Anxiety Disorder Group Research Articles

Classification of obsessive compulsive disorder by EEG complexity and hemispheric dependency measurements.

In the present study, both single channel electroencephalography (EEG) complexity and two channel interhemispheric dependency measurements have newly been examined for classification of patients with obsessive-compulsive disorder (OCD) and controls by using support vector machine classifiers. Three embedding entropy measurements (approximate entropy, sample entropy, permutation entropy (PermEn)) are used to estimate single channel EEG complexity for 19-channel eyes closed cortical measurements. Mean coherence and mutual information are examined to measure the level of interhemispheric dependency in frequency and statistical domain, respectively for eight distinct electrode pairs placed on the scalp with respect to the international 10-20 electrode placement system. All methods are applied to short EEG segments of 2 s. The classification performance is measured 20 times with different 2-fold cross-validation data for both single channel complexity features (19 features) and interhemispheric dependency features (eight features). The highest classification accuracy of 85 ±5.2% is provided by PermEn at prefrontal regions of the brain. Even if the classification success do not provided by other methods as high as PermEn, the clear differences between patients and controls at prefrontal regions can also be obtained by using other methods except coherence. In conclusion, OCD, defined as illness of orbitofronto-striatal structures [Beucke et al., JAMA Psychiatry70 (2013) 619-629; Cavedini et al., Psychiatry Res.78 (1998) 21-28; Menzies et al., Neurosci. Biobehav. Rev.32(3) (2008) 525-549], is caused by functional abnormalities in the pre-frontal regions. Particularly, patients are characterized by lower EEG complexity at both pre-frontal regions and right fronto-temporal locations. Our results are compatible with imaging studies that define OCD as a sub group of anxiety disorders exhibited a decreased complexity (such as anorexia nervosa [Toth et al., Int. J. Psychophysiol.51(3) (2004) 253-260] and panic disorder [Bob et al., Physiol. Res.55 (2006) S113-S119]).

Psychosocial Characteristics of Subjects Who Hoped to Receive Psychotherapy as Part of a Research Study in Japan

Aims: This study examined the psychosocial characteristics of subjects who hoped to receive psychotherapy, but were not receiving psychiatric medication as part of a research study using quantitative methods to measure psychometric properties in Japan. Methods: Subjects were examined using the Structured Clinical Interview for DSM-IV Axis I disorders, Global Assessment of Functioning, a questionnaire (including the resilience scale, social desirability scale, and the State Trait Anger Expression Inventory (STAXI)) and psychological assessments. Results: Of the 67 people who initially volunteered, 22 came to the clinical centre at Tokyo International University. Of these, 16 completed a psychiatric diagnostic interview. They all had a fair IQ and were highly resilient and functioning well. Nine subjects had an Axis I disorder that could be classified as a life-long prevalence or 12-month prevalence. The subjects were diagnosed as follows: depressive episode group (N=7), manic episode group (N=1), anxiety disorder group (N=7), and eating disorder group (N =2). There were no significant differences between the subjects with (N=9) and without (N=6) a psychiatric diagnosis except for GAF. The results of a Mann-Whitney test between subjects with or without a desire to seek psychotherapy revealed that the former (N=7)

Aberrant amygdala functional connectivity at rest in pediatric anxiety disorders.

BackgroundChildhood onset of anxiety disorders is associated with greater functional impairment and burden across the lifespan. Recent work suggests that generalized anxiety disorder (GAD) is characterized by dysfunctional connectivity in amygdala-based circuits at rest in adolescents, consistent with adults. However, neural mechanisms underlying a broad spectrum of often-comorbid anxiety disorders in children remains unclear and understudied. The current study examines amygdala functional connectivity at rest in children and adolescents across comorbid anxiety disorders (ADs) including youth with primary diagnoses of GAD and social phobia (SP).ResultsCompared with healthy controls (HCs), AD youth exhibited hyperconnectivity between the right amygdala and the insula and hypoconnectivity between the left amygdala and the ventromedial prefrontal cortex (vmPFC) and posterior cingulate cortex (PCC). Within the AD group, connectivity was not correlated with anxiety severity and only the amygdala-PCC connectivity was positively correlated with age.ConclusionsOur findings indicate that youth with comorbid ADs demonstrate aberrant connectivity in the anterior limbic network (ALN) as well as the PCC at rest. This extends upon previous work suggesting alterations in amygdala circuits underlying fear learning, emotion regulation, and the processing of interoceptive states. Presence of these findings within this young, comorbid sample points to underlying common mechanisms across ADs and illuminates future targets for prevention and intervention in childhood.

Anxiety Sensitivity in Patients with Alcohol Dependence: A Cross-Sectional Case-Control Study

Anxiety Sensitivity (AS) is a cognitive risk and maintenance factor for anxiety disorders, and it consists of three dimensions: Physical concerns, Cognitive concerns, and Social concerns. No study has investigated the role of AS in individuals with Alcohol-Dependence (A-D), comparing a group of patients with Alcohol-Dependence (A-D) to patients with Anxiety Disorders (AD) and healthy individuals on AS dimensions. Specific dimensions of AS might play a role as cognitive vulnerability and maintenance factors also for A-D-related problems. Examination of AS in patients with A-D might inform clinical practice and public health policy suggesting the integration of treatments specifically targeting AS in A-D patients. The current study aimed to explore the relationship between AS dimensions and A-D. One hundred twenty-five participants, including patients with a diagnosis of A-D (n= 35), patients with a diagnosis of any Anxiety Disorder (AD) (n= 40) and healthy individuals as a control group (CG) (n= 50) completed the ASI-3, STAI-Y and BDI-II. After controlling for anxious traits, A-D patients had stronger Social concerns. Physical and Cognitive concerns appeared, however, significantly more severe among the AD group than the other two groups. Given the strong association between Social concerns and A-D, treatments for A-D patients should also target Social concerns. Study limitations, implications for mental health policy and intervention programs are addressed.

Of 'disgrace' and 'pain'--corticolimbic interaction patterns for disorder-relevant and emotional words in social phobia.

Limbic hyperactivation and an impaired functional interplay between the amygdala and the prefrontal cortex are discussed to go along with, or even cause, pathological anxiety. Within the multi-faceted group of anxiety disorders, the highly prevalent social phobia (SP) is characterized by excessive fear of being negatively evaluated. Although there is widespread evidence for amygdala hypersensitivity to emotional faces in SP, verbal material has rarely been used in imaging studies, in particular with an eye on disorder-specificity. Using functional magnetic resonance imaging (fMRI) and a block design consisting of (1) overall negative, (2) social-phobia related, (3) positive, and (4) neutral words, we studied 25 female patients with social phobia and 25 healthy female control subjects (HC). Results demonstrated amygdala hyperactivation to disorder-relevant but not to generally negative words in SP patients, with a positive correlation to symptom severity. A functional connectivity analysis revealed a weaker coupling between the amygdala and the left middle frontal gyrus in patients. Symptom severity was negatively related to connectivity strength between the amygdala and the ventromedial prefrontal and orbitofrontal cortex (Brodmann Area 10 and 11). The findings clearly support the view of a hypersensitive threat-detection system, combined with disorder-related alterations in amygdala-prefrontal cortex connectivity in pathological anxiety.

Symptom Profiles in Depersonalization and Anxiety Disorders: An Analysis of the Beck Anxiety Inventory

Background: Depersonalization disorder (DPD) entails distressing alterations in self-experiencing. However, it has long been recognized that depersonalisation symptoms occur in other disorders, particularly anxiety and panic. One strand of research proposes that depersonalization phenomenology arises through altered autonomic arousal in response to stress. Sampling and Methods: We sought to examine profiles of anxiety symptoms through a secondary data analysis of individual items and factor subscales on the Beck Anxiety Inventory (BAI), comparing two relatively large patient samples with DPD or with a variety of anxiety conditions, respectively. The DPD sample (n = 106) had a lower overall BAI score than the combined anxiety disorders group (n = 525). Results: After controlling for this as well as for potential confounders such as age and gender, the DPD group presented significantly lower scores on the panic subscale, marginally lower scores on the autonomic subscale and significantly higher scores on the neurophysiological subscale of the BAI. Conclusions: These differences imply similarities between the cognitive components of DPD and anxiety disorders while physiological experiences diverge. The findings encourage future research looking at direct physiological measures and longitudinal designs to confirm the mechanisms underlying different clinical manifestations of anxiety.

A comparative analysis of personality pathology profiles among patients with pure depressive-, pure anxiety-, and pure somatoform disorders

BackgroundDepressive-, anxiety-, and somatoform disorders are among the most common psychiatric disorders. The assessment of comorbid personality pathology or traits in these disorders is relevant, because it can lead to the exacerbation of them or to poorer remission rates. To date, no research findings have been published on the comparison of these three prevalent patient groups with regard to comorbid dimensional personality pathology. MethodsData of participants (18–60 years) came from a web-based Routine Outcome Monitoring (ROM) programme. The present study used baseline data and was designed to compare personality pathology profiles between three separate outpatient groups: pure anxiety disorders (n=1633), pure depressive disorders (n=1794), and pure somatoform disorders (n=479). Personality pathology was measured with the Dimensional Assessment of Personality Pathology-Short Form (DAPP-SF). ResultsThe pure depressive disorder group, in comparison to the other two disorder groups, exhibited the worst psychopathological and functional health image and most personality pathology. In the pure anxiety disorder group, the highest mean was found for the personality trait Anxiousness; and in the pure depressive disorder group for the traits Identity problems, Affective lability, Anxiousness, and Restricted expression. LimitationsThe cross-sectional nature of the study limits the conclusions that can be drawn. ConclusionsThe assessment of comorbid personality pathology in depressive-, anxiety-, somatoform disorders is clinically relevant, whether a patient has a personality disorder or not. This way, treatment could partly be focused on specific personality traits that may be counterproductive for treatment outcome, especially in depressive disorders.

Beyond generalized anxiety disorder: Psychometric properties of the GAD-7 in a heterogeneous psychiatric sample

BackgroundAlthough developed as a screener for Generalized Anxiety Disorder (GAD) in primary care, the GAD-7 is now commonly used as a measure of general anxiety symptoms across various settings and populations. However, little is known about its psychometric properties when used in such heterogeneous samples. We examined the internal consistency, convergent validity, sensitivity and specificity, sensitivity to change, and structure of the GAD-7 in patients receiving brief, intensive CBT treatment in a partial hospital setting. We also examined the properties of a modified version that assessed symptoms over the past 24-h. MethodsParticipants (n=1082) completed the GAD-7 upon admission and discharge from a partial hospital program. They also completed measures of worry, depression, and well being and a structured diagnostic interview. We examined psychometric properties in the total sample and separately for patients with GAD, post-traumatic stress disorder, Social Anxiety Disorder (SAD), and panic disorder. ResultsInternal consistency and convergent validity were good for the total sample and each anxiety disorder group. The GAD-7 demonstrated poor specificity and a high false positive rate for all anxiety disorders. Sensitivity to change was generally good. Factor analysis revealed that a one-factor structure did not fit the data well. The 24-h version performed similarly to the original version. ConclusionsThe GAD-7 performed well as a measure of anxiety symptom severity, but not as a screener in this psychiatric sample. It is a useful outcome measure for hetereogenous samples, but it may not perform as well specifically for individuals with SAD. A modified version of the GAD-7 that assessed anxiety symptoms over the past 24-h appears to be a reliable and valid modification.

Specificity of Implicit-Shame Associations

In this study, we investigated the specificity of implicit-shame associations across individuals diagnosed with body dysmorphic disorder ( n = 30), obsessive-compulsive disorder ( n = 30), and social anxiety disorder ( n = 29) and individuals in a mentally healthy control group ( n = 33). All participants completed a series of Implicit Association Tests that tapped into shame associated with each disorder. Planned contrasts indicated that compared with individuals in the other groups, individuals in the body dysmorphic disorder group had greater body-relevant implicit shame and those in the obsessive-compulsive disorder group had greater implicit shame tied to obsessive thoughts. The social anxiety disorder group did not differ significantly from the other groups on implicit performance-relevant shame, although in comparison with the other clinical groups, means were in the expected direction. Our comparative design adds to existing cognitive-behavioral conceptualizations of body dysmorphic, obsessive-compulsive, and social anxiety disorders that have traditionally focused on strategic forms of cognition within a single disorder.

Lipid peroxidation markers in children with anxiety disorders and their diagnostic implications

ObjectiveNumerous factors, including genetic, neurobiological, neurochemical, and psychological factors, are thought to be involved in the development of anxiety disorders. The latest findings show that the pathophysiology of anxiety disorders might be associated with oxidative stress and lipid peroxidation; however, no studies have so far investigated lipid peroxidation markers in children with anxiety disorders. Serum levels of lipid hydroperoxide (LOOH) are a reliable marker of lipid peroxidation. Paraoxonase and arylesterase are two enzymes that protect against such peroxidation, and might also be diagnostic markers. In this study, we investigated whether there are associations between anxiety disorders and lipid peroxidation markers in children, and assessed the diagnostic performance of these markers.MethodsThe study group consisted of 37 patients (children and adolescents) with anxiety disorders. A control group, matched for age and gender, was composed of 36 healthy subjects. Venous blood samples were collected, and LOOH levels and paraoxonase and arylesterase activity were measured.ResultsLOOH levels were significantly higher in the anxiety disorders group than in the control group. There were no significant differences in paraoxonase or arylesterase activities between the patient and the control groups.DiscussionLipid peroxidation or oxidative damage might play a role in the aetiopathogenesis of anxiety disorders. LOOH may be a potential biological marker for anxiety disorders in children.

Somatic symptoms in children with anxiety disorders: an exploratory cross-sectional study of the relationship between subjective and objective measures

Symptoms of childhood anxiety disorders include activation of bodily stress systems to fear stimuli, indicating alterations of the autonomic nervous system (ANS). Self-reported somatic symptoms are frequently reported, while studies including objective measures of ANS are scarce and show inconsistent results. Even less studied is the relationship between subjective and objective measures of somatic symptoms in anxious children. Increased knowledge of this relationship may have relevance for treatment programmes for anxiety disorders. This cross-sectional study examined subjective and objective measures of ANS responsiveness in a clinical sample of children with anxiety disorders (7-13 years; n = 23) and in healthy controls (HC; n = 22) with equal distributions of gender and age. The subjective measure used was the Multidimensional Anxiety Scale for Children, which includes a subscale on somatic symptoms. The objective measures consisted of an orthostatic challenge (head-up tilt test), and an isometric muscular exercise (handgrip) while the participants were attached to the Task Force Monitor, a combined hardware and software device used for continuous, non-invasive recording of cardiovascular variables. The anxiety disorder group reported significantly more somatic symptoms than HCs (both by mother and child reports). In contrast, no relevant differences in cardiovascular variables were demonstrated between the anxiety group and HCs. Finally, there were no significant correlations between subjective and objective measures in either group. Because of the small sample size, the findings must be interpreted carefully, but the results do not support previous reports of functional alterations of the ANS in anxious children.

Is post-event processing a social anxiety specific or transdiagnostic cognitive process in the anxiety spectrum?

Research on post-event processing (PEP), where individuals conduct a post-mortem evaluation of a social situation, has focused primarily on its relationship with social anxiety. The current study examined: 1) levels of PEP for a standardized event in different anxiety disorders; 2) the relationship between peak anxiety levels during this event and subsequent PEP; and 3) the relationship between PEP and disorder-specific symptom severity. Participants with primary DSM-IV diagnoses of social anxiety disorder (SAD), obsessive compulsive disorder (OCD), panic disorder with/without agoraphobia (PD/A), or generalized anxiety disorder (GAD) completed diagnosis specific symptom measures before attending group cognitive behavioural therapy (CBT) specific to their diagnosis. Participants rated their peak anxiety level during the first group therapy session, and one week later rated PEP in the context of CBT. The results indicated that all anxiety disorder groups showed heightened and equivalent PEP ratings. Peak state anxiety during the first CBT session predicted subsequent level of PEP, irrespective of diagnostic group. PEP ratings were found to be associated with disorder-specific symptom severity in SAD, GAD, and PD/A, but not in OCD. PEP may be a transdiagnostic process with relevance to a broad range of anxiety disorders, not just SAD.

일부 대학생들의 사회심리적 스트레스, 불안 및 우울수준과 그의 관련요인

본 연구는 대학생들이 경험하는 스트레스, 불안 및 우울수준을 파악하고 그에 관련된 요인을 검토하고자 실시하였다. 조사대상은 대전광역시에 소재하고 있는 대학에 재학 중인 대학생 551명으로 하였으며, 자료 수집은 2012년 4월 1일부터 6월 30일까지의 기간 동안에 표준화된 자기기입식 설문지(self-administered questionnaire)를 사용한 설문조사에 의하였다. 설문지의 내용은 독립변수로 학생들의 개인 및 가정생활특성, 학교생활 특성 및 건강관련행위 특성을 조사하였고, 종속변수로는 사회심리적 스트레스수준, 불안수준 및 우울수준을 조사하였다. 연구결과, 조사대상 대학생들이 경험하고 있는 고위험 스트레스는 22.7%, 불안은 15.6%, 우울은 22.1%로 나타났으며, 이들에 관련된 요인으로는 성별, 가정의 경제상태, 가정생활의 만족도, 학교성적, 교우관계, 학교생활에 대한 만족도, 주관적인 수면의질 및 주관적인 건강상태 등을 지적할 수 있었다. 특히, 사회심리적 스트레스에는 개인 및 가정생활 특성 변수가, 불안 및 우울에는 사회심리적 스트레스가 많은 영향을 미치는 것으로 확인되었다. 따라서 대학생들의 스트레스, 불안 및 우울수준을 낮추기 위해서는 개인 및 가정생활 특성이나 학교생활 특성 외에도 사회심리적 스트레스 요인을 적절하게 통제할 수 있는 프로그램의 개발 및 운영이 필요하다고 본다. The purpose of this study was to measure the level of psychosocial stress, anxiety and depression symptoms among college students, and to reveal its related factors. The survey was filled out by 551 students from Daejon City from April 1, 2012 to July 30, 2012. The independent variables of the questionnaire were socio-demographic characteristics, family life, school life, and other variables health related while the dependent variables were psychosocial stress, anxiety and depression symptoms. As a results, 22.7% of the study subjects were in the high-risk stress group, 15.6% of study subject were in the anxiety disorder group, and 22.1% were in the mild to moderate depression group. In addition, its related factors were influenced by a variety of factors such as gender, family income, satisfaction of family life, grades, social life, satisfaction of school life, subjective sleep quality, subjective health status. Psychosocial stress was significantly influenced by socio-demographic characteristics and family life variables, while anxiety and depression symptoms were influenced more so by psychosocial stress. In order to lower the level of psychosocial stress, anxiety and depression symptoms of college students, the development of programs that monitor the psychosocial stress, socio-demographic characteristics, family life variables, and school variables is imperative.

Trajectories of functioning after remission from anxiety disorders: 2-year course and outcome predictors

Anxiety disorders are associated with substantial functional limitations but the course of functioning following symptom remission remains largely unknown. Using data from the Netherlands Study of Depression and Anxiety (NESDA), we examined the 2-year trajectories of functioning in participants with chronic (n = 586) or remitting anxiety disorders (n = 385) and in healthy controls (n = 585). In participants with remitting anxiety disorders, we identified predictors of functioning from among sociodemographic, clinical and vulnerability variables. Data were analysed using linear mixed models (LMMs). Functioning was assessed with the World Health Organization Disability Assessment Schedule II (WHO DAS II). At baseline, participants with remitting anxiety disorders functioned significantly better than those with chronic anxiety disorders, but significantly worse than controls. In both anxiety disorder groups, most impairment was reported in social functioning, occupational functioning and cognition. During the follow-up, functioning improved in both groups, probably due to treatments received. Participants who achieved symptom remission experienced moderate improvements in social functioning and cognition but not in occupational functioning. Of those who remitted, 45.8% reported functioning scores similar to healthy controls whereas 28.5% still functioned at the level of those with chronic anxiety disorders. Worse functioning was predicted by severe anxiety disorders, use of psychological treatment, co-morbid depressive disorders and maladaptive personality traits. In anxiety disorders, symptom remission is accompanied by improvements in functioning but significant functional impairments may persist because of co-morbid disorders, lower functioning prior to the onset of the anxiety disorder or residual subthreshold anxiety symptoms.

345 – Methyl tetrahydrofolate reductase polymorphism, folic acid, B12 in a sample of patients with depressive and anxiety symptoms

Introduction There are several theories concerning potential associations between depression and levels of vitamin B12 and folate. Aim of the study To investigate the relationship between depression and vitamin B12, folate, and the methylenetetrahydrofolate reductase 677C T polymorphism. To compare this associations, in anxiety and depression. Subjects and methods 90 subjects were randomly selected in a comparative cross sectional study. The sample consists of three groups: a group of depressive disorders without psychotic symptoms (n = 30), a group of anxiety disorders (n = 30) and control group (n = 30). The patients were recruited from psychiatric out- patient clinic. Patients were diagnosed according to DSMIV criteria. Beck depression Inventory for severity of depression, Hamilton rating scale of depression, Hamilton rating scale of anxiety. Laboratory: Simultaneous assay of vitamin B12 and folic acid by Radio-immune assay technique and analysis of MTHFR (C677T) by means of PCR and RFLP. Results Both anxiety and depression groups has the same percentage of gene mutation (33.3%). Folic acid and Vitamin B 12 mean values were highest in control group followed by the anxiety group then the least was in depression. Within the depression group there is a negative correlation between the severity of depression and folic acid. Within the depression group, patients with mutant gene have lower level of both Folic acid and Vitamin B12 than patients with non mutant gene. Conclusion Folic acid and Vitamin B12 were lower than normal in both anxiety and depression patients and this was combined with gene mutation.

Brain-Derived Neurotrophic Factor (BDNF) protein levels in anxiety disorders: systematic review and meta-regression analysis

Background: Brain-Derived Neurotrophic Factor (BDNF) is a neurotrophin that is involved in the synaptic plasticity and survival of neurons. BDNF is believed to be involved in the pathogenesis of several neuropsychiatric disorders. As findings of BDNF levels in anxiety disorders have been inconsistent, we undertook to conduct a systematic review and meta-analysis of studies that assessed BDNF protein levels in these disorders.Methods: We conducted the review using electronic databases and searched reference lists of relevant articles for any further studies. Studies that measured BDNF protein levels in any anxiety disorder and compared these to a control group were included. Effect sizes of the differences in BDNF levels between anxiety disorder and control groups were calculated.Results: Eight studies with a total of 1179 participants were included. Initial findings suggested that BDNF levels were lower in individuals with any anxiety disorder compared to those without [Standard Mean Difference (SMD) = −0.94 (−1.75, −0.12), p ≤ 0.05]. This was, however, dependent on source of BDNF protein [plasma: SMD = −1.31 (−1.69, −0.92), p ≤ 0.01; serum: SMD = −1.06 (−2.27, 0.16), p ≥ 0.01] and type of anxiety disorder [PTSD: SMD = −0.05 (−1.66, 1.75), p ≥ 0.01; OCD: SMD = −2.33 (−4.21, −0.45), p ≤ 0.01].Conclusion: Although BDNF levels appear to be reduced in individuals with an anxiety disorder, this is not consistent across the various anxiety disorders and may largely be explained by the significantly lowered BDNF levels found in OCD. Results further appear to be mediated by differences in sampling methods. Findings are, however, limited by the lack of research in this area, and given the potential for BDNF as a biomarker of anxiety disorders, it would be useful to clarify the relationship further.

Anxiety Disorders in Bipolar I Mania: Prevalence, Effect on Illness Severity, and Treatment Implications

Background:Comorbidity in bipolar disorder (BP) is common, of which anxiety disorder (AD) comorbidity has received recent attention. The aim of the present study was to find the prevalence of (current and lifetime) ADs in BP I with recent episode mania, its effect on illness severity and its treatment implications. This is unlike the convention of associating “anxiety” with depression. Here, the hierarchical diagnostic criterion of the DSM IV-TR was suspended for heuristic purpose.Materials and Methods:Consecutively admitted 102 consenting in-patients of bipolar mania were evaluated on Young Mania Rating Scale, Brief Psychiatric Rating Scale, and Hamilton Rating Scale for Anxiety, at baseline and after 45 days. When the patient became cooperative, Schedule for Affective Disorders and Schizophrenia - the lifetime version interview AD section, was conducted. Protocol for management of current acute state was kept flexible and naturalistic. All treatment details, historical bipolar illness and socio-demographic variables were collected from case record file and unstructured interview with patient and caregiver.Results:High prevalence of lifetime (70.2 percent) and moderate levels of current (29.6 percent) comorbid ADs were found. Comorbid lifetime AD was associated with more severe BP course (more past depressive episodes (P<0.001), less inter-episode recovery (P<0.01), and poorer response to acute phase treatment). Comorbid AD group needed more number of mood stabilizers for acute management (P<0.05).Conclusion:Findings illustrate the importance of this comorbidity having implications for psychiatric diagnostic systems.

Effects of Pain and Prescription Opioid Use on Outcomes in a Collaborative Care Intervention for Anxiety

To determine the effects of pain and opioid pain medication use on clinical and functional outcomes in 1004 primary care patients with an anxiety disorder randomized to receive the Coordinated Anxiety Learning and Management (CALM) collaborative care intervention (cognitive-behavioral therapy and/or medication) versus usual care. A total of 1004 patients with panic disorder, generalized anxiety disorder, social anxiety disorder, or posttraumatic stress disorder were randomized to CALM or usual care. Outcomes at 6, 12, and 18 months were compared in patients with and without moderate pain interference (for the entire anxiety disorder group and then just those with comorbid major depression) and in patients taking and not taking opioid medication (entire group, just those with comorbid major depression, and just those with moderate pain interference). Patients with pain interference and patients taking opioid pain medication were more anxious [Brief Symptom Inventory anxiety subscale] and disabled (Sheehan Disability) at baseline, improved over time at similar rates, but at 18 months had lower response and remission rates. There was no moderating effect on the intervention. In patients with comorbid major depression, patients using opioid medications showed a trend for less disability improvement over time, and in patients with pain, patients using opioids showed less sustained anxiety response at 18 months. Anxious patients with pain benefit as much as those without pain from cognitive-behavioral therapy and medication treatment. Among patients with pain, however, there is some evidence of a reduced anxiety treatment response in those taking opioid medication, which should be further studied.

Sensitivity and Specificity of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A Community-Based Study

The aim of this cross-sectional community-based study was to examine the sensitivity and specificity of the Screen for Child Anxiety Related Emotional Disorders (SCARED) to the diagnosis of anxiety disorders (AD). Participants were 119 students aged 9-18. Psychiatric diagnoses were assessed by a psychiatrist throughout a structural clinical interview (K-SADS-PL). Forty-four participants had positive diagnosis for at least one AD. The total score of the SCARED significantly differentiated anxious from non-anxious children with an optimal cutoff point of 22 (sensitivity = 81.8 %; specificity = 52.0 %). SCARED subscales of social phobia and separation anxiety disorder, but not generalized anxiety disorder, revealed better discrimination proprieties than total scores to screen for that specific disorder (p < .05). Both total and specific SCARED scores presented moderate sensitivity and specificity for detecting AD in a community sample. Investigators interested in screening for specific AD, rather than the group of AD, may benefit from using the specific subscales.

Decreased plasma nesfatin-1 levels in patients with generalized anxiety disorder

Nesfatin-1, a recently discovered satiety molecule, is localized in neurons of the hypothalamus and brain stem and colocalized with stress-related substances. However, the relation between nesfatin-1 and stressor related behaviors like anxiety and/or fear has not yet been investigated in human subjects. In the present study, our aim was to investigate whether there was a relationship between plasma nesfatin-1 levels and generalized anxiety disorder. The study group consisted of 40 patients (BMI, 22.98 ± 0.56) with generalized anxiety disorder and 34 age-matched healthy male control subjects (23.05 ± 0.4). Patients fully met the fourth Diagnostic and Statistical Manual of Mental Disorders, text revision. Blood samples for nesfatin-1 were drawn at the end of an overnight fasting period at least 10h. Plasma nesfatin-1 levels were measured and found significantly lower in anxiety disorder group than in control group (0.35 ± 0.037 ng/ml vs. 0.63 ± 0.080 ng/ml, respectively, p<0.05). Low nesfatin-1 levels may be related with generalized anxiety disorder.