Co-occurring Anxiety Symptoms Research Articles

Anxiety Symptoms in Boys with Autism Spectrum Disorder, Attention-Deficit Hyperactivity Disorder, or Chronic Multiple Tic Disorder and Community Controls

We compared symptoms of generalized anxiety disorder (GAD) and separation anxiety disorder (SAD) in 5 groups of boys with neurobehavioral syndromes: attention-deficit/hyperactivity disorder (ADHD) plus autism spectrum disorder (ASD), ADHD plus chronic multiple tic disorder (CMTD), ASD only, ADHD only, and community Controls. Anxiety symptoms were assessed using parent and teacher versions of a DSM-IV-referenced rating scale. All three groups of boys with co-morbid ADHD evidenced more severe anxiety than Controls. Group differences in anxiety varied as a function of symptom, disorder, informant, and co-morbidity supporting the notion that co-morbid neurobehavioral syndromes differentially impact clinical features of co-occurring anxiety symptoms. Findings also suggest that GAD and SAD are phenomenologically unique, even in children with ASD. Implications for nosology are discussed.

Use of Atomoxetine in Patients with Attention-Deficit Hyperactivity Disorder and Co-Morbid Conditions

Attention-deficit hyperactivity disorder (ADHD) is one of the most common neurobehavioural disorders in children. It has been shown that as many as 85% of patients with ADHD have at least one psychiatric co-morbidity, and approximately 60% have at least two. Atomoxetine is a specific, noradrenergic reuptake inhibitor that provides an effective treatment option for patients with ADHD and co-morbid conditions. The efficacy of atomoxetine in treating ADHD appears to be unaffected by the presence of co-morbid conditions. Therapy with atomoxetine has been associated with statistically significant improvements in symptoms of oppositional defiant disorder in most, but not all, studies. Limited data suggest this agent may have potential in improving co-occurring symptoms of anxiety and may be useful in patients with co-morbid conditions such as tics or Tourette's syndrome. The tolerability profile of atomoxetine in patients with ADHD and co-morbid conditions was similar to that of patients with uncomplicated ADHD. Atomoxetine was well tolerated, with adverse events generally mild and transient; the most frequent adverse events in patients with ADHD included abdominal pain, decreased appetite, nausea and vomiting. The favourable safety and efficacy profile of atomoxetine makes it a promising treatment for patients with ADHD and associated co-morbidities.

Rumination and Depression in Adolescence: Investigating Symptom Specificity in a Multiwave Prospective Study

A ruminative response style has been shown to predict depressive symptoms among youth and adults, but it is unclear whether rumination is associated specifically with depression compared with co-occurring symptoms of anxiety and externalizing behaviors. This prospective, multiwave study investigated whether baseline rumination predicted prospective elevations in depressive symptoms specifically. Rumination was assessed at baseline in a sample of early and middle adolescents (N = 350, 6–10th graders). Symptom measures of depression, anxious arousal, general internalizing, and conduct/externalizing problems with good discriminant validity were assessed at four time points over a 5-month period. Results using hierarchical linear modeling show that rumination predicted prospective fluctuations in symptoms of depression and general internalizing problems specifically but not anxious arousal or externalizing problems. Rumination predicted increasing prospective trajectories of general internalizing symptoms. Baseline rumination interacted with prospective co-occurring fluctuations of anxious arousal and externalizing behaviors over time to predict the highest levels of prospective depressive symptoms. Rumination partly mediated the sex difference (girls > boys) in depressive and internalizing symptoms.

Treatment of Depression and Menopause-Related Symptoms With the Serotonin-Norepinephrine Reuptake Inhibitor Duloxetine

Postmenopausal women with depression frequently have co-occurring symptoms of hot flashes (vasomotor symptoms), sleep disturbance, anxiety, and pain. Treatment strategies that target all of these symptoms together have not been investigated to date. Study participants were postmenopausal women, 40 to 60 years old, with major depressive disorder (DSM-IV criteria) and vasomotor symptoms. The study design included a 2-week, single-blind placebo run-in phase followed by an 8-week open-label flexible-dosing (60-120 mg per day) study of duloxetine for women who did not respond to placebo. The primary outcome measure was change in Montgomery-Asberg Depression Rating Scale (MADRS) score during 8 weeks of duloxetine therapy. Secondary outcome measures included changes in vasomotor symptoms, sleep quality, anxiety, and pain. Analyses were conducted using non-parametric methods. Patients were enrolled in the study from May 31, 2005, through May 22, 2006. Of 30 women eligible to participate in this study, 20 initiated treatment with open-label duloxetine. Fourteen (70.0%) of these women completed the study. There was a statistically significant decrease in MADRS scores after 8 weeks of treatment (p < .001), with scores declining from 19.0 (interquartile range [IQR] = 15.0-21.0) to 5.5 (IQR = 3.0-9.0). There was also a statistically significant improvement in vasomotor symptoms (p = .003), anxiety (p = .002), sleep quality (p < .001), and pain (p < .05). Postmenopausal women with depression and vasomotor symptoms had significant improvement in depression, vasomotor symptoms, sleep, anxiety, and pain after 8 weeks of open-label duloxetine therapy. Given the common co-occurrence of these symptoms in postmenopausal women, duloxetine may offer important therapeutic benefits for postmenopausal women who have depression and menopause-related symptoms.

Childhood trauma and obsessive-compulsive symptoms

Childhood trauma is known to predispose to a variety of psychiatric disorders, including mood, anxiety, eating, and personality disorders. However, the relationship between childhood trauma and obsessive-compulsive symptoms has not been well studied. This study examines the relationship between childhood trauma, personality facets, and obsessive-compulsive symptoms in 938 college students using the Childhood Trauma Questionnaire, the Leyton Obsessional Inventory, and the NEO Personality Inventory-Revised. Between 13 and 30% of subjects met criteria for childhood trauma, with emotional neglect the most commonly reported experience. There was a small but significant association between obsessive-compulsive symptoms and childhood trauma, specifically emotional abuse and physical neglect, all of which was accounted for by co-occurring anxiety symptoms. An independent association was also seen between emotional abuse, physical abuse, and high levels of obsessive-compulsive symptoms ("probable obsessive-compulsive disorder"), which remained significant in the context of co-occurring anxiety symptoms. A similar association was seen between obsessive-compulsive symptoms and conscientiousness, and between emotional neglect and sexual abuse and conscientiousness, suggesting that an indirect role for childhood trauma in the development of obsessive-compulsive symptoms may also exist.

Anxiety enhances the detrimental effect of depressive symptoms on health status following percutaneous coronary intervention

Objective We examined whether anxiety has incremental value to depressive symptoms in predicting health status in patients undergoing percutaneous coronary intervention (PCI) treated in the drug-eluting stent era. Methods A series of consecutive patients ( n=692) undergoing PCI as part of the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital registry completed the Hospital Anxiety and Depression Scale at 6 months and the Short-Form Health Survey (SF-36) at 6 and 12 months post-PCI. Results Of 692 patients, 471 (68.1%) had no symptoms of anxiety nor depression, 62 (9.0%) had anxiety only, 59 (8.5%) had depressive symptoms only, and 100 (14.5%) had co-occurring symptoms. There was an overall significant improvement in health status between 6 and 12 months post-PCI ( P<.001); the interaction effect for time by psychological symptoms was also significant ( P=.003). Generally, patients with co-occurring symptoms reported significantly poorer health status compared with the other three groups ( Ps <.001). Patients with co-occurring symptomatology were also at greater risk of impaired health status on six of the eight subdomains of the SF-36 compared with the other three symptom groups, adjusting for baseline characteristics and health status at 6 months. Conclusion Patients with co-occurring symptoms of anxiety and depression reported poorer health status compared with anxious or depressed-only patients and no-symptom patients, showing that anxiety has incremental value to depressive symptoms in identifying PCI patients at risk for impaired health status treated in the drug-eluting stent era.

Clinical perspectives on the treatment of selective mutism.

Abstract Selective mutism is a childhood disorder characterized by a failure to speak in some but not all of the contexts where speaking is normally expected. It is commonly associated with co-occurring anxiety, both on the part of the child and on the part of one or more family members. The prevailing opinion on treatment recommends medication, cognitive-behavioral therapy (CBT) and family counseling. However, treatment efficacy research is extremely limited. Further, since selective mutism is often first identified during the preschool years, CBT must be modified to match a child's developmental level. This paper summarizes the nature and prevalence of selective mutism, techniques used to treat this disorder, and issues in need of research. The discussion of behavioral treatment techniques is based on the literature and on the author's clinical experience. Keywords: Selective Mutism; Operant Conditioning, Cognitive Behavior Therapy, Communication Hierarchy, Talking Scale, Talking Map, Parent Counseling, Collaboration. Introduction Selective mutism is an intriguing childhood disorder that presents considerable treatment challenges. The core symptom is that a child persistently and systematically refrains from speaking in some settings where speaking is expected (e.g., school, community) but speaks fluently in other settings (e.g., home.) Often there are additional complicating factors, such as co-occurring anxiety symptoms or oppositional behaviors, as well as a familial history of anxiety. While a number of articles have been written about selective mutism, there is no universally accepted treatment regimen. Following a short summary describing the nature and incidence of selective mutism, this paper will address approaches to treatment based on the literature and on the author's clinical experience with this population. Also presented are recommendations for research. Definition, Incidence, and Co-Occurring Conditions According to the DSM-IV-TR (American Psychiatric Association, 2000) the onset of selective mutism usually occurs before the age of five years. However, sometimes it is not recognized as a specific problem until a child enters school, when the systematic and selective failure to talk becomes more noticeable. A clinical diagnosis of selective mutism is made on the basis of five criteria: A. The child refrains from speaking in specific social situations (e.g., school) while speaking in others (e.g., home) B. Failure to speak interferes with educational achievement or with social communication C. Symptoms persist for at least one month (not including the first month of school) D. The failure to speak can not be attributed to a lack of knowledge or comfort with the spoken language (as might be true for bilingual children who have immigrated from another culture). E. The symptoms are not better accounted for by a communication disorder, a pervasive developmental disorder, or a psychotic disorder. Prevalence estimates of selective mutism range from .03 to 2 percent; and it is more common among girls, with ratios ranging from 1.5 to 2.6 girls to 1 boy with the diagnosis (Garcia, Freeman, Francis, Miller, & Leonard, 2004). Current research indicates that children with selective mutism show more anxiety symptoms than do other children (Bergman, Piacenti, & McCracken, 2002; Cunningham, McHolm, Boyle, & Patel, 2004) and that anxiety symptoms co-occur with selective mutism at a rate of 74 to 100 percent (Garcia et al.; Kristensen, 2000; Vecchio & Kearney, 2005). Oppositional disorder may also co-occur, but there is some dispute in the literature about its co-occurrence rate. Garcia et al., and Vecchio and Kearney reported that the rate of occurrence is quite low. However, Cunningham et al. reported oppositional disorder to co-occur twice as often among children with selective mutism as among children in a control group. …

Risk Factors for Community Violence Exposure in Adolescence

Community violence is recognized a significant public health problem. However, only a paucity of research has examined risk factors for community violence exposure across domains relevant to adolescents or using longitudinal data. This study examined youth aggressive behavior in relation to community violence exposure among a community epidemiologically defined sample of 582 (45% female) urban adolescents. Internalizing behaviors, deviant peer affiliation, and parental monitoring were examined as moderators of the association between aggressive behavior and exposure to community violence. For males with aggressive behavior problems and deviant peer affiliation or low parental monitoring, co-occurring anxiety symptoms protected against subsequent witnessing community violence. In contrast, males with aggressive behavior problems and co-occurring depressive symptoms were at increased risk for witnessing community violence. Implications of the findings for preventive interventions and future research are discussed.

Time course of response to antidepressants in late-life major depression: therapeutic implications.

In the treatment of depression, there is considerable interest in the time course of response and, in particular, the speed with which individuals recover from depressive episodes. Examination of the time course and speed of response is critical for assessing the usefulness of specific treatments. However, while this issue has received attention in mid-life adult populations, it has received little consideration in the context of late-life major depression. The synthesis of empirical reports indicates that, while older adults with depression seem to respond with the same speed as mid-life adults, several factors have consistently been associated with reduced speed of response to antidepressant treatment, including greater severity of depressive symptoms and co-occurring anxiety symptoms. Limited evidence suggests that sleep impairment and genetic factors (e.g. presence of the s allele of the serotonin transporter gene promoter region) may also be associated with reduced speed of response. Some factors have consistently been found to be unrelated to speed of response (demographic characteristics, nonpsychiatric physical illnesses) whereas other factors have only mixed evidence supporting any effect (psychosocial and other clinical factors). While there is little work available to date, some evidence suggests that time course and speed of response affect longer-term outcomes of depression pharmacotherapy; thus, older adults with more rapid versus slower patterns of response may differ in the types of maintenance treatment needed to avert additional depressive episodes. None of potential strategies for accelerating speed of response have been clearly shown to be effective in late-life depression. Future treatment studies for late-life depression should routinely consider not only overall efficacy of a given pharmacotherapy (i.e. total rate of response), but time course and speed of response. To this end, new investigations must be designed to overcome the methodological limitations of prior studies that have examined time course and they should include a range of potential covariates and outcomes of between-patient differences in speed of response. Better understanding of factors related to such differences may suggest new intervention strategies to accelerate response.