Anxiety Disorders Interview Schedule-Revised Research Articles

Time-varying moderation of treatment outcomes by illness duration and comorbid depression in generalized anxiety disorder.

To extend the sparse literature on moderators, we used time-varying effect modeling (TVEM; Tan, Shiyko, Li, Li, & Dierker, 2012) to examine how depressive symptoms and duration of generalized anxiety disorder (GAD) moderated effects of 3 treatments for GAD (applied relaxation [AR], cognitive-behavioral therapy [CBT], and nondirective therapy [ND]) over time using intensive repeated measures. In a secondary analysis of Borkovec and Costello (1993), 66 GAD clients were randomly assigned to AR (n = 23), CBT (n = 23), or ND (n = 20). Clients received 12 therapy sessions over 6 weeks, and after 2 weeks of posttreatment assessment, had 2 additional weekly fading sessions. They completed thrice daily anxiety ratings during this 10-week period. GAD duration (Anxiety Disorders Interview Schedule-Revised) and depressive symptoms (Hamilton Depression Rating Scale) were assessed at baseline. Longer GAD duration predicted less anxiety reduction in CBT and ND relative to AR. These effects were pronounced in the later phase of treatment, suggesting benefits of focused relaxation practice for clients with longer duration. Higher depression predicted better response to CBT than AR and ND. The moderation effects were also more noticeable in the later phase. In multilevel analyses, a similar moderation pattern held at 1-year follow-up on clinician-rated measures. GAD clients with long-standing symptoms may benefit more from repeatedly practicing fewer skills than learning multiple skills. On the other hand, clients with comorbid depression may respond better to CBT than AR, perhaps because CBT includes cognitive interventions that can generalize to depression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Family history of psychological problems in generalized anxiety disorder

The current investigation examined self-reported family history of psychological problems in a large sample of individuals diagnosed with generalized anxiety disorder (GAD) and nonanxious controls. The GAD participants were all individuals receiving cognitive-behavioral therapy as part of two large randomized clinical trials. Family history information was obtained from the Anxiety Disorders Interview Schedule-Revised (ADIS-R; DiNardo & Barlow, 1988). The results indicate that, compared to control participants, individuals with GAD were more likely to have family members with anxiety problems, but not other psychological problems. Possible mechanisms for the familial transmission of GAD are discussed.

Specific phobia is a frequent non-motor feature in stiff man syndrome

Objective: To investigate systematically the rate and type of phobia in stiff man syndrome and its variants, and to compare patients with stiff man syndrome with and without phobia for...

Selective processing of threatening information: effects of attachment representation and anxiety disorder on attention and memory.

To investigate the effect of the mental representation of attachment on information processing, 28 anxiety disorder outpatients, as diagnosed by the Anxiety Disorders Interview Schedule-Revised, were administered the Adult Attachment Interview and the State-Trait Anxiety Inventory. They also completed an emotional Stroop task with subliminal and supraliminal exposure conditions, a free recall memory task, and a recognition test. All tasks contained threatening, neutral, and positively valenced stimuli. A nonclinical comparison group of 56 participants completed the same measures. Results on the Stroop task showed color-naming interference for threatening words in the supraliminal condition only. Nonclinical participants with insecure attachment representations showed a global response inhibition to the Stroop task. Clinical participants with secure attachment representations showed the largest Stroop interference of the threatening words compared to the other groups. Results on the free recall task showed superior recall of all types of stimuli by participants with secure attachment representations. In the outpatient group, participants with secure attachment representations showed superior recall of threatening words on the free recall task, compared to insecure participants. Results on the recognition task showed no differences between attachment groups. We conclude that secure attachment representations are characterized by open communication about and processing of threatening information, leading to less defensive exclusion of negative material during the attentional stage of information processing and to better recall of threatening information in a later stage. Attachment insecurity, but not the type of insecurity, seems a decisive factor in attention and memory processes.

The Effects of Cognitive-Behavior Therapy for Panic Disorder on Comorbid Conditions

In a replication and extension of prior research (Brown, Antony, & Barlow, 1995) examining the impact of treatment on additional diagnoses, our study investigated the effects of cognitive-behavioral treatment for panic disorder on frequency and severity of comorbid conditions in 33 principal panic disorder patients. Patients were diagnosed using the Anxiety Disorders Interview Schedule-Revised (ADIS-R; Di Nardo & Barlow, 1988) and assigned severity ratings indicating degree of distress and/or impairment for both principal panic disorder and comorbid conditions. A high rate of comorbidity (63.6%) was found at pretreatment. Following cognitive-behavioral treatment, there was a significant reduction in the number of patients with at least one additional diagnosis ( p < .01); the greatest declines were found in comorbid social phobia and generalized anxiety disorder. Severity ratings also declined significantly from pre- to posttreatment for comorbid social phobia, generalized anxiety disorder, and posttraumatic stress disorder ( p < .01) and were marginally significant for depression. There was a trend for comorbidity to reduce likelihood of achieving high improvement in panic at posttreatment. Implications of these findings for classification and treatment mechanisms are discussed.

Diagnostic reliability of the DSM-III-R anxiety disorders. Mediating effects of patient and diagnostician characteristics.

Factors influencing diagnostic reliability were examined using a sample of 267 patients who underwent two independent administrations of the Anxiety Disorders Interview Schedule--Revised (ADIS-R). Several potential mediators were examined in terms of their association with interrater agreement as measured by kappa coefficients. These included comorbidity, disorder severity, diagnostician training, patient education, presence of behavioral feature, and time separating interviews. Results suggest that several factors appear to have an important effect on diagnostic agreement, most notably, the presence or absence of comorbidity and the presence or absence of overt behavioral symptoms. Details of these influences and the impact of other selected mediators on the diagnosis of anxiety disorders are presented.

Discriminant validity of the symptoms constituting the DSM-III-R and DSM-IV associated symptom criterion of generalized anxiety disorder

The associated (somatic) symptom criterion for DSM-IV generalized anxiety disorder (GAD) requires at least 3 of a list of 6 symptoms that previously resided in the Motor Tension (MT) and Vigilance and Scanning (VS) clusters of DSM-III-R. The decision to retain these six symptoms while eliminating all symptoms from the Autonomic Hyperactivity (AH) cluster, was made with limited data on discriminant validity and classification accuracy of the proposed DSM-IV associated symptom criterion. The present study examined this issue in a large sample ( N = 390) of patients with a DSM-III-R anxiety or mood disorder, all of whom were administered the GAD associated symptom ratings from the Anxiety Disorders Interview Schedule-Revised. Scores from the MT, VS, and DSM-IV symptom clusters correlated more strongly ( ps < .05) with measure of GAD (e.g., Penn State Worry Questionnaire) than did AH scores. Analyses that differentiated patients with GAD from other anxiety disorder groups produced the largest effect sizes using MT, VS, and DSM-IV cluster scores; GAD differed from mood disorders only on scores from the AH cluster. Whereas 98.6% of patients with GAD met the “3 of 6 symptoms” criterion proposed in DSM-IV, a large percentage of patients with other diagnoses met this criterion also (range = 35.3% to 92.9%). Raising the criterion to require four or more symptoms increased specificity without adversely affecting sensitivity. Implications for conceptual models of GAD are considered.

The diagnostic significance of the functional impairment and subjective distress criterion: An illustration with the DSM-III-R anxiety disorders

The assessment of subjective distress and functional impairment and its influence on DSM-III-R and DSM-IV mood and anxiety disorders are considered. Patients (n=267) were diagnosed at an anxiety disorders clinic using a semistructured interview (Anxiety Disorders Interview Schedule-Revised). DSM-III-R diagnoses that met the DSM-III-R distress/impairment criterion and subclinical diagnoses (those meeting all criteria except clinically significant distress or impairment) were compared. Of the DSM-III-R anxiety disorders, simple phobia and, to a lesser extent, social phobia frequently were diagnosed as subclinicals: Of 210 subclinical diagnoses assigned, 46% were simple phobia and 23% were social phobia. Also, test-retest reliability figures were significantly lower for diagnoses of social phobia when assigned at the subclinical rather than the clinical level. The difference approached significance for simple phobia. Overall, the findings support the DSM-IV Task Force's decision to explicitly include a distress/impairment criterion in the diagnostic criteria of most diagnoses in DSM-IV, despite the possible redundancy of doing so. In addition, the need to develop operational definitions for the distress and impairment criterion is noted.

Reliability of DSM-III-R Anxiety Disorder Categories

A large reliability study of DSM-III-R anxiety disorders is reported in which outpatients (n = 267) received two independent structured interviews (Anxiety Disorders Interview Schedule-Revised). It is the only reliability study to date in which the final DSM-III-R criteria are used throughout the study. Reliability was assessed for each diagnosis when it was assigned as a principal diagnosis and when it was assigned as either a principal or an additional diagnosis. Excellent reliability was obtained for current principal diagnoses of simple phobia, social phobia, and obsessive-compulsive disorder. Agreement was good for panic disorder when all severity levels of agoraphobic avoidance were combined. Reliability was fair for generalized anxiety disorder. Remaining diagnostic difficulties, particularly in identifying levels of agoraphobic avoidance and in reliably diagnosing generalized anxiety disorder, are discussed in the context of changes in diagnostic criteria that are under consideration for DSM-IV.

Diagnostic and symptom distinguishability of generalized anxiety disorder and obsessive-compulsive disorder

In light of recent observations (e.g., DSM-IV Task Force) of apparent similarities between features of generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD), particularly chronic worry and obsessions, the present study examined the extent to which the two disorders were distinguishable at the diagnostic level and by self-report questionnaires. Subjects were 46 patients with GAD and 31 patients with OCD diagnosed via the Anxiety Disorders Interview Schedule-Revised (ADIS-R). Of 41 patients who received two independent ADIS-Rs, in no instance did one interviewer assign a principal diagnosis of GAD and the other, OCD. Furthermore, analyses of diagnostic comorbidity indicated that GAD and OCD infrequently co-occurred. Patients with GAD and patients with OCD were reliably distinguished by ADIS-R screening items and self-report measures of the essential features of each disorder (e.g., presence of uncontrollable worry, obsessions), but did not differ on associated features (e.g., anxiety, depression). Correlational analyses using a large sample (N=533) revealed that, despite having reliable shared variance, measures of worry and obsessions evidenced considerable differentiation as well.

Structured interview assessment of nonclinical panic

Numerous researchers have asserted that the study of nonclinical panic may have considerable utility to the evaluation of current conceptual models of panic and panic disorder. Despite evidence suggesting many similarities between nonclinical panic and panic disorder, the significance of these findings is mitigated by several methodological difficulties including the use of panic classification schemes involving questionnaire assessment and failure to consider DSM-III-R criteria for panic, particularly spontaneous panic. Accordingly, the present study examined the prevalence and nature of panic in a large nonclinical sample (N=171) using the Anxiety Disorders Interview Schedule-Revised (ADIS-R). Interrater agreement of ADIS-R panic classifications was high (kappa = .83). Whereas the one-year prevalence of panic (29.2%) was similar to rates obtained in previous studies that used questionnaire-based classifications, the rate of uncued panic was substantially lower (2.3%). Moreover, a large proportion of panics reported by subjects appeared to represent reactions to situations associated with actual threat (i.e., true alarm reactions). These data are discussed as suggesting potential caveats in the use of extant nonclinical panic findings to contribute to the understanding of panic disorder.

An assessment of structured diagnostic interviews for adult anxiety disorders

Structured diagnostic interviews have been developed to aid reliable diagnosis of psychiatric disorders. Five of the available interviews are reviewed with respect to adult anxiety disorders: the Anxiety Disorders Interview Schedule-Revised (ADIS-R), the Composite International Diagnostic Interview (CIDI), the Schedule for Affective Disorders and Schizophrenia (SADS), the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), and the Structured Clinical Interview for DSM-III-R (SCID). Each of these assessment instruments is compared concerning their relative merits, psychometric properties, and usefulness to practicing clinicians and researchers. It is concluded that structured interviews increase diagnostic reliability. Since reliability is a prerequisite for validity, structured diagnostic interviews represent a necessary addition to research clinical assessment.

Obsessive compulsive disorder: Symptoms and diagnosis in a college sample

The Padua Inventory (PI) a self-report measure of obsessions and compulsions, was administered to 678 individuals. Six to seven months after, this initial screening, the Anxiety Disorders Interview Schedule-Revised (ADIS-R) was administered to 14 individuals who scored in the top 3% and 14 individuals who scored between the 42nd and 48th percentile on the PI. In the diagnostic interview, the 14 high scorers reported significantly more obsessions and compulsions, more general worry, and moresevere physiological symptoms when they worry than the comparison group. In addition, 9 of the 14 high scorers met DSM-III-R criteria for obsessive compulsive disorder with 3 of these 9 individuals also meeting criteria for generalized anxiety disorder though none had ever sought treatment for obsessions, compulsions, or worry. The high scorers also reported more obsessions and compulsions during 7 days of self-monitoring and had more depressive symptoms than the comparison group. Suggestions are made for additional research on OCD.

Syndrome comorbidity in patients diagnosed with a DSM-III--R anxiety disorder.

One hundred thirty patients presenting at an anxiety disorders research clinic were administered a structured interview (i.e., Anxiety Disorders Interview Schedule-Revised). Diagnoses were made in accordance with Diagnostic and Statistical Manual (rev. 3rd ed.) criteria. Seventy percent of patients received at least one additional but secondary Axis I diagnosis. The most common additional diagnoses were simple and social phobia, which were assigned to nearly one third of all patients. In addition, 33% of anxiety disorder patients received an additional diagnosis of a depressive mood disorder (i.e., dysthymia or major depression). The distribution of specific additional diagnoses are presented for each principal anxiety disorder category. The scientific and clinical implications of comorbidity are discussed while considering the relatively high patterns of syndrome comorbidity found in the present study, which is consistent with several earlier studies.