caused by different body sensations all related to three groups of subjects: a sample of patients with panic disorder, a sample of patients with history of myocardial infarction and a sample of healthy control subjects from general population. Three samples are observed in the study: A) 53 patients with the diagnosis of panic disorder; B) 25 patients with history of myocardial infarction; and C) 47 healthy controls from general population. The catastrophic cognitions were assessed by the Agoraphobic Cognitions Questionnaire (ACQ) and the Body Sensations Questionnaire (BSQ). These questionnaires assess the catastrophic thoughts associated with panic and agoraphobia (ACQ) and the fear of body sensations (BSQ). All study subjects answered questionnaires items, and the scores of the answers were compared among the groups. The results of the study suggest that: 1) There is no statistical difference in the tendency to catastrophically interpret body sensations and therefore to induce anxiety in the samples of healthy general population and patients with history of myocardial infarction; 2) The patients with panic disorder have a statistically significantly more intensive tendency to catastrophically interpret benign somatic symptoms and therefore to induce a high level of anxiety in comparison to the sample of patients with the history of serious somatic illness (myocardial infarction) and the sample of healthy general population. The tendency to catastrophically interpret benign somatic symptoms and therefore to inducea high level of anxiety in patients with panic disorder, confirms the cognitive aetiology model of panic disorder and suggests that it should be the focus of prophylactic and therapeutic management of patients with panic disorder.

27.2 Examining the Psychometric Properties and Clinical Utility of the Toronto Obsessive-Compulsive Scale (TOCS) in a Pediatric Clinical Sample

Epidemiology of panic attacks, panic disorder and the moderating role of age: Results from a population-based study

Processing impairments in OCD: It is more than inhibition!

This study investigated the neurocognitive correlates of childhood OCD and TS, which are purported to share frontal–striatal dysfunction. Neurocognitive measures tapping frontal–striatal functions such as executive, attention/memory, and visuomotor abilities were administered to three groups of participants, OCD without comorbid TS (OCD), TS without comorbid OCD (TS), and normal controls. Results suggested that OCD group demonstrated deficits in the area of spatial attention relative to healthy controls. The OCD participants demonstrated no cognitive deficits compared to the TS group. TS participants showed trends towards impairments in the areas of response inhibition, divided attention, and cognitive flexibility relative to the OCD and normal control groups. Spatial attention deficits for the OCD group are partially consistent with adult OCD studies indicating deficits in spatial memory. TS findings were less robust and may be construed tentatively as suggestive of executive function deficits. Future research is needed to delineate the influence of development on neurocognitive deficits associated with OCD and TS.

The purpose of the study was to evaluate 1) whether an underlying familial predisposition is shared by all anxiety disorders or whether specific risks are associated with specific disorders, and 2) whether panic disorder and major depression have a familial link. The study compared four groups of children: 1) offspring of parents with panic disorder and comorbid major depression (N=179), 2) offspring of parents with panic disorder without comorbid major depression (N=29), 3) offspring of parents with major depression without comorbid panic disorder (N=59), and 4) offspring of parents with neither panic disorder nor major depression (N=113). Parental panic disorder, regardless of comorbidity with major depression, was associated with an increased risk for panic disorder and agoraphobia in offspring. Parental major depression, regardless of comorbidity with panic disorder, was associated with increased risks for social phobia, major depression, disruptive behavior disorders, and poorer social functioning in offspring. Both parental panic disorder and parental major depression, individually or comorbidly, were associated with increased risk for separation anxiety disorder and multiple (two or more) anxiety disorders in offspring. These findings confirm and extend previous results documenting significant associations between the presence of panic disorder and major depression in parents and patterns of psychopathology and dysfunction in their offspring.

Alexithymia and anxiety sensitivity in populations at high risk for panic disorder

Background and objectivesIt has been suggested that reassurance seeking may play an important role in the development and maintenance of common mental health problems such as OCD and depression. We considered the extent of reassurance seeking in depression and OCD relative to a healthy comparison group and tested the hypothesis that reassurance seeking is primarily motivated by threat in those suffering from OCD and by interpersonal concerns in those suffering from depression. MethodsThe frequency and intensity of reassurance seeking and the motivation for seeking reassurance was measured using the reassurance seeking questionnaire in 28 people with OCD, 18 people with depression and 29 healthy controls. ResultsThe OCD group sought reassurance more and at a higher intensity than both the depression group and healthy controls. For the OCD group, reassurance seeking was found to be linked to threat concern motivation. The depression group were not motivated by threat or interpersonal concerns. LimitationsThe OCD group did not significantly differ from the depression group on the measure of depression, most likely due to secondary depression in the OCD group. ConclusionsFor people suffering from OCD, reassurance is motivated by threat concern. For the depression group, levels of reassurance seeking were not substantially increased relative to controls, and the motivation to seek reassurance is less clear but interpersonal concern may not be a distinct motivational factor.

Recent investigations have included mindfulness as a component of intervention for OCD. However, the extent to which processes underlying OCD interfere with mindfulness has not been examined. Limited research has examined neuropsychological functions as mechanisms to explain different levels of mindfulness across individuals. Research in OCD highlights impairment in visual/spatial working memory as possible unique deficits; these and other components of executive functioning may also be important for mindfulness. Participants (N = 103) exceeding clinical cutoffs on measures of OCD, depressive, or generalized anxiety symptoms, or were healthy controls, completed a self-report measure of mindfulness and computerized measures of working memory and cognitive inhibition. Results demonstrated the OCD group scored significantly lower than the anxiety and control groups on some facets of mindfulness. The OCD group performed significantly worse on visual but not spatial working memory compared to verbal working memory. Additionally, the OCD group showed significantly poorer performance on all working memory tasks compared to the control group but not in comparison to other groups. There were no significant differences between the OCD group and the depression group on any measure. Finally, regression models examining working memory and cognitive inhibition as predictors of mindfulness found some support for two of the five facets of mindfulness, though the individual predictors were not significant. Implications are discussed in the context of mindfulness and executive functioning in OCD in terms of future research and treatment.

BackgroundThis longitudinal study aims to investigate differences in long-term disability between social anxiety disorder (SAD), panic disorder with agoraphobia (PDA), panic disorder without agoraphobia (PD), generalized anxiety disorder (GAD) and multiple anxiety disorders (multiple AD), focusing on the effects of different course trajectories (remission, recurrence and chronic course) and specific symptom dimensions (anxiety arousal and avoidance behaviour).MethodsData were used from participants with no psychiatric diagnosis (healthy controls, n = 647) or with a current anxiety disorder (SAD, n = 191; PDA, n = 90; PD, n = 84; GAD, n = 110; multiple AD, n = 480). Severity of anxiety arousal and avoidance behaviour symptoms was measured using the Beck Anxiety Inventory and the Fear Questionnaire. The World Health Organization Disability Assessment Schedule II was used to measure disability.ResultsLong-term disability was most prevalent in participants with SAD and multiple AD, and lowest in PDA and PD. GAD had an intermediate position. Anxiety arousal and avoidance behaviour were associated with more long-term disability in anxiety disorders than course trajectories.ConclusionsVarious anxiety disorders have different disability levels over 4 years of time, therefore diagnostic distinction is important for treatment focus. Anxiety arousal and avoidance behaviour are major predictors for long-term disability in anxiety disorders.

Disability in anxiety disorders

Ask the Expert: Treatments for Panic Disorder

Introduction In panic disorder, sensitivity to bodily sensations increases due to the patient's cognitive vulnerability. Cognitive behavioural therapy (CBT) can help to decrease sensitivity to bodily sensations by correcting these cognitive distortions by controlling negative thoughts and panic attacks. Aims This study verified whether group CBT is more effective than treatment as usual (TAU) in South Korean patients with panic disorder. Methods The study participants consisted of 76 panic disorder patients. Patients in the therapy condition attended sessions once a week for a total of 12 sessions in addition to drug treatment. Results In the therapy condition, there were significant decreases in panic-related bodily sensations and ranking and belief scores for catastrophic misinterpretation of external events. Discussion Group CBT, in comparison to TAU, decreases panic and agoraphobia symptom severity in South Korean patients with panic disorder. Our study provides evidence for the effectiveness of a panic disorder management programme that integrates group CBT and traditional pharmacotherapeutic treatment for patients with panic disorder. Implications for Practice The cognitive behavioural approach is needed to reduce panic and agoraphobia symptoms for hospitalized patients with panic disorder more than activity therapies, medications and supportive counselling by doctors and nurses.