Coexisting Anxiety Disorders Research Articles

Alcohol Use and Anxiety: Diagnostic and Management Issues

Alcohol Use and Anxiety: Diagnostic and Management Issues

The Effect of Paroxetine on the Reduction of Migraine Frequency is Independent of Its Anxiolytic Effect

Background and purposeAnxiety is the most important precipitating factor of migraine attacks, and more than half of migraineurs have coexisting anxiety disorders. Paroxetine, an antidepressant, is one of the selective serotonin reuptake inhibitors (SSRIs) that has an anxiolytic effect, and is also known to be effective for migraine prophylaxis. The aim of this study was to determine the role of the anxiolytic effect of paroxetine on the prevention of migraine.MethodsThis study investigated migraineurs with a general anxiety disorder who visited the neurological clinic. The following efficacy variables were assessed at baseline and after taking paroxetine (20 for 12 weeks: headache frequency, Hamilton Anxiety Rating Scale (HAM-A), Headache Management Self-Efficacy Scale (HMSE), and Headache Disability Inventory (HDI). The correlation between the headache responsiveness to paroxetine and improvement in anxiety levels was analyzed.ResultsTwenty-four patients (aged 54.96±12.09 years, mean±SD) were included in this study. Paroxetine reduced headache frequency by 49.1% within 12 weeks (p<0.05 vs baseline). HAM-A and HMSE scores also showed an improvement, whereas there was no significant change in HDI score. The baseline HAM-A scores did not differ between paroxetine responders and nonresponders. In addition, the improvement in HAM-A score was not correlated with the reduction in headache frequency.ConclusionsParoxetine decreased the headache frequency and reduced anxiety levels. However, the anxiolytic effect of paroxetine was not correlated with the migraine prevention effect. These observation indicate that the anxiolytic effect of paroxetine does not contribute strongly to its prophylactic effect on migraine frequency in migraineurs with anxiety disorder.

Screening and assessing adult asthmatics for anxiety disorders.

The purpose of this study was to evaluate a strategy designed to permit early detection of anxiety disorders in asthmatics. Ninety-one adult asthmatics were screened for anxiety disorders using the Sheehan Patient Rated Anxiety Scale (SPRAS) and the Anxiety Sensitivity Index (ASI) and then individually evaluated by a nurse trained in the administration of the Anxiety Disorders Interview Schedule-IV (ADIS-IV. Thirty-five (38%) of the participants met the diagnostic criteria for one or more anxiety disorders. Comparison of the SPRAS and ASI findings revealed that the SPRAS was more effective in detecting asthmatics likely to be suffering from coexisting anxiety disorders. Comparison of the nurses diagnostic formulations with those of an expert revealed that trained nurses using the ADIS-IV can diagnose anxiety disorders in the asthmatic population with a high degree of accuracy. These results have implications for resolving the problem of unrecognized and untreated anxiety disorders in the asthmatic population.

Affective correlates of trichotillomania

Affective correlates of hair pulling were investigated in a sample of 44 participants diagnosed with trichotillomania (TM). Participants completed the Hair Pulling Survey on which they rated the intensity of ten different affective states across three different phases of hair pulling (before, during and after). Repeated measures analysis of variance was used to examine the change of emotional experience across the hair pulling cycle. Results indicated significant decreases in boredom, anxiety and tension, and significant increases in guilt relief, sadness and anger across time ( p<0.005). The role of co-existent anxiety and mood disorders also was examined using repeated measures analysis of variance. Results of these analyses indicated that patients with and without co-existent disorders differed only on patterns of anger across time, and therefore do not support affective subtypes of TM patients based on co-existent diagnosis. Implications of these findings for conceptualization and treatment of TM are discussed.

Does a coexisting anxiety disorder predict persistence of depressive illness in primary care patients with major depression?

We assessed whether a coexisting anxiety disorder predicts risk for persistent depression in primary care patients with major depression at baseline. Patients with major depression were identified in a 12-month prospective cohort study at a University-based family practice clinic. Presence of an anxiety disorder and other potential prognostic factors were measured at baseline. Persistent depressive illness (major depression, minor depression, or dysthymia) was determined at 12 months. Of 85 patients with major depression at baseline, 43 had coexisting anxiety disorder (38 with social phobia). The risk for persistent depression at 12 months was 44% greater [Risk Ratio (RR) = 1.44, 95% confidence interval (CI) 1.02–2.04] in those with coexisting anxiety. This risk persisted in stratified analysis controlling for other prognostic factors. Patients with coexisting anxiety had greater mean depressive severity [repeated measures analysis of variance (ANOVA), p < 0.04] and total disability days (54.9 vs 19.8, p < 0.02) over the 12-month study. Patients with social phobia had similar increased risk for persistent depression (RR = 1.40, 95% CI 0.98–2.00). A coexisting anxiety disorder indicates risk for persistent depression in primary care patients with major depression. Social phobia may be important to recognize in these patients. Identifying anxiety disorders can help primary care clinicians target patients needing more aggressive treatment for depression.

Differences in the Course of Alcohol Withdrawal in Women and Men: A Polish Sample

A retrospective study compared the course of alcohol withdrawal, including delirium tremens, in women and men hospitalized in the Nowowiejski Hospital in Warsaw from 1973 to 1987. Medical records pertaining to 1179 patients were analyzed; 13.8% of these patients were women and 86.2% were men. The study showed that women began intensive alcohol drinking later than men (p < 0.0001), but the period between the onset of alcohol abuse and the first occurrence of alcohol withdrawal was shorter in women than in men (p < 0.0001). In the period of heavy drinking before hospitalization, women consumed significantly less alcohol then men (p < 0.0001); moreover, women drank nonbeverage alcohol less frequently than men (p < 0.05). Women were hospitalized substantially longer than men (p < 0.0001), whereas the duration of alcohol withdrawal symptoms at the time of hospitalization was comparable in both groups. Withdrawal seizures were significantly more frequent among men than among women (p < 0.001). Significant differences in the patients' somatic conditions were not noted between the groups, with the exception of anemia and decreased potassium concentration, which were more frequently observed in women (both p < 0.0001), and of increased concentration of ALT and hypoproteinemia, which were more frequent in men (respectively, p < 0.05 and p < 0.01). Co-existing personality disorders, depressive disorders, and anxiety disorders--as well as abuse of benzodiazepines and barbiturates--were more frequently observed in women (p < 0.0001). The period between the first hospitalization due to alcohol withdrawal and the time of death was significantly shorter in men than in women (p < 0.05). The results point to differences in the conditions and the course of alcohol dependence and alcohol withdrawal between women and men.

Anxiety in alcohol-dependent patients

Alcoholism and anxiety disorders are concomitant far more frequently than might be expected. The great prevalence of anxiety disorders in alcoholics constitutes an important clinical issue because alcoholic subjects with a coexisting anxiety disorder suffer more frequent and more severe relapses than nonalcoholic control subjects. The former also how greater liability to psychotropic drug abuse and overdose behaviour, and are at greater risk of suicide. The type of relationship between alcohol dependence and anxiety disorders has considerable theoretical meaning. Four possible non-mutually exclusive ways of association are discussed: 1. the ingestion of alcohol may be an attempt at self-medication of anxiety symptoms; 2. anxiety and alcohol abuse may, independent of each other, be based on a third underlying, possibly genetic, factor; 3. anxiety may be a toxic effect of alcohol abuse or of withdrawal; 4. anxiety may result from cognitive processes in connection with alcohol abuse or withdrawal. Clinical guidelines for the pharmacotherapy of anxiety in patients suffering from alcoholism are outlined.

Depression in Young People: Initial Presentation and Clinical Course

This project was designed to provide prospective data on the clinical presentation and longitudinal course of depression in children and adolescents. Children and their parent(s) completed a structured diagnostic interview (Schedule for Affective Disorders and Schizophrenia for School Age Children) at intake, and then yearly for 3 years. Collateral data were collected on school, social, and family functioning. Mean length of initial depressive episode was 35.6 weeks, SD of 26 weeks. Of the 65 depressed youths who completed the 3-year follow-up, 35 (54%) disclosed another episode of depression. Demographic, family-environment, and diagnostic variables were explored as predictors of characteristics of initial episode, recurrence of depression, and psychosocial competence at follow-up. Female gender and presence of a coexisting anxiety disorder were significantly related to severity of initial depression. Family environment was the only predictor significantly related to overall psychosocial competence over 3 years. The findings confirm depression in youth as a valid clinical phenomenon, with substantial risk of recurrence. Increased levels of stress in the family environment were associated with poorer overall outcomes.

Examination of comorbid anxiety in psychiatric inpatients

Seventy-three percent of 90 psychiatric inpatients had a coexisting anxiety disorder. There were few differences between patients with or without coexisting anxiety on more than 100 clinical and demographic variables that were tested. Patients who had an anxiety syndrome before the onset of their major psychiatric disorder also showed few differences when compared with patients whose anxiety started coincident to or after another DSM-III axis I disorder. The concept of primary/secondary anxiety disorder may not be useful when applied to a cross-section of psychiatric inpatients.

Increased severity of alcohol withdrawal in in‐patient alcoholics with a co‐existing anxiety diagnosis

The purpose of this study was to determine whether alcoholics with a co-existing anxiety disorder (dual-diagnosed group) experienced different withdrawal symptomatology from alcoholics without an anxiety disorder (alcohol-only group). Symptoms of alcohol withdrawal were measured on admission to an in-patient treatment program and throughout treatment (days 0, 2, 7, 14 and 21) using the revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale. The dual-diagnosed group exhibited more severe alcohol withdrawal, as indicated by higher total CIWA-Ar scores, at all time points than the alcohol-only group. The possibility that anxiety disorders and alcohol withdrawal share a common neurochemical basis and that the CIWA-Ar scale may be useful as a screening instrument for anxiety disorders in alcoholics is discussed.

Major depression with and without a coexisting anxiety disorder: social dysfunction, social integration, and personality features

Twenty-two inpatients with an acute major depression without an additional lifetime DSM-III axis I diagnosis were compared with 20 inpatients suffering from an acute major depression with a coexistent anxiety disorder. The comparisons focused on social dysfunction, social support, and premorbid personality features. Characteristics of provoking life events and chronic conditions of life during the year before the index admission were analyzed exploratively. Major depressives with an anxiety disorder reported a higher number of abnormal premorbid personality traits such as neuroticism and a tendency towards social isolation; they had fewer confidants and lived alone more frequently than pure major depressives. Furthermore, pure major depressives reported more non-illness-related chronic burdening conditions during the year before the onset of depression than did major depressives with an anxiety disorder. However, there were no differences between the patient groups as to social dysfunction. The results point to fewer personal and social resources of the comorbidity group.

Comparison of DSM-III Separation Anxiety and Overanxious Disorders: Demographic Characteristics and Patterns of Comorbidity

In an initial empirical evaluation of the DSM-III diagnostic categories of separation anxiety disorder (SAD) and overanxious disorder (OAD), the demographic characteristics and patterns of comorbidity associated with the two anxiety diagnoses were examined and compared in a clinical sample of 69 children and adolescents. The two anxiety disorders differed on several dimensions: age, social class, and presence of a coexisting anxiety disorder. Children with SAD were younger and from families of lower socioeconomic status than children with OAD. Children with OAD were much more likely than children with SAD to present with an additional concurrent anxiety disorder, usually simple phobia or panic disorder. Results from this study support the DSM-III distinction between SAD and OAD.

Cholinergic REM induction response: Separation of anxiety and depression

Five groups of subjects underwent EEG sleep recordings, arecoline rapid eye movement (REM) induction response testing, and Schedule for Affective Disorders and Schizophrenia (SADS) interview. Group I: 20 patients with primary major depressive disorder (MDD) (endogenous) without any coexisting anxiety disorder; Group II: 19 primary MDD (endogenous) patients with secondary panic, GAD, or phobic disorders; Group III: 18 patients with primary anxiety disorder without coexisting MDD; Group IV: 14 patients with primary anxiety plus secondary MDD; Group V: 26 normal controls. Modified Research Diagnostic Criteria (RDC) were used for diagnosis, based on the SADS interview. There was considerable overlap of SADS scaled scores between patient groups, which is consistent with a heterogeneous clinical presentation of depressive and anxiety states. REM latency was significantly shorter in patients with primary MDD (without anxiety) as compared with that in patients with primary anxiety (no MDD) and normals. Arecoline REM induction response time was significantly shorter in both primary affective groups (I and II) as compared with primary anxiety (no MDD) patients and normal controls. REM latency and arecoline REM induction time was not significantly different between the primary anxiety groups (III and IV) and normals. The study highlights the use of biological markers in differentiating between clinical syndromes confounded by mixed or overlapping phenomenology.