Number Of Anxiety Disorders Research Articles

Defense reactions to interoceptive threats: A comparison between loaded breathing and aversive picture viewing

Human fear research has mostly applied exteroceptive stimuli to induce fear. Interoceptive sensations however can also be very threatening and play a major role in a number of anxiety disorders. In this study, we compared affective responses to inspiratory resistive loads with those to aversive pictures. During repeated administrations of two loads, a light and a moderate one, and five aversive pictures we measured electrodermal activity, startle blink responses, subjective fear and ratings on valence, arousal and dominance. Results indicate that loads evoke affective reactions comparable or stronger than those evoked by the pictures. Startle data did not follow this pattern with an absence of startle potentiation during the moderate load, suggesting that fear potentiated startle does not occur when the background aversive stimulus is of an interoceptive nature.

Comorbid panic attacks among individuals with posttraumatic stress disorder: Associations with traumatic event exposure history, symptoms, and impairment

Little is known about the prevalence of panic attacks in PTSD and their influence on symptom severity and disability. Utilizing the National Comorbidity Survey-Replication data, respondents meeting DSM-IV criteria for past year PTSD ( n = 203) with and without comorbid panic attacks were compared across various dimensions. Past year panic attacks were found among 35% of the sample and were associated with greater PTSD-related disability and less time spent at work. Panic attacks were also associated with greater prevalence of comorbid depression, substance abuse/dependence, medically unexplained chronic pain, number of anxiety disorders and lifetime traumatic events, PTSD reexperiencing and avoidance/numbing symptoms, and treatment-seeking related to traumatic stress reactions. Multivariate analyses revealed that panic attacks were one of the only unique predictors of severe PTSD-related disability. Overall, findings suggest that panic attacks are common among individuals with PTSD; therapeutic strategies targeting panic in this population may be of significant benefit.

The moderation of an early intervention program for anxiety and depression by specific psychological symptoms.

The current study examined the influence of a number of psychological factors on the effectiveness of an early intervention program targeting anxiety and depression in a non-clinical sample of college students. The early intervention program comprised elements of the cognitive-behavioral analysis system of psychotherapy (McCullough, 2000) delivered in a 2-hour computer-based educational program. Participants completed measures of depression, anxiety, and general distress prior to the intervention program and then again 8 weeks later. Additionally, participants were assessed for past major depression, sleep related difficulties, a number of anxiety disorders, and suicide ideation. Moderation of the effectiveness of the early intervention program by these factors depended on the dependent variable of interest, specifically: the effectiveness of the intervention program on symptoms of depression was moderated by insomnia; symptoms of anxiety by past post-traumatic stress disorder (PTSD) and specific phobia as well as sleep problems related to nightmares; and symptoms of general negative affect by social phobia and suicide ideation. Implications are discussed.

Comorbidity and treatment issues in juvenile bipolar disorder

Juvenile bipolar disorder (BD) is reported to be more treatment-resistant than adult BD, and to show poorer outcome. Predictors of treatment non-response in early onset BD are not well defined. Many potential domains of variables may be considered. Age, gender and age at onset of BD can affect both clinical presentation and pattern of comorbidity, and both these issues may affect the pharmacological response. Some features, which in adult patients with BD are considered predictors of poor treatment response, such as severity, mixed states, psychotic symptoms, and co-morbid substance abuse are particularly frequent in youths, and they also may influence pharmacological response in children and adolescents as well. We explored this issue in a study, conducted in the last 3 years, aimed to explore the role of lifetime comorbid externalizing and internalizing disorders as possible predictors of treatment non-response, in bipolar children and adolescents with manic or mixed episodes. Nonresponders had more frequently co-morbid conduct disorder and/or ADHD. Furthermore, they were globally more severe at baseline and required more frequent addition of antipsychotic medications than treatmentresponder patients. Co-morbid anxiety disorders in our sample did not predict treatment resistance. Interestingly, anxiety disorders and CD were inversely related, with the number of anxiety disorders significantly lower in subjects without CD comorbidity. The use of antipsychotics was associated with treatment non-response, and it was probably related to the severity of the subjects who received these drugs (i.e. higher prevalence of impulsivity, psychomotor agitation, behavioral problems, psychotic symptoms). Different mechanisms can be involved in treatment-resistance of bipolar subjects with co-morbid externalizing disorders. BD plus externalizing disorders may represent a specific subtype, with earlier-onset and resistance to traditional anti-manic and mood stabilizing drugs. Poorer treatment response in BD with co-occurring externalizing disorders may be also accounted for by a more problematic compliance to treatment. Several comorbidities with negative prognostic implications (i.e. substance abuse, antisocial behaviors), which are more frequent in bipolar patients with externalizing disorders, may further affect clinical course. Follow-up studies with larger samples of subjects with BD and/or externalizing disorders appropriately treated with different options are needed to address this important issue. Additional stimulant medication after adequate coverage with mood stabilizers might represent one rational approach to this group of refractory bipolar children. from International Society on Brain and Behaviour: 3rd International Congress on Brain and Behaviour Thessaloniki, Greece. 28 November – 2 December 2007

Emerging anxiolytics

Anxiety disorders are the most common of the psychiatric disorders and are also associated with significant economic costs and impaired work productivity. The first-line pharmacotherapy of pharmatherapy for a number of anxiety disorders comprises selective serotonin re-uptake inhibitors (SSRIs) and serotonin and noradrenaline re-uptake inhibitors (SNRIs). Benzodiazepines are still widely used for the treatment of several anxiety disorders. Although these agents are effective, many patients are treatment-refractory and more effective, better tolerated medications are required. This paper discusses the understandings of mechanisms involved in the anxiety disorders and reviews emerging medications. Mechanisms underlying the use of d-cycloserine, second generation antipsychotics and β-blockers are particularly exciting.

Researchers Link Normal Grief to Major Depression

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessResearchers Link Normal Grief to Major DepressionJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:3 Aug 2007https://doi.org/10.1176/pn.42.15.0028aFor some time now, psychiatric scientists have been making forays into the nether world of bereavement, and their efforts seem to be leading to some clarification of what grief for a loved one is and what it is not.Normal grief for a loved one, for example, does not seem to be the same as complicated or traumatic grief. The latter is characterized by persistent difficulty in accepting the death, recurrent pangs of intense grief, preoccupation with thoughts and images of the deceased, and avoidance of reminders of the loss (Psychiatric News, July 6, 2005; April 6).Also, the depression stemming from complicated grief does not seem to be the same as major depression.On the other hand, depression stemming from normal grief seems to be very closely related to major depression, two psychiatrists now conclude. Sidney Zisook, M.D., a professor of psychiatry at the University of California at San Diego, and Kenneth Kendler, M.D., a professor of psychiatry and human genetics at Virginia Commonwealth University, presented data backing their theory in the June Psychological Medicine.Zisook and Kendler searched all English-language reports in Medline up to November 2006 to identify published data about key characteristics that define bereavement depression and standard major depression. They then compared characteristics for both types of depression.Several of their results indicated that bereavement depression might be a separate disorder from major depression. For example, although women are more vulnerable to major depression, men may be equally as vulnerable to bereavement depression.Most of their analysis, however, suggested that bereavement depression is closely related to major depression. For instance, bereavement depression, like major depression, is more common in younger adults than in older ones, more likely to occur in individuals with a personal or family history of major depression, more likely to occur in persons in poor health than in good health, and more likely to occur in those with little social support.Furthermore, both bereavement depression and major depression are accompanied by heightened adrenocortical activity, impaired immune responses, and sleep disturbances. And bereavement depression has clinical characteristics similar to those of major depression—impaired psychosocial function, comorbidity with a number of anxiety disorders, and symptoms of worthlessness and suicidality.“Overall, the prevailing evidence more strongly supports similarities than differences between bereavement-related depression and standard major depression,” Zisook and Kendler concluded.These findings have important clinical implications, Zisook and Kendler believe. For example, DSM-IV-TR guidelines for diagnosing depression indicate that bereavement depression can only be diagnosed as major depression if it exceeds two months or if specific symptoms, such as suicidal ideation, morbid preoccupation with worthlessness, or psychomotor retardation, are present. Yet if bereavement depression is the same as major depression these guidelines may be invalid.On the other hand, if depression following the death of a loved one should be largely excluded from the definition of major depression, then should depression following other types of losses, say a divorce or bankruptcy, also be excluded from it? Currently, “DSM-IV-TR singles out bereavement as the only stressful life event that excludes the diagnosis of major depressive episode when all other features are present,” Zisook and Kendler noted.“The ideal study to test the validity of the bereavement exclusion,” they pointed out, “would compare individuals with depressive syndromes beginning within two months of the loss of a loved one...[to individuals with] major depressive episodes of similar duration and symptom profile whose onset is unrelated to the death of a loved one.” But “Unfortunately, we found no such studies in the literature,” they said.What about treatment? “The ultimate decision of when, whether, and how to treat the depression,” Zisook told Psychiatric News,“ should be made on the basis of considerations generally used for other, nonbereavement-related depressions, such as past history of depression and response to treatment, severity and chronicity of the episode, comorbidity, anxiety level, suicidal ideation, effects on functioning, supports, et cetera. The decision should not be based on time since the death of a loved one.”Zisook and Kendler's review was not supported by outside funding.An abstract of “Is Bereavement-Related Depression Different Than Non-Bereavement-Related Depression?” is posted at<http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=1018312>.▪ ISSUES NewArchived

Anxiety disorders and suicidal behaviours in adolescence and young adulthood: findings from a longitudinal study

The aim of this study was to estimate the extent to which anxiety disorders contribute to an increase in suicidal behaviour after controlling for both observed and non-observed sources of confounding. Data were collected from the Christchurch Health and Development Study (CHDS), a 25-year longitudinal study of over 1000 participants. Measures of anxiety disorders [phobia, generalized anxiety disorder (GAD), panic disorder], major depression (MD), substance use disorders, conduct/antisocial personality disorder, stressful life events, unemployment, and suicidal ideation/attempts for subjects aged 16-18, 18-21 and 21-25 years were used to fit random and fixed effects regression models of the associations between anxiety disorders and suicidal behaviours. Anxiety disorders were strongly associated with suicidal ideation/attempts. Any single anxiety disorder increased the odds of suicidal ideation by 7.96 times [95% confidence interval (CI) 5.69-11.13] and increased the rate of suicide attempts by 5.85 times (95% CI 3.66-9.32). Control for co-occurring mental disorders, non-observed fixed confounding factors and life stress reduced these associations [suicidal ideation odds ratio (OR) 2.80, 95% CI 1.71-4.58; suicide attempts incidence rate ratio (IRR) 1.90, 95% CI 1.07-3.39]. Rates of suicidal behaviour also increased with the number of anxiety disorders. Estimates of the population attributable risk suggested that anxiety disorders accounted for 7-10% of the suicidality in the cohort. Anxiety disorders may be a risk factor for suicidality, even after controlling for confounding, with risks increasing with multiple anxiety disorders. Management of anxiety disorders may be an important component in strategies to reduce population rates of suicide.

Health Anxiety, Hypochondriasis, and the Anxiety Disorders

Although clinical observations suggest that health-related anxiety is present, to some extent, in a number of anxiety disorders, this relationship has not been examined empirically. The present study therefore utilized the Short Health Anxiety Inventory (SHAI) to elucidate the structure of such symptoms among patients with anxiety disorders and to empirically investigate the presence of health anxiety in various anxiety disorders. Confirmatory factor analysis yielded equivalent support for either a 2-factor or 3-factor model of the SHAI’s latent structure. The measure demonstrated good reliability, convergent validity, and discriminant validity. Comparison of SHAI scores across groups of patients with various anxiety disorders revealed elevated levels of health anxiety among patients with hypochondriasis and panic disorder relative to those with other anxiety disorders. Receiver operating characteristic analyses supported the utility of the SHAI as a diagnostic tool for screening patients with hypochondriasis utilizing empirically derived cut scores. Findings are discussed in terms of cognitive-behavioral models of anxiety disorders.

Dose–response relationship between number of comorbid anxiety disorders in adolescent bipolar/unipolar disorders, and psychosis, suicidality, substance abuse and familiality

Objectives To ascertain rates of panic, obsessive-compulsive (OCD) and social phobic disorders among adolescents with bipolar disorder (BP), unipolar major depressive disorder (MDD) and psychiatric comparison patients, to assess their relationships to suicidality, psychosis, comorbidity patterns and familiality. Methods The first author (SCD) interviewed 313 Latino adolescents using a structured interview based on the SCID. Family history was ascertained by live interview or interview by proxy. Patients were classified as BP, MDD, or non-affectively ill comparison controls (CC). Data regarding suicidality and psychosis were collected. Regression analysis was used to test associations and control for confounding effects. Positive likelihood ratios were used to measure the dose–response relationships between number of anxiety disorders and measures of severity of illness and familial loading for affective illness. Results Of the total sample, 36.7% were BP, 44.7% MDD and 18.5% CC. In BP vs. MDD the odds of panic disorder were 4.4, of OCD 5.1, and of social phobia 3.3. MDD, in turn, were more likely to have these disorders than CC. BP (but not MDD) with panic disorder and social phobia, were more likely to have suicidal ideation; among the anxiety disorders, only social phobia was associated with having greater odds of suicide attempts. Among BP and MDD, patients with all three anxiety disorders were more likely to be psychotic. Presence of any mood disorder among first-degree relatives substantially increased the odds of having panic disorder and social phobia. The presence of one comorbid anxiety disorder increased the odds of having another. Finally, there were dose–response relationships between number of anxiety disorders and measures of severity of illness and familial loading for affective illness. Limitations Single interviewer using the SCID; cross sectional exploratory study. Conclusions BP adolescents have a greater anxiety disorder burden than their MDD counterparts. The results are compatible with the hypothesis that heavy familial–genetic loading for affective illness in juveniles is associated with bipolarity, cumulative anxiety disorder comorbidity, suicidality and psychosis. These observations are in line with pioneering psychopathologic observation in the early 1900s by two French psychiatrists, Gilbert Ballet and Pierre Kahn, who saw common ground between what until then had been considered the distinct categories of the neuroses and cyclothymic (circular) psychoses. This perspective has much in common with current complex genetic models of anxious diatheses in bipolar disorder.

The emergence of tics during escitalopram and sertraline treatment

The selective serotonin reuptake inhibitors (SSRIs) have well-established antidepressant activity and have also demonstrated efficacy in a number of anxiety disorders, including panic disorder. The SSRIs, escitalopram and sertraline, are well-tolerated and movement disorders are rarely associated with their use. We present a case of the emergence of tics associated with escitalopram and sertraline treatment, which might be due to an imbalance in the dopaminergic neurotransmitter system.

Treating Anxiety Disorders Might Prevent Depression

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessTreating Anxiety Disorders Might Prevent DepressionJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:2 Jul 2004https://doi.org/10.1176/pn.39.13.0390046aWhile it is common knowledge that anxiety and depression are related, exactly how remains in question.A new German study, published in the May Journal of Clinical Psychiatry, has one answer: A number of anxiety disorders appear to be capable of triggering a major depression.The study was a joint collaborative program between the Max Planck Institute of Psychiatry and the Institute of Clinical Psychology and Psychotherapy at Dresden Technical University. Some 2,500 adolescents and young adults living in the Munich, Germany, area were included in the investigation. At the start of the study, the Munich-Composite International Diagnostic Interview was used to determine whether the subjects had experienced any of five DSM-IV anxiety disorders—generalized anxiety disorder, panic disorder, agoraphobia, social phobia, or specific phobia. Subjects were assessed again with the interview instrument one to two years later, then again three to four years later to learn whether they had experienced a major depressive disorder since the study began. The researchers then attempted to see whether they could find any relationship between having an anxiety disorder at the start of the study and subsequently developing a major depressive disorder.The researchers found a significantly increased risk of developing a major depressive disorder if one had had, prior to that time, generalized anxiety disorder, panic disorder, agoraphobia, social phobia, or a specific phobia. Generalized anxiety disorder showed the strongest link, followed by panic disorder, then agoraphobia, social phobia, and finally specific phobia.Also, respondents with two or more anxiety disorders at the start of the study were found to have a significantly higher risk of a major depressive disorder compared with individuals with one anxiety disorder at that time. What's more, subjects with severe disabling anxiety were significantly more at risk of depression than were subjects with less-crippling anxiety.How might anxiety trigger depression? The researchers speculated on several possible mechanisms. For example, early-onset panic disorder might dysregulate the neurotransmitter serotonin, leading in turn to depression. Or anxiety might lead to reduced academic or occupational performance and fewer social interactions, and these effects in turn might trigger a depression.The clinical implications of their findings, the investigators pointed out in their study report, are that “effective treatment of anxiety disorders, specifically those associated with extreme disability, might be important for targeted primary prevention of major depressive disorder.”The study was financed by the German Ministry of Research and Technology and the National Institute of Mental Health.The study, “What Characteristics of Primary Anxiety Disorders Predict Subsequent Major Depressive Disorder?,” can be accessed online at<www.psychiatrist.com> by clicking on “Recent Tables of Contents” and then the May issue. ▪ ISSUES NewArchived

Factors associated with high use of public mental health services by persons with borderline personality disorder.

The research presented here was a pilot study to identify clinical factors associated with high use (as opposed to lower use) of inpatient psychiatric services by persons with borderline personality disorder. The initial sample was a random sample of English- and Spanish-speaking persons aged 18 to 60 years who had received at least one outpatient mental health service in the previous 90-day period and were enrolled in one of the participating mental health centers in King County, Washington. A random sample of persons who met selection criteria was randomly drawn; persons with high levels of use were oversampled to ensure adequate representation. Twenty-nine participants met full criteria for borderline personality disorder on the Personality Disorders Examination structured interview and completed all measures. Fifteen (52 percent) of these had a high level of use of inpatient services, and 14 did not. High use of inpatient psychiatric services was predicted by a history of parasuicide in the previous two years but not by the number or severity of parasuicides; by the presence and number of anxiety disorders but not by depression or psychotic or substance use disorders; and by poorer cognitive functioning. Life stressors, global functioning, and health service variables did not differentiate patients with high levels of service use from other patients with borderline personality disorder. Further research should explore these predictors of service use to determine whether they are replicated in larger samples, and treatments that target these variables should be evaluated.

Clinical Characteristics of Patients with Major Affective Disorders and Comorbid Migraine

The present study was undertaken to examine the clinical characteristics of patients with major affective disorders and comorbid migraine. Patients (n = 102) with an index episode of either major depression or mania were interviewed with a semi-structured interview based partly on DSM-IV criteria and partly on Akiskal's criteria for affective temperaments. Compared to the patients without migraine (n = 49), the patients with comorbid migraine (n - 53) had a higher frequency of bipolar II disorder (43% vs. 10%), a lower frequency of bipolar I disorder (11% vs. 33%), an approximately equal frequency of unipolar depressive disorder (45% vs. 57%) and a higher frequency of affective temperaments (45% vs. 22%). The migraine patients also had a greater number of anxiety disorders (3.0 vs. 1.9) and a higher frequency of panic disorder and agoraphobia. Gender distribution, age, age at onset of first affective episode, number of previous episodes and symptoms during depressive episodes were similar in both groups. Based on these findings it is suggested that the presence of migraine may be used to delineate a distinct subgroup of the major affective disorders.