... Loss Surgery? A Week of Healthy Breakfasts Shyness Anxiety Disorders KidsHealth > For Teens > Anxiety Disorders A A ... Do en español Trastornos de ansiedad What Is Anxiety? Liam had always looked out for his younger ...
Klein, Rachel G.
Because of their high prevalence and their negative long-term consequences, child anxiety disorders have become an important focus of interest. Whether pathological anxiety and normal fear are similar processes continues to be controversial. Comparative studies of child anxiety disorders are scarce, but there is some support for the current…
... Anxiety, anxiety disorders, anxious, behavior therapy, GAD, generalized anxiety disorder, mental health neuroses, mood disorders, psychiatric disorder, psychotherapy Family Health, Men, Seniors, Women January 1996 Copyright © American Academy of Family PhysiciansThis ...
Full Text Available Anxiety disorders are a highly prevalent and disabling class of psychiatric disorders. Anxiety disorders are highly prevalent and associated with substantial distress, morbidity and mortality. Recent epidemiological studies of anxiety disorders provided evidence of their high frequency in the general population worldwide. Anxiety disorders afflict an estimated 15.7 million people in the United States each year. Anxiety disorders are highly prevalent in adults with females showing higher preponderance of 2:1 as compared to males. Anxiety disorders are a group of mental disorders characterized by various combinations of key features - Irritability, fear, Insomnia, Nervousness, Tachycardia, Inability to concentrate, poor coping skills, Palpitation, Sweating, Agoraphobia and Social Withdrawal. The anxiety disorders, including panic disorder (PD, generalized anxiety disorder (GAD, social anxiety disorder (SAD, and posttraumatic stress disorder (PTSD, are among the disabling medical disorders. The neurobiology of anxiety disorders is not fully understood, but several different biologic abnormalities have been implicated in their etiology. The GABA, NE and 5HT systems play crucial roles in mediating the affective circuitry underlying the highly related clinical disorders of anxiety. Anxiety is a common psychiatric condition characterized by unnecessary aggression, poor quality of life, fear, worry, avoidance, and compulsive rituals that are associated with significant distress.
... to participate in social functions. Social anxiety disorder affects the ability to function in work and relationships. ... Alcohol or other drug use may occur with social anxiety disorder. Loneliness and social isolation may occur.
Stacey A. Hofflich
Full Text Available Los síntomas somáticos en niños han sido asociados con trastornos de interiorización, especialmente de ansiedad. Sin embargo, pocos estudios han examinado los síntomas somáticos precisos en trastornos de ansiedad específicos. Desde este estudio cuasi-experimental se examinan el tipo y la frecuencia de síntomas somáticos en niños (n = 178; rango de edad 714 años con trastorno generalizado de ansiedad (TAG, fobia social (FS, ansiedad de separación (AS y sin ningún trastorno de ansiedad. Los niños y sus padres, que acudieron en busca de tratamiento, completaron una entrevista diagnóstica estructurada, los niños completaron además la Multidimensional Anxiety Scale for Children (MASC (March, Parker, Sullivan, Stallings, y Conners. Los niños diagnosticados con un trastorno de ansiedad informaron de síntomas somáticos más frecuentes que aquellos sin trastorno de ansiedad, pero los síntomas somáticos no difirieron entre los principales grupos de trastornos de ansiedad. Los niños con trastornos de ansiedad y depresivos comórbidos manifestaron síntomas somáticos más frecuentemente que aquellos sin trastornos comórbidos. Se discuten los resultados en términos de los síntomas somáticos como a criterios dentro del sistema diagnóstico, y b parte del proceso de evitación.
Nauta, M.H.; Emmelkamp, P.M.G.; Sturmey, P.; Hersen, M.
Separation anxiety disorder (SAD) is the only anxiety disorder that is specific to childhood; however, SAD has hardly ever been addressed as a separate disorder in clinical trials investigating treatment outcome. So far, only parent training has been developed specifically for SAD. This particular t
Engel, Kirsten; Bandelow, Borwin; Gruber, Oliver; Wedekind, Dirk
Neuroimaging studies have gained increasing importance in validating neurobiological network hypotheses for anxiety disorders. Functional imaging procedures and radioligand binding studies in healthy subjects and in patients with anxiety disorders provide growing evidence of the existence of a complex anxiety network, including limbic, brainstem, temporal, and prefrontal cortical regions. Obviously, "normal anxiety" does not equal "pathological anxiety" although many phenomena are evident in healthy subjects, however to a lower extent. Differential effects of distinct brain regions and lateralization phenomena in different anxiety disorders are mentioned. An overview of neuroimaging investigations in anxiety disorders is given after a brief summary of results from healthy volunteers. Concluding implications for future research are made by the authors.
... a serious disease is unreasonable or unfounded. Illness anxiety disorder is different from somatic symptom disorder. With somatic symptom disorder, the person has physical pain or other symptoms, but the medical cause is not found. Exams and Tests The doctor or nurse will examine you and ...
Becker, E.S.; Roth, W.T.; Andrich, M.; Margraf, J.
Two experiments were conducted to study selective memory bias favoring anxiety-relevant materials in patients with anxiety disorders. In the 1st experiment, 32 patients with generalized anxiety disorder (GAD), 30 with social phobia (speaking anxiety), and 31 control participants incidentally learned
Peretti, C S
Anxious subjects present attentional disorders that are manifest with an increased bias towards threatening contents stimuli. In tasks derived from the Stroop task (such as emotional Stroop, a variant of the classic Stroop task) congruence between anxious themes or manifestations and stimuli content induces information processing changes leading to a slowness of response speed. In this case, results are similar to those obtained in signal detection tasks either when information is visually or auditorily presented. In anxious subjects an inconscious activation provoked by anxiogenic words is observed. Because such activation is independent from the semantic content of the words, an emotional priming has been hypothesized. Berck formulated an hypervigilance theory according to which anxiety provokes a selective distractibility regarding non pertinent stimuli. Such attentional selectivity would be responsible of a cognitive vulnerability in anxious subjects. State but not trait anxiety induces working memory performances deficit. On the bases of Baddeley's working memory framework, Eysenck proposed that anxiety uses part of the limited attentional capacity, placing the subject in a dual task situation. In that, he has to cope with pertinent information and anxiety generated information. If anxiety leads to better performance in simple tasks by recruiting motivational capacities, in tasks with high information content, anxious subjects performances are impaired. Changes in the long-term memory do not seem to fit with the theoretical models based on cognitive impairment observed in patients suffering from depressive states. Anxious subjects presented a memory bias towards anxiogenic information in implicit memory tasks. But experimental data are still too searce to describe implicit performance of anxious subjects and more systematic studies are therefore needed.
An evidence-based review of nonpharmacological treatments for anxiety disorders is presented. The vast majority of the controlled research is devoted to cognitive behavior therapy (CBT) and shows its efficiency and effectiveness in all the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) anxiety disorders in meta-analyses. Relaxation, psychoanalytic therapies, Rogerian nondirective therapy, hypnotherapy and supportive therapy were examined in a few controlled stu...
... Disorder Specific Phobias Obsessive-Compulsive Disorder (OCD) Posttraumatic Stress Disorder (PTSD) Depression Bipolar Disorder Suicide and Prevention Stress Related Illnesses Myth-Conceptions Find ...
... Disorder Specific Phobias Obsessive-Compulsive Disorder (OCD) Posttraumatic Stress Disorder (PTSD) Depression Bipolar Disorder Suicide and Prevention Stress Related Illnesses Myth-Conceptions Find ...
O'Neil, Kelly A.; Puleo, Connor M.; Benjamin, Courtney L.; Podell, Jennifer L.; Kendall, Philip C.
Evidence is mixed regarding an independent association between anxiety and suicidality in youth. Study 1 examined suicidal ideation in treatment-referred, anxiety-disordered youth (N = 312, aged 7-17). Forty-one percent of anxiety-disordered youth endorsed suicidal ideation. Anxiety disorder severity, global impairment, and current depressive…
The fifth edition of Diagnostic and Statistical Manual, the DSM-5 appeared officially in May 2013 during the development of the 166th Annual Meetingof the American Psychiatric Association (APA) in San Francisco. The drafting process was long and complex; much of the debate became public so that the expectations were great. And it must be said that the new edition did not disappoint, as many changes were made in relation to their predecessors. In Chapter of Anxiety Disorders, which is reviewed in this article, the changes were significant. Obsessive-compulsive disorder and Stress-related disorders were excluded and new clinical pictures, such as separation anxiety disorder and selective mutism, were included. And took place was the long awaited split between panic disorder and agoraphobia, now two separate disorders.
An evidence-based review of nonpharmacological treatments for anxiety disorders is presented. The vast majority of the controlled research is devoted to cognitive behavior therapy (CBT) and shows its efficiency and effectiveness in all the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) anxiety disorders in meta-analyses. Relaxation, psychoanalytic therapies, Rogerian nondirective therapy, hypnotherapy and supportive therapy were examined in a few controlled studies, which preclude any definite conclusion about their effectiveness in specific phobias, agoraphobia, panic disorder, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD), CBT was clearly better than psychoanalytic therapy in generalized anxiety disorder (GAD) and performance anxiety Psychological debriefing for PTSD appeared detrimental to the patients in one high-quality meta-analysis. Uncontrolled studies of psychosurgery techniques for intractable OCD demonstrated a limited success and detrimental side effects. The same was true for sympathectomy in ereutophobia. Transcranial neurostimulation for OCD is under preliminary study. The theoretical and practical problems of CBT dissemination are discussed.
Hughes, Alicia A.; Furr, Jami M.; Sood, Erica D.; Barmish, Andrea J.; Kendall, Philip C.
Examined the prevalence of anxiety, mood, and substance use disorders in the parents of anxiety disordered (AD) children relative to children with no psychological disorder (NPD). The specificity of relationships between child and parent anxiety disorders was also investigated. Results revealed higher prevalence rates of anxiety disorders in…
Grant, Joe E.; Odlaug, Brian Lawrence
may differentially impact men (Grant and Potenza 2007 ), the goal of this chapter is to discuss the role of gender in our understanding and treating of anxiety disorders. Specifically, we will be discussing the impact of gender on social anxiety disorder, panic disorder, generalized anxiety disorder...
Stein, Murray B
Generalized anxiety disorder (GAD) is a common illness with diagnostic criteria that have changed substantially over time. Symptoms of GAD overlap with those of major depressive disorder to such an extent that studying one disorder without studying the other may be impossible. Such an overlap, combined with potentially inappropriate diagnostic criteria for GAD, makes diagnosing and researching GAD challenging. Recent research into the genetics and neural circuitry of GAD may suggest solutions for the disorder's diagnostic controversies and point the way to productive future studies of etiology and pathophysiology.
Hofmann, S.G.; Smits, J.A.J.; Asnaani, A.; Gutner, C.A.; Otto, M.W.
Cognitive-behavioral therapy is an effective intervention for anxiety disorders. However, a significant number of people do not respond or only show partial response even after an adequate course of the treatment. Recent research has shown that the efficacy of the intervention can be improved by the
J.S. Legerstee; N. Garnefski; F.C. Jellesma; F.C. Verhulst; E.M.W.J. Utens
To investigate differences in cognitive coping strategies between anxiety-disordered and non-anxious 9-11-year-old children. Additionally, differences in cognitive coping between specific anxiety disorders were examined. A clinical sample of 131 anxiety-disordered children and a general population s
Full Text Available Introduction. Anxiety, as a primary symptom, includes all conditions of indefinite fear and psychic disorders dominated by fear. All dialysis patients suffer from anxiety as an independent phenomenon, or as part of another disease. Material and Methods. This study included 753 patients on chronic hemodialysis in Bosnia and Herzegovina (B&H in the period 1999-2004. The patients were divided into two groups: the first group included 348 patients with Balkan Endemic Nephropathy (BEN, and the control group included 405 patients with other diagnoses causing renal insufficiency (N18. The study was designed as a comparative cross sectional study, and patients were tested using questionnaires assessing anxiety, depression and general mental health status. Statistical analysis was done using standard descriptive and analytical methods. Results. Socio-demographic data showed highly significant differences between BEN and N18 in relation to place of residence (urban/rural (c2 = 23.970 p<0.01; in the incidence of renal comorbidity (c2 = 23.970 p<0.01; familial renal comorbidity (c2 = 23.970 p<0.01; and migrations (c2 = 4.874 p<0.01. Beck Anxiety Inventory Scores were highly significantly different between the two groups p<0.001, in regard to the incidence and variables. Hamilton Depression Rating Scale demonstrated a group significance p<0.001, and variables pointed to somatization, general anxiety and depression. This was confirmed by mini-mental state examination pointing to generalmental weakness. Conclusion. Anxiety appeared in all tested dialysis patients. It may be independent, somatized as part of another mental disorder or reinforced by a cognitive damage. Structured anxiety and depression result in pre-suicidal risk. .
Rubinchik, Sofya M.; Kablinger, Anita S.; Gardner, J. Suzette
Objective: Approximately 30% of women experience some type of anxiety disorder during their lifetime. In addition, some evidence exists that anxiety disorders can affect pregnancy outcomes. This article reviews the literature on the course of generalized anxiety disorder (GAD) and panic disorder during pregnancy and the postpartum period and presents guidelines for management.
Autism Spectrum Disorders; Autism; Asperger's Syndrome; Pervasive Developmental Disability - Not Otherwise Specified; Obsessive-compulsive Disorder; Social Phobia; Generalized Anxiety Disorder; Specific Phobia; Separation Anxiety Disorder
Christmas, David M; Hood, Sean D
Anxiety disorders are common and debilitating mental illnesses. Current pharmacological treatments are beset by problems of poor efficacy and side effect profiles. Increasing understanding of novel neurotransmitter systems and the interplay between these systems is broadening the scope of anxiolytic drug treatment. This article aims to describe the areas of current interest and possible future development of anxiolytic drugs by outlining recent patents in this field. A patent database was searched for 17 neurotransmitters and their synonyms as well as 23 compounds of recent known interest from May 2003 to May 2005. The internet resources Pubmed and Google Scholar were searched for peer reviewed literature using the same search parameters. Results were grouped into neurotransmitter systems to present an overview of recent developments in the neuropharmacology of anxiety disorders.
Calamari, John E.; Rector, Neil A.; Woodard, John L.; Cohen, Robyn J.; Chik, Heather M.
Anxiety sensitivity (AS), a cognitive risk factor for anxiety disorders, was evaluated in a homogeneous obsessive-compulsive disorder (OCD) sample. A total of 280 individuals with OCD completed measures. Evaluation of the Anxiety Sensitivity Index revealed a latent structure that was congruent with previous studies showing a single higher order…
... anxiety disorder. "Everybody has anxiety," says Dr. Daniel Pine, a psychiatrist and an NIH neuroscientist. "The tricky ... people visit their doctors because of headaches, racing heart, or other physical complaints without realizing that these ...
Lin, En-Ju D
In addition to the classical neurotransmitters, neuropeptides represent an important class of modulators for affective behaviors and associated disorders, such as anxiety disorders. Many neuropeptides are abundantly expressed in brain regions involved in emotional processing and anxiety behaviors. Moreover, risk factors for anxiety disorders such as stress modulate the expression of various neuropeptides in the brain. Due to the high prevalence of anxiety disorders and yet limited treatment options, there is a clear need for more effective therapeutics. In this regard, the various neuropeptides represent exciting candidates for new therapeutic designs. In this review, I will provide an up-to-date summary on the evidences for the involvement of seven neuropeptides in anxiety: corticotropin-releasing factor, urocortins, vasopressin, oxytocin, substance P, neuropeptide Y and galanin. This review will cover the behavioral effects of these neuropeptides in animal models of anxiety by both genetic and pharmacological manipulations. Human studies indicating a role for these neuropeptides in anxiety disorders will also be discussed.
K. Hek (Karin)
textabstractAnxiety disorders and depression are common and complex disorders. Despite decades of research, their etiology is largely unknown. Study of the occurrence and determinants, i.e. the epidemiology of anxiety disorders and depression, helps unravel their etiology. This thesis examines the e
Vogelzangs, N.; Beekman, A. T. F.; de Jonge, P.; Penninx, Brenda
Although anxiety disorders, like depression, are increasingly being associated with metabolic and cardiovascular burden, in contrast with depression, the role of inflammation in anxiety has sparsely been examined. This large cohort study examines the association between anxiety disorders and anxiety
Kindt, M.; Bögels, S.M.; Morren, M.
The present study examined processing bias in children suffering from anxiety disorders. Processing bias was assessed using of the emotional Stroop task in clinically referred children with separation anxiety disorder (SAD), social phobia (SP), and/or generalised anxiety disorder (GAD) and normal co
Özgün Karaer KARAPIÇAK
Full Text Available Objective: Health anxiety is the fear of being or getting seriously sick due to the misinterpretation of physical symptoms. Severe health anxiety is also named as hypochondriasis. Belief of having a disease due to the misinterpretation of physical symptoms is also seen in panic disorder and somatization disorder. The aim of this study is to search the health anxiety in panic disorder, somatization disorder and hypochondriasis and compare it with healthy volunteers. Method: SCID-I was used to determine psychiatric disorders in patient group. In order to assess the clinical state and disease severity of the patient group; Panic and Agoraphobia Scale, Hamilton Anxiety Rating Scale, Inventory of Depressive Symptomatology were used for patients with panic disorder and Symptom Interpretation Questionnaire, Hamilton Anxiety Rating Scale, Inventory of Depressive Symptomatology were used for patients with somatization disorder and hypochondriasis. Brief Symptom Inventory was used to assess psychopathology in healthy group. In order to evaluate health anxiety of both groups, Health Anxiety Inventory-Short Form was used. Results: Results of this study support that health anxiety is a significant major component of hypochondriasis. On the other hand, health anxiety seems to be common in panic disorder and somatization disorder. Health anxiety also may be a part of depression or present in healthy people. Conclusion: Further studies are needed in order to search how to manage health anxiety appropriately and which psychotherapeutic interventions are more effective.
Verduin, Timothy L.; Kendall, Philip C.
Examined three aspects of childhood anxiety and peer liking: (1) whether or not children can detect anxiety in age-mates, (2) the degree to which peer-reported anxiety, self-reported anxiety, and presence of anxiety disorders are associated with peer liking, and (3) whether or not self-reported anxiety and presence of anxiety disorders are…
Meier, Sandra M; Mattheisen, Manuel; Mors, Ole;
BACKGROUND: Anxiety disorders and depression are the most common mental disorders worldwide and have a striking impact on global disease burden. Although depression has consistently been found to increase mortality; the role of anxiety disorders in predicting mortality risk is unclear. AIMS......: To assess mortality risk in people with anxiety disorders. METHOD: We used nationwide Danish register data to conduct a prospective cohort study with over 30 million person-years of follow-up. RESULTS: In total, 1066 (2.1%) people with anxiety disorders died during an average follow-up of 9.7 years....... The risk of death by natural and unnatural causes was significantly higher among individuals with anxiety disorders (natural mortality rate ratio (MRR) = 1.39, 95% CI 1.28-1.51; unnatural MRR = 2.46, 95% CI 2.20-2.73) compared with the general population. Of those who died from unnatural causes, 16.5% had...
Alkozei, Anna; Creswell, Cathy; Cooper, Peter J.; Allen, John J.B.
Background Psychophysiological theories suggest that individuals with anxiety disorders may evidence inflexibility in their autonomic activity at rest and when responding to stressors. In addition, theories of social anxiety disorder, in particular, highlight the importance of physical symptoms. Research on autonomic activity in childhood (social) anxiety disorders, however, is scarce and has produced inconsistent findings, possibly because of methodological limitations. Method The present study aimed to account for limitations of previous studies and measured respiratory sinus arrhythmia (RSA) and heart rate (HR) using Actiheart heart rate monitors and software (Version 4) during rest and in response to a social and a non-social stressor in 60 anxious (30 socially anxious and 30 ‘other’ anxious), and 30 nonanxious sex-and age-matched 7–12 year olds. In addition, the effect of state anxiety during the tasks was explored. Results No group differences at rest or in response to stress were found. Importantly, however, with increases in state anxiety, all children, regardless of their anxiety diagnoses showed less autonomic responding (i.e., less change in HR and RSA from baseline in response to task) and took longer to recover once the stressor had passed. Limitations This study focused primarily on parasympathetic arousal and lacked measures of sympathetic arousal. Conclusion The findings suggest that childhood anxiety disorders may not be characterized by inflexible autonomic responding, and that previous findings to the contrary may have been the result of differences in subjective anxiety between anxious and nonanxious groups during the tasks, rather than a function of chronic autonomic dysregulation. PMID:25590763
Stein, Dan J
Obsessive-compulsive disorder is currently classified as an anxiety disorder. However, there is growing interest in the concept of an obsessive-compulsive spectrum of disorders (OCSDs). The relationship between anxiety disorders and OCSDs has been questioned. The psychobiology of anxiety disorders and OCSDs is briefly reviewed in this article. While there appear to be several distinct contrasts in the underlying psychobiology of these conditions, there is also evidence of overlapping mechanisms. In addition, there are crucial gaps in our current database, confounding nosological decision-making. Conceptualizing various anxiety disorders and putative OCSDs as lying within a broader spectrum of emotional disorders may be useful. However, clinicians must also recognize that individual anxiety and obsessive-compulsive spectrum conditions, including disorders characterized by body-focused repetitive behaviors, have distinct psychobiological underpinnings and require different treatment approaches.
Bičíková, M; Dušková, M; Vítků, J; Kalvachová, B; Řípová, D; Mohr, P; Stárka, L
Reduced levels of vitamin or its metabolites have been reported in various psychiatric disorders. Insufficient levels of vitamin D in depressive patients have been confirmed by many authors, but there have been conflicting results in subjects with anxiety disorders. In the present cross-sectional study, levels of calcidiol were determined in groups of depressive men and women and in men and women with anxiety disorders and compared with age matched controls. Significantly lower levels of calcidiol were found in men and women with depression as well as in age matched patients with anxiety disorders.
Hofmeijer-Sevink, Mieke Klein; Batelaan, Neeltje M.; van Megen, Harold J. G. M.; Penninx, Brenda W.; Cath, Danielle C.; van den Hout, Marcel A.; van Balkom, Anton J. L. M.
Background: To study the clinical relevance of type of comorbidity and number of comorbid disorders in anxiety disorders. Four groups were compared according to sociodemographic-, vulnerability- and clinical factors: single anxiety disorder, anxiety-anxiety comorbidity, anxiety-depressive comorbidit
Hogendoorn, Sanne M; Prins, Pier J M; Vervoort, Leentje; Wolters, Lidewij H; Nauta, Maaike H; Hartman, Catharina A; Moorlag, Harma; de Haan, Else; Boer, Frits
Negatively valenced thoughts are assumed to play a central role in the development and maintenance of anxiety. However, the role of positive thoughts in anxiety is rather unclear. In the current study we examined the role of negative and positive self-statements in the anxiety level of anxious and non-anxious children. Participants were 139 anxiety disordered children and 293 non-anxious children (8-18 years). Compared to non-anxious children, anxious children reported more negative thoughts, less positive thoughts and lower State of Mind (SOM) ratios (ratio of positive to negative thoughts). Negative thoughts and SOM ratios were the strongest predictors of anxiety level in anxious children; whereas both negative and positive thoughts were the strongest predictors of anxiety level in non-anxious children. To conclude, a lack of positive thoughts might be more than just an epiphenomenon of anxiety level and might deserve a place in the cognitive model of anxiety.
Stoddard, Joel; Stringaris, Argyris; Brotman, Melissa A.; Montville, Daniel; Pine, Daniel S.; Leibenluft, Ellen
Background: Our objective was to compare self- and parent-reported irritability in youths with anxiety disorders, healthy youths, and those with mood disorders characterized by irritability. Irritability is a common but relatively understudied psychiatric symptom in child and adolescent anxiety disorders. In anxious youths, little is known about the severity of irritability, its impact on functioning, or the effect of informant source on reports of irritability. Method: We compared parent- an...
Baldwin, David S; Gordon, Robert; Abelli, Marianna; Pini, Stefano
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) categorization of mental disorders places "separation anxiety disorder" within the broad group of anxiety disorders, and its diagnosis no longer rests on establishing an onset during childhood or adolescence. In previous editions of DSM, it was included within the disorders usually first diagnosed in infancy, childhood, or adolescence, with the requirement for an onset of symptoms before the age of 18 years: symptomatic adults could only receive a retrospective diagnosis, based on establishing this early onset. The new position of separation anxiety disorder is based upon the findings of epidemiological studies that revealed the unexpectedly high prevalence of the condition in adults, often in individuals with an onset of symptoms after the teenage years; its prominent place within the DSM-5 group of anxiety disorders should encourage further research into its epidemiology, etiology, and treatment. This review examines the clinical features and boundaries of the condition, and offers guidance on how it can be distinguished from other anxiety disorders and other mental disorders in which "separation anxiety" may be apparent.
The diploma thesis presents all important literature that deals with socially anxious children who have speech disorders. The term social anxiety is defined based on anxiety in general. There are different interpretations of both terms. But the fact is that we talk about social anxiety when a person experiences fear, tension in social situations. He has a feeling that others value and test him whereas he will not be able to meet their standards. He is afraid and expects criticism, reprima...
Forbes, Erika E.; Bertocci, Michele A.; Gregory, Alice M.; Ryan, Neal D.; Axelson, David A.; Birmaher, Boris; Dahl, Ronald E.
A study to examine sleep problems encountered in anxiety and depressive disorders among children and adolescents is conducted. Results indicated subjective and objective sleep problems in children and adolescents with anxiety disorders and need to be kept in mind when treating young anxious people.
... other times, it develops into panic attacks and phobias. Identifying the Signs Anxiety disorders vary from teenager ... may begin to avoid normal activities and routines. Phobias Many fears of younger children are mild, passing, ...
Full Text Available The issue of co-morbidity in Anxiety and Depression as disorders leads to questions about the integrity of their present taxonomies in mental health diagnostics. At face value the two appear to have discrete differences, yet nonetheless demonstrate a high co-morbidity rate and shared symptoms implying pathological similarities rather than that of chance. Reviewing evidence from behavioural, neural, and biological sources that elaborate on the aspects of these two constructs, helps to illustrate the nature of these apparent differences and similarities. Integrating evidence from the anxiety and depression literature with the pathological process best illustrated by the burnout theory, alongside with support from the neurobiology of anxiety and stress, presents a proposition of a basic and natural anxiety pathology that when excessive, may result in the symptoms psychology has come to know as representative of anxiety and depressive disorders.
Hofmann, Stefan G; Anu Asnaani, M A; Hinton, Devon E
To examine cultural aspects in social anxiety and social anxiety disorder (SAD), we reviewed the literature on the prevalence rates, expressions, and treatments of social anxiety/SAD as they relate to culture, race, and ethnicity. We further reviewed factors that contribute to the differences in social anxiety/SAD between different cultures, including individualism/collectivism, perception of social norms, self-construal, gender roles, and gender role identification. Our review suggests that the prevalence and expression of social anxiety/SAD depends on the particular culture. Asian cultures typically show the lowest rates, whereas Russian and US samples show the highest rates, of SAD. Taijin kyofusho is discussed as a possible culture-specific expression of social anxiety, although the empirical evidence concerning the validity of this syndrome has been mixed. It is concluded that the individual's social concerns need to be examined in the context of the person's cultural, racial, and ethnic background in order to adequately assess the degree and expression of social anxiety and SAD. This has direct relevance for the upcoming DSM-V.
Nathalie P. Lizeretti; María Vázquez Costa; Ana Gimeno-Bayón
Anxiety disorders (AD) are by far the most frequent psychiatric disorders, and according to epidemiologic data their chronicity, comorbidities, and negative prognostic constitute a public health problem. This is why it is necessary to continue exploring the factors which contribute to the incidence, appearance, and maintenance of this set of disorders. The goal of this study has been to analyze the possible relationship between Emotional Intelligence (EI) and personality disorders (PersD) in ...
Hofmann, Stefan G; Hinton, Devon E
A person's cultural background influences the experience and expression of emotions. In reviewing the recent literature on cross-cultural aspects of anxiety disorders, we identified some culturally related ethnopsychology/ethnophysiology factors (the culture's conceptualizations of how the mind and body function) and contextual factors that influence anxiety disorders. Ethnopsychology/ethnophysiology factors include the person's ideas about the mental and bodily processes (and their interaction), whereas contextual factors are associated with the social norms and rules that may contribute to anxiety, including individualism vs. collectivism and self-construals. From the perspective of ethnopsychology/ethnophysiology and contextual factors, we will discuss "khyâl cap" ("wind attacks"), taijin kyofusho, and ataques de nervios, three prominent examples of culture-specific expressions of anxiety disorders that have all been included in the DSM-5 list of cultural concepts of distress.
Bögels, S.M.; Knappe, S.; Clark, L.A.
Unlike other DSM-IV anxiety disorders, separation anxiety disorder (SAD) has been considered a disorder that typically begins in childhood, and could be diagnosed only in adults "if onset is before 18." Moreover, SAD is the only DSM-IV anxiety disorder placed under "Disorders Usually First Diagnosed
Kossowsky, Joe; Wilhelm, Frank H.; Roth, Walton T.; Schneider, Silvia
Background: Separation anxiety disorder (SAD) is one of the most common anxiety disorders in childhood and is predictive of adult anxiety disorders, especially panic disorder. However, the disorder has seldom been studied and the attempt to distinguish SAD from other anxiety disorders with regard to psychophysiology has not been made. We expected…
I. Lindhout; M. Markus; T. Hoogendijk; S. Borst; R. Maingay; P. Spinhoven; R. van Dyck; F. Boer
This study investigated whether anxiety-disordered (AD) parents differ in their childrearing style from non-disordered parents. A clinical sample of 36 AD parents with children aged 6-18 was compared with a normal control sample of 36 parents. Childrearing was assessed through parent report and chil
Affrunti, Nicholas W; Woodruff-Borden, Janet
Although perfectionism has been identified as a factor in many psychiatric disorders across the life span, it is relatively understudied in pediatric anxiety and depressive disorders. Furthermore, there exists little cohesion among previous research, restricting the conclusions that can be made across studies. In this review, research associating perfectionism with pediatric anxiety and depression is examined and a framework is presented synthesizing research to date. We focus on detailing the current understanding of how perfectionism develops and interacts with other developmental features characteristic of anxiety and depression in children and potential pathways that result in anxiety and depressive disorders. This includes: how perfectionism is measured in children, comparisons with relevant adult literature, the development of perfectionism in children and adolescents, mediators and moderators of the link between perfectionism and anxiety and depression, and the role of perfectionism in treatment and prevention of these disorders. We also present research detailing perfectionism across cultures. Findings from these studies are beginning to implicate perfectionism as an underlying process that may contribute broadly to the development of anxiety and depression in a pediatric population. Throughout the review, difficulties, limitations, and gaps in the current understanding are presented while offering suggestions for future research.
Christiansen, Dorte Mølgaard
), specific phobia (SP), social anxiety disorder (SAD), generalised anxiety disorder (GAD), obsessive-compulsive disorder (OCD), and acute and posttraumatic stress disorder (ASD and PTSD), although the latter three are technically no longer categorised as anxiety disorders according to DSM-5. This chapter...... provides an overview of research on sex and gender differences in anxiety disorders ranging from the well-established female preponderance in prevalence and severity to possible sex differences in the risk and protective factors associated with anxiety, sex differences in the clinical presentation......Several studies have examined sex differences in different anxiety disorders. Females are repeatedly found to be more likely than males to suffer from anxiety in general and to be diagnosed with most anxiety disorders, including agoraphobia (AG), panic disorder (PD), separation anxiety (SA...
Arntz, A.; Emmelkamp, P.; Ehring, T.
For a long time the diagnosis of personality disorder was associated with therapeutic pessimism: People with these problems were viewed as untreatable, due to fundamental character complications. Failures of anxiety disorder treatment tended to be labeled as "personality disorder". There is little e
Full Text Available Abstract Background There is a possibility that genuine halitosis patients' anxiety do not recover after oral malodor treatment due to their social anxiety disorder. The objective of this study was to investigate the influence of social anxiety disorder on the level of anxiety in genuine halitosis patients before and after treatment for oral malodor. Methods The subjects were 262 genuine halitosis patients who visited the Fresh Breath Clinic from March, 2008 to October, 2009. The subjects who had score 2 or higher by the organoleptic test were diagnosed as genuine halitosis patients. Gas chromatography (GC was conducted before and after oral malodor treatment for the oral malodor measurement. Based on their risk of social anxiety disorder, subjects were divided into low- and high-risk groups using the Liebowitz Social Anxiety Scale (LSAS. The questions related to oral malodor and the clinical oral examination were both conducted before oral malodor treatment. The level of anxiety before and after oral malodor treatment was evaluated using the Visual Analogue Scale of Anxiety (VAAS. Results More than 20% of subjects had a score of 60 or more on the LSAS (high LSAS group. The mean age and the percentage of females were significantly higher in the high LSAS group compared to the low LSAS group. The high LSAS group was more likely to have problems associated with oral malodor and to adopt measures against oral malodor compared to the low LSAS group. The mean concentrations of H2S and CH3SH by GC significantly decreased after the oral malodor treatment in both LSAS groups. VAAS scores also significantly decreased after treatment in both LSAS groups. The logistic regression analysis indicated that the high LSAS group had a 2.28 times higher risk of having a post-VAAS score of 50 or more compared to the low LSAS group. Conclusions This study revealed that genuine halitosis patients with a strong trait of social anxiety disorder have difficulty
... health, money, or family problems. But people with generalized anxiety disorder (GAD) feel extremely worried or feel nervous about ... I find more information? To learn more about generalized anxiety disorder, visit: MedlinePlus (National Library of Medicine) http: / / medlineplus. ...
EMMELKAMP, PMG; GERLSMA, C
The present paper provides a review of the literature on the relationship between marital factors and anxiety disorders. The review is based on both a descriptive and quantitative analysis. Studies of the marital relationship and outcome of exposure therapy are reviewed, as are studies investigating
den Boer, PCAM; Wiersma, D; Russo, S; van den Bosch, RJ
Background The established mental health care system does not have the resources to meet the extensive need for care of those with anxiety and depressive disorders. Paraprofessionals partially replacing professionals may be cost-effective. Objectives To investigate the effectiveness of any kind of p
Marks, I M
From protozoa to mammals, organisms have been selectively bred for genetic differences in defensive behaviour which are accompanied by differences in brain and other biological functions. Studies of twins indicate some genetic control of normal human fear from infancy onwards, of anxiety as a symptom and as a syndrome, and of phobic and obsessive-compulsive phenomena. Anxiety disorders are more common among the relatives of affected probands than of controls, especially among female and first-degree relatives; alcoholism and secondary depression may also be over-represented. Familial influences have been found for panic disorder, agoraphobia, and obsessive-compulsive problems. Panic disorder in depressed probands increases the risk to their relatives of phobia as well as of panic disorder, major depression, and alcoholism. The strongest family history of all anxiety disorders is seen in blood-injury phobia; even though it can be successfully treated by exposure, its roots may lie in a genetically determined specific autonomic susceptibility. Some genetic effects can be modified by environmental means.
Aktar, E.; Majdandžić, M.; De, Vente W.; Bögels, S.M.
Background: Anxiety runs in families. Observational learning of anxious behavior from parents with anxiety disorders plays an important role in the intergenerational transmission of anxiety. We investigated the link between parental anxiety (parental lifetime anxiety disorders and expressed parental
Full Text Available Stress has major role in functional gastrointestinal system disorders. The most typical example of this situation is Irritable bowel syndrome. Gastrointestinal system’s response to acute or short-term of stress is delay of gastric emptying and stimulation of colonic transition. While CRF2 receptors are mediate the upper section inhibition, CRF1 is responsible for the lower part colonic and anxiogenic response. Visceral hypersensitivity is managed by the emotional motor system, the amygdala plays a significant role and mucosal mast cells arise. But in people with symptoms of functional gastrointestinal, how is differ motility response in healthy individuals, this situation is due to lack of autonomous nervous system or an increased sensitivity of stress is not adequately understood. The brain-gastrointestinal axis frequency and severity of symptoms associated with negative emotions. American Gastroenterology Association is closely associated with the quality of life and is very difficult to treat the symptoms of gastrointestinal disorders, re-interpreted under the heading of 'Gastrointestinal Distress'. This review is defined as gastrointestinal distresses, physical, emotional, and behavioral components as a disorder in which, almost like an anxiety disorder are discussed. Physical component is pain, gas, and defecation problems, cognitive component is external foci control, catastrophization and anticipatory anxiety, the emotional component is somatic anxiety, hypervigilance, and avoidance of gastrointestinal stimuli as defined. [Archives Medical Review Journal 2012; 21(2.000: 122-133
Sáiz Martínez, Pilar Alejandra; Jimenez Treviño, Luis; Díaz Mesa, Eva M; García-Portilla González, M Paz; Marina González, Pedro; Al-Halabí, Susana; Szerman, Néstor; Bobes García, Julio; Ruiz, Pedro
Anxiety disorders and substance use disorders are highly comorbid (between 18% and 37%), and such comorbidity complicates treatment and worsens prognosis (including higher suicide risk). There are not many research works on the specific pharmacologic treatment of dual comorbid anxiety disorders. Most authors recommend a simultaneous approach of both, anxiety and substance use, disorders. Research data on pharmacotherapy suggest that psychotropics used in the treatment of anxiety disorders are also effective in dual diagnosis. SSRIs are considered first-line therapy in the treatment of dual anxiety while benzodiacepines should be avoided. New generation antiepileptic have shown efficacy in case series and open label studies in the latest years, thus being a promising treatment option for dual comorbid anxiety disorders, specially pregabalin in generalized anxiety disorder.
Teachman, Bethany A.; Joormann, Jutta; Steinman, Shari; Gotlib, Ian H.
In this paper we examine the nature of automatic cognitive processing in anxiety disorders and Major Depressive Disorder (MDD). Rather than viewing automaticity as a unitary construct, we follow a social cognition perspective (Bargh, 1994) that argues for four theoretically independent features of automaticity: unconscious (processing of emotional stimuli occurs outside awareness), efficient (processing emotional meaning uses minimal attentional resources), unintentional (no goal is needed to engage in processing emotional meaning), and uncontrollable (limited ability to avoid, alter or terminate processing emotional stimuli). Our review of the literature suggests that most anxiety disorders are characterized by uncontrollable, and likely also unconscious and unintentional, biased processing of threat-relevant information. In contrast, MDD is most clearly typified by uncontrollable, but not unconscious or unintentional, processing of negative information. For the anxiety disorders and for MDD, there is not sufficient evidence to draw firm conclusions about efficiency of processing, though early indications are that neither anxiety disorders nor MDD are characterized by this feature. Clinical and theoretical implications of these findings are discussed and directions for future research are offered. In particular, it is clear that paradigms that more directly delineate the different features of automaticity are required to gain a more comprehensive and systematic understanding of the importance of automatic processing in emotion dysregulation. PMID:22858684
Nelson, Jason M.; Lindstrom, Will; Foels, Patricia A.
Test anxiety was examined in college students with and without attention deficit hyperactivity disorder (ADHD). Results indicated that, relative to college students without ADHD, college students with ADHD reported higher total test anxiety as well as specific aspects of test anxiety, including worry (i.e., cognitive aspects of test anxiety) and…
Alline C. Campos
Full Text Available Anxiety and stress-related disorders are severe psychiatric conditions that affect performance in daily tasks and represent a high cost to public health. The initial observation of Charles Darwin that animals and human beings share similar characteristics in the expression of emotion raise the possibility of studying the mechanisms of psychiatric disorders in other mammals (mainly rodents. The development of animal models of anxiety and stress has helped to identify the pharmacological mechanisms and potential clinical effects of several drugs. Animal models of anxiety are based on conflict situations that can generate opposite motivational states induced by approach-avoidance situations. The present review revisited the main rodent models of anxiety and stress responses used worldwide. Here we defined as “ethological” the tests that assess unlearned/unpunished responses (such as the elevated plus maze, light-dark box, and open field, whereas models that involve learned/punished responses are referred to as “conditioned operant conflict tests” (such as the Vogel conflict test. We also discussed models that involve mainly classical conditioning tests (fear conditioning. Finally, we addressed the main protocols used to induce stress responses in rodents, including psychosocial (social defeat and neonatal isolation stress, physical (restraint stress, and chronic unpredictable stress.
Cassidy, Jude; Lichtenstein-Phelps, June; Sibrava, Nicholas J.; Thomas, Charles L., Jr.; Borkovec, Thomas D.
Even though generalized anxiety disorder (GAD) is one of the most common of the anxiety disorders, relatively little is known about its precursors. Bowlby's attachment theory provides a framework within which these precursors can be considered. According to Bowlby, adult anxiety may be rooted in childhood experiences that leave a child uncertain…
Werner, Kelly H.; Jazaieri, Hooria; Goldin, Philippe R; Ziv, Michal; Heimberg, Richard G.; Gross, James J.
Self-compassion refers to having an accepting and caring orientation towards oneself. Although self-compassion has been studied primarily in healthy populations, one particularly compelling clinical context in which to examine self-compassion is social anxiety disorder (SAD). SAD is characterized by high levels of negative self-criticism as well as an abiding concern about others’ evaluation of one’s performance. In the present study, we tested the hypotheses that (1) people with SAD would de...
Réus, Gislaine Z; Dos Santos, Maria Augusta B; Abelaira, Helena M; Quevedo, João
Anxiety disorders pose one of the largest threats to global mental health, and they predominantly emerge early in life. Social anxiety disorder, also known as social phobia, is the most common of all anxiety disorders. Moreover, it has severe consequences and is a disabling disorder that can cause an individual to be unable to perform the tasks of daily life. Social anxiety disorder is associated with the subsequent development of major depression and other mental diseases, as well as increased substance abuse. Although some neurobiological alterations have been found to be associated with social anxiety disorder, little is known about this disorder. Animal models are useful tools for the investigation of this disorder, as well as for finding new pharmacological targets for treatment. Thus, this review will highlight the main animal models of anxiety associated with social phobia.
Byrne Gerard JA
Full Text Available Anxiety disorders decline in prevalence with advancing age but remain more common than depressive disorders. They are often of late-onset and there is frequent comorbidity with depressive disorders and physical illness. While anxiety disorders in older people are likely to respond to the same non-pharmacological interventions that have been shown to work in younger people, there is currently little formal evidence of this. Although there is some evidence that the non-benzodiazepine anxiolytic medication, buspirone, is effective against late life anxiety symptoms, clinical trials in older people with rigorously diagnosed anxiety disorders are needed. An anxiety scale with demonstrated reliability and validity in older people is needed for screening for pathological anxiety and for measuring change in older patients undergoing treatment for anxiety disorders.
Stefan G. Hofmann
Full Text Available Although exposure-based treatments and anxiolytic medications are more effective than placebo for treating anxiety disorders, there is still considerable room for further improvement. Interestingly, combining these two modalities is usually not more effective than the monotherapies. Recent translational research has identified a number of novel approaches for treating anxiety disorders using agents that serve as neuroenhancers (also known as cognitive enhancers. Several of these agents have been studied to determine their efficacy at improving treatment outcome for patients with anxiety and other psychiatric disorders. In this review, we examine d-cycloserine, yohimbine, cortisol, catecholamines, oxytocin, modafinil, and nutrients such as caffeine and amino fatty acids as potential neuroenhancers. Of these agents, d-cycloserine shows the most promise as an effective neuroenhancer for extinction learning and exposure therapy. Yet, the optimal dosing and dose timing for drug administration remains uncertain. There is partial support for cortisol, catecholamines, yohimbine and oxytocin for improving extinction learning and exposure therapy. There is less evidence to indicate that modafinil and nutrients such as caffeine and amino fatty acids are effective neuroenhancers. More research is needed to determine their long term efficacy and clinical utility of these agents.
Hearn, Cate S; Donovan, Caroline L; Spence, Susan H; March, Sonja; Holmes, Monique C
Social anxiety disorder (SAD) in children is often comorbid with generalized anxiety disorder (GAD). We investigated whether worry, intolerance of uncertainty, beliefs about worry, negative problem orientation and cognitive avoidance, that are typically associated with GAD, are present in children with SAD. Participants included 60 children (8-12 years), matched on age and gender. Groups included children: with primary GAD and without SAD (GAD); with primary SAD and without GAD (SAD); and without an anxiety disorder (NAD). GAD and SAD groups scored significantly higher than the NAD group on worry, intolerance of uncertainty, negative beliefs about worry and negative problem orientation, however, they did not score differently from each other. Only the GAD group scored significantly higher than the NAD group on cognitive avoidance. These findings further understanding of the structure of SAD and suggest that the high comorbidity between SAD and GAD may be due to similar underlying processes within the disorders.
Full Text Available Objective. The purpose of this study was to compare the prevalence of comorbid eating disorders in Obsessive-Compulsive Disorder (OCD and other common anxiety disorders. Method. 179 patients from the same geographical area with a diagnosis of OCD or an anxiety disorder were divided into two groups based on their primary diagnosis. The prevalence of a comorbid eating disorder was calculated in both groups. Results. There was no statistically significant difference in the prevalence of comorbid eating disorders between the OCD and other anxiety disorders group. Conclusions. These results suggest that the prevalence of comorbid eating disorders does not differ in anxiety disorders when compared with OCD. However, in both groups, it remains statistically higher than that of the general population.
... Where can I find more information? Share Generalized Anxiety Disorder: When Worry Gets Out of Control Download ... Order a free hardcopy What Is GAD? Occasional anxiety is a normal part of life. You might ...
Objective To explore the social and psychological risk factors to anxiety disorders in adolescents,and to screen protective factors and risk factors and establish the prediction model.Methods The Screen for Child Anxiety
Legerstee, J.S.; Huizink, A.C.; Gastel, W. van; Liber, J.M.; Treffers, P.D.A.; Verhulst, F.C.; Utens, E.M.W.J.
Objective: To determine the differential impact of maternal and paternal internalizing psychopathology on cognitive-behavioural treatment (CBT) outcome of anxiety-disordered children and adolescents. Method: Participants consisted of 127 children and 51 adolescents with a primary anxiety diagnosis.
Cooper, P J; Gallop, C.; Willetts, L.; Creswell, C
An examination was made of the extent to which maternal anxiety predicted response to treatment of children presenting with an anxiety disorder. In a sample of 55 children referred to a local NHS CAMH service for treatment of an anxiety disorder, systematic mental state interview assessment was made of both mothers and children, and both completed self-report questionnaires to assess aspects of anxiety, both immediately before the children received treatment and following treatment. Children ...
Nathalie P. Lizeretti
Full Text Available Anxiety disorders (AD are by far the most frequent psychiatric disorders, and according to epidemiologic data their chronicity, comorbidities, and negative prognostic constitute a public health problem. This is why it is necessary to continue exploring the factors which contribute to the incidence, appearance, and maintenance of this set of disorders. The goal of this study has been to analyze the possible relationship between Emotional Intelligence (EI and personality disorders (PersD in outpatients suffering from AD. The sample was made up of 146 patients with AD from the Mental Health Center at the Health Consortium of Maresme, who were evaluated with the STAI, MSCEIT, and MCMI-II questionnaires. The main findings indicate that 89,4% of the patients in the sample met the criteria for the diagnosis of some PersD. The findings also confirm that patients with AD present a low EI, especially because of difficulties in the skills of emotional comprehension and regulation, and the lack of these skills is related to a higher level of anxiety and the presence of PersD. These findings suggest the need to consider emotional skills of EI and personality as central elements for the diagnosis and treatment of AD.
Full Text Available Anxiety disorders are classified according to symptoms, time course and therapeutic response. Concurrently, the experimental analysis of defensive behavior has identified three strategies of defense that are shared by different animal species, triggered by situations of potential, distal and proximal predatory threat, respectively. The first one consists of cautious exploration of the environment for risk assessment. The associated emotion is supposed to be anxiety and its pathology, Generalized Anxiety Disorder. The second is manifested by oriented escape or by behavioral inhibition, being related to normal fear and to Specific Phobias, as disorders. The third consists of disorganized flight or complete immobility, associated to dread and Panic Disorder. Among conspecific interactions lies a forth defense strategy, submission, that has been related to normal social anxiety (shyness and to Social Anxiety Disorder. In turn, Posttraumatic Stress Disorder and Obsessive-Compulsive Disorder do not seem to be directly related to innate defense reactions. Such evolutionary approach offers a reliable theoretical framework for the study of the biological determinants of anxiety disorders, and a sound basis for psychiatric classification.Os transtornos de ansiedade são classificados conforme a sintomatologia, decurso temporal e resposta terapêutica. Paralelamente, a análise experimental dos comportamentos de defesa identificou três estratégias comuns a diferentes espécies de animais, desencadeadas por situações de perigo predatório potencial, distal ou proximal, respectivamente. A primeira consiste na investigação cautelosa do ambiente, avaliando o risco. Supõe-se que a emoção que a acompanha seja a ansiedade e sua patologia, o Transtorno de Ansiedade Generalizada. A segunda é expressa pela fuga orientada ou pela inibição comportamental, sendo a emoção correlata o medo, e a patologia representada pelas Fobias Específicas. Finalmente, a
Full Text Available Anxiety is characterized most commonly as a diffuse, unpleasant, vague sense of apprehension, often accompanied by autonomic symptoms such as headache, perspiration, palpitations, tightness in the chest, mild stomach discomfort and restlessness, indicated by an inability to sit or stand still for long. Anxiety disorder is one of important cause of development of hypertension, although it is multifactorial. It increases sympathetic nervous system which causes hypertension due to alterations in baro reflex and chemo reflex pathways at both peripheral and central level. It also increases norepinephrine which acts on β1 receptor (in brain, myocardium and kidney and increases cardiac force, rate of contraction, renin release and β2 receptor (in pulmonary system and blood vessels and decreases resistance of pulmonary airway and blood vessels-leading to hypertension.
Otto, Michael W; Simon, Naomi M; Powers, Mark; Hinton, Devon; Zalta, Alyson K; Pollack, Mark H
Initial research suggests that rates of isolated sleep paralysis (ISP) are elevated in individuals with panic disorder and particularly low in individuals with other anxiety disorders. To further evaluate these findings, we examined rates of ISP in a sample outpatients with primary diagnoses of panic disorder (n=24), social anxiety disorder (n=18), or generalized anxiety disorder (n=18). We obtained an overall rate of ISP of 19.7%; rates for patients with panic disorder (20.8%) fell between those with generalized anxiety disorder (15.8%) and social phobia (22.2%). Analysis of comorbidities failed to provide evidence of link between depressive disorders and ISP, but did indicate a significant association between anxiety comorbidity and higher rates of ISP. Results are discussed relative to other variables predicting variability in the occurrence of ISP.
Griffiths, Helen; Fazel, Mina
Anxiety disorders are among the most common mental health disorders of childhood. Three quarters of anxiety disorders have their origins in childhood, with presentation often chronic in nature. Children with an anxiety disorder are 3.5 times more likely to experience depression or anxiety in adulthood, highlighting the importance of early diagnosis and appropriate treatment. Making a diagnosis can often prove difficult. It is important for clinicians to distinguish between normal anxiety and anxiety disorders. In the latter, symptoms may impair function and/or cause marked avoidance behaviour and significant distress. Younger children, who are less able to verbalise their anxiety, may show symptoms of regression of physical abilities (e.g. toileting, requiring carrying); increased attachment seeking behaviours (e.g. becoming more clingy); or increased physical symptoms (e.g. stomach aches). NICE quality standards recommend the need for an accurate assessment of which specific anxiety disorder the individual is experiencing, its severity, and the impact on functioning. NICE guidance for assessment of social anxiety disorder may be extrapolated to the assessment of other anxiety disorders: e.g. giving the child the opportunity to provide information on their own, and conducting a risk assessment. Where the child is experiencing significant distress or functional impairment (e.g. missing school, not taking part in age-appropriate activity), then specialist input is likely to be needed.
Allan, Nicholas P; Oglesby, Mary E; Short, Nicole A; Schmidt, Norman B
Panic attacks (PAs) are characterized by overwhelming surges of fear and discomfort and are one of the most frequently occurring symptoms in psychiatric populations. The most recent version of the Diagnostic and Statistical Manual of Mental Disorders (i.e. DSM-5) allows for a panic attack (PA) specifier for all disorders, including social anxiety disorder (SAD). However, there is little research examining differences between individuals diagnosed with SAD with the PA specifier versus individuals diagnosed with SAD without the PA specifier. The current study examined social anxiety, mood, anxiety, and anxiety sensitivity social concerns, a risk factor for social anxiety in SAD-diagnosed individuals without (N = 52) and with (N = 14) the PA specifier. The groups differed only in somatic symptoms of anxiety. Result of the current study provides preliminary evidence that the presence of the PA specifier in social anxiety does not result in elevated levels of comorbidity or a more severe presentation of social anxiety.
Kinrys, Gustavo; Wygant,Lisa E
Women have a substantially higher risk of developing lifetime anxiety disorders compared with men. In addition, research evidence has generally observed an increased symptom severity, chronic course, and functional impairment in women with anxiety disorders in comparison to men. However, the reasons for the increased risk in developing an anxiety disorder in women are still unknown and have yet to be adequately investigated. Evidence from various studies has suggested that genetic factors and...
Creswell, Cathy; Apetroaia, Adela; Murray, Lynne; Cooper, Peter
Parental emotional distress, particularly high maternal anxiety, is one of the most consistent predictors of child anxiety treatment outcome. In order to identify the cognitive, affective, and behavioral parenting characteristics of mothers of children with anxiety disorders who themselves have an anxiety disorder, we assessed the expectations, appraisals, and behaviors of 88 mothers of anxious children (44 mothers who were not anxious [NONANX] and 44 mothers with a current anxiety disorder [ANX]) when interacting with their 7-12-year-old children. There were no observed differences in anxiety and avoidance among children of ANX and NONANX mothers, but, compared with NONANX mothers, ANX mothers held more negative expectations, and they differed on observations of intrusiveness, expressed anxiety, warmth, and the quality of the relationship. Associations were moderated by the degree to which children expressed anxiety during the tasks. Maternal-reported negative emotions during the task significantly mediated the association between maternal anxiety status and the observed quality of the relationship. These findings suggest that maternal anxiety disorder is associated with reduced tolerance of children's negative emotions. This may interfere with the maintenance of a positive, supportive mother-child interaction under conditions of stress and, as such, this may impede optimum treatment outcomes. The findings identify potential cognitive, affective, and behavioral targets to improve treatment outcomes for children with anxiety disorders in the context of a current maternal anxiety disorder.
Creswell, Cathy; Waite, Polly; Cooper, Peter J
Anxiety disorders in childhood and adolescence are extremely common and are often associated with lifelong psychiatric disturbance. Consistent with DSM-5 and the extant literature, this review concerns the assessment and treatment of specific phobias, separation anxiety disorder, generalised anxiety disorder, social anxiety disorder, panic disorder and agoraphobia. Evidence-based psychological treatments (cognitive behaviour therapy; CBT) for these disorders have been developed and investigated, and in recent years promising low-intensity versions of CBT interventions have been proposed that offer a means to increase access to evidence-based treatments. There is some evidence of effectiveness of pharmacological treatments for anxiety disorders in children and young people, however, routine prescription is not recommended due to concerns about potential harm.
Mitrousia, V; Giotakos, O
During the last decade a number of studies have been conducted in order to examine if virtual reality exposure therapy can be an alternative form of therapy for the treatment of mental disorders and particularly for the treatment of anxiety disorders. Imaginal exposure therapy, which is one of the components of Cognitive Behavioral Therapy, cannot be easily applied to all patients and in cases like those virtual reality can be used as an alternative or a supportive psychotherapeutic technique. Most studies using virtual reality have focused on anxiety disorders, mainly in specific phobias, but some extend to other disorders such as eating disorders, drug dependence, pain control and palliative care and rehabilitation. Main characteristics of virtual reality therapy are: "interaction", "immersion", and "presence". High levels of "immersion" and "presence" are associated with increased response to exposure therapy in virtual environments, as well as better therapeutic outcomes and sustained therapeutic gains. Typical devices that are used in order patient's immersion to be achieved are the Head-Mounted Displays (HMD), which are only for individual use, and the computer automatic virtual environment (CAVE), which is a multiuser. Virtual reality therapy's disadvantages lie in the difficulties that arise due to the demanded specialized technology skills, devices' cost and side effects. Therapists' training is necessary in order for them to be able to manipulate the software and the hardware and to adjust it to each case's needs. Devices' cost is high but as technology continuously improves it constantly decreases. Immersion during virtual reality therapy can induce mild and temporary side effects such as nausea, dizziness or headache. Until today, however, experience shows that virtual reality offers several advantages. Patient's avoidance to be exposed in phobic stimuli is reduced via the use of virtual reality since the patient is exposed to them as many times as he
van Steensel, F.J.A.; Bögels, S.M.; Perrin, S.
There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk of anxiety and anxiety disorders. However, it is less clear which of the specific DSM-IV anxiety disorders occur most in this population. The present study used meta-analytic tec
Werner, Kelly H; Jazaieri, Hooria; Goldin, Philippe R; Ziv, Michal; Heimberg, Richard G; Gross, James J
Self-compassion refers to having an accepting and caring orientation towards oneself. Although self-compassion has been studied primarily in healthy populations, one particularly compelling clinical context in which to examine self-compassion is social anxiety disorder (SAD). SAD is characterized by high levels of negative self-criticism as well as an abiding concern about others' evaluation of one's performance. In the present study, we tested the hypotheses that: (1) people with SAD would demonstrate less self-compassion than healthy controls (HCs), (2) self-compassion would relate to severity of social anxiety and fear of evaluation among people with SAD, and (3) age would be negatively correlated with self-compassion for people with SAD, but not for HC. As expected, people with SAD reported less self-compassion than HCs on the Self-Compassion Scale and its subscales. Within the SAD group, lesser self-compassion was not generally associated with severity of social anxiety, but it was associated with greater fear of both negative and positive evaluation. Age was negatively correlated with self-compassion for people with SAD, whereas age was positively correlated with self-compassion for HC. These findings suggest that self-compassion may be a particularly important target for assessment and treatment in persons with SAD.
Webb, C M; Thuras, P; Peterson, C B; Lampert, J; Miller, D; Crow, S J
Although previous research has supported the importance of anxiety as an etiological and maintenance factor for eating disorders, the specific mechanisms are not well understood. The role of anxiety in the context of eating behavior is especially unclear. The purpose of this study was to identify anxiety-eliciting eating situations and anxiety management strategies patients use to mitigate anxiety experienced in the context of eating as determined by diagnostic groups and symptom patterns. Fifty-three eating disorder outpatients were administered the Eating and Anxiety Questionnaire (EAQ) and the Eating Disorder Diagnostic Scale. Ratings indicated significant anxiety in most eating situations, whereas management strategies were more limited yet regularly employed. Factor analysis of the EAQ revealed a 6-factor solution for anxiety management strategies and a 4-factor solution for anxiety-eliciting situations. These results indicate patients with eating disorders report high levels of anxiety associated with eating behaviors but utilize limited yet consistent anxiety management strategies. Effective intervention strategies for managing eating-related anxiety should be incorporated into treatment and may need to be specified for different diagnostic subgroups.
Full Text Available The aim of this review is to summarize research on the emerging role of episodic memories in the context of anxiety disorders (AD. The available literature on explicit-, autobiographical- and episodic memory function in AD including neuroimaging studies is critically discussed. We describe the methodological diversity of episodic memory research in AD and discuss the need for novel tests to measure episodic memory in a clinical setting. We argue that alterations in episodic memory functions might contribute to the etiology of AD. We further explain why future research on the interplay between episodic memory function and emotional disorders as well as its neuroanatomical foundations offers the promise to increase the effectiveness of modern psychological treatments. We conclude that one major task is to develop methods and training programs that might help patients suffering from AD to better understand, interpret and possibly actively use their episodic memories in a way that would support therapeutic interventions and counteract the occurrence of symptoms.
Wu, Jade Q; Szpunar, Karl K; Godovich, Sheina A; Schacter, Daniel L; Hofmann, Stefan G
Research on future-oriented cognition in generalized anxiety disorder (GAD) has primarily focused on worry, while less is known about the role of episodic future thinking (EFT), an imagery-based cognitive process. To characterize EFT in this disorder, we used the experimental recombination procedure, in which 21 GAD and 19 healthy participants simulated positive, neutral and negative novel future events either once or repeatedly, and rated their phenomenological experience of EFT. Results showed that healthy controls spontaneously generated more detailed EFT over repeated simulations. Both groups found EFT easier to generate after repeated simulations, except when GAD participants simulated positive events. They also perceived higher plausibility of negative-not positive or neutral-future events than did controls. These results demonstrate a negativity bias in GAD individuals' episodic future cognition, and suggest their relative deficit in generating vivid EFT. We discuss implications for the theory and treatment of GAD.
de Ruiter, C.; Garssen, B.; Rijken, H.; Kraaimaat, F.
The symptom complex of panic disorder and generalized anxiety disorder suggests an etiological role for hyperventilation. The present study investigates the overlap between DSM-III-R panic disorder, panic disorder with agoraphobia and generalized anxiety disorder with hyperventilation syndrome (HVS)
Duval, Elizabeth R; Javanbakht, Arash; Liberzon, Israel
Anxiety and stress disorders are among the most prevalent neuropsychiatric disorders. In recent years, multiple studies have examined brain regions and networks involved in anxiety symptomatology in an effort to better understand the mechanisms involved and to develop more effective treatments. However, much remains unknown regarding the specific abnormalities and interactions between networks of regions underlying anxiety disorder presentations. We examined recent neuroimaging literature that aims to identify neural mechanisms underlying anxiety, searching for patterns of neural dysfunction that might be specific to different anxiety disorder categories. Across different anxiety and stress disorders, patterns of hyperactivation in emotion-generating regions and hypoactivation in prefrontal/regulatory regions are common in the literature. Interestingly, evidence of differential patterns is also emerging, such that within a spectrum of disorders ranging from more fear-based to more anxiety-based, greater involvement of emotion-generating regions is reported in panic disorder and specific phobia, and greater involvement of prefrontal regions is reported in generalized anxiety disorder and posttraumatic stress disorder. We summarize the pertinent literature and suggest areas for continued investigation.
Shin, Lisa M; Liberzon, Israel
Anxiety disorders are a significant problem in the community, and recent neuroimaging research has focused on determining the brain circuits that underlie them. Research on the neurocircuitry of anxiety disorders has its roots in the study of fear circuits in animal models and the study of brain responses to emotional stimuli in healthy humans. We review this research, as well as neuroimaging studies of anxiety disorders. In general, these studies have reported relatively heightened amygdala activation in response to disorder-relevant stimuli in post-traumatic stress disorder, social phobia, and specific phobia. Activation in the insular cortex appears to be heightened in many of the anxiety disorders. Unlike other anxiety disorders, post-traumatic stress disorder is associated with diminished responsivity in the rostral anterior cingulate cortex and adjacent ventral medial prefrontal cortex. Additional research will be needed to (1) clarify the exact role of each component of the fear circuitry in the anxiety disorders, (2) determine whether functional abnormalities identified in the anxiety disorders represent acquired signs of the disorders or vulnerability factors that increase the risk of developing them, (3) link the findings of functional neuroimaging studies with those of neurochemistry studies, and (4) use functional neuroimaging to predict treatment response and assess treatment-related changes in brain function. PMID:19625997
Blessing, Esther M; Steenkamp, Maria M; Manzanares, Jorge; Marmar, Charles R
Cannabidiol (CBD), a Cannabis sativa constituent, is a pharmacologically broad-spectrum drug that in recent years has drawn increasing interest as a treatment for a range of neuropsychiatric disorders. The purpose of the current review is to determine CBD's potential as a treatment for anxiety-related disorders, by assessing evidence from preclinical, human experimental, clinical, and epidemiological studies. We found that existing preclinical evidence strongly supports CBD as a treatment for generalized anxiety disorder, panic disorder, social anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder when administered acutely; however, few studies have investigated chronic CBD dosing. Likewise, evidence from human studies supports an anxiolytic role of CBD, but is currently limited to acute dosing, also with few studies in clinical populations. Overall, current evidence indicates CBD has considerable potential as a treatment for multiple anxiety disorders, with need for further study of chronic and therapeutic effects in relevant clinical populations.
Knapp, Ashley A; Blumenthal, Heidemarie; Mischel, Emily R; Badour, Christal L; Leen-Feldner, Ellen W
Anxiety psychopathology, one of the most prevalent classes of disorder among youth, is linked to detrimental outcomes. Accordingly, identifying factors that influence vulnerability to anxiety disorders is important. One promising factor, given emerging evidence for its transdiagnostic nature, is anxiety sensitivity (AS); however, relatively little is known about the linkage between AS and indicators of generalized anxiety disorder (GAD), particularly among youth. The aim of the current investigation was to address this gap in the literature using a community-based sample of adolescents aged 10-17 years (n = 165; M age = 14.49 years, SD = 2.26). Results indicated global AS and the AS-physical concerns dimension were significantly associated with worry, generalized anxiety symptoms, and GAD diagnosis assessed via a structured clinical interview, above and beyond key theoretically-relevant covariates. These findings add to a growing body of work underscoring the relevance of AS for multiple types of anxiety-related disorders among youth.
Thaíse Campos Mondin
Full Text Available Objective: To assess the prevalence of anxiety disorders and associated factors in young adults. Methods: Cross-sectional population-based study of individuals between the ages of 18 and 24 years randomly selected from 89 census-based sectors to ensure an adequate sample size. Household selection within the sectors was performed according to a systematic sampling process. Anxiety disorders were assessed using the Mini International Neuropsychiatric Interview (MINI. The final sample comprised 1,560 young adults. Results: Of the participants who were diagnosed with anxiety disorders, 12.3% had agoraphobia, 9.7% had generalised anxiety disorder, 4.0% had social phobia, 3.3% had obsessive-compulsive disorder, 2.5% had panic disorder, and 2.1% had post-traumatic stress disorder; only 23.8% had received any previous treatment. Anxiety disorders were associated with sex, socioeconomic status, psychiatric problems in parents, alcohol abuse, and tobacco use. Conclusions: The identification of factors associated with anxiety disorders in young people enables us to develop intervention strategies. Anxiety disorders are not only highly prevalent but are also associated with significant functional impairment, significant reductions in quality of life, lower productivity, and higher rates of comorbidities.
Waters, Allison M.; Schilpzand, Elizabeth; Bell, Clare; Walker, Lynn S.; Baber, Kari
This study examined the incidence and correlates of functional gastrointestinal symptoms in children with anxiety disorders. Participants were 6-13 year old children diagnosed with one or more anxiety disorders (n = 54) and non-clinical control children (n = 51). Telephone diagnostic interviews were performed with parents to determine the presence…
Masi, Gabriele; Millepiedi, Stefania; Mucci, Maria; Poli, Paola; Bertini, Nicoletta; Milantoni, Luca
Objective: There are insufficient data on generalized anxiety disorder in children and adolescents. Symptoms and comorbidity of generalized anxiety disorder are described as a function of age, gender, and comorbidity in a consecutive series of referred children and adolescents. Method: One hundred fifty-seven outpatients (97 males and 60 females,…
Tan, Shary; Moulding, Richard; Nedeljkovic, Maja; Kyrios, Michael
Generalised anxiety disorder (GAD) is the most significant and common of the anxiety disorders. Intolerance of uncertainty (IU) and negative metacognitive beliefs are two prominent cognitive factors in models of GAD, however only one study to date has examined the relative contribution of these factors. Therefore, this study aimed to investigate…
Rapee, Ronald M.; Coplan, Robert J.
Fearful temperaments have been identified as a major risk factor for anxiety disorders. However, descriptions of fearful temperament and several forms of anxiety disorder show strong similarities. This raises the question whether these terms may simply refer to different aspects of the same underlying construct. The current review examines…
Kutlu, Munir Gunes; Gould, Thomas J
Anxiety disorders are a group of crippling mental diseases affecting millions of Americans with a 30% lifetime prevalence and costs associated with healthcare of $42.3 billion. While anxiety disorders show high levels of co-morbidity with smoking (45.3% vs. 22.5% in healthy individuals), they are also more common among the smoking population (22% vs. 11.1% in the non-smoking population). Moreover, there is clear evidence that smoking modulates symptom severity in patients with anxiety disorders. In order to better understand this relationship, several animal paradigms are used to model several key symptoms of anxiety disorders; these include fear conditioning and measures of anxiety. Studies clearly demonstrate that nicotine mediates acquisition and extinction of fear as well as anxiety through the modulation of specific subtypes of nicotinic acetylcholine receptors (nAChRs) in brain regions involved in emotion processing such as the hippocampus. However, the direction of nicotine's effects on these behaviors is determined by several factors that include the length of administration, hippocampus-dependency of the fear learning task, and source of anxiety (novelty-driven vs. social anxiety). Overall, the studies reviewed here suggest that nicotine alters behaviors related to fear and anxiety and that nicotine contributes to the development, maintenance, and reoccurrence of anxiety disorders.
Misri, Shaila; Abizadeh, Jasmin; Sanders, Shawn; Swift, Elena
Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum.
Bilgiç, Ayhan; Türkoğlu, Serhat; Ozcan, Ozlem; Tufan, Ali Evren; Yılmaz, Savaş; Yüksel, Tuğba
Attention-deficit hyperactivity disorder (ADHD) is often comorbid with anxiety disorders and previous studies observed that anxiety could have an impact on the clinical course of ADHD and comorbid disruptive behavioral disorders (conduct disorders and oppositional-defiant disorders). Anxiety sensitivity (AS) is a different concept from anxiety per se and it is believed to represent the constitutionally based sensitivity of individuals to anxiety and anxiety symptoms. We aimed to assess the associations between anxiety, AS and symptoms of disruptive behavioral disorders (DBD) in a clinical sample of children and adolescents with ADHD. The sample consisted of 274 treatment naive children with ADHD aged 8-17 years. The severity of ADHD symptoms and comorbid DBD were assessed via parent rated Turgay DSM-IV-Based Child and Adolescent Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S), Conners' Parent Rating Scale (CPRS), and Conners' Teacher Rating Scale (CTRS). AS and severity of anxiety symptoms of children were evaluated by self-report inventories. The association between anxiety, AS, and DBD was evaluated using structural equation modeling. Analyses revealed that AS social subscale scores negatively predicted symptoms of conduct disorder (CD) reported in T-DSM-IV-S. On the other hand, CD symptoms positively predicted severity of anxiety. No direct relationships were detected between anxiety, AS and oppositional-defiant behavior scores in any scales. These results may suggest a protective effect of AS social area on the development of conduct disorder in the presence of a diagnosis of ADHD, while the presence of symptoms of CD may be a vulnerability factor for the development of anxiety symptoms in children and adolescents with ADHD.
Versella, Mark V; Piccirillo, Marilyn L; Potter, Carrie M; Olino, Thomas M; Heimberg, Richard G
Individuals with social anxiety disorder (SAD) exhibit elevated levels of anger and anger suppression, which are both associated with increased depression, diminished quality of life, and poorer treatment outcomes. However, little is known about how anger experiences differ among individuals with SAD and whether any heterogeneity might relate to negative outcomes. This investigation sought to empirically define anger profiles among 136 treatment-seeking individuals with SAD and to assess their association with distress and impairment. A latent class analysis was conducted utilizing the trait subscales of the State-Trait Anger Expression Inventory-2 as indicators of class membership. Analysis revealed four distinct anger profiles, with greatest distress and impairment generally demonstrated by individuals with elevated trait anger, a greater tendency to suppress the expression of anger, and diminished ability to adaptively control their anger expression. These results have implications for tailoring more effective interventions for socially anxious individuals.
Full Text Available Introduction. In addition to significant prevalence of generalized anxiety disorder (GAD and related consequences, it seems that this disorder has not been studied sufficiently in Serbia. Objective. The aim of this study was to investigate the understanding of psychopathology and the adequate treatment of patients with GAD by psychiatrists in Serbia. Methods. The study comprised 84 doctors - psychiatrists and neuropsychiatrists who were engaged in treatment of patients with GAD. Anonymous survey was used as the basic instrument, which collected information about the socio-demographic and professional data, experience in treating GAD and understanding psychopathology of GAD, as well as the first and the second choice therapy for patients with GAD. Results. The majority of psychiatrists (62.2% indicated the symptoms of distress/tension and slightly lower percent (36.6% designated the symptoms of worry/anxiety as the key symptoms of GAD when it was diagnosed. The results showed that almost all patients (96.5% had been treated with benzodiazepines before coming to psychiatrists. Most psychiatrists preferred the use of SSRI/SNRI antidepressants (76.2%, usually in combination with benzodiazepines (71.4% for the treatment of patients with GAD; however, if these doctors got GAD, the preference of benzodiazepine use would be significantly lesser (45.2% than for the treatment of their patients. Preference for the use of SSRI/SNRI antidepressants was significantly more frequent in physicians with completed residency. Conclusion. The understanding of psychopathology and treatment practice for patients with GAD in this sample of psychiatrists in Serbia is mostly consistent with the current trends for GAD treatment.
Hendriks, S.M.; Licht, C.M.M.; Spijker, J; Beekman, A T F; Hardeveld, F.; de Graaf, R.; Penninx, B.W.J.H.
Background: This investigation examines differences in cognitive profiles in subjects with major depressive disorder (MDD) and generalized anxiety disorder (GAD). Methods: Data were used from subjects with current MDD (n = 655), GAD (n = 107) and comorbid MDD/GAD (n = 266) diagnosis from the Netherlands Study of Depression and Anxiety (NESDA). The Composite Interview Diagnostic Instrument was used to diagnose MDD and GAD. Cognitive profiles were measured using the Leiden Index of Depression S...
Full Text Available Abstract Background Adult separation anxiety disorder (ASAD has been identified recently, but there is a paucity of data about its prevalence and associated characteristics amongst anxiety patients. This study assessed the prevalence and risk factor profile associated with ASAD in an anxiety clinic. Methods Clinical psychologists assigned 520 consecutive patients to DSM-IV adult anxiety subcategories using the SCID. We also measured demographic factors and reports of early separation anxiety (the Separation Anxiety Symptom Inventory and a retrospective diagnosis of childhood separation anxiety disorder. Other self-report measures included the Adult Separation Anxiety Symptom Questionnaire (ASA-27, the Depression, Anxiety, Stress Scales (DASS-21, personality traits measured by the NEO PI-R and the Work and Social Adjustment Scale. These measures were included in three models examining for overall differences and then by gender: Model 1 compared the conventional SCID anxiety subtypes (excluding PTSD and OCD because of insufficient numbers; Model 2 divided the sample into those with and without ASAD; Model 3 compared those with ASAD with the individual anxiety subtypes in the residual group. Results Patients with ASAD had elevated early separation anxiety scores but this association was unique in females only. Except for social phobia in relation to some comparisons, those with ASAD recorded more severe symptoms of depression, anxiety and stress, higher neuroticism scores, and greater levels of disability. Conclusions Patients with ASAD attending an anxiety clinic are highly symptomatic and disabled. The findings have implications for the classification, clinical identification and treatment of adult anxiety disorders.
Generalized Anxiety Disorder and Social Anxiety Disorder, but Not Panic Anxiety Disorder, Are Associated with Higher Sensitivity to Learning from Negative Feedback: Behavioral and Computational Investigation.
Khdour, Hussain Y; Abushalbaq, Oday M; Mughrabi, Ibrahim T; Imam, Aya F; Gluck, Mark A; Herzallah, Mohammad M; Moustafa, Ahmed A
Anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic anxiety disorder (PAD), are a group of common psychiatric conditions. They are characterized by excessive worrying, uneasiness, and fear of future events, such that they affect social and occupational functioning. Anxiety disorders can alter behavior and cognition as well, yet little is known about the particular domains they affect. In this study, we tested the cognitive correlates of medication-free patients with GAD, SAD, and PAD, along with matched healthy participants using a probabilistic category-learning task that allows the dissociation between positive and negative feedback learning. We also fitted all participants' data to a Q-learning model and various actor-critic models that examine learning rate parameters from positive and negative feedback to investigate effects of valence vs. action on performance. SAD and GAD patients were more sensitive to negative feedback than either PAD patients or healthy participants. PAD, SAD, and GAD patients did not differ in positive-feedback learning compared to healthy participants. We found that Q-learning models provide the simplest fit of the data in comparison to other models. However, computational analysis revealed that groups did not differ in terms of learning rate or exploration values. These findings argue that (a) not all anxiety spectrum disorders share similar cognitive correlates, but are rather different in ways that do not link them to the hallmark of anxiety (higher sensitivity to negative feedback); and (b) perception of negative consequences is the core feature of GAD and SAD, but not PAD. Further research is needed to examine the similarities and differences between anxiety spectrum disorders in other cognitive domains and potential implementation of behavioral therapy to remediate cognitive deficits.
de Souza Moura, Antonio Marcos; Lamego, Murilo Khede; Paes, Flávia; Rocha, Nuno Barbosa; Simoes-Silva, Vitor; Rocha, Susana; Sá Filho,Alberto Souza; Rimes, Ridson; Manochio, João; Budde, Henning; Wegner, Mirko; Mura, Gioia; Arias-Carrión,Oscar; Yuan, Ti-Fei; Nardi, Antonio Egidio
Anxiety disorders are the most common psychiatric disorders observed currently. It is a normal adaptive response to stress that allows coping with adverse situations. Nevertheless, when anxiety becomes excessive or disproportional in relation to the situation that evokes it or when there is not any special object directed at it, such as an irrational dread of routine stimuli, it becomes a disabling disorder and is considered to be pathological. The traditional treatment used is medication and...
de Jongh, A; Ten Broeke, E
Based on the assumptions of Shapiro's adaptive information-processing model, it could be argued that a large proportion of people suffering from an anxiety disorder would benefit from eye movement desensitization and reprocessing (EMDR). This article provides an overview of the current empirical evidence on the application of EMDR for the anxiety disorders spectrum other than posttraumatic stress disorder (PTSD). Reviewing the existing literature, it is disappointing to find that 20 years aft...
Fang, Angela; Hofmann, Stefan G.
Social anxiety disorder (SAD) and body dysmorphic disorder (BDD) are two separate, but conceptually overlapping nosological entities. In this review, we examine similarities between SAD and BDD in comorbidity, phenomenology, cognitive biases, treatment outcome, and cross-cultural aspects. Our review suggests that SAD and BDD are highly comorbid, show a similar age of onset, share a chronic trajectory, and show similar cognitive biases for interpreting ambiguous social information in a negative manner. Furthermore, research from treatment outcome studies have demonstrated that improvements in SAD were significantly correlated with improvements in BDD. Findings from cross-cultural research suggest that BDD may be conceived as a subtype of SAD in some Eastern cultures. Directions for future research and clinical implications of these findings are discussed. PMID:20817336
Milad, Mohammed R; Rauch, Scott L
Advances in neuroimaging techniques over the past two decades have allowed scientists to investigate the neurocircuitry of anxiety disorders. Such research has implicated the orbitofrontal cortex (OFC). Characterizing the role of OFC in anxiety disorders, however, is principally complicated by two factors-differences in underlying pathophysiology across the anxiety disorders and heterogeneity in function across different OFC sub-territories. Contemporary neurocircuitry models of anxiety disorders have primarily focused on amygdalo-cortical interactions. The amygdala is implicated in generating fear responses, whereas cortical regions, specifically the medial OFC (mOFC) and the ventromedial prefrontal cortex (vmPFC), are implicated in fear extinction. In contrast to mOFC, anterolateral OFC (lOFC) has been associated with negative affects and obsessions and thus dysfunctional lOFC may underlie different aspects of certain anxiety disorders. Herein, we aim to review the above-mentioned theories and provide a heuristic model for conceptualizing the respective roles of mOFC and lOFC in the pathophysiology and treatment of anxiety disorders. We will also review the role of the OFC in fear extinction and the implications of this role to the pathophysiology of anxiety disorders.
Duits, P.; Cath, D.C.; Heitland, I.; Baas, J.M.P.
Although impaired fear extinction has repeatedly been demonstrated in patients with anxiety disorders, little is known about whether these impairments persist after treatment. The current comparative exploratory study investigated fear extinction in 26 patients treated for their anxiety disorder in
Seligman, Laura D.; Ollendick, Thomas H.
Synopsis Cognitive behavioral therapies (CBTs) have been shown to be efficacious for the treatment of anxiety disorders in children and adolescents. Randomized clinical trials indicate that approximately two-thirds of children treated with CBT will be free of their primary diagnosis at posttreatment. Although several CBT treatment packages have been investigated in youth with diverse anxiety disorders, common core components have been identified. A comprehensive assessment, development of a good therapeutic relationship and working alliance, cognitive restructuring, repeated exposure with reduction of avoidance behavior, and skills training comprise the core procedures for the treatment of anxiety disorders in youth. PMID:21440852
Kamrowska, Anna; Gmitrowicz, Agnieszka
Risk of generalized anxiety disorder (GAD) within life is estimated at 2.6-5.1%. Amongst etiological factors that affect the development of the disorder are: biological and psychological problems, including cognitive models. There are known several cognitive models: metacognitive, Borkovec'c model and the model developed in Quebec. Key cognitive contents that occur with generalized anxiety disorder are focused on two aspects: metacognitive beliefs and intolerance of uncertainty. A primary purpose of cognitive-behavioural therapy (CBT) is the modification of dysfunctional beliefs about worry. Cognitive behavioural therapy is effective in reducing anxiety, makes it easier to operate in the professional sphere and improves the quality of life.
Hogendoorn, S.M.; Prins, P.J.M.; Vervoort, L.; Wolters, L.H.; Nauta, M.H.; Hartman, C.A.; Moorlag, H; de Haan, E.; Boer, F.
Negatively valenced thoughts are assumed to play a central role in the development and maintenance of anxiety. However, the role of positive thoughts in anxiety is rather unclear. In the current study we examined the role of negative and positive self-statements in the anxiety level of anxious and n
Full Text Available Most recommendations for treatment of anxiety in later life are based on evidence, derived from studies of younger populations. An important challenge is the high psychic and physical comorbidity of primary anxiety disorders. The aim of our study was to examine the pharmacological treatment of elderly patients in acute psychiatry setting, presenting with anxiety disorder.All subjects underwent clinical psychiatric examination and evaluation according to ICD-10 and DSM-IV criteria for an anxiety disorder and depression. The patients were examined also for a physical comorbidity.Depressive-anxious or comorbid with depression anxious patients prevailed. Primary solitary anxiety disorders were less seen. High physical comorbidity was registerd. Pharmacologic treatment consisted mostly of benzodiazepines and antidepressants. A considerable number of patients received Quetiapine in their therapeutic plans.Pharmacologic treatment in elderly patients with anxiety disorders should be precisely administered. Standard pharmacotherapy of anxiety disorders for a number of elderly patients needs to be modified. Further research is needed to determine the most appropriate safe and effective treatment model.
... Disorder Specific Phobias Obsessive-Compulsive Disorder (OCD) Posttraumatic Stress Disorder (PTSD) Depression Bipolar Disorder Suicide and Prevention Stress Related Illnesses Myth-Conceptions Find ...
Gadow, Kenneth D.; Nolan, Edith E.
Objective: To determine if comorbid anxiety disorder is associated with differential response to immediate release methylphenidate (MPH-IR) in children with both ADHD and chronic multiple tic disorder (CMTD). Method: Children with (n = 17) and without (n = 37) diagnosed anxiety disorder (ANX) were evaluated in an 8-week, placebo-controlled trial…
Boschloo, Lynn; Vogelzangs, Nicole; van den Brink, Wim; Smit, Johannes H.; Veltman, Dick J.; Beekman, Aartjan T. F.; Penninx, Brenda
Background Inconsistent findings have been reported on the role of comorbid alcohol use disorders as risk factors for a persistent course of depressive and anxiety disorders. Aims To determine whether the course of depressive and/or anxiety disorders is conditional on the type (abuse or dependence)
Hendriks, Sanne M.; Licht, Carmilla M. M.; Spijker, Jan; Beekman, Aartjan T. F.; Hardeveld, Florian; de Graaf, Ron; Penninx, Brenda W. J. H.
Background: This investigation examines differences in cognitive profiles in subjects with major depressive disorder (MDD) and generalized anxiety disorder (GAD). Methods: Data were used from subjects with current MDD (n = 655), GAD (n = 107) and comorbid MDD/GAD (n = 266) diagnosis from the Netherl
van Steensel, Francisca J. A.; Deutschman, Amber A. C. G.; Bögels, Susan M.
The psychometric properties of a questionnaire developed to assess symptoms of anxiety disorders (SCARED-71) were compared between two groups of children: children with high-functioning autism spectrum disorder and comorbid anxiety disorders (ASD-group; "n" = 115), and children with anxiety disorders (AD-group; "n" = 122).…
Cremers, H.R.; Roelofs, K.
Social anxiety is a common disorder characterized by a persistent and excessive fear of one or more social or performance situations. Behavioral inhibition is one of the early indicators of social anxiety, which later in life may advance into a certain personality structure (low extraversion and hig
van Steensel, Francisca J. A.; Bogels, Susan M.; Wood, Jeffrey J.
The aim of this study was to examine ASD traits in children with clinical anxiety in early development, as well as current manifestations. Parents of 42 children with an anxiety disorder (but no known diagnosis of ASD) and 42 typically developing children were interviewed using the Autism Diagnostic Interview (ADI-R). They also completed…
Wehry, Anna M; Beesdo-Baum, Katja; Hennelly, Meghann M; Connolly, Sucheta D; Strawn, Jeffrey R
Recent advances in the developmental epidemiology, neurobiology, and treatment of pediatric anxiety disorders have increased our understanding of these conditions and herald improved outcomes for affected children and adolescents. This article reviews the current epidemiology, longitudinal trajectory, and neurobiology of anxiety disorders in youth. Additionally, we summarize the current evidence for both psychotherapeutic and psychopharmacologic treatments of fear-based anxiety disorders (e.g., generalized, social, and separation anxiety disorders) in children and adolescents. Current data suggest that these disorders begin in childhood and adolescence, exhibit homotypic continuity, and increase the risk of secondary anxiety and mood disorders. Psychopharmacologic trials involving selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SSNRIs) are effective in pediatric patients with anxiety disorders and have generally demonstrated moderate effect sizes. Additionally, current data support cognitive behavioral therapy (CBT) for the treatment of these conditions in youth and suggest that the combination of psychotherapy + an SSRI may be associated with greater improvement than would be expected with either treatment as monotherapy.
Zimmermann, Peter; Iwanski, Alexandra; Çelik, Fatma
From an attachment perspective, insecure attachment patterns in both infancy and adolescence are risk factors for the development of anxiety disorders in adolescence. Dysfunctional emotion regulation and biased social information processing are possible mediating processes. This study examines differences in emotion regulation, emotional vulnerability, and behaviour inhibition in adolescents with clinical diagnosis of anxiety disorder and healthy controls. Adolescents with anxiety disorder reported more maladaptive emotion regulation depending on the specific emotion and a higher incidence of reporting hurt feelings in social interactions. In contrast, behaviour inhibition did not explain additional variance. The results suggest that adolescents with anxiety disorders show a bias in the interpretation of social interactions as frequently emotionally hurting, and the use of dysfunctional emotion regulation strategies that minimize the possibility for effective social emotion regulation by close others or therapists. The results are interpreted within attachment framework.
Brownlie, E B; Bao, Lin; Beitchman, Joseph
Language disorder is associated with anxiety and with social problems in childhood and adolescence. However, the relation between language disorder and adult social anxiety is not well known. This study examines social anxiety in early adulthood in a 26-year prospective longitudinal study following individuals identified with a communication disorder at age 5 and a control group. Social anxiety diagnoses and subthreshold symptoms were examined at ages 19, 25, and 31 using a structured diagnostic interview; social anxiety symptoms related to social interaction and social performance were also assessed dimensionally at age 31. Multiple imputation was used to address attrition. Compared to controls, participants with childhood language disorder had higher rates of subthreshold social phobia at ages 19 and 25 and endorsed higher levels of social interaction anxiety symptoms at age 31, with particular difficulty talking to others and asserting their perspectives. Childhood language disorder is a specific risk factor for a circumscribed set of social anxiety symptoms in adulthood, which are likely associated with communication challenges.
Lader, Malcolm; Kyriacou, Andri
The large class of CNS-depressant medications-the benzodiazepines-have been extensively used for over 50 years, anxiety disorders being one of the main indications. A substantial proportion (perhaps up to 20-30 %) of long-term users becomes physically dependent on them. Problems with their use became manifest, and dependence, withdrawal difficulties and abuse were documented by the 1980s. Many such users experience physical and psychological withdrawal symptoms on attempted cessation and may develop clinically troublesome syndromes even during slow tapering. Few studies have been conducted to establish the optimal withdrawal schedules. The usual management comprises slow withdrawal over weeks or months together with psychotherapy of various modalities. Pharmacological aids include antidepressants such as the SSRIs especially if depressive symptoms supervene. Other pharmacological agents such as the benzodiazepine antagonist, flumazenil, and the hormonal agent, melatonin, remain largely experimental. The purpose of this review is to analyse the evidence for the efficacy of the usual withdrawal regimes and the newer agents. It is concluded that little evidence exists outside the usual principles of drug withdrawal but there are some promising leads.
Zayfert, Claudia; Dums, Aricca R; Ferguson, Robert J; Hegel, Mark T
Although anxiety disorders have been associated with impairments in self-reported health functioning, the relative effect of various anxiety disorders has not been studied. We compared health functioning of patients with a principal diagnosis of posttraumatic stress disorder (PTSD), panic disorder (PD), generalized anxiety disorder (GAD), and major depressive disorder (MDD). Patients with PTSD and MDD were equally impaired on overall mental health functioning, and both were significantly worse than patients with PD and GAD. PTSD was associated with significantly worse physical health functioning relative to PD, GAD, and MDD. Hierarchical regression showed that the association of PTSD with physical health functioning was unique and was not caused by the effects of age, depression, or comorbid anxiety disorders. Both PTSD and comorbid anxiety accounted for unique variance in mental functioning. These results highlight the association of PTSD with impaired physical and mental functioning and suggest that effective treatment of PTSD may affect overall health.
Aakruti Kaikini*, Swati Dhande, Kalpana Patil and Vilasrao Kadam
Full Text Available Anxiety and depression is basically a disorder of the present modern world and its prevalence is seen increasing day by day. According to WHO, anxiety and depression will be the second largest cause of disability worldwide by year 2020. The major problem associated with this disorder is that common masses are unaware about this disorder and hence less than 25% of those affected have access to appropriate treatments. The medications currently used for treatment of this disorder are based on the earlier theories of anxiety and depression. These medications have many side effects as well as are associated with tolerance and dependence on prolonged usage. This article mainly focuses on the new theory involved in neurobiology of this disorder and drugs which can be developed on basis of the same.
Renno, Patricia; Wood, Jeffrey J.
Despite reports of high anxiety in children with autism spectrum disorders (ASD), there is controversy regarding differential diagnosis of ASD symptoms and anxiety symptoms. This study examined 88 children, aged 7-11 years, with ASD referred for concerns about anxiety. A multitrait-(social anxiety, separation anxiety, overall anxiety severity, and…
Faravelli, Carlo; Lo Sauro, Carolina; Godini, Lucia; Lelli, Lorenzo; Benni, Laura; Pietrini, Francesco; Lazzeretti, Lisa; Talamba, Gabriela Alina; Fioravanti, Giulia; Ricca, Valdo
Anxiety disorders are among the most common of all mental disorders and their pathogenesis is a major topic in psychiatry, both for prevention and treatment. Early stressful life events and alterations of hypothalamic pituitary adrenal (HPA) axis function seem to have a significant role in the onset of anxiety. Existing data appear to support the mediating effect of the HPA axis between childhood traumata and posttraumatic stress disorder. Findings on the HPA axis activity at baseline and after stimuli in panic disordered patients are inconclusive, even if stressful life events may have a triggering function in the development of this disorder. Data on the relationship between stress, HPA axis functioning and obsessive-compulsive disorder (OCD) are scarce and discordant, but an increased activity of the HPA axis is reported in OCD patients. Moreover, normal basal cortisol levels and hyper-responsiveness of the adrenal cortex during a psychosocial stressor are observed in social phobics. Finally, abnormal HPA axis activity has also been observed in generalized anxiety disordered patients. While several hypothesis have attempted to explain these findings over time, currently the most widely accepted theory is that early stressful life events may provoke alterations of the stress response and thus of the HPA axis, that can endure during adulthood, predisposing individuals to develop psychopathology. All theories are reviewed and the authors conclude that childhood life events and HPA abnormalities may be specifically and transnosographically related to all anxiety disorders, as well as, more broadly, to all psychiatric disorders.
evidence suggests that it may be a risk factor for emotion dysregulation and anxiety in not only ASD, but also other disorders such as ADHD and anorexia...ASD), yet we still know very little about the early risk factors for anxiety in ASD. Research is beginning to provide some clues regarding early... risk factors for anxiety in individuals with ASD, suggesting that sensory over-responsivity (SOR) may be an early emerging risk factor for anxiety in
Levinson, Cheri A.; RODEBAUGH, THOMAS L.
Social anxiety and eating disorders are highly comorbid. However, it is unknown how specific domains of social anxiety relate to disordered eating. We provide data on these relationships and investigate social appearance anxiety and fear of negative evaluation as potential vulnerabilities linking social anxiety with eating disorders. Specifically, we examined five domains of social anxiety: Social interaction anxiety, fear of scrutiny, fear of positive evaluation, fear of negative evaluation,...
Moskowitz Amanda T
Full Text Available Abstract Background Among the psychological difficulties seen in children of parents with substance use problems, the anxiety disorders are among the most chronic conditions. Although children of alcoholic parents often struggle with the effects of parental substance use problems long into adulthood, empirical investigations of the influence of parental substance use disorders on the course of anxiety disorders in adult offspring are rare. The purpose of this study was to examine prospectively the relationship between parental substance use disorders and the course of anxiety disorders in adulthood over the course of 12 years. Methods Data on 618 subjects were derived from the Harvard/Brown Anxiety Research Project (HARP, a longitudinal naturalistic investigation of the clinical course of multiple anxiety disorders. Kaplan-Meier survival estimates were used to calculate probabilities of time to anxiety disorder remission and relapse. Proportional hazards regressions were conducted to determine whether the likelihood of remission and relapse for specific anxiety disorders was lower for those who had a history of parental substance use disorders than for individuals without this parental history. Results Adults with a history of parental substance use disorders were significantly more likely to be divorced and to have a high school level of education. History of parental substance use disorder was a significant predictor of relapse of social phobia and panic disorders. Conclusion These findings provide compelling evidence that adult children of parents with substance use disorders are more likely to have relapses of social phobia and panic disorders. Clinicians who treat adults with anxiety disorders should assess parental substance use disorders and dependence histories. Such information may facilitate treatment planning with regards to their patients' level of vulnerability to perceive scrutiny by others in social situations, and ability to
Drake, Kelly L.; Ginsburg, Golda S.
It is now widely accepted that anxiety disorders run in families, and current etiological models have proposed both genetic and environmental pathways to anxiety development. In this paper, the familial role in the development, treatment, and prevention of anxiety disorders in children is reviewed. We focus on three anxiety disorders in youth,…
Xiao-Jing Li; Yan-Ling He; Hong Ma; Zhe-Ning Liu; Fu-Jun Jia; Ling Zhang; Lan Zhang
AIM:To investigate the prevalence and physicians'detection rate of depressive and anxiety disorders in gastrointestinal (GI) outpatients across China.METHODS:A hospital-based cross-sectional survey was conducted in the GI outpatient departments of 13general hospitals.A total of 1995 GI outpatients were recruited and screened with the Hospital Anxiety and Depression Scale (HADS).The physicians of the GI departments performed routine clinical diagnosis and management without knowing the HADS score results.SubJects with HADS scores ≥ 8 were subsequently interviewed by psychiatrists using the Mini International Neuropsychiatric Interview (MINI) to make further diagnoses.RESULTS:There were 1059 patients with HADS score ≥ 8 and 674 (63.64％) of them undertook the MINI interview by psychiatrists.Based on the criteria of Diagnostic and Statistical Manual of Mental Disorders (4th edition),the adjusted current prevalence for depressive disorders,anxiety disorders,and comorbidity of both disorders in the GI outpatients was 14.39％,9.42％ and 4.66％,respectively.Prevalence of depressive disorders with suicidal problems [suicide attempt or suicide-related ideation prior or current; module C (suicide) of MINI score ≥ 1] was 5.84％ in women and 1.64％ in men.The GI physicians' detection rate of depressive and anxiety disorders accounted for 4.14％.CONCLUSION:While the prevalence of depressive and anxiety disorders is high in Chinese GI outpatients,the detection rate of depressive and anxiety disorders by physicians is low.
Full Text Available Abstract Aims The aim of this study was to investigate the effect of juggling therapy for anxiety disorder patients. Design and Method Subjects were 17 female outpatients who met the DSM-IV diagnostic criteria for anxiety disorders. Subjects were treated with standard psychotherapy, medication and counseling for 6 months. For the last 3 months of treatment, subjects were randomized into either a non-juggling group (n = 9 or a juggling therapy group (juggling group: n = 8. The juggling group gradually acquired juggling skills by practicing juggling beanbags (otedama in Japan with both hands. The therapeutic effect was evaluated using scores of psychological testing (STAI: State and Trate Anxiety Inventry, POMS: Profile of Mood Status and of ADL (FAI: Franchay Activity Index collected before treatment, 3 months after treatment (before juggling therapy, and at the end of both treatments. Results After 6 months, an analysis of variance revealed that scores on the state anxiety, trait anxiety subscales of STAI and tension-anxiety (T-A score of POMS were significantly lower in the juggling group than in the non-juggling group (p Conclusion These findings suggest that juggling therapy may be effective for the treatment of anxiety disorders.
Dudaee-Faass, Sigal; Marnane, Claire; Wagner, Renate
Two case reports are described in which patients presented for the treatment of multiple comorbid anxiety disorders, all of which appeared to derive from prolonged separation anxiety disorder. In particular, these adults had effectively altered their lifestyles to avoid separation, thereby displaying only ambiguous separation anxiety symptoms that…
Conner, Caitlin M.; Maddox, Brenna B.; White, Susan W.
Comorbid anxiety is common among children with Autism Spectrum Disorder (ASD), and parents of children with ASD are more likely to have anxiety disorders. This study investigated the relationship between parents' state and trait anxiety and parent-reported internalizing and externalizing symptoms among adolescents (n = 30) with ASD, as well…
Goodwin, Guy M
The anxiety disorders include generalized anxiety disorder, specific phobia, social phobia, agoraphobia, and panic disorder. In addition to the specific symptoms of these disorders, there may be a common experience of anxiety and even dysphoria across the conditions, and of course recourse to the same drug or choice of drugs for treatment. This overlap probably occurs because of universal dimensions of distress or negative affectivity, a shared genetic predisposition, and a common neurobiology Evidence of shared genes is still based mainly on twin studies, but the shared neurobiology can be investigated directly by the investigation of emotional or cognitive bias either behaviorally or using functional brain imaging. This intermediate phenotype can then provide a substrate for understanding and developing medicines and psychological treatments.
... An antidepressant, which can help with anxiety and depression. This kind of medicine can take weeks to work. It is a safe medium- to long-term treatment for GAD. A benzodiazepine, which acts faster than ...
... symptoms of anxiety, such as trembling and sweating. Cognitive Behavioral Therapy (CBT) CBT (sometimes called "talk therapy" ... aerobic exercise may have a calming effect. Since caffeine, certain illicit drugs, and even some over-the- ...
Smoller, Jordan W; Gardner-Schuster, Erica; Covino, Jennifer
Panic disorder and phobic anxiety disorders are common disorders that are often chronic and disabling. Genetic epidemiologic studies have documented that these disorders are familial and moderately heritable. Linkage studies have implicated several chromosomal regions that may harbor susceptibility genes; however, candidate gene association studies have not established a role for any specific loci to date. Increasing evidence from family and genetic studies suggests that genes underlying these disorders overlap and transcend diagnostic boundaries. Heritable forms of anxious temperament, anxiety-related personality traits and neuroimaging assays of fear circuitry may represent intermediate phenotypes that predispose to panic and phobic disorders. The identification of specific susceptibility variants will likely require much larger sample sizes and the integration of insights from genetic analyses of animal models and intermediate phenotypes.
Akram, Umair; Ellis, Jason; Myachykov, Andriy; Chapman, Ashley; Barclay, Nicola
Individuals with insomnia often report aspects of perfectionism alongside symptoms of anxiety and depression. However, there has been limited examination of these factors together. The current study investigated whether individuals with insomnia report increased perfectionism compared to normal-sleepers. Further, the mediating role of anxiety and depression was examined. Participants were 39 individuals with DSM-5 defined Insomnia Disorder, and 39 normal-sleepers, who completed two measures o...
Monique Aucoin; Sukriti Bhardwaj
Observational evidence suggests that a relationship may exist between high glycemic index diets and the development of anxiety and depression symptoms; however, as no interventional studies assessing this relationship in a psychiatric population have been completed, the possibility of a causal link is unclear. AB is a 15-year-old female who presented with concerns of generalized anxiety disorder and hypoglycemia symptoms. Her diet consisted primarily of refined carbohydrates. The addition of ...
Osório, Flávia de Lima; Crippa, José Alexandre de Souza; Loureiro, Sonia Regina
Great progress has been observed in the literature over the last decade regarding the validation of instruments for the assessment of Social Anxiety Disorder in the Brazilian context. Particularly outstanding in this respect is the production of a group of Brazilian investigators regarding the psychometric study of the following instruments: Liebowitz Social Anxiety Scale, Social Phobia Inventory, Brief Social Phobia Scale, Disability Profile, Liebowitz Self-Rated Disability Scale, Social Phobia Safety Behaviors Scale and Self-Statements During Public Speaking Scale, which have proved to be appropriate and valid for use in the adult Brazilian population, representing resources for the assessment of social anxiety in clinical and experimental situations.
El-Bar, Nurit; Laufer, Offir; Yoran-Hegesh, Roni; Paz, Rony
Over-generalization of dangerous stimuli is a possible etiological account of anxiety. Recently, we demonstrated it could result from alterations in early perceptual mechanisms, i.e., a fundamental change in the way the stimulus is perceived. Yet it is still unclear if these mechanisms already exist in youth, or develop only later. The purpose of this study was therefore to explore the mechanism of generalization in youth suffering from anxiety disorders. Children and adolescents with anxiety disorders and age-matched control participants underwent a conditioning task where a loss or gain outcome was associated with two well-separated tones. A generalization probe then followed in which different surrounding tones were presented and classified. Generalization curves and changes in discrimination abilities were compared between groups and according to the background variables. We found that patients had lower perceptual discrimination thresholds after conditioning, and tended to have wider generalization curve. Relative enhanced generalization was observed in adolescents with anxiety, in males, and as the level of anxiety rose. Our results suggest that over-generalization in anxiety can start already during adolescence, and may suggest that an early perceptual source can give rise to later more cognitive over-generalization during adult anxiety.
Barrera, Terri L.; Norton, Peter J.
Interest in the assessment of quality of life in the anxiety disorders is growing. The present study examined quality of life impairments in individuals with Generalized Anxiety Disorder (GAD), Social Phobia, and Panic Disorder. Results showed that individuals with these disorders reported less satisfaction with their quality of life than non-anxious adults in the community. However, the degree of quality of life impairment is similar across these three disorders. Additionally, comorbid depression, but not anxiety, was found to negatively impact quality of life in these individuals. Finally, diagnostic symptom severity was not found to influence quality of life, indicating that subjective measures of quality of life offer unique information on the effects of anxiety disorders. PMID:19640675
de Souza Moura, Antonio Marcos; Lamego, Murilo Khede; Paes, Flávia; Ferreira Rocha, Nuno Barbosa; Simoes-Silva, Vitor; Rocha, Susana Almeida; de Sá Filho, Alberto Souza; Rimes, Ridson; Manochio, João; Budde, Henning; Wegner, Mirko; Mura, Gioia; Arias-Carrión, Oscar; Yuan, Ti-Fei; Nardi, Antonio Egidio; Machado, Sergio
Anxiety disorders are the most common psychiatric disorders observed currently. It is a normal adaptive response to stress that allows coping with adverse situations. Nevertheless, when anxiety becomes excessive or disproportional in relation to the situation that evokes it or when there is not any special object directed at it, such as an irrational dread of routine stimuli, it becomes a disabling disorder and is considered to be pathological. The traditional treatment used is medication and cognitive behavioral psychotherapy, however, last years the practice of physical exercise, specifically aerobic exercise, has been investigated as a new non-pharmacological therapy for anxiety disorders. Thus, the aim of this article was to provide information on research results and key chains related to the therapeutic effects of aerobic exercise compared with other types of interventions to treat anxiety, which may become a useful clinical application in a near future. Researches have shown the effectiveness of alternative treatments, such as physical exercise, minimizing high financial costs and minimizing side effects. The sample analyzed, 66.8% was composed of women and 80% with severity of symptoms anxiety as moderate to severe. The data analyzed in this review allows us to claim that alternative therapies like exercise are effective in controlling and reducing symptoms, as 91% of anxiety disorders surveys have shown effective results in treating. However, there is still disagreement regarding the effect of exercise compared to the use of antidepressant symptoms and cognitive function in anxiety, this suggests that there is no consensus on the correct intensity of aerobic exercise as to achieve the best dose-response, with intensities high to moderate or moderate to mild.
Boland, Elaine M; Ross, Richard J
Sleep disturbance is frequently associated with generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. This article reviews recent advances in understanding the mechanisms of the sleep disturbances in these disorders and discusses the implications for developing improved treatments.
Esbjorn, B. H.; Bender, P. K.; Reinholdt-Dunne, M. L.; Munck, L. A.; Ollendick, T. H.
Anxiety disorders are among the most common psychiatric disorders in childhood. Nonetheless, theoretical knowledge of the development and maintenance of childhood anxiety disorders is still in its infancy. Recently, research has begun to investigate the influence of emotion regulation on anxiety disorders. Although a relation between anxiety…
D.J. Stein; N.A. Fineberg; O.J. Bienvenu; D. Denys; C. Lochner; G. Nestadt; J.F. Leckman; S.L. Rauch; K.A. Phillips
In DSM-III, DSM-III-R, and DSM-IV, obsessive-compulsive disorder (OCD) was classified as an anxiety disorder. In ICD-10, OCD is classified separately from the anxiety disorders, although within the same larger category as anxiety disorders (as one of the "neurotic, stress-related, and somatoform dis
Morrison, Amanda S; Brozovich, Faith A; Lee, Ihno A; Jazaieri, Hooria; Goldin, Philippe R; Heimberg, Richard G; Gross, James J
The subjective experience of anxiety plays a central role in cognitive behavioral models of social anxiety disorder (SAD). However, much remains to be learned about the temporal dynamics of anxiety elicited by feared social situations. The aims of the current study were: (1) to compare anxiety trajectories during a speech task in individuals with SAD (n=135) versus healthy controls (HCs; n=47), and (2) to compare the effects of CBT on anxiety trajectories with a waitlist control condition. SAD was associated with higher levels of anxiety and greater increases in anticipatory anxiety compared to HCs, but not differential change in anxiety from pre- to post-speech. CBT was associated with decreases in anxiety from pre- to post-speech but not with changes in absolute levels of anticipatory anxiety or rates of change in anxiety during anticipation. The findings suggest that anticipatory experiences should be further incorporated into exposures.
Sipos, Kornel; Bodo, Michael; Szalay, Piroska; Szucs, Attila
In order to test the hypothesis that anxiety is a risk factor for cardiovascular disease, specifically stroke, we simultaneously measured anxiety and cerebral vascular alternation, using a computer-based system, "Cerberus." Sixty nine psychiatric patients (including an alcoholic subgroup) were selected as subjects for measurements conducted in Kecskemet, Hungary. The five-item short form of anxiety test (STAI) was administered twice during the same session. Between each test, brain pulse waves were recorded by rheoencephalogram (REG). A REG peak time above 180 milliseconds was considered a cerebrovascular alteration (modified after Jenkner). Data were sorted into two groups: low anxiety (N=10) and high anxiety (N=10). Significant differences were found between cardiovascular risk factors (panxiety group, and two in the low anxiety group. For the two anxiety groups, there were no significant differences in body mass index, cardiovascular sympathetic-parasympathetic balance, age and symptoms of transient ischemic attack. The correlation of REG and age was significantly different only for the alcoholic subgroup (Szalay et al, 2007). These data support the hypothesis that a correlation exists between cerebrovascular disorder and anxiety in the studied population.
Full Text Available Cognitive behavioral therapy is still one of the most important treatment modalities in social anxiety disorder with a high level of evidence. However, some patients do not fully benefit from these therapies and this fact leads to ongoing search for new approaches. This paper reviews use of cognitive behavioral therapy in social anxiety disorder studies and discusses related updated concepts. The frequent use of computer-assisted therapy for most of recent studies was found noteworthy. Recent studies regarding social anxiety disorder focused on concepts such as attention bias, biased information processing, attention training, judgment biases, internet-based cognitive behavioral therapies and social mishap exposure. Internet-based cognitive-behavioral therapy seemed to be a good option for people who were unable to access face to face treatment. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2015; 7(3.000: 229-243
Guttmann-Steinmetz, Sarit; Gadow, Kenneth D.; DeVincent, Carla J.; Crowell, Judy
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…
When applied to the construction of anxiety disorders, theories of poststructuralist historicism emphasize acts of interpretation that constitute and construct the disorders and problematize the processes by which meaning is constructed. An examination of the historical formulations of anxiety disorders, and in particular, agoraphobia, provides the opportunity for reanalyzing traditional approaches to the classifications of disorders. Psychological issues of paradox, attachment, and personal identity, which are crucial to current conceptualizations of agoraphobia, are acutely problematized within a poststructuralist historicist hermeneutic. A rethinking of disorder construction from within this hermeneutic suggests replacing individualistic conceptualizations of personal identity with a broader view that recognizes and celebrates multiplicity and that displays formulations of the self in a contextualized and historicized status, thus enabling a fuller engagement with the social world.
Full Text Available Kyungwook Kim,1 Seul Lee,2 Jong-Hoon Kim1–3 1Gachon University School of Medicine, 2Department of Psychiatry, Gil Medical Center, Gachon University School of Medicine, Gachon University, 3Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea Background: Generalized anxiety disorder (GAD is a chronic and highly prevalent disorder that is characterized by a number of autonomic nervous system symptoms. The purpose of this study was to investigate the linear and nonlinear complexity measures of heart rate variability (HRV, measuring autonomic regulation, and to evaluate the relationship between HRV parameters and the severity of anxiety, in medication-free patients with GAD. Methods: Assessments of linear and nonlinear complexity measures of HRV were performed in 42 medication-free patients with GAD and 50 healthy control subjects. In addition, the severity of anxiety symptoms was assessed using the State-Trait Anxiety Inventory and Beck Anxiety Inventory. The values of the HRV measures of the groups were compared, and the correlations between the HRV measures and the severity of anxiety symptoms were assessed. Results: The GAD group showed significantly lower standard deviation of RR intervals and the square root of the mean squared differences of successive normal sinus intervals values compared to the control group (P<0.01. The approximate entropy value, which is a nonlinear complexity indicator, was also significantly lower in the patient group than in the control group (P<0.01. In correlation analysis, there were no significant correlations between HRV parameters and the severity of anxiety symptoms. Conclusion: The present study indicates that GAD is significantly associated with reduced HRV, suggesting that autonomic neurocardiac integrity is substantially impaired in patients with GAD. Future prospective studies are required to investigate the effects of pharmacological or non-pharmacological treatment on
Reinholt, Nina; Krogh, Jesper
Transdiagnostic approaches to cognitive behaviour therapy (TCBT) of anxiety disorders have drawn increasing interest and empirical testing over the past decade. In this paper, we review evidence of the overall efficacy of TCBT for anxiety disorders, as well as TCBT efficacy compared with wait......-list, treatment-as-usual, and diagnosis-specific cognitive behaviour therapy (CBT) controls. A total of 11 studies reporting 12 trials (n = 1933) were included in the systematic review. Results from the meta-analysis of 11 trials suggest that TCBT was generally associated with positive outcome; TCBT patients did...
Ali Reza Shafiee-Kandjani
Full Text Available "n Objective: Patients with bipolar mood disorder constitute a relatively large number of individuals hospitalized in psychiatric hospitals. This disorder is highly co-morbid with other psychiatric disorders and may effect their clinical course. The goal of this study was to determine the co-occurrence rate of anxiety disorders and substance abuse with bipolar mood disorders and their impact on clinical course. "n Methods: 153 bipolar patients (type I were selected among the hospitalized patients at Razi Psychiatric Hospital in Tabriz, Iran, from September 2007 to October 2008 through convenience sampling method. The participants were evaluated by a structured clinical interview based on DSM-IV criteria (SCID, Hamilton Rating Scale for Depression (HRSD and Young Mania Rating Scale (YMRS. Results: Co-morbidity of anxiety disorders was 43% . Occurrence of anxiety disorders was 26% for obsessive-compulsive disorder, 24.8% for generalized anxiety disorder, 3.9% for phobia and 2% for panic disorder. Co-morbidity of substance abuse was 7.2% and the highest occurrence of substance abuse was 5.2% for alcoholism and 3.9% for opium. No significant difference was observed between the severity of disease and duration of hospitalization in bipolar patients with or without anxiety disorder. The severity of disease and duration of hospitalization in bipolar patients with substance abuse was higher compared to bipolar patients without substance abuse (P<0.05. "nConclusions: This study suggests that there is a high co-morbidity between anxiety disorders and substance abuse with bipolar disorder. Further, this study suggests that co-occurrence of substance abuse disorder with bipolar disorder increases the severity of the disease and duration of hospitalization.
among individuals with Autism (ASD), yet we still know very little about the early risk factors for anxiety in ASD. Research is beginning to provide...of research by our group focused on early detection and prevention of anxiety disorders in young children with ASD. II. Keywords Autism , Anxiety...was hired as a Research Coordinator I to assist with all aspects of the project, including EEG data collection and analysis. Mrs. Tourian terminated
Meier, Sandra M; Bulik, Cynthia M; Thornton, Laura M; Mattheisen, Manuel; Mortensen, Preben B; Petersen, Liselotte
Anxiety disorders and anorexia nervosa are frequently acknowledged to be highly comorbid conditions, but still, little is known about the clinical and aetiological cohesion of specific anxiety diagnoses and anorexia nervosa. Using the comprehensive Danish population registers, we aimed to determine the risk of anorexia nervosa in patients with register-detected severe anxiety disorders. We also explored whether parental psychopathology was associated with offspring's anorexia nervosa. Anxiety disorders increased the risk of subsequent anorexia nervosa, with the highest risk observed in obsessive-compulsive disorder. Especially, male anxiety patients were at an increased risk for anorexia nervosa. Furthermore, an increased risk was observed in offspring of fathers with panic disorder. A diagnosis of an anxiety disorder, specifically obsessive-compulsive disorder, constitutes a risk factor for subsequent diagnosis of anorexia nervosa. These observations support the notion that anxiety disorders and anorexia nervosa share etiological mechanisms and/or that anxiety represents one developmental pathway to anorexia nervosa.
Volkova, O M; Kozlovskaia, G V; Proselkova, M O
The complex of such phenomena as anxiety and fear in children of the early age and their relationship with risk factors for psychic pathology were investigated. Eighty cases of anxiety-phobic disorders in children of the first five years of life were studied. The types of behavioral and somatic reactions that allowed to reveal not only the clinically expressed phenomena of anxiety and fear but the higher readiness to them were described. The first anxiety-phobic reactions appeared at the age when emotional functions were not completely formed and might be considered as the presentations of emotional dysontogenesis. The authors assume that characteristics of fear expression in the early age allow to suspect a mental disease which might be timely diagnosed in case of its manifestation. The conclusions made in the paper may be useful for clinical practice of pediatricians, children neurologists, psychologists and psychiatrists.
Are Worry and Rumination Specific Pathways Linking Neuroticism and Symptoms of Anxiety and Depression in Patients with Generalized Anxiety Disorder, Major Depressive Disorder and Mixed Anxiety-Depressive Disorder?
Hipólito Merino; Carmen Senra; Fátima Ferreiro
This study examines the relationships between neuroticism (higher-order vulnerability factor), the cognitive styles of worry, brooding and reflection (second-order vulnerability factors) and symptoms of anxiety and depression in three groups of patients: patients with Generalized Anxiety Disorder (GAD), with Major Depressive Disorder (MDD) and with Mixed Anxiety-Depressive Disorder (MADD). One hundred and thirty four patients completed a battery of questionnaires including measures of neuroti...
Johnson, Sverre U.; Hoffart, Asle
We aimed to systematically evaluate a generic model of metacognitive therapy (MCT) with a highly comorbid anxiety disorder patient, that had been treated with diagnosis-specific cognitive-behavioral therapy (CBT) without significant effect. Traditionally, CBT has progressed within a disorder-specific approach, however, it has been suggested that this could be less optimal with highly comorbid patients. To address comorbidity, transdiagnostic treatment models have been emerging. This case study used an AB-design with repeated assessments during each therapy session and a 1-year follow-up assessment to evaluate the effectiveness of MCT. Following 8 sessions of MCT, significant decrease in anxiety and depression symptoms, as well as loss of diagnostic status was observed. Outcomes were preserved at 12 months follow up. The generic model of MCT seems promising as an approach to highly comorbid mixed anxiety depression patients. Further testing using more powered methodologies are needed. PMID:27746757
Dias, Brian G; Banerjee, Sunayana B; Goodman, Jared V; Ressler, Kerry J
Fear and anxiety are debilitating conditions that affect a significant number of individuals in their lifetimes. Understanding underlying mechanisms of these disorders affords us the possibility of therapeutic intervention. Such clarity in terms of mechanism and intervention can only come from an amalgamation of research from human to animal studies that attempt to mimic the human condition, both of which are discussed in this review. We begin by presenting an outline of our current understanding of the neurobiological basis of fear and anxiety. This outline spans various levels of organization that include the circuitry, molecular pathways, genetic and epigenetic components of fear and anxiety. Using these organizational levels as a scaffold, we then discuss strategies that are currently used to ameliorate these disorders, and forecast future interventions that hold therapeutic promise. Among these newer promising treatments, we include, optogenetic, pharmacological, and extinction-based approaches, as well as lifestyle modifications, with combinatorial treatment regimens of these holding the most promise.
Labrecque, Joane; Marchand, Andre; Dugas, Michel J.; Letarte, Andree
The goal of this study was to evaluate the efficacy of cognitive-behavioral therapy for comorbid panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) by combining treatment strategies for both disorders. A single-case, multiple-baseline design across participants was used. Three participants with primary PDA and secondary…
Dar, Kaiser A; Iqbal, Naved
Ample work has already been conducted on worry and rumination as negative thought processes involved in the etiology of most of the anxiety and mood related disorders. However, minimal effort has been exerted to investigate whether one type of negative thought process can make way for another type of negative thought process, and if so, how it subsequently results in experiencing a host of symptoms reflective of one or the other type of psychological distress. Therefore, the present study was taken up to investigate whether rumination mediates the relationship between worry and generalized anxiety disorder (GAD), and between worry and obsessive compulsive disorder (OCD) in two clinical groups. Self-report questionnaires tapping worry, rumination, generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) were administered to a clinical sample of 60 patients aged 30-40. Worry, rumination, generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) correlated substantially with each other, however, rumination did not mediate the relationship between worry and generalized anxiety disorder (GAD) and between worry and obsessive compulsive disorder (OCD). We also analyzed differences of outcome variables within two clinical groups. These results showed that worry and rumination were significantly different between GAD and OCD groups.
Acarturk, C.; Cuijpers, P.; Straten, van A.; Graaf, de R.
Abstract Background Older meta-analyses of the effects of psychological treatments of social anxiety disorder have found that these treatments have moderate to large effects. However, these earlier meta-analyses also included non-randomized studies, and there are many featured studies in this area w
B. van Bockstaele; S.M. Bögels
Over the past decades, a wealth of evidence has accumulated indicating that cognitive processes, such as attention for unwanted stimuli or sensations and the negative interpretation of ambiguous signals, are critically involved in the development and maintenance of social anxiety disorder (SAD). Alt
Wichstrøm, Lars; Belsky, Jay; Berg-Nielsen, Turid Suzanne
Background: Anxiety disorders are often present at preschool age. Research on older children and studies contrasting preschoolers with high versus low behavioral inhibition (BI) highlight several risk factors, but these have not been investigated in community samples of young children. Child, parent, and peer factors at age 4 were therefore…
Esbjørn, Barbara Hoff; Normann, Nicoline; Reinholdt-Dunne, Marie Louise
-c) with generalised anxiety disorder (GAD) and create suggestions for an adapted manual. The adaptation was based on the structure and techniques used in MCT for adults with GAD. However, the developmental limitations of children were taken into account. For instance, therapy was aided with worksheets, practical...
Beesdo-Baum, K.; Jenjahn, E.; Höfler, M.; Lüken, U.; Becker, E.S.; Hoyer, J.
Background The behavioral symptoms of Generalized Anxiety Disorder (GAD) are not well characterized. This study examines behavioral symptoms in patients with GAD compared to healthy participants, their change during behavioral therapy, and their role for predicting short- and long-term outcome. Meth
McConachie, Helen; McLaughlin, Eleanor; Grahame, Victoria; Taylor, Helen; Honey, Emma; Tavernor, Laura; Rodgers, Jacqui; Freeston, Mark; Hemm, Cahley; Steen, Nick; Le Couteur, Ann
Aim: To investigate the acceptability and feasibility of adapted group therapy for anxiety in children with autism spectrum disorder in a pilot randomised controlled trial. Method: A total of 32 children aged 9-13 years were randomised to immediate or delayed therapy using the "Exploring Feelings" manual (Attwood, 2004). Child and parent…
Schmidt, Norman B.; Buckner, Julia D.; Keough, Meghan E.
Emerging evidence suggests that elevated anxiety sensitivity (AS) is associated with substance use disorders. However, prospective evidence regarding this association is currently lacking. The primary aim of the present study was to determine whether AS is involved in the pathogenesis of substance-related psychopathology. A large, nonclinical…
Gerrits, Marloes M. J. G.; van Oppen, Patricia; van Marwijk, Harm W. J.; Penninx, Brenda W. J. H.; van der Horst, Henritte E.
Patients with pain may be at increased risk of developing a first episode of depressive or anxiety disorder. Insight into possible associations between specific pain characteristics and such a development could help clinicians to improve prevention and treatment strategies. The objectives of this st
Leahy, Robert L.
Cognitive-behavioral treatment for all anxiety disorders involves exposure to feared situations and feared emotions. Dropout from therapy is a continued problem for final treatment effectiveness. A meta-emotional model of fear of negative emotions (and anxious sensations and thoughts) is advanced that can be used as a transdiagnostic treatment…
Oude Voshaar, R.C.; Hendriks, G.J.; Keijsers, G.P.J.; Balkom, A.J.L.M. van
This is the protocol for a review and there is no abstract. The objectives are as follows: 1. To assess the efficacy and feasability of CBT (CT, BT, CBT and third wave CBT interventions) for different anxiety disorders in older adults aged 55 years or over compared with minimal management 2. To asse
Parrish, Danielle E.; Oxhandler, Holly K.; Duron, Jacuelynn F.; Swank, Paul; Bordnick, Patrick
Purpose: This study assessed the feasibility of virtual reality (VR) exposure as an assessment and treatment modality for youth with social anxiety disorder (SAD). Methods: Forty-one adolescents, 20 of which were identified as having SAD, were recruited from a community sample. Youth with and without SAD were exposed to two social virtual…
de Jongh, A.; ten Broeke, E.
Based on the assumptions of Shapiro's adaptive information-processing model, it could be argued that a large proportion of people suffering from an anxiety disorder would benefit from eye movement desensitization and reprocessing (EMDR). This article provides an overview of the current empirical evi
Estácio Amaro da Silva Júnior
Full Text Available ABSTRACT Objective To evaluate, in a community sample of adolescents, the presence of comorbidities in different anxiety disorders. Methods This is a cross-sectional study, initially composed of 2,457 adolescents, aged between 10-17 years old, from public schools of the area covered by the Basic Health Unit of a university hospital. We applied the Screen for Child Anxiety Related Emotional Disorders (SCARED to assess for anxiety disorders. Then, 138 positive cases in the screening were assessed for mental disorders through the Schedule for Affective Disorder and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL. Results Patients with anxiety disorders had more association with other anxiety disorders, as well as depression, and enuresis. The most common comorbidity described in our study was between generalized anxiety disorder and separation anxiety disorder (OR = 4.21, 95% CI 1.88, 9.58. Significant association was observed between other disorders such as enuresis and separation anxiety disorder (OR = 3.81, 95% CI 1.16, 12.49, as well as depression and generalized anxiety disorder (OR = 3.40; 95% CI 1.52, 7.61. Conclusion Our study showed a relevant presence of comorbidities adolescents with anxiety disorders, selected from a community sample, especially regarding other anxiety disorders. Nevertheless, further studies are needed to confirm our findings.
Cousineau, Héloïse; Marchand, André; Bouchard, Stéphane; Bélanger, Claude; Gosselin, Patrick; Langlois, Frédéric; Labrecque, Joane; Dugas, Michel J; Belleville, Geneviève
Patients with panic disorder with agoraphobia (PDA) or generalized anxiety disorder (GAD) frequently also suffer from insomnia. However, the impact of cognitive-behavioral therapy (CBT) for anxiety disorders on insomnia has been understudied. Furthermore, comorbidity between anxiety disorders is common. Our main objective was to assess the impact of CBT for PDA or GAD on insomnia. In a quasi-experimental design, 86 participants with PDA and GAD received conventional CBT for their primary disorder or combined CBT for both disorders. Overall, CBTs had a significant impact on reducing insomnia symptoms (η = 0.58). However, among people with insomnia at pretest (67%), 33% still had an insomnia diagnosis, and the majority (63%) had clinically significant residual insomnia following treatment. In conclusion, the CBTs had a positive effect on the reduction of insomnia, but a significant proportion of participants still had insomnia problems following treatment. Clinicians should address insomnia during CBT for PDA and GAD.
Schellekens, A.F.A.; Jong, C.A.J. de; Buitelaar, J.; Verkes, R.J.
INTRODUCTION: Alcohol dependence and anxiety disorders often co-occur. Yet, the effect of co-morbid anxiety disorders on the alcohol relapse-risk after treatment is under debate. This study investigated the effect of co-morbid anxiety disorders on relapse rates in alcohol dependence. We hypothesized
Schellekens, A.F.A.; Jong, C.A.J. de; Buitelaar, J.K.; Verkes, R.J.
Introduction Alcohol dependence and anxiety disorders often co-occur. Yet, the effect of co-morbid anxiety disorders on the alcohol relapse-risk after treatment is under debate. This study investigated the effect of co-morbid anxiety disorders on relapse rates in alcohol dependence. We hypothesized
van Steensel, Francisca J. A.; Bogels, Susan M.; Dirksen, Carmen D.
Comorbid anxiety disorders are common in children with autism spectrum disorders (ASD). However, studies comparing children with ASD to clinically anxious children are rare. This study investigated anxiety problems and health-related quality of life in children with high-functioning ASD and comorbid anxiety disorders (referred to as the ASD…
Scharfstein, Lindsay; Alfano, Candice; Beidel, Deborah; Wong, Nina
A common assumption is that all youth with anxiety disorders (AD) experience impaired peer relationships relative to healthy control children. Social impairments have been identified among youth with certain AD (e.g., social anxiety disorder; SAD), but less is known about the peer relationships of children with generalized anxiety disorder (GAD).…
Full Text Available Objective. The purpose of this paper is to provide evidence for the relationship between personality disorders (PDs, obsessive compulsive disorder (OCD, and other anxiety disorders different from OCD (non-OCD symptomatology. Method. The sample consisted of a group of 122 individuals divided into three groups (41 OCD; 40 non-OCD, and 41 controls matched by sex, age, and educational level. All the individuals answered the IPDE questionnaire and were evaluated by means of the SCID-I and SCID-II interviews. Results. Patients with OCD and non-OCD present a higher presence of PD. There was an increase in cluster C diagnoses in both groups, with no statistically significant differences between them. Conclusions. Presenting anxiety disorder seems to cause a specific vulnerability for PD. Most of the PDs that were presented belonged to cluster C. Obsessive Compulsive Personality Disorder (OCPD is the most common among OCD. However, it does not occur more frequently among OCD patients than among other anxious patients, which does not confirm the continuum between obsessive personality and OCD. Implications for categorical and dimensional diagnoses are discussed.
Pini, Stefano; Abelli, Marianna; Troisi, Alfonso; Siracusano, Alberto; Cassano, Giovanni B; Shear, Katherine M; Baldwin, David
Epidemiological studies indicate that separation anxiety disorder occurs more frequently in adults than children. It is unclear whether the presence of adult separation anxiety disorder (ASAD) is a manifestation of anxious attachment, or a form of agoraphobia, or a specific condition with clinically significant consequences. We conducted a study to examine these questions. A sample of 141 adult outpatients with panic disorder participated in the study. Participants completed standardized measures of separation anxiety, attachment style, agoraphobia, panic disorder severity and quality of life. Patients with ASAD (49.5% of our sample) had greater panic symptom severity and more impairment in quality of life than those without separation anxiety. We found a greater rate of symptoms suggestive of anxious attachment among panic patients with ASAD compared to those without ASAD. However, the relationship between ASAD and attachment style is not strong, and adult ASAD occurs in some patients who report secure attachment style. Similarly, there is little evidence for the idea that separation anxiety disorder is a form of agoraphobia. Factor analysis shows clear differentiation of agoraphobic and separation anxiety symptoms. Our data corroborate the notion that ASAD is a distinct condition associated with impairment in quality of life and needs to be better recognized and treated in patients with panic disorder.
Relapse prevention and residual symptoms: a closer analysis of placebo-controlled continuation studies with escitalopram in major depressive disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder
Bech, Per; Lönn, Sara L; Overø, Kerstin F
-Severity of Illness scores and relapse status in 4 studies published from 2005 to 2007, 1 each in major depressive disorder (MDD), generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD), were analyzed using mixed-effects model repeated measures as a function of Montgomery...
Saeed, Sy Atezaz; Antonacci, Diana J; Bloch, Richard M
Anxiety and depression are among the most common conditions cited by those seeking treatment with complementary and alternative therapies, such as exercise, meditation, tai chi, qigong, and yoga. The use of these therapies is increasing. Several studies of exercise and yoga have demonstrated therapeutic effectiveness superior to no-activity controls and comparable with established depression and anxiety treatments (e.g., cognitive behavior therapy, sertraline, imipramine). High-energy exercise (i.e., weekly expenditure of at least 17.5 kcal per kg) and frequent aerobic exercise (i.e., at least three to five times per week) reduce symptoms of depression more than less frequent or lower-energy exercise. Mindful meditation and exercise have positive effects as adjunctive treatments for depressive disorders, although some studies show multiple methodological weaknesses. For anxiety disorders, exercise and yoga have also shown positive effects, but there are far less data on the effects of exercise on anxiety than for exercise on depression. Tai chi, qigong, and meditation have not shown effectiveness as alternative treatments for depression and anxiety.
Cremers, Henk R; Roelofs, Karin
Social anxiety is a common disorder characterized by a persistent and excessive fear of one or more social or performance situations. Behavioral inhibition is one of the early indicators of social anxiety, which later in life may advance into a certain personality structure (low extraversion and high neuroticism) and the development of maladaptive cognitive biases. While there are several effective psycho- and pharmacotherapy options, a large number of patients benefit insufficiently from these therapies. Brain and neuroendocrine research can help uncover both the biological basis of social anxiety and potentially provide indicators, 'biomarkers,' that may be informative for early disease detection or treatment response, above and beyond self-report data. Several large-scale brain networks related to emotion, motivation, cognitive control, and self-referential processing have been identified, and are affected in social anxiety. Social anxiety is further characterized by increased cortisol response and lower testosterone levels. These neuroendocrine systems are also related to altered connectivity patterns, such as reduced amygdala-prefrontal coupling. Much work is needed however to further elucidate such interactions between neuroendocrine functioning and large-scale brain networks. Despite the great promise of brain research in uncovering the neurobiological basis of social anxiety, several methodological and conceptual issues also need to be considered. WIREs Cogn Sci 2016, 7:218-232. doi: 10.1002/wcs.1390 For further resources related to this article, please visit the WIREs website.
Kim, Kyungwook; Lee, Seul; Kim, Jong-Hoon
Background Generalized anxiety disorder (GAD) is a chronic and highly prevalent disorder that is characterized by a number of autonomic nervous system symptoms. The purpose of this study was to investigate the linear and nonlinear complexity measures of heart rate variability (HRV), measuring autonomic regulation, and to evaluate the relationship between HRV parameters and the severity of anxiety, in medication-free patients with GAD. Methods Assessments of linear and nonlinear complexity measures of HRV were performed in 42 medication-free patients with GAD and 50 healthy control subjects. In addition, the severity of anxiety symptoms was assessed using the State-Trait Anxiety Inventory and Beck Anxiety Inventory. The values of the HRV measures of the groups were compared, and the correlations between the HRV measures and the severity of anxiety symptoms were assessed. Results The GAD group showed significantly lower standard deviation of RR intervals and the square root of the mean squared differences of successive normal sinus intervals values compared to the control group (P<0.01). The approximate entropy value, which is a nonlinear complexity indicator, was also significantly lower in the patient group than in the control group (P<0.01). In correlation analysis, there were no significant correlations between HRV parameters and the severity of anxiety symptoms. Conclusion The present study indicates that GAD is significantly associated with reduced HRV, suggesting that autonomic neurocardiac integrity is substantially impaired in patients with GAD. Future prospective studies are required to investigate the effects of pharmacological or non-pharmacological treatment on neuroautonomic modulation in patients with GAD. PMID:27994467
Saavedra, Lissette M.; Silverman, Wendy K.; Morgan-Lopez, Antonio A.; Kurtines, William M.
Background: The present study's aim was to examine the long-term effects (8 to 13 years post-treatment; M = 9.83 years; SD = 1.71) of the most widely used treatment approaches of exposure-based cognitive behavioral treatment for phobic and anxiety disorders in children and adolescents (i.e., group treatment and two variants of individual…
Trevor R Norman
Full Text Available Trevor R Norman, James S OlverDepartment of Psychiatry, University of Melbourne, Austin Hospital, Heidelberg, Victoria, AustraliaAbstract: Duloxetine, a medication with effects on both serotonin and noradrenaline transporter molecules, has recently been approved for the treatment of generalized anxiety disorder. The evidence for its efficacy lies in a limited number of double blind, placebo controlled comparisons. Statistically significant improvements in the Hamilton Anxiety Rating Scale from baseline were demonstrated in all studies at doses of 60 to 120 mg per day. The significance of such changes in terms of clinical improvements compared to placebo is less certain, particularly when the effect size of the change is calculated. In comparative trials with venlafaxine, duloxetine was as effective in providing relief of anxiety symptoms. In addition to improvements in clinical symptoms duloxetine has also been associated with restitution of role function as measured by disability scales. Duloxetine use is associated with nausea, dizziness, dry mouth, constipation, insomnia, somnolence, hyperhidrosis, decreased libido and vomiting. These treatment emergent side effects were generally of mild to moderate severity and were tolerated over time. Using a tapered withdrawal schedule over two weeks in the clinical trials, duloxetine was associated with only a mild withdrawal syndrome in up to about 30% of patients compared to about 17% in placebo treated patients. Duloxetine in doses of up to 200 mg twice daily did not prolong the QTc interval in healthy volunteers. Like other agents with dual neurotransmitter actions duloxetine reduces the symptoms of generalized anxiety disorder in short term treatments. Further evidence for its efficacy and safety in long term treatment is required.Keywords: duloxetine, generalized anxiety disorder, Hamilton anxiety rating scale, withdrawal syndrome, psycho-social function
Settipani, Cara A.; Kendall, Philip C.
Social functioning was assessed using the Child Behavior Checklist and Teacher Report Form for children with anxiety disorders who participated in a randomized clinical trial (N = 161, aged 7-14). Significant relationships were found between severity of children's principal anxiety disorder and most measures of social functioning, such that poorer…
Terrill, Alexandra L.; Hartoonian, Narineh; Beier, Meghan; Salem, Rana; Alschuler, Kevin
Background: Generalized anxiety disorder (GAD) is common in multiple sclerosis (MS) but understudied. Reliable and valid measures are needed to advance clinical care and expand research in this area. The objectives of this study were to examine the psychometric properties of the 7-item Generalized Anxiety Disorder Scale (GAD-7) in individuals with MS and to analyze correlates of GAD.
Renno, Patricia; Wood, Jeffrey J.
Despite reports of high anxiety in children with autism spectrum disorders (ASD), there is controversy regarding differential diagnosis of ASD symptoms and anxiety symptoms. This study examined 88 children, aged 7–11 years, with ASD referred for concerns about anxiety. A multitrait-(social anxiety, separation anxiety, overall anxiety severity, and overall ASD severity), multimethod- (diagnostic interviews, parent-, and child-based measures) analysis was conducted. Results from structural equa...
Park, Subin; Park, Min-Hyeon; Kim, Hyo Jin; Yoo, Hee Jeong
The objective of this study was to examine (a) anxiety and depression symptoms in children with Asperger syndrome (AS) compared to children with attention-deficit/hyperactivity disorder (ADHD) and children with depressive disorder; (b) parental anxiety and depressive symptoms in the three groups; and (c) the association between the anxiety and…
Möller, Eline L; Bögels, Susan M
With DSM-5, the American Psychiatric Association encourages complementing categorical diagnoses with dimensional severity ratings. We therefore examined the psychometric properties of the DSM-5 Dimensional Anxiety Scales, a set of brief dimensional scales that are consistent in content and structure and assess DSM-5-based core features of anxiety disorders. Participants (285 males, 255 females) completed the DSM-5 Dimensional Anxiety Scales for social anxiety disorder, generalized anxiety disorder, specific phobia, agoraphobia, and panic disorder that were included in previous studies on the scales, and also for separation anxiety disorder, which is included in the DSM-5 chapter on anxiety disorders. Moreover, they completed the Screen for Child Anxiety Related Emotional Disorders Adult version (SCARED-A). The DSM-5 Dimensional Anxiety Scales demonstrated high internal consistency, and the scales correlated significantly and substantially with corresponding SCARED-A subscales, supporting convergent validity. Separation anxiety appeared present among adults, supporting the DSM-5 recognition of separation anxiety as an anxiety disorder across the life span. To conclude, the DSM-5 Dimensional Anxiety Scales are a valuable tool to screen for specific adult anxiety disorders, including separation anxiety. Research in more diverse and clinical samples with anxiety disorders is needed. © 2016 The Authors International Journal of Methods in Psychiatric Research Published by John Wiley & Sons Ltd.
Levinson, Cheri A; Rodebaugh, Thomas L; White, Emily K; Menatti, Andrew R; Weeks, Justin W; Iacovino, Juliette M; Warren, Cortney S
Social anxiety and eating disorders are highly comorbid. Social appearance anxiety (i.e., fear of negative evaluation of one's appearance), general fear of negative evaluation, and perfectionism have each been proposed as risk factors for both social anxiety disorder and the eating disorders. However, no research to date has examined all three factors simultaneously. Using structural equation modeling in two diverse samples (N=236; N=136) we tested a model in which each of these risk factors were uniquely associated with social anxiety and eating disorder symptoms. We found support for social appearance anxiety as a shared risk factor between social anxiety and eating disorder symptoms, whereas fear of negative evaluation was a risk factor only for social anxiety symptoms. Despite significant zero-order relationships, two facets of perfectionism (high standards and maladaptive perfectionism) did not emerge as a risk factor for either disorder when all constructs were considered. These results were maintained when gender, body mass index, trait negative affect, and depression were included in the model. It is possible that treating negative appearance evaluation fears may reduce both eating disorder and social anxiety symptoms.
Tinoco-González, Daniella; Fullana, Miquel Angel; Torrents-Rodas, David; Bonillo, Albert; Vervliet, Bram; Blasco, María Jesús; Farré, Magí; Torrubia, Rafael
Abnormal fear conditioning processes (including fear acquisition and conditioned fear-generalization) have been implicated in the pathogenesis of anxiety disorders. Previous research has shown that individuals with panic disorder present enhanced conditioned fear-generalization in comparison to healthy controls. Enhanced conditioned fear-generalization could also characterize generalized anxiety disorder (GAD), but research so far is inconclusive. An important confounding factor in previous research is comorbidity. The present study examined conditioned fear-acquisition and fear-generalization in 28 patients with GAD and 30 healthy controls using a recently developed fear acquisition and generalization paradigm assessing fear-potentiated startle and online expectancies of the unconditioned stimulus. Analyses focused on GAD patients without comorbidity but included also patients with comorbid anxiety disorders. Patients and controls did not differ as regards fear acquisition. However, contrary to our hypothesis, both groups did not differ either in most indexes of conditioned fear-generalization. Moreover, dimensional measures of GAD symptoms were not correlated with conditioned fear-generalization indexes. Comorbidity did not have a significant impact on the results. Our data suggest that conditioned fear-generalization is not enhanced in GAD. Results are discussed with special attention to the possible effects of comorbidity on fear learning abnormalities.
Davidson, Jonathan R
Many patients with generalized anxiety disorder (GAD) do not receive adequate treatment. Several classes of drugs, including benzodiazepines, azapirones, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, antihistamines, alpha(2)delta Ca++ channel modulators, and atypical antipsychotics are consistently beneficial in patients with GAD. Cognitive therapy is also effective as a first-line treatment. When individualizing treatment, drug dose ranges and side effect profiles need to be considered, as well as the patient's comorbid conditions. Doses may need to be reduced for elderly or medically ill patients or those taking other medications. Doses may need to be increased for refractory cases. Common comorbid conditions with GAD include depression, alcohol or drug abuse, social anxiety disorder, and panic disorder. In patients with significant depression, an antidepressant is more likely to succeed than a benzodiazepine. Generalized anxiety disorder is a chronic illness that requires long-term treatment. Remission is attainable but can take several months, and stopping medication increases the risk of relapse within the first year of initiating treatment.
Tanios, Christine Y; Abou-Saleh, Mohammad T; Karam, Aimée N; Salamoun, Mariana M; Mneimneh, Zeina N; Karam, Elie G
Epidemiological studies are quite rare in the Arab world. The Institute for Development Research Advocacy and Applied Care (IDRAAC) has conducted a systematic review of all epidemiologic research on anxiety disorders in the Arab world up to 2006. Specific keywords were used in the search for affective disorders, namely anxiety, generalized anxiety disorder, GAD, panic, separation anxiety disorder, SAD, overanxious disorder, OAD, phobia, fear, post-traumatic stress disorder, PTSD, obsessive compulsive disorder (OCD), obsessive compulsive symptom (OCS), obsession, compulsion, obsessive, compulsive. All results were screened and categorized. Epidemiological data on prevalence, gender differences, age of onset, comorbidity, risk factors and treatment of anxiety disorders in the Arab world were found in clinical and community samples. There is an evident need for national data on anxiety disorders in the Arab world in order to identify the magnitude of these diseases and their burden on the individual and community.
Kaczkurkin, Antonia N; Foa, Edna B
A large amount of research has accumulated on the efficacy and effectiveness of cognitive-behavioral therapy (CBT) for anxiety disorders including posttraumatic stress disorder, obsessive-compulsive disorder, panic disorder, generalized anxiety disorder, social anxiety disorder, and specific phobia. The purpose of the current article is to provide an overview of two of the most commonly used CBT methods used to treat anxiety disorders (exposure and cognitive therapy) and to summarize and discuss the current empirical research regarding the usefulness of these techniques for each anxiety disorder. Additionally, we discuss the difficulties that arise when comparing active CBT treatments, and we suggest directions for future research. Overall, CBT appears to be both efficacious and effective in the treatment of anxiety disorders, but dismantling studies are needed to determine which specific treatment components lead to beneficial outcomes and which patients are most likely to benefit from these treatment components.
Duits, Puck; Cath, Danielle C; Heitland, Ivo; Baas, Johanna M P
Although impaired fear extinction has repeatedly been demonstrated in patients with anxiety disorders, little is known about whether these impairments persist after treatment. The current comparative exploratory study investigated fear extinction in 26 patients treated for their anxiety disorder in the years preceding the study as compared to 17 healthy control subjects. Fear-potentiated startle and subjective fear were measured in a cue and context fear conditioning paradigm within a virtual reality environment. Results indicated no differences in fear extinction between treated anxiety patients and control subjects. However, scores on the Beck Anxiety Inventory across all participants revealed impaired extinction of fear potentiated startle in subjects with high compared to low anxiety symptoms over the past week. Taken together, this exploratory study found no support for impaired fear extinction in treated anxiety patients, and implies that current anxiety symptoms rather than previous patient status determine the success of extinction.
Full Text Available Although impaired fear extinction has repeatedly been demonstrated in patients with anxiety disorders, little is known about whether these impairments persist after treatment. The current comparative exploratory study investigated fear extinction in 26 patients treated for their anxiety disorder in the years preceding the study as compared to 17 healthy control subjects. Fear-potentiated startle and subjective fear were measured in a cue and context fear conditioning paradigm within a virtual reality environment. Results indicated no differences in fear extinction between treated anxiety patients and control subjects. However, scores on the Beck Anxiety Inventory across all participants revealed impaired extinction of fear potentiated startle in subjects with high compared to low anxiety symptoms over the past week. Taken together, this exploratory study found no support for impaired fear extinction in treated anxiety patients, and implies that current anxiety symptoms rather than previous patient status determine the success of extinction.
Kennedy, Susan J.; Rapee, Ronald M.; Edwards, Susan L.
The efficacy of early intervention for preschool-aged children at risk of anxiety disorders is investigated. Brief early intervention delivered through parents can reduce anxiety and associated risk and may alter the developmental trajectory of anxiety in some young children.
Kerns, Connor Morrow; Kendall, Philip C; Berry, Leandra; Souders, Margaret C; Franklin, Martin E; Schultz, Robert T; Miller, Judith; Herrington, John
We assessed anxiety consistent (i.e., "traditional") and inconsistent (i.e., "atypical") with diagnostic and statistical manual (DSM) definitions in autism spectrum disorder (ASD). Differential relationships between traditional anxiety, atypical anxiety, child characteristics, anxiety predictors and ASD-symptomology were explored. Fifty-nine participants (7-17 years, M(age) = 10.48 years; IQ > 60) with ASD and parents completed semi-structured interviews, self- and parent-reports. Seventeen percent of youth presented with traditional anxiety, 15 % with atypical anxiety, and 31 % with both. Language ability, anxious cognitions and hypersensitivity predicted traditional anxiety, whereas traditional anxiety and ASD symptoms predicted atypical anxiety. Findings suggest youth with ASD express anxiety in ways similar and dissimilar to DSM definitions. Similarities support the presence of comorbid anxiety disorders in ASD. Whether dissimilarities are unique to ASD requires further examination.
Borderline mental disorders are weakly pronounced disturbance of human mental activity (neurotical level). They develop on the border between mental health and true mental illness, but they are separate nosological entities. They are polymorphic in clinical manifestations, but at the same time they have common characteristics. Without speciﬁc treatment they tend to become chronic with the development of social maladjustment with the development of social maladjustment. This article provides s...
Japanese Ministry of Health, Labour and Welfare shows that the estimated number of all patients with any anxiety disorders is more than ten million, while the number of all depressive patients is about six million. Thus, anxiety disorders are very important in daily clinical situation of psychiatry. Recently, DSM-5 draft posted online (http://www.dsm5.org). Many of the disorders that were previously listed in the anxiety disorders chapter in DSM-IV have been distributed throughout this chapter as well as separate chapters on obsessive-compulsive and related disorders and trauma-and stressor-related disorders. As for panic disorder that was one of the new concepts of psychiatric disorder in DSM-III, there are some changes in the criteria, for instance subcategory according to with/without agoraphobia are discontinued since agoraphobia is proposed to be a codable disorder in DSM-5. In this paper, we will review the history and pathogenesis of panic disorder and the relationships between DSM and ICD, and then discuss the present and future of panic disorder viewed in DSM-5 draft.
Langley, Audra K; Falk, Avital; Peris, Tara; Wiley, Joshua F; Kendall, Philip C; Ginsburg, Golda; Birmaher, Boris; March, John; Albano, Ann Marie; Piacentini, John
The purpose of the current investigation was to examine the factor structure, reliability, and construct validity of both the Child and Parent version of the Child Anxiety Impact Scale (CAIS) using data obtained from the Child/Adolescent Anxiety Multimodal Study (Walkup et al., 2008 ). The CAIS child and parent versions measure anxiety-related functional impairment in school, social, and family domains. Participants were 488 children ages 7 to 17 (M age = 10.7, SD = 2.8 years) enrolled as part of the CAMS study across 6 sites and their primary parent or caregiver. Families participated in a structured diagnostic interview and then completed the CAIS along with other measures. Confirmatory factor analysis revealed that the a priori three-factor structure (school, social, and home/family) for the CAIS parent- and CAIS child-report was a reasonable fit, with a comparative fit index of .88 and root mean square error of approximation of .05. Internal consistency was very good for total score and subscales of both versions of the scale (Cronbach's α = .70-.90). The CAIS total scores demonstrated good construct validity, showing predicted significant correlations with the Child Behavior Checklist (CBCL) Internalizing Scale, the Multidimensional Anxiety Scale for Children (MASC) and Screen for Child Anxiety Related Emotional Disorders (SCARED) Total Scores, the Pediatric Anxiety Rating Scale, and the Children's Global Assessment Scale. In addition, CAIS Social and School subscales were significantly related to similar subscales on the CBCL, SCARED, and MASC. The results provide support that the CAIS is a reliable and valid measure for the assessment of the impact of anxiety on child and adolescent functioning.
Kaat, Aaron J.; Lecavalier, Luc
Autism spectrum disorder (ASD) and anxiety frequently co-occur. Research on the phenomenology and treatment of anxiety in ASD is expanding, but is hampered by the lack of instruments validated for this population. This study evaluated the self- and parent-reported Revised Child Anxiety and Depression Scale and the Multidimensional Anxiety Scale in…
Lecavalier, Luc; Wood, Jeffrey J.; Halladay, Alycia K.; Jones, Nancy E.; Aman, Michael G.; Cook, Edwin H.; Handen, Benjamin L.; King, Bryan H.; Pearson, Deborah A.; Hallett, Victoria; Sullivan, Katherine Anne; Grondhuis, Sabrina; Bishop, Somer L.; Horrigan, Joseph P.; Dawson, Geraldine; Scahill, Lawrence
Despite the high rate of anxiety in individuals with autism spectrum disorder (ASD), measuring anxiety in ASD is fraught with uncertainty. This is due, in part, to incomplete consensus on the manifestations of anxiety in this population. Autism Speaks assembled a panel of experts to conduct a systematic review of available measures for anxiety in…
Kerns, Connor Morrow; Kendall, Philip C.; Berry, Leandra; Souders, Margaret C.; Franklin, Martin E.; Schultz, Robert T.; Miller, Judith; Herrington, John
We assessed anxiety consistent (i.e., "traditional") and inconsistent (i.e., "atypical") with diagnostic and statistical manual (DSM) definitions in autism spectrum disorder (ASD). Differential relationships between traditional anxiety, atypical anxiety, child characteristics, anxiety predictors and ASD-symptomology were…
Labrecque, Joane; Dugas, Michel J.; Marchand, Andre; Letarte, Andree
The goal of this study was to evaluate the efficacy of a cognitive-behavioral treatment package for comorbid generalized anxiety disorder (GAD) and panic disorder with agoraphobia (PDA). A single-case, multiple-baseline, across-subjects design was used with 3 primary GAD patients with secondary PDA. The efficacy of the treatment was evaluated with…
Bekhuis, E.; Schoevers, R. A.; van Borkulo, C. D.; Rosmalen, J. G. M.; Boschloo, L.
Background Major depressive disorder (MDD) and generalized anxiety disorder (GAD) often co-occur with somatic symptomatology. Little is known about the contributions of individual symptoms to this association and more insight into their relationships could help to identify symptoms that are central
Bekhuis, E.; Schoevers, R.A.; van Borkulo, C.D.; Rosmalen, J.G.M.; Boschloo, L.
Major depressive disorder (MDD) and generalized anxiety disorder (GAD) often co-occur with somatic symptomatology. Little is known about the contributions of individual symptoms to this association and more insight into their relationships could help to identify symptoms that are central in the proc
HAI Ri-han; CHEN Xi-zhen; GENG Jian-hong; WANG Si-you
Purpose To investigate the curative effect of electroacupuncture on anxiety neurosis. Method Twenty-six female patients with extensive anxiety neurosis were selected according to CCMD-2-R diagnostic criteria. Evaluations based on STAI were made before and after electroacupuncture treatment for 4 times. Points Baihui ( GV 20), Shangxing ( GV 23), Neiguan ( PC 6),Shenmen ( HT 7 ), Zusanli ( ST 36), Sanyinjiao ( SP 6) and Taichong (LR 3 ) were selected for electroacupuncture treatment. One course of treatment consisted of 10 days and a total of 3 courses were carried out. Results The effective rate was 80.8% at the completion of treatment. The scores of state-anxiety index (S-Al) and typical-anxiety index (T-Al) were significantly decreased as compared with before the treatment ( P < 0.01 ), especially in the patients with recovery or improvement (P <0.01 and P < 0. 05 ). Conclusion Electroacupuncture treatment has a good effect on extensive anxiety disorder and can avoid the dependence of the patients on anxio lytics.
Orgilés Amorós, Mireia; Espada Sánchez, José Pedro; Méndez Carrillo, Xavier
Anxiety in children through separation from parents is one of the most frequent psychological problems in the infantile population. Children of divorce are more vulnerable to suffer this disorder due to the abrupt separation from one of the parents after the break-up, which they may experience as a traumatic event that predisposes them to react anxiously in daily separations. The purpose of this study is to examine the presence of symptoms of separation anxiety and general anxiety in a Spanish sample of 95 students of ages between 8 and 12 years. They were compared to a group of children of similar ages and sex whose parents are not divorced. The results show that children of divorce present higher levels of separation anxiety than the children whose parents remain together. Moreover, they show significant levels of generalized anxiety, but similar to that of the other group of children (undivorced parents). The clinical implications of these findings are discussed, emphasizing the importance of cooperation and frequent contact of the children with both parents to promote their security and autonomy.
Full Text Available Alan Wright, Chad VanDenBergCenter for Clinical Research, Mercer University, Atlanta, GA, USAAbstract: Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI which is FDA approved for the treatment of generalized anxiety disorder (GAD in doses of 30 mg to 120 mg daily. Duloxetine has been shown to significantly improve symptoms of GAD as measured through the Hamilton Anxiety Rating Scale (HAMA, the Clinical Global Impressions Scale (CGI-I, and other various outcome measures in several placebo-controlled, randomized, double blind, multi-center studies. Symptom improvement began within the first few weeks, and continued for the duration of the studies. In addition, duloxetine has also been shown to improve outcomes in elderly patients with GAD, and in GAD patients with clinically significant pain symptoms. Duloxetine was noninferior compared with venlafaxine XR. Duloxetine was found to have a good tolerability profile which was predictable and similar to another SNRI, venlafaxine. Adverse events (AEs such as nausea, constipation, dry mouth, and insomnia were mild and transient, and occurred at relatively low rates. It was found to have a low frequency of drug interactions. In conclusion, duloxetine, a selective inhibitor for the serotonin and norepinephrine transporters, is efficacious in the treatment of GAD, and has a predictable tolerability profile, with AEs generally being mild to moderate.Keywords: duloxetine, generalized anxiety disorder, anxiety, GAD
Gorini, Alessandra; Pallavicini, Federica; Algeri, Davide; Repetto, Claudia; Gaggioli, Andrea; Riva, Giuseppe
Generalized anxiety disorder (GAD) is a common anxiety disorder characterized by 6 months of "excessive anxiety and worry" about a variety of events and situations. Anxiety and worry are often accompanied by additional symptoms like restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension and disturbed sleep. GAD is usually treated with medications and/or psychotherapy. In particular, the two most promising treatments seem to be cognitive therapy and applied relaxation. In this study we integrated these approaches through the use of a biofeedback enhanced virtual reality (VR) system used both for relaxation and controlled exposure. Moreover, this experience is strengthened by the use of a mobile phone that allows patients to perform the virtual experience even in an outpatient setting. This paper describe the results of a controlled trial (NCT00602212) involving 20 GAD patients randomly assigned to the following groups: (1) the VR and Mobile group (VRMB) including biofeedback; (2) the VR and Mobile group (VRM) without biofeedback; (3) the waiting list (WL) group. The clinical data underlined that (a) VR can be used also in the treatment of GAD; (b) in a VR treatment, patients take advantage of a mobile device that delivers in an outpatient setting guided experiences, similar to the one experienced in VR.
Andrews, G; Anderson, T M; Slade, T; Sunderland, M
The American Psychiatric Association and the World Health Organization have begun to revise their classifications of mental disorders. Four issues related to these revisions are discussed in this study: the structure of the classifications, the relationship between categories and dimensions, the sensitivity of categorical thresholds to definitions, and maximizing the utility and validity of the diagnostic process. There is now sufficient evidence to consider replacing the present groupings of disorders with an empirically based structure that reflects the actual similarities among disorders. For example, perhaps the present depression and anxiety disorders would be best grouped as internalizing disorders. Most mental disorders exist on a severity dimension. The reliability and validity of the classification might be improved if we accepted the dimensional nature of disorders while retaining the use of categorical diagnoses to enhance clinical utility. Definitions of the thresholds that define categories are very susceptible to detail. In International Classification of Diseases-11(ICD-11) and Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V), disorders about which there is agreement should be identically defined, and disorders in which there is disagreement should be defined differently, so that research can identify which definition is more valid. The present diagnostic criteria are too complex to have acceptable clinical utility. We propose a reduced criterion set that can be remembered by clinicians and an enhanced criterion set for use with decision support tools.
Clark, Duncan B.; Birmaher, Boris; Axelson, David; Monk, Kelly; Kalas, Catherine; Ehmann, Mary; Bridge, Jeffrey; Wood, D. Scott; Muthen, Bengt; Brent, David
Objective: To assess the efficacy of fluoxetine for the long-term treatment of children and adolescents with anxiety disorders, including generalized anxiety disorder, separation anxiety disorder, and/or social phobia. Method: Children and adolescents (7-17 years old) with anxiety disorders were studied in open treatment for 1 year after they…
Winkel, Susanne; Einsle, Franziska; Pieper, Lars; Höfler, Michael; Wittchen, Hans-Ulrich; Martini, Julia
The purpose of this study was to prospectively examine the relationships between maternal DSM-IV-TR anxiety disorders, depressive disorders, and body mass index (BMI) with arterial hypertension and blood pressure during pregnancy. In the Maternal Anxiety in Relation to Infant Development (MARI) study, N = 306 women were enrolled in early pregnancy and repeatedly assessed during peripartum period. DSM-IV-TR anxiety and depressive disorders prior to pregnancy, lifetime anxiety/depression liability, and BMI during early pregnancy were assessed with the Composite International Diagnostic Interview for Women (CIDI-V). Based on their prepregnancy status, all participants were assigned to one of the following initial diagnostic groups: no anxiety nor depressive disorder (no AD), pure depressive disorder (pure D), pure anxiety disorder (pure A), and comorbid anxiety and depressive disorder (comorbid AD). Blood pressure measurements were derived from medical records. Arterial hypertension during pregnancy was defined by at least two blood pressure values ≥140 mmHg systolic and/or ≥90 mmHg diastolic. N = 283 women with at least four documented blood pressure measurements during pregnancy were included in the analyses. In this sample, N = 47 women (16.6 %) were identified with arterial hypertension during pregnancy. Women with comorbid AD (reference group: no AD) had a significantly higher blood pressure after adjustment for age, parity, smoking, occupation, household income, and education (systolic: linear regression coefficient [β] = 3.0, 95 % confidence interval [CI] = 0.2-5.7; diastolic, β = 2.3, 95 % CI = 0.1-4.4). Anxiety liability was associated with an increased risk of hypertension (odds ratio [OR] = 1.1, 95 % CI = 1.0-1.3) and a higher systolic blood pressure (β = 0.4, 95 % CI = 0.0-0.7). The adjusted interaction model revealed a significant interaction between the diagnostic group pure A and BMI for
Winthorst Wim H
Full Text Available Abstract Background Little is known about seasonality of specific depressive symptoms and anxiety symptoms in different patient populations. This study aims to assess seasonal variation of depressive and anxiety symptoms in a primary care population and across participants who were classified in diagnostic groups 1 healthy controls 2 patients with a major depressive disorder, 3 patients with any anxiety disorder and 4 patients with a major depression and any anxiety disorder. Methods Data were used from the Netherlands Study of Depression and Anxiety (NESDA. First, in 5549 patients from the NESDA primary care recruitment population the Kessler-10 screening questionnaire was used and data were analyzed across season in a multilevel linear model. Second, in 1090 subjects classified into four groups according to psychiatric status according to the Composite International Diagnostic Interview, overall depressive symptoms and atypical versus melancholic features were assessed with the Inventory of Depressive Symptoms. Anxiety and fear were assessed with the Beck Anxiety Inventory and the Fear questionnaire. Symptom levels across season were analyzed in a linear regression model. Results In the primary care population the severity of depressive and anxiety symptoms did not show a seasonal pattern. In the diagnostic groups healthy controls and patients with any anxiety disorder, but not patients with a major depressive disorder, showed a small rise in depressive symptoms in winter. Atypical and melancholic symptoms were both elevated in winter. No seasonal pattern for anxiety symptoms was found. There was a small gender related seasonal effect for fear symptoms. Conclusions Seasonal differences in severity or type of depressive and anxiety symptoms, as measured with a general screening instrument and symptom questionnaires, were absent or small in effect size in a primary care population and in patient populations with a major depressive disorder and
Meyerbröker, K.; Emmelkamp, P.M.G.
In recent years, virtual reality exposure therapy (VRET) has become an interesting alternative for the treatment of anxiety disorders. Research has focused on the efficacy of VRET in treating anxiety disorders: phobias, panic disorder, and posttraumatic stress disorder. In this systematic review, st
Vieira Karen F
Full Text Available Abstract Background Over the past several decades, complementary and alternative medications have increasingly become a part of everyday treatment. With the rising cost of prescription medications and their production of unwanted side effects, patients are exploring herbal and other natural remedies for the management and treatment of psychological conditions. Psychological disorders are one of the most frequent conditions seen by clinicians, and often require a long-term regimen of prescription medications. Approximately 6.8 million Americans suffer from generalized anxiety disorder. Many also suffer from the spectrum of behavioural and physical side effects that often accompany its treatment. It is not surprising that there is universal interest in finding effective natural anxiolytic (anti-anxiety treatments with a lower risk of adverse effects or withdrawal. Methods An electronic and manual search was performed through MEDLINE/PubMed and EBSCO. Articles were not discriminated by date of publication. Available clinical studies published in English that used human participants and examined the anxiolytic potential of dietary and herbal supplements were included. Data were extracted and compiled into tables that included the study design, sample population, intervention, control, length of treatment, outcomes, direction of evidence, and reported adverse events. Results A total of 24 studies that investigated five different CAM monotherapies and eight different combination treatments and involved 2619 participants met the inclusion criteria and were analyzed. There were 21 randomized controlled trials and three open-label, uncontrolled observational studies. Most studies involved patients who had been diagnosed with either an anxiety disorder or depression (n = 1786. However, eight studies used healthy volunteers (n = 877 who had normal levels of anxiety, were undergoing surgery, tested at the upper limit of the normal range of a trait anxiety
Full Text Available Introduction: Eating Disorder Symptoms and social anxiety can be occurring in the same time. Also social anxiety is one of the important factors predicting Eating Disorder symptoms which vary among different cultures and countries. The aim of this study was to determine the relationship between Eating Disorder symptoms and social anxiety in school boys. Materials and Methods: This was a cross-sectional study on 361 high school boys in isfahan who were selected through two-step random sampling. The students completed a questionnaire concerning demographic characteristics, Eating Disorder Questionnaire and social anxiety. Data were analyzed by the statistical tests of Pearson correlation coefficient, Student’s t-test, one-way analysis of variance (ANOVA, and regression through SPSS version 14. Results: Based on the findings, the mean (SD value for age was 14.14 (1.2 years and for BMI was 23.25 (0.3.35.2% had eating disorder and 17.5% bulimia and30% had anorexia nervosa Symptoms. Also there was a positive correlation between the rate of Eating Disorder Symptoms, bulimia and anorexia nervosa and social anxiety. (P=0.004, r= 0.287, P=0.001, r= 0.257, P=0.020, r= 0.242. Conclusions: There was correlation between the Eating Disorder Symptoms and social anxiety in school boys.So educating people like caregivers by community health midwives regarding nutritional problems in during adolescence can be effective in early diagnosing and identifying such disorders.
Zeijlmans van Emmichhoven, I.A.; van IJzendoorn, M.H.; de Ruiter, C.; Brosschot, J.F.
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 complet
Rodgers, Jacqui; Riby, Deborah M.; Janes, Emily; Connolly, Brenda; McConachie, Helen
Children with Autism Spectrum Disorder or Williams syndrome are vulnerable to anxiety. The factors that contribute to this risk remain unclear. This study compared anxiety in autism spectrum disorder and Williams Syndrome and examined the relationship between repetitive behaviours and anxiety. Thirty-four children with autism and twenty children…
Handley, Alicia K; Egan, Sarah J.; Kane, Robert T.; Rees, Clare S
Background The relationships between perfectionism, pathological worry and generalised anxiety disorder (GAD) were investigated in a clinical sample presenting for treatment of perfectionism. Method This study explored the utility of perfectionism in predicting pathological worry in a sample of individuals with elevated perfectionism and GAD (n = 36). Following this, the study examined whether perfectionism could predict a principal GAD diagnosis in the full sample (n = 42). Results Scores on...
Fear or phobia is a common phenomenon, but many people develop specific types of phobic anxiety disorders. The more common ones are agoraphobia, specific phobias and social phobia. Agoraphobia is often associated with panic attacks, while specific phobia is often accompanied by fainting spells. Social phobia is often a neglected topic, but is now becoming more important. Each type of phobia has its own unique features and deserves specific forms of treatment.
Full Text Available Jan Prasko,1 Ales Grambal,1 Petra Kasalova,1 Dana Kamardova,1 Marie Ociskova,1 Michaela Holubova,1,2 Kristyna Vrbova,1 Zuzana Sigmundova,1 Klara Latalova,1 Milos Slepecky,3 Marta Zatkova3 1Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc, 2Psychiatric Department, Hospital Liberec, Liberec, Czech Republic; 3Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, Slovak Republic Objective: The central goal of the study was to analyze the impact of dissociation on the treatment effectiveness in patients with anxiety/neurotic spectrum and depressive disorders with or without comorbid personality disorders.Methods: The research sample consisted of inpatients who were hospitalized in the psychiatric department and met the ICD-10 criteria for diagnosis of depressive disorder, panic disorder, generalized anxiety disorder, mixed anxiety–depressive disorder, agoraphobia, social phobia, obsessive compulsive disorder, posttraumatic stress disorder, adjustment disorders, dissociative/conversion disorders, somatoform disorder, or other anxiety/neurotic spectrum disorder. The participants completed these measures at the start and end of the therapeutic program – Beck Depression Inventory, Beck Anxiety Inventory, a subjective version of Clinical Global Impression-Severity, Sheehan Patient-Related Anxiety Scale, and Dissociative Experience Scale.Results: A total of 840 patients with anxiety or depressive spectrum disorders, who were resistant to pharmacological treatment on an outpatient basis and were referred for hospitalization for the 6-week complex therapeutic program, were enrolled in this study. Of them, 606 were statistically analyzed. Data from the remaining 234 (27.86% patients were not used because of various reasons (103 prematurely finished the program, 131 did not fill in most of the
Max, Jeffrey E; Lopez, Aholibama; Wilde, Elisabeth A; Bigler, Erin D; Schachar, Russell J; Saunders, Ann; Ewing-Cobbs, Linda; Chapman, Sandra B; Yang, Tony T; Levin, Harvey S
The objective of this prospective longitudinal study was to assess the nature, rate, predictive variables, and neuroimaging characteristics of novel (new-onset) anxiety disorders (compared with no novel anxiety disorders) 6-12 months after pediatric traumatic brain injury (TBI). Psychiatric and psychosocial interviews were administered to children who sustained mild to severe TBI at baseline (soon after injury) and at the 12-month follow-up post-injury (n= 125). The psychiatric outcome of children 12-months post-injury revealed that novel anxiety disorders present in the second six months after TBI were heterogeneous and occurred in 13 (10.4%) participants. Novel anxiety disorder was significantly associated with concurrent novel depressive disorder and with novel personality change due to TBI. Novel anxiety disorder was marginally associated with younger age at injury and with pre-injury anxiety disorder in univariate analyses. Age at injury, pre-injury anxiety disorder, and personality change due to TBI were each significantly and independently related to novel anxiety disorder in a logistic regression analysis. There were no significant neuroimaging group differences. These findings suggest that the emergence of novel anxiety disorder after TBI might be related to a broader problem of affective dysregulation especially in younger children and those with a vulnerability even to pre-injury anxiety disorder.
Scharfstein, Lindsay A; Beidel, Deborah C
Whereas much is known about the deficits in social behaviors and social competence in youth with social anxiety disorder (SAD), less is known about those characteristics among youth with generalized anxiety disorder (GAD). This study aimed to better elucidate the social repertoire and peer acceptance of youth with SAD and youth with GAD, relative to normal control (NC) youth. The sample consisted of 58 primarily Caucasian children, ages 6 to 13 years: 20 SAD (12 female), 18 GAD (12 female), and 20 NC (9 female). Diagnoses were based on Anxiety Disorders Interview Schedule for DSM-IV: Children and Parent Versions interviews. A multimodal assessment strategy included parent and child reports, observer ratings of social performance, computer-based analysis of vocal qualities of speech, and peer ratings of likeability and friendship potential. Whereas self- and parental report did not differentiate the two diagnostic groups, differences on observable behaviors were apparent. Children with SAD exhibited anxious speech patterns, extended speech latencies, a paucity of speech, few spontaneous vocalizations, and ineffective social responses; they were perceived by peers as less likeable and socially desirable. Children with GAD had typical speech patterns and were well liked by their peers but displayed fewer spontaneous comments and questions than NC children. Parent and child reports are less sensitive to what could be important differences in social skill between youth with SAD and GAD. Direct observations, computer-based measures of speech quality, and peer ratings identify specific group differences, suggesting the need for a comprehensive evaluation to inform treatment planning.
Full Text Available Body stability is controlled by the postural system and can be affected by fear and anxiety. Few studies have addressed freezing posture in psychiatric disorders. The purpose of the present study was to assess posturographic behavior in 30 patients with social anxiety disorder (SAD and 35 without SAD during presentation of blocks of pictures with different valences. Neutral images consisted of objects taken from a catalog of pictures, negative images were mutilation pictures and anxiogenic images were related to situations regarding SAD fears. While participants were standing on a force platform, similar to a balance, displacement of the center of pressure in the mediolateral and anteroposterior directions was measured. We found that the SAD group exhibited a lower sway area and a lower velocity of sway throughout the experiment independent of the visual stimuli, in which the phobic pictures, a stimulus associated with a defense response, were unable to evoke a significantly more rigid posture than the others. We hypothesize that patients with SAD when entering in a situation of exposure, from the moment the pictures are presented, tend to move less than controls, remaining this way until the experiment ends. This discrete body manifestation can provide additional data to the characterization of SAD and its differentiation from other anxiety disorders, especially in situations regarding facing fear.
Didem Behice ÖZTOP
Full Text Available Currently, Cognitive Behavioral Therapy (CBT becomes one of the leading approaches in the psychotherapy. However,use of CBT in childhood psychotherapy is considerably novel. After 1990s, it has been understood that it is an effectivemethod for children and adolescents. Anxiety disorders are one of the most common problems in the field of childhoodand adolescent psychiatry. In the studies conducted, the effectiveness of CBT was demonstrated in anxiety disorders ofthe children and adolescents. Moreover, it was suggested that this effectiveness is permanent in some studies. Prioritygoal of CBT is to change inappropriate learning and thinking patterns in the children and adolescents. By “now and here”fashion, it is attempted to reveal the origin of current problems. During the process, the factors are considered, whichcause to maintain the symptoms. It is attempted to decrease signs caused to stress by improving coping skills duringtherapy. To this end, methods including observation, relaxation training, systematic desensitization, social skills training,cognitive restructuring and exposure therapy are applied in sessions by taking child’s problems into consideration. Scalesspecific to anxiety disorders are used in the assessment and follow-up. Age and development level of the child should beparticularly taken into account while using assessment tools and therapeutic modality.
Katzman, Martin A.; Bleau, Pierre; Blier, Pierre; Chokka, Pratap; Kjernisted, Kevin; van Ameringen, Michael; ,
Background Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated. Methods These guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980–2012). Treat...
Silove, Derrick; Marnane, Claire
There is a need to explain the high level of comorbidity between separation anxiety disorder (SAD) in adulthood and panic disorder with agoraphobia (Pd-Ag). One possibility is that inadequate specification of symptom domains and/or diagnostic questions accounts for some of the comorbidity. The present anxiety clinic study examined responses of adult patients (n = 646) with SAD and/or Pd-Ag on eight symptom domains based on a previous factor analysis of a commonly used separation anxiety measure, the ASA-27, as well as on the Anxiety Sensitivity Index. We also examined questionnaire items that did not load on the factor structure. All separation anxiety domains distinguished strongly between SAD and Pd-Ag. Comparisons across three groups (SAD alone, Pd-Ag alone and comorbid SAD/Pd-Ag) revealed that two symptom domains (anxiety about embarking on trips, and sleep disturbances) showed some overlap between Pd-Ag and SAD. Two of the items of the ASA-27 that did not load with other items in the factor analysis also showed overlap with Pd-Ag, with both referring to anxieties about leaving home. Patients with SAD (with or without Pd-Ag) returned higher scores on anxiety sensitivity than those with Pd-Ag alone. The findings support the distinctiveness of the construct of SAD and the capacity of the ASA-27 to discriminate between that disorder and Pd-Ag. SAD appears to be a more severe form of anxiety than Pd-Ag. There may be a need to refine items to include the reasons for avoiding leaving home, reluctance to sleep alone and to embark on trips, to ensure accurate discrimination between Pd-Ag and SAD in adulthood.
Waugh Christian E
Full Text Available Abstract Background Despite advances in neurobiological research on Major Depressive Disorder and Social Anxiety Disorder, little is known about the neural functioning of individuals with comorbid depression/social anxiety. We examined the timing of neural responses to social stress in individuals with major depression and/or social anxiety. We hypothesized that having social anxiety would be associated with earlier responses to stress, having major depression would be associated with sustained responses to stress, and that comorbid participants would exhibit both of these response patterns. Methods Participants were females diagnosed with pure depression (n = 12, pure social anxiety (n = 16, comorbid depression/social anxiety (n = 17, or as never having had any Axis-I disorder (control; n = 17. Blood oxygenation-level dependent activity (BOLD was assessed with functional magnetic resonance imaging (fMRI. To induce social stress, participants prepared a speech that was ostensibly to be evaluated by a third party. Results Whereas being diagnosed with depression was associated with a resurgence of activation in the medial frontal cortex late in the stressor, having social anxiety was associated with a vigilance-avoidance activation pattern in the occipital cortex and insula. Comorbid participants exhibited activation patterns that generally overlapped with the non-comorbid groups, with the exception of an intermediate level of activation, between the level of activation of the pure depression and social anxiety groups, in the middle and posterior cingulate cortex. Conclusions These findings advance our understanding of the neural underpinnings of major depression and social anxiety, and of their comorbidity. Future research should elucidate more precisely the behavioral correlates of these patterns of brain activation.
Sterling, Lindsey; Renno, Patricia; Storch, Eric A; Ehrenreich-May, Jill; Lewin, Adam B; Arnold, Elysse; Lin, Enjey; Wood, Jeffrey
High rates of anxiety and depression are reported among youth with autism spectrum disorders. These conditions are generally assessed using measures validated for typically developing youth. Few studies have investigated their validity for autism spectrum disorders, which is crucial for accurate assessment and the provision of proper treatment. The Revised Children's Anxiety and Depression Scale was evaluated with 67 youth with autism spectrum disorders to examine its utility in measuring anxiety and depression in this population. Parents and children (aged 11-15 years) referred to a multisite intervention study completed the Pediatric Anxiety Rating Scale, Multidimensional Anxiety Scale for Children, Anxiety Disorders Interview Schedule, Child Behavior Checklist, and Revised Children's Anxiety and Depression Scale. Results suggest acceptable internal consistency of the Revised Children's Anxiety and Depression Scale. Modest convergent validity was found among the Revised Children's Anxiety and Depression Scale and other standardized measures of anxiety and depression. There were stronger correlations between Revised Children's Anxiety and Depression Scale Total scores and subscales of measures expected to correlate significantly than those not expected to correlate. One exception was a significant association between the Revised Children's Anxiety and Depression Scale and Child Behavior Checklist Attention subscale, calling into question the divergent validity in separating anxiety from attention problems. Overall, results suggest preliminary support for the Revised Children's Anxiety and Depression Scale in youth with high-functioning autism spectrum disorders.
The nature of the relationship between 'panic disorder', agoraphobia and general anxiety disorder remains open. The aetiological theories which have tried to link them with the aid of biological and psychological concepts fail to take account of conflicting observations. 'Panic' attacks are not confined to agoraphobic and related disorders, being indistinguishable from the attacks of acute anxiety and phobic aversion manifest in a wide range of anxiety and affective disorders. There is continuity and discontinuity in the evolution of agoraphobia; those affected differ in respect of a range of premorbid features from patients with other disorders and control subjects. These variables include family history, life development, trait anxiety and other personality characteristics including introversion, neuroticism and probably emotional dependence on others. Not all the claims made on behalf of the efficacy of pharmacological treatment on the one hand and behavioural therapies on the other are substantiated. The success achieved by behavioural treatment appear to endure over some years. But the residual disabilities and defects that follow all forms of treatment and the problems posed by patient selection and high drop-out rates have received insufficient attention. Aetiological theories of agoraphobia and related conditions have been advanced along biomedical, psychological and psychodynamic lines. Some evidence supports each kind of theory. But none is wholly consistent with the findings regarding its phenomenology and evolution. Recent biological investigations have led to the formulation of hypotheses in relation to anticipatory and chronic anxiety in terms of changes in synaptic connections, enhancement of transmitter release as well as alterations in molecular configuration and regulation of gene expression. It would be premature to conclude that these findings can provide a unitary conceptual framework for the explanation of human anxiety disorders. The
Weissman, Adam S.; Chu, Brian C.; Reddy, Linda A.; Mohlman, Jan
Inattention is among the most commonly referred problems for school-aged youth. Research suggests distinct mechanisms may contribute to attention problems in youth with anxiety disorders versus youth with attention deficit hyperactivity disorder (ADHD). This study compared children (8-17 years) with anxiety disorders (n = 24) and children (8-16…
Jennifer L Hudson
Full Text Available BACKGROUND: To inform early intervention practice, the present research examines how child anxiety, behavioural inhibition, maternal overinvolvement, maternal negativity, mother-child attachment and maternal anxiety, as assessed at age four, predict anxiety at age nine. METHOD: 202 children (102 behaviourally inhibited and 100 behaviourally uninhibited aged 3-4 years were initially recruited and the predictors outlined above were assessed. Diagnostic assessments, using the Anxiety Disorders Interview Schedule, were then conducted five years later. RESULTS: Behavioural inhibition, maternal anxiety, and maternal overinvolvement were significant predictors of clinical anxiety, even after controlling for baseline anxiety (p.1. CONCLUSIONS: Preschool children who show anxiety, are inhibited, have overinvolved mothers and mothers with anxiety disorders are at increased risk for anxiety in middle childhood. These factors can be used to identify suitable participants for early intervention and can be targeted within intervention programs.
Hendriks, S.M.; Spijker, J.; Licht, C.M.; Hardeveld, F.; Graaf, R. de; Batelaan, N.M.; Penninx, B.W.; Beekman, A.T.
BACKGROUND: This longitudinal study aims to compare long-term work disability and absenteeism between anxiety and depressive disorders focusing on the effects of different course trajectories (remission, recurrence and chronic course) and specific symptom dimensions (anxiety arousal, avoidance behav
Jakobsen, I. S.; Horwood, L. J.; Fergusson, D. M.
Previous research has shown that children with high levels of early anxiety/withdrawal are at increased risk of later anxiety and depression. It has also been found that positive parent-child attachment reduces the risk of these disorders. The aim of this paper was to examine the extent to which...... positive parent-child attachment acted to mitigate the risk of later internalising disorders amongst children with high levels of early anxiety/withdrawal using data from a 30 years longitudinal study of a New Zealand birth cohort. The findings of this study showed that: (a) increasing rates of early...... anxiety/withdrawal were associated with an increased risk of later anxiety and depression; (b) positive parent-child attachment in adolescence was associated with a decline in the risk of later anxiety and depression; and (c) these associations persisted even after controlling for confounding factors...
Gerardi, Maryrose; Cukor, Judith; Difede, Joann; Rizzo, Albert; Rothbaum, Barbara Olasov
Anxiety disorders, including phobias and post-traumatic stress disorder, are common and disabling disorders that often involve avoidance behavior. Cognitive-behavioral treatments, specifically imaginal and in vivo forms of exposure therapy, have been accepted and successful forms of treatment for these disorders. Virtual reality exposure therapy, an alternative to more traditional exposure-based therapies, involves immersion in a computer-generated virtual environment that minimizes avoidance and facilitates emotional processing. In this article, we review evidence on the application of virtual reality exposure therapy to the treatment of specific phobias and post-traumatic stress disorder and discuss its advantages and cautions.
Waite, Polly; Creswell, Cathy
Parental behaviors, most notably overcontrol, lack of warmth and expressed anxiety, have been implicated in models of the development and maintenance of anxiety disorders in children and young people. Theories of normative development have proposed that different parental responses are required to support emotional development in childhood and adolescence, yet age has not typically been taken into account in studies of parenting and anxiety disorders. In order to identify whether associations between anxiety disorder status and parenting differ in children and adolescents, we compared observed behaviors of parents of children (7-10 years) and adolescents (13-16 years) with and without anxiety disorders (n = 120), while they undertook a series of mildly anxiety-provoking tasks. Parents of adolescents showed significantly lower levels of expressed anxiety, intrusiveness and warm engagement than parents of children. Furthermore, offspring age moderated the association between anxiety disorder status and parenting behaviors. Specifically, parents of adolescents with anxiety disorders showed higher intrusiveness and lower warm engagement than parents of non-anxious adolescents. A similar relationship between these parenting behaviors and anxiety disorder status was not observed among parents of children. The findings suggest that theoretical accounts of the role of parental behaviors in anxiety disorders in children and adolescents should distinguish between these different developmental periods. Further experimental research to establish causality, however, would be required before committing additional resources to targeting parenting factors within treatment.
Williams, Monnica T; Beckmann-Mendez, Diana A; Turkheimer, Eric
Anxiety disorders are understudied, underdiagnosed, and undertreated in African Americans. Research focused on the phenomenology, etiology, and treatment of anxiety in African Americans has been hampered by lack of inclusion of this population in clinical research studies. The reason for exclusion is not well understood, although cultural mistrust has been hypothesized as a major barrier to research participation. This article reviews the relevant literature to date and examines the experience of 6 African American adults who participated in a larger clinical assessment study about anxiety. Drawing upon in-depth semistructured interviews about their subjective experiences, we examined participant perspectives about the assessment process, opinions about African American perception of anxiety studies, and participant-generated ideas about how to improve African American participation. Based on a qualitative analysis of responses, feelings of mistrust emerged as a dominant theme. Concerns fell under 6 categories, including not wanting to speak for others, confidentiality, self and group presentation concerns, repercussions of disclosure, potential covert purposes of the study, and the desire to confide only in close others. Suggestions for increasing African American participation are discussed, including assurances of confidentiality, adequate compensation, and a comfortable study environment.
Full Text Available Background and objectives: Various clinical aspects of Major Depressive Disorder (MDD are related to the neuropsychological impairments characteristic of this illness. The aim of this study was to determine the relation between certain clinical variables of MDD - in particular the presence of comorbid anxiety disorders - and the neuropsychological performance of patients with MDD selected for a clinical trial. Methods: Using cluster analyses, we generated two groups of patients: one group with Major Depressive Disorder and a Comorbid Anxiety Disorder (MDDAD, and the other with Pure Major Depressive Disorder (PMDD. Both groups were assessed clinically and neuropsychologically before and after 24 weeks of pharmacological treatment. Neuropsychological performance prior to treatment was comparable in the two groups. Results: After treatment, both groups showed cognitive improvement in attention tasks, memory, and executive functions Conclusions: The PMDD group obtained greater neurocognitive benefits from the antidepressive treatment than the MDDAD group.
Levinson, Cheri A; Rodebaugh, Thomas L
Social anxiety and eating disorders are highly comorbid. Several explanations for these high levels of comorbidity have been theorized. First, social anxiety might be a vulnerability factor for eating disorders. Second, eating disorders might be a vulnerability factor for social anxiety. Third, the two kinds of disorders may have common, shared psychological vulnerabilities. The current study (N = 300 undergraduate women) investigates a model of social anxiety and eating disorder symptoms that examines each of these possibilities across two time points (Time 1 and six months later). We do not find support for either social anxiety or eating disorder symptoms per se predicting each other across time. Instead, we find that some underlying vulnerabilities prospectively predict symptoms of both disorders, whereas other vulnerabilities are specific to symptoms of one disorder. Specifically we find that maladaptive perfectionism is a shared prospective vulnerability for social anxiety and eating disorder symptoms. Alternatively, we find that social appearance anxiety is specific for eating disorder symptoms, whereas high standards is specific for social anxiety symptoms. These data help clarify our understanding of how and why social anxiety and eating disorder symptoms frequently co-occur.
Frala, Jamie L.; Leen-Feldner, Ellen W.; Blumenthal, Heidemarie; Barreto, Carolina C.
This study examined the associations among perceived control over anxiety-related events, worry, and both symptoms and diagnoses of generalized anxiety disorder (GAD). The sample was comprised of 140 adolescents (60 girls) between the ages of 10 and 17 years (M[subscript age] = 14.6 years; SD = 2.25) recruited from the general community. Findings…
Bart, Orit; Bar-Haim, Yair; Weizman, Einat; Levin, Moran; Sadeh, Avi; Mintz, Matti
Comorbidity between balance and anxiety disorders in adult population is a well-studied clinical entity. Children might be particularly prone to develop balance-anxiety comorbidity, but surprisingly they are practically neglected in this field of research. The consequence is that children are treated for what seems to be the primary disorder…
Jakobsen, Ida Skytte; Horwood, L. John; Fergusson, David M.
Previous research has shown that children with high levels of early anxiety/withdrawal are at increased risk of later anxiety and depression. It has also been found that positive parent-child attachment reduces the risk of these disorders. The aim of this paper was to examine the extent to which positive parent-child attachment acted to mitigate…
Hofmann, Stefan G; Richey, J Anthony; Kashdan, Todd B; McKnight, Patrick E
Anxiety disorders and externalizing problems are both associated with substance use disorders. However, the nature of this relationship remains unclear. To examine whether presence of an anxiety disorder changes the association between externalizing problems (conduct disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder) and substance use disorders, we analyzed data from the National Comorbidity Survey-Replication, which is based on a nationally representative sample of 9282 English-speaking adults. Presence of externalizing problems was associated with an increased odds for alcohol abuse (OR: 6.7, CI: 5.6-8.1), alcohol dependence (OR: 7.6, CI: 5.9-9.6), substance abuse (OR: 9.9, CI: 8.1-12.2), and substance dependence (OR: 13.1, CI: 9.6-17.8). Similarly, anxiety disorders were associated with increased odds for substance use disorders. The highest association was found between post-traumatic stress disorder and substance use disorder (OR: 9.2, CI: 5.4-15.5). Individuals who met diagnostic criteria for an anxiety disorder and externalizing problems showed consistently and significantly lower odds for substance use problems than subjects with externalizing problems without a comorbid anxiety disorder. The results suggest that presence of any anxiety disorder reduces the association between externalizing problems and substance use disorders, possibly because the fear of bodily symptoms prevents individuals with externalizing problems from engaging in drug-seeking behaviors.
Dan J Stein
Full Text Available Individuals with social anxiety disorder (SAD are characterized by fear or anxiety about social situations, but also by important alterations in self-referential processing. Given advances in our understanding of the neurocircuitry and neurochemistry of SAD, the question arises of the relationship between this research and an emergent literature on the psychobiology of self and self-consciousness. A number of investigations of SAD have highlighted altered activity in the medial prefrontal cortex (involved in self-representation, insula (involved in interoceptive processing, and other structures that play a role in bodily self-consciousness, as well as the potential value of interventions such as selective serotonin reuptake inhibitors and self-focused reappraisal in normalizing such changes. Future studies to more closely investigate associations between psychobiological alterations and changes in self-related processing in SAD, may be useful in shedding additional light on both SAD and self-consciousness.
Stein, Dan J
Individuals with social anxiety disorder (SAD) are characterized by fear or anxiety about social situations, but also by important alterations in self-referential processing. Given advances in our understanding of the neurocircuitry and neurochemistry of SAD, the question arises of the relationship between this research and an emergent literature on the psychobiology of self and self-consciousness. A number of investigations of SAD have highlighted altered activity in the medial prefrontal cortex (mPFC; involved in self-representation), insula (involved in interoceptive processing), and other structures that play a role in bodily self-consciousness, as well as the potential value of interventions such as selective serotonin reuptake inhibitors (SSRI) and self-focused reappraisal in normalizing such changes. Future studies to more closely investigate associations between psychobiological alterations and changes in self-related processing in SAD, may be useful in shedding additional light on both SAD and self-consciousness.
Emhan, Ali; Selek, Salih; Bayazıt, Hüseyin; Fatih Karababa, İbrahim; Katı, Mahmut; Aksoy, Nurten
Generalized anxiety disorder (GAD) is a prevalent psychiatric disorder. The exact causes of GAD still unknown, in addition to neurochemical and neuroanatomic disorders, genetic and environmental factors are discussed in etiology. In our study we aimed to evaluate the oxidative metabolism's status and investigate the role of oxidative metabolites in GAD. Blood samples were taken from enrolled subjects in appropriate way and total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were studied in Harran University Biochemistry Labs. Results were compared between groups. The patients' TOS and OSI levels were significantly higher than control group. The patients' TAS levels were significantly lower than controls'. According to our findings, oxidative stress mechanism might have a role in GAD pathophysiology. In the future, total antioxidants may be used as a biologic marker in GAD etiology but more research is needed.
Ellard, Kristen K.; Deckersbach, Thilo; Sylvia, Louisa G.; Nierenberg, Andrew A.; Barlow, David H.
Bipolar disorder (BD) is a chronic, debilitating disorder with recurrent manic and depressive episodes. More than 75% of bipolar patients have a current or lifetime diagnosis of a comorbid anxiety disorder. Comorbid anxiety in BD is associated with greater illness severity, greater functional impairment, and poorer illness-related outcomes.…
Factor, Reina S.; Condy, Emma E.; Farley, Julee P.; Scarpa, Angela
While the function of restricted repetitive behaviors (RRBs) in autism spectrum disorder (ASD) is unclear, RRBs may function as anxiety reduction strategies (Joosten et al. "J Autism Dev Disord" 39(3):521-531, 2009. Moreover, anxiety in ASD is associated with low social motivation (Swain et al. "J Autism Dev Disord," 2015. The…
Kerns, Connor Morrow; Maddox, Brenna B.; Kendall, Philip C.; Rump, Keiran; Berry, Leandra; Schultz, Robert T.; Souders, Margaret C.; Bennett, Amanda; Herrington, John; Miller, Judith
This study investigated the accuracy of brief anxiety scales for non-treatment-seeking youth with autism spectrum disorder. In all, 54 youth (7-17?years; IQ: 67-158) with autism spectrum disorder and their parents completed (a) an expanded version of the Anxiety Disorders Interview Schedule--Child/Parent designed to capture typical and atypical…
Full Text Available Background: Anxiety disorders increase risk of future cardiovascular disease (CVD and mortality, even after controlling for confounds including smoking, lifestyle, and socioeconomic status, and irrespective of a history of medical disorders. While impaired vagal function, indicated by reductions in heart rate variability (HRV, may be one mechanism linking anxiety disorders to CVD, prior studies have reported inconsistent findings highlighting the need for meta-analysis.Method: Studies comparing resting state HRV recordings in patients with an anxiety disorder as a primary diagnosis and healthy controls were considered for meta-analysis. Results: Meta-analyses were based on 36 articles, including 2086 patients with an anxiety disorder and 2294 controls. Overall, anxiety disorders were characterised by lower HRV (high frequency: Hedges’ g = -.29. 95%CI: -.41 to -.17, p < 0.001; time domain: Hedges’ g = -0.45, 95%CI: -0.57 to -0.33, p < .001 than controls. Panic Disorder (n=447, Post-Traumatic Stress Disorder (n=192, Generalized Anxiety Disorder (n=68, and Social anxiety disorder (n=90, but not Obsessive Compulsive Disorder (n=40, displayed reductions in high frequency HRV relative to controls (all ps < .001. Conclusions: Anxiety disorders are associated with reduced HRV, findings associated with a small to moderate effect size. Findings have important implications for future physical health and wellbeing of patients, highlighting a need for comprehensive cardiovascular risk reduction.
Oude Voshaar, R.C.; Veen, D.C. van der; Kapur, N.; Hunt, I.; Williams, A.; Pachana, N.A.
BACKGROUND: Anxiety disorders are assumed to increase suicide risk, although confounding by comorbid psychiatric disorders may be one explanation. This study describes the characteristics of older patients with an anxiety disorder who died by suicide in comparison to younger patients. METHOD: A 15-y
Oude Voshaar, R. C.; van der Veen, D.C.; Kapur, N.; Hunt, I.; Williams, A.; Pachana, N. A.
Background: Anxiety disorders are assumed to increase suicide risk, although confounding by comorbid psychiatric disorders may be one explanation. This study describes the characteristics of older patients with an anxiety disorder who died by suicide in comparison to younger patients. Method: A 15-y
Seldenrijk, Adrie; Vogelzangs, Nicole; van Hout, Hein P. J.; van Marwijk, Harm W. J.; Diamant, Michaela; Penninx, Brenda W. J. H.
Objective: Current evidence regarding the association between psychopathology and subclinical atherosclerosis show inconsistent results. The present study examined whether subclinical atherosclerosis was more prevalent in a large cohort of persons with depressive or anxiety disorders as compared to
Glasheen, Cristie; Richardson, Gale A; Kim, Kevin H; Larkby, Cynthia A; Swartz, Holly A; Day, Nancy L
This study evaluated whether exposure to maternal pre- or postnatal depression or anxiety symptoms predicted psychopathology in adolescent offspring. Growth mixture modeling was used to identify trajectories of pre- and postnatal depression and anxiety symptoms in 577 women of low socioeconomic status selected from a prenatal clinic. Logistic regression models indicated that maternal pre- and postnatal depression trajectory exposure was not associated with offspring major depression, anxiety, or conduct disorder, but exposure to the high depression trajectory was associated with lower anxiety symptoms in males. Exposure to medium and high pre- and postnatal anxiety was associated with the risk of conduct disorder among offspring. Male offspring exposed to medium and high pre- and postnatal anxiety had higher odds of conduct disorder than did males with low exposure levels. Females exposed to medium or high pre- and postnatal anxiety were less likely to meet conduct disorder criteria than were females with lower exposure. To the best of our knowledge, this is the first study to examine the effect of pre- and postnatal anxiety trajectories on the risk of conduct disorder in offspring. These results suggest new directions for investigating the etiology of conduct disorder with a novel target for intervention.
Kreys, Tiffany-Jade M; Phan, Stephanie V
To evaluate the efficacy and tolerability of quetiapine for the treatment of generalized anxiety disorder (GAD), a literature search of the Medline database was conducted from inception to May 2014. The search was not restricted by language. Keywords used in the search were quetiapine and generalized anxiety disorder or anxiety. All studies assessing the use of quetiapine as monotherapy or adjunct therapy for the primary management of GAD in adults 18-65 years of age were included in this review. The nine studies included in this review were three studies evaluating the use of quetiapine extended release (XR) as monotherapy for acute GAD treatment, one study evaluating quetiapine XR monotherapy for maintenance treatment of GAD, and five studies evaluating quetiapine (2 XR, 3 immediate release) as adjunct therapy for acute GAD treatment. Quetiapine displayed both efficacy and tolerability in all monotherapy trials evaluating its use for acute and long-term treatment of GAD. Despite some limitations to and heterogeneity among the five adjunct therapy studies, three studies showed that quetiapine resulted in statistically significant changes in the Hamilton Anxiety Rating Scale or Clinical Global Impressions-Severity of Illness Scale scores. Although future studies of longer duration with broader inclusion criteria are needed to further evaluate the benefits and risks of quetiapine for GAD, in patients failing to respond to conventional antidepressant therapy, quetiapine may be a potential treatment option. With appropriate monitoring and management of adverse effects, the potential benefits of quetiapine in patients with treatment-refractory GAD may outweigh the risks associated with its use.
Beghi, Ettore; Bussone, Gennaro; D'Amico, Domenico; Cortelli, Pietro; Cevoli, Sabina; Manzoni, Gian Camillo; Torelli, Paola; Tonini, Maria Clara; Allais, Giovanni; De Simone, Roberto; D'Onofrio, Florindo; Genco, Sergio; Moschiano, Franca; Beghi, Massimiliano; Salvi, Sara
The objective of this paper was to assess prevalence and characteristics of anxiety and depression in migraine without aura and tension-type headache, either isolated or in combination. Although the association between headache and psychiatric disorders is undisputed, patients with migraine and/or tension-type headache have been frequently investigated in different settings and using different tests, which prevents meaningful comparisons. Psychiatric comorbidity was tested through structured interview and the MINI inventory in 158 adults with migraine without aura and in 216 persons with tension-type headache or migraine plus tension-type headache. 49 patients reported psychiatric disorders: migraine 10.9%, tension-type headache 12.8%, and migraine plus tension-type headache 21.4%. The MINI detected a depressive episode in 59.9, 67.0, and 69.6% of cases. Values were 18.4, 19.3, and 18.4% for anxiety, 12.7, 5.5, and 14.2%, for panic disorder and 2.3, 1.1 and 9.4% (p = 0.009) for obsessive-compulsive disorder. Multivariate analysis showed panic disorder prevailing in migraine compared with the other groups (OR 2.9; 95% CI 1.2-7.0). The association was higher (OR 6.3; 95% CI 1.4-28.5) when migraine (with or without tension-type headache) was compared to pure tension-type headache. This also applied to obsessive-compulsive disorder (OR 4.8; 95% CI 1.1-20.9) in migraine plus tension-type headache. Psychopathology of primary headache can reflect shared risk factors, pathophysiologic mechanisms, and disease burden.
As many as 1 in 4 Americans will experience an anxiety disorder at some point in their lives, and many will also suffer the depression, substance abuse, distressing physical signs, and socioeconomic problems that often accompany these disorders when left untreated. Anxiety disorders can be detected using simple screening tools in the physician's office. Early and effective treatment with appropriate medication can significantly reduce the psychic and physical symptoms of anxiety, lowering the...
Puck eDuits; Danielle C. eCath; Ivo eHeitland; Johanna M. P. eBaas
Although impaired fear extinction has repeatedly been demonstrated in patients with anxiety disorders, little is known about whether these impairments persist after treatment. The current comparative exploratory study investigated fear extinction in 26 patients treated for their anxiety disorder in the years preceding the study as compared to 17 healthy control subjects. Fear-potentiated startle and subjective fear were measured in a cue and context fear conditioning paradigm within a virtual...
Cuijpers, Pim; Gentili, Claudio; Banos, Rosa M; Garcia-Campayo, Javier; Botella, Cristina; Cristea, Ioana A
Although cognitive and behavioral therapies are effective in the treatment of anxiety disorders, it is not clear what the relative effects of these treatments are. We conducted a meta-analysis of trials comparing cognitive and behavioral therapies with a control condition, in patients with social anxiety disorder (SAD), generalized anxiety disorder (GAD) and panic disorder. We included 42 studies in which generic measures of anxiety were used (BAI, HAMA, STAI-State and Trait). Only the effects of treatment for panic disorder as measured on the BAI (13.33 points; 95% CI: 10.58-16.07) were significantly (p=0.001) larger than the effect sizes on GAD (6.06 points; 95% CI: 3.96-8.16) and SAD (5.92 points; 95% CI: 4.64-7.20). The effects remained significant after adjusting for baseline severity and other major characteristics of the trials. The results should be considered with caution because of the small number of studies in many subgroups and the high risk of bias in most studies.
Ramsawh, Holly J; Chavira, Denise A; Stein, Murray B
The current review describes the phenomenology of several common anxiety disorders in children and adolescents as they present in medical settings. Anxiety disorders and associated features in children are described, along with epidemiology, functional impairment, common somatic complaints, medical comorbidity, health care utilization, and presentation in general and in specialty pediatric medical settings. Recommendations for clinical management in pediatric settings are presented, and evidence-based interventions and emerging treatments for pediatric anxiety disorders are described. The review concludes with a discussion of future research directions that may lead to increased recognition and improved management of anxiety disorders in pediatric medical settings.
Full Text Available Elizabeth R Duval, Arash Javanbakht, Israel LiberzonDepartment of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USAAbstract: Anxiety and stress disorders are among the most prevalent neuropsychiatric disorders. In recent years, multiple studies have examined brain regions and networks involved in anxiety symptomatology in an effort to better understand the mechanisms involved and to develop more effective treatments. However, much remains unknown regarding the specific abnormalities and interactions between networks of regions underlying anxiety disorder presentations. We examined recent neuroimaging literature that aims to identify neural mechanisms underlying anxiety, searching for patterns of neural dysfunction that might be specific to different anxiety disorder categories. Across different anxiety and stress disorders, patterns of hyperactivation in emotion-generating regions and hypoactivation in prefrontal/regulatory regions are common in the literature. Interestingly, evidence of differential patterns is also emerging, such that within a spectrum of disorders ranging from more fear-based to more anxiety-based, greater involvement of emotion-generating regions is reported in panic disorder and specific phobia, and greater involvement of prefrontal regions is reported in generalized anxiety disorder and posttraumatic stress disorder. We summarize the pertinent literature and suggest areas for continued investigation.Keywords: fear, anxiety, neuroimaging
Full Text Available Background: Most common mental disorders (CMDs such as anxiety disorders and depressive disorders run a persistent and long course. This results in significant impairment of quality of life (QOL of patients and their families. Evidence-based psychosocial interventions using findings in our own socio-cultural context would help clinicians in holistic management. Objectives: To document illness profile, treatment satisfaction, and QOL in various domains of life in study population and normal controls. Study Design: Cross-sectional analytical study of patients group and their normal family members as a comparison group. Materials and Methods: A total of 100 consecutive patients of depressive disorders and anxiety disorders (ICD-10 clinical diagnosis attending outpatient clinic of the medical college hospital and their age- and gender-matched relatives as the control group were recruited. Socio-demographic profile was documented along with illness parameters: Severity of illness, treatment satisfaction, and QOL was measured using semi- structured interview, HAM, Beck′s depression Inventory, and WHO-QOL scale. Results: The study group measured significantly low on QOL than the comparison group. The two groups differed significantly on the paired " t" test of significance and the variation had a genuine assignable cause. Notwithstanding some variables having a confounding effect and the limitations of a cross-sectional study, the study was conclusive in demonstrating statistically significant impairment of QOL of patients with CMDs, making a strong case for clinicians to pay attention to holistic management of patients. The study has generated QOL data on a small but significant normative population which may serve purpose in future QOL studies.
Pelissolo, Antoine; Moukheiber, Albert; Mallet, Luc
Even though obsessive-compulsive disorders (OCD) and anxiety disorders (AD) have been separated in the taxonomy adopted by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, many issues remain concerning the physiopathological similarities and differences between those categories. Our objective was therefore to explore and compare their personality and emotional features, with the assumption that the distinction of two independent spectrums should imply the existence of two partially distinct temperamental profiles. We used the Temperament and Character Inventory (TCI-R) and the Positive and Negative Emotionality (PNE) scale to compare two groups of patients with OCD (n=227) or AD (n=827). The latter group included patients with social anxiety disorder, panic disorder, agoraphobia, and generalized anxiety disorder. Most temperament, character and emotionality measures showed no significant differences between both groups. In the personality measures results, only the self-directedness score (TCI-R) was significantly lower in OCD patients but this difference was not significant when the comparison was adjusted for the depressive scale score and age. Only lower PNE positive affects scores were obtained in OCD patients in the adjusted comparisons. These findings suggest that OCD and AD are not really distinguishable from the point of view of associated personality traits.
Reaven, Judy; Washington, Lindsay; Moody, Eric J; Stern, Jessica A; Hepburn, Susan L; Blakeley-Smith, Audrey
In response to the high co-occurrence of anxiety symptoms in youth with autism spectrum disorder (ASD), several interventions have been developed for this population. In spite of promising findings, some youth with ASD respond only minimally to such interventions. To understand potential factors that may impact treatment response, the current study explores the role of parental anxiety in youth treatment outcome. Thirty-one youth with ASD, ages 7-18, and their parents participated in the study. Parents completed the State/Trait Anxiety Inventory pre- and post-treatment. Contrary to previous research, there was no correlation between parental anxiety and youth anxiety at baseline or post-treatment. However, parental trait anxiety significantly decreased from pre- to post-treatment for parents of treatment responders. The findings are consistent with previous research and suggest a youth-to-parent influence.
Suzuki, Shunji; Shinmura, Hiroki; Kato, Masahiko
Background We examined the risk of hypertensive disorders in relation to maternal depressive and anxiety disorders which were diagnosed before or during early pregnancy in Japanese women. Methods We reviewed the obstetric records of all Japanese singleton deliveries at ≥ 22 weeks’ gestation managed at the Japanese Red Cross Katsushika Maternity Hospital between 2009 and 2014. Potential risk factors for hypertensive disorders with maternal depressive and anxiety disorders were selected as foll...
Amir, Nader; Prouvost, Caroline; Kuckertz, Jennie M.
Cognitive models of social anxiety posit that recurrent interpretation of ambiguous information as threatening maintains symptoms (e.g. Clark & Wells, 1995, pp. 69–93, Social phobia: Diagnosis, assessment, and treatment. New York: Guilford Press; Rapee & Heimberg, 1997, pp. 741–756, Behavior Research and Therapy, 35). However, biased interpretation may also be represented as a failure to make a benign interpretation of the ambiguous event. Furthermore, interpretation bias can be characterized by both an online (automatic) component and an offline (effortful) component (Hirsch & Clark, 2004, pp. 799–825, Clinical Psychology Review, 24). To measure both benign and threat biases, as well as examine the effect of social anxiety on offline versus online interpretations, Beard and Amir (2009, pp. 1135–1141, Behaviour Research and Therapy, 46) developed the Word Sentence Association Paradigm (WSAP). In the current study, we administered the WSAP to a group of participants diagnosed with social anxiety disorder (SAD) as well as to a group of non-anxious control (NAC) participants. We found that participants with SAD demonstrated a lack of benign online bias, but not an online threat bias when compared to NACs. However, when examining offline biases, SAD patients endorsed social threat interpretations and rejected benign social interpretations to a greater degree than non-anxious individuals. Our results, when taken together, clearly implicate the role of reduced bias toward benign information in SAD. PMID:22545788
Full Text Available Objective: Anxiety disorders are highly prevalent in the United States, and if untreated, result in a number of negative outcomes. This study aimed to investigate psychiatrists' current treatment practices for patients with anxiety disorders in the United States. Methods: Psychiatrist-reported data from the 1997 and 1999 American Psychiatric Institute for Research and Education Practice Research Network (PRN Study of Psychiatric Patients and Treatments (SPPT were examined, focusing on patients diagnosed with anxiety disorders. Information related to diagnostic and clinical features and treatments provided were obtained. Results: Anxiety disorders remain underdiagnosed and undertreated, since only 11.4% of the sample received a principal diagnosis of an anxiety disorder in a real world setting. Posttraumatic stress disorder was associated with particularly high comorbidity and disability, and social anxiety disorder was relatively rarely diagnosed and treated. Although combined pharmacotherapy and psychotherapy was commonly used to treat anxiety disorders, anxiolytics were more commonly prescribed than selective serotonin reuptake inhibitors (SSRIs. Conclusions: These data provide a picture of diagnosis and practice patterns across a range of psychiatric settings and suggest that anxiety disorders, despite being among the most prevalent of psychiatric disorders remain underdiagnosed and undertreated particularly in respect of the use of psychotherapeutic interventions.
Coutinho, Fernanda Corrêa; Dias, Gisele Pereira; do Nascimento Bevilaqua, Mário Cesar; Gardino, Patricia Franca; Pimentel Rangé, Bernard; Nardi, Antonio Egidio
This article proposes a revision of the historical evolution of the concepts of generalized anxiety disorder (GAD). Currently, Darwin's evolutionary theory is the hegemonic paradigm for modern science and influences research on mental disorders. Throughout the 20th Century, the editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association) have changed the diagnostic criteria for GAD, reflecting the prevailing psychiatric understanding of this disorder. The prevalence and symptoms of major depression and GAD show the fragility of the categorical conception of these conditions. Differences in cultural views towards anxiety disorders also suggest that anxiety cannot have a uniform definition. This article provides contributions for reflecting future guidelines concerning the diagnostic criteria for GAD in DSM-V.
Full Text Available Anxiety disorders are very common in secondary school children with little epidemiological data from countries like India. The objective of this study was to assess the prevalence of anxiety disorders in higher secondary school students using Screen for Ch ild Anxiety Related Emotional Disorders (SCARED questionnaire. Methodology: The study was conducted in July 2014 and 100 students belonging to class 11 and class 12 of a higher secondary school at Tiptur were included in the study. The SCARED questionnair es were used to assess anxiety in these children. Results: In this study, 37% were found to have anxiety disorder (p value < 0.001. Of these majority (58% were females which was significant. Of the 100 children, 64% had PN (panic disorder, 10% had GD (g eneralized anxiety disorder, 53% had SP (separation anxiety, 15% had SC (social anxiety disorder and 16% had SH (significant school avoidance. Hence in this study, panic disorder and separation anxiety were found to be highly prevalent. In this study o f the children who had anxiety, majority of these children’s mothers (79% and majority of the children’s fathers were illiterate (54%. In this study, of the children with anxiety, 76% belonged to nuclear family and majority i.e. 84% belonged to rural are a. Conclusion: This study shows the high prevalence of undiagnosed depression and anxiety disorders among adolescents and hence the need for them. Early interventions can provide long - term health and socioeconomic benefits by prevention of the onset of men tal health problems and their development into chronic disorders.
Strang, John F.; Kenworthy, Lauren; Daniolos, Peter; Case, Laura; Wills, Meagan C.; Martin, Alex; Wallace, Gregory L.
Recent studies have shown that rates of depression and anxiety symptoms are elevated among individuals with autism spectrum disorders (ASDs) of various ages and IQs and that depression/anxiety symptoms are associated with higher IQ and fewer ASD symptoms. In this study which examined correlates of depression and anxiety symptoms in the full…
Attention bias modification (ABM) is a newly emerging therapy for anxiety disorders that is rooted in current cognitive models of anxiety and in established experimental data on threat-related attentional biases in anxiety. This review describes the evidence indicating that ABM has the potential to become an enhancing tool for current…
Holwerda, T.J.; Schoevers, R.A.; Dekker, J.J.M.; Deeg, D.J.H.; Jonker, C.; Beekman, A.T.F.
after adjustment for the different variables. Conclusions In elderly persons depression increases the risk of death in men. Neither generalized anxiety nor mixed anxiety-depression are associated with excess mortality. Generalized anxiety disorder may even predict less mortality in depressive elderl
Dudeney, Joanne; Sharpe, Louise; Sicouri, Gemma; Lorimer, Sarah; Dear, Blake F; Jaffe, Adam; Selvadurai, Hiran; Hunt, Caroline
Children with asthma have a high prevalence of anxiety disorders, however, very little is known about the mechanisms that confer vulnerability for anxiety in this population. This study investigated whether children with asthma and anxiety disorders display attentional biases towards threatening stimuli, similar to what has been seen in children with anxiety disorders more generally. We also examined the relationships between attentional biases and anxiety symptomatology and asthma control for children with asthma. Ninety-three children, aged 8-13, took part in the study and were recruited into one of four conditions (asthma/anxiety, asthma, anxiety, control). Asthma was medically confirmed and anxiety was assessed through clinical interview. We used self- and parent-report questionnaires to measure child asthma (ATAQ) and anxiety (SCAS, CASI) variables. Participants completed a visual dot-probe task designed to measure attentional bias towards two types of stimuli: asthma related words and general threat words, as well as tasks to assess reading ability and attentional control. Results showed that attentional biases did not differ between the groups, although children with anxiety disorders displayed poorer attentional control. A significant correlation was found between poor asthma control and an attentional bias of asthma stimuli. While we found no evidence that anxiety disorders in children with asthma were associated with threat- or asthma-related attentional biases, preliminary evidence suggested that children with poor asthma control displayed biases towards asthma-specific stimuli. Future research is needed to explore whether these attentional biases are adaptive.
Kircanski, Katharina; Johnson, Douglas C; Mateen, Maria; Bjork, Robert A; Gotlib, Ian H
Generalized Anxiety Disorder (GAD) is characterized by cognitive biases toward threat-relevant information, but the underlying mechanisms are unclear. We translated a retrieval-practice paradigm from cognitive science to investigate impaired inhibition of threat information as one such mechanism. Participants diagnosed with GAD and never-disordered control participants learned a series of cue-target pairs; whereas some cues were associated only with neutral targets, others were associated with both neutral and threat targets. Next, participants practiced retrieving neutral targets, which typically suppresses the subsequent recall of unpracticed associated targets (retrieval-induced forgetting; RIF). Finally, participants were tested on their recall of all targets. Despite showing intact RIF of neutral targets, the GAD group failed to exhibit RIF of threat targets. Furthermore, within the GAD group, less RIF of threat targets correlated with greater pervasiveness of worry. Deficits in inhibitory control over threat-relevant information may underlie the cognitive pathology of GAD, which has important treatment implications.
Pisano, S; Catone, G; Pascotto, A; Iuliano, R; Tiano, C; Milone, A; Masi, G; Gritti, A
Recently, social anxiety disorder (SAD) and paranoia have been demonstrated to be closely related. However, data were primarily drawn from adult community samples or patients with schizophrenia. The present study used a cross-sectional design to evaluate a sample of adolescents with SAD (n = 30, mean age 15.3 ± 0.9 years) compared with an age- and sex-matched group of healthy controls (n = 26, mean age 15.9 ± 1.6 years). The SAD group displayed more frequent and intense paranoid thoughts than the control group (t = 4.16, p paranoia may lead to incorrect diagnoses (e.g. misdiagnosis of psychotic disorders), or it may negatively influence the (psycho)therapeutic process and patient outcomes.
Low Nancy CP
Full Text Available Abstract Background Parental history of mood or anxiety disorders is one of the strongest and most consistent risk factors for the development of these disorders in offspring. Gaps remain however in our knowledge of whether maternal or paternal disorders are more strongly associated with offspring disorders, and whether the association exists in non-clinical samples. This study uses a large population-based sample to test if maternal or paternal history of mood and/or anxiety disorders increases the risk of mood and/or anxiety disorders, or symptoms of specific anxiety disorders, in offspring. Methods Data were drawn from the Nicotine Dependence in Teens Study, a prospective cohort investigation of 1293 grade 7 students. Data on mental health outcomes were collected in mailed self-report questionnaires when participants were aged 20.4 (0.7 years on average. Parental data were collected in mailed self-report questionnaires. This current analysis pertains to 564 participants with maternal and/or paternal data. The association between maternal and paternal history and each of diagnosed anxiety disorder, diagnosed mood disorder, and symptoms of specific anxiety disorders in offspring was studied in multivariate logistic regression. Results A higher proportion of mothers than fathers had a diagnosed mood/anxiety disorder (23% versus 12%. Similarly, 14% of female offspring had a diagnosed mood/anxiety disorder, compared to 6% of male offspring. The adjusted odds ratio (95% confidence interval for maternal history was 2.2 (1.1, 4.5 for diagnosed mood disorders, 4.0 (2.1, 7.8 for diagnosed anxiety disorders, and 2.2 (1.2, 4.0 for social phobia symptoms. Paternal history was not associated with any of the mental health outcomes in offspring. Conclusion Maternal, but not paternal mood/anxiety disorders were associated with diagnosed psychiatric disorders, as well as symptoms of specific anxiety disorders, in offspring. Efforts to detect mood and anxiety
Benzodiazepines (BDZs) continue to be shrouded in controversy, mainly because of dependence associated with their long-term use and some of their side effects. Despite treatment recommendations favoring newer antidepressants, BDZs are still commonly prescribed for anxiety and related disorders. Recent studies have demonstrated that long-term use of BDZs for these conditions can be effective and safe and that BDZs can be combined with psychological therapy and antidepressants to produce optimal outcomes. Such findings, along with a failure to convincingly demonstrate the overall superiority of alternative pharmacotherapy for anxiety and related disorders, have given an impetus to a reconsideration of the role of BDZs. This article reviews BDZs and other pharmacotherapy options for anxiety and related disorders and suggests that treatment guidelines should acknowledge that BDZs can be used as first-line, long-term pharmacological treatment for panic disorder, generalized anxiety disorder and social anxiety disorder.
Stein, Dan J; Fineberg, Naomi A; Bienvenu, O Joseph; Denys, Damiaan; Lochner, Christine; Nestadt, Gerald; Leckman, James F; Rauch, Scott L; Phillips, Katharine A
In DSM-III, DSM-III-R, and DSM-IV, obsessive-compulsive disorder (OCD) was classified as an anxiety disorder. In ICD-10, OCD is classified separately from the anxiety disorders, although within the same larger category as anxiety disorders (as one of the "neurotic, stress-related, and somatoform disorders"). Ongoing advances in our understanding of OCD and other anxiety disorders have raised the question of whether OCD should continue to be classified with the anxiety disorders in DSM-V. This review presents a number of options and preliminary recommendations to be considered for DSM-V. Evidence is reviewed for retaining OCD in the category of anxiety disorders, and for moving OCD to a separate category of obsessive-compulsive (OC)-spectrum disorders, if such a category is included in DSM-V. Our preliminary recommendation is that OCD be retained in the category of anxiety disorders but that this category also includes OC-spectrum disorders along with OCD. If this change is made, the name of this category should be changed to reflect this proposed change.
Otowa, T.; Hek, K.; Lee, M.; Byrne, E. M.; Mirza, S. S.; Nivard, M. G.; Bigdeli, T.; Aggen, S. H.; Adkins, D.; Wolen, A.; Fanous, A.; Keller, M. C.; Castelao, E.; Kutalik, Z.; der Auwera, S. V.; Homuth, G.; Nauck, M.; Teumer, A.; Milaneschi, Y.; Hottenga, J-J; Direk, N.; Hofman, A.; Uitterlinden, A.; Mulder, C. L.; Henders, A. K.; Medland, S. E.; Gordon, S.; Heath, A. C.; Madden, P. A. F.; Pergadia, M. L.; van der Most, P. J.; Nolte, I. M.; van Oort, F. V. A.; Hartman, C. A.; Oldehinkel, A. J.; Preisig, M.; Grabe, H. J.; Middeldorp, C. M.; Penninx, B. W. J. H.; Boomsma, D.; Martin, N. G.; Montgomery, G.; Maher, B. S.; van den Oord, E. J.; Wray, N. R.; Tiemeier, H.; Hettema, J. M.
Anxiety disorders (ADs), namely generalized AD, panic disorder and phobias, are common, etiologically complex conditions with a partially genetic basis. Despite differing on diagnostic definitions based on clinical presentation, ADs likely represent various expressions of an underlying common diathe
Mahoney, Alison E J; Hobbs, Megan J; Newby, Jill M; Williams, Alishia D; Sunderland, Matthew; Andrews, Gavin
BACKGROUND: Understanding behavioral avoidance associated with generalized anxiety disorder (GAD) has implications for the classification, theoretical conceptualization, and clinical management of the disorder. This study describes the development and preliminary psychometric evaluation of a self-re
Meyerbröker, Katharina; Emmelkamp, Paul M G
In recent years, virtual reality exposure therapy (VRET) has become an interesting alternative for the treatment of anxiety disorders. Research has focused on the efficacy of VRET in treating anxiety disorders: phobias, panic disorder, and posttraumatic stress disorder. In this systematic review, strict methodological criteria are used to give an overview of the controlled trials regarding the efficacy of VRET in patients with anxiety disorders. Furthermore, research into process variables such as the therapeutic alliance and cognitions and enhancement of therapy effects through cognitive enhancers is discussed. The implications for implementation into clinical practice are considered.
Jongerden, L.; Bögels, S.M.
We examined (1) whether families of clinic-referred anxiety-disordered children are characterized by anxiety-enhancing parenting and family functioning, compared to control families; (2) whether family cognitive-behavioral therapy (FCBT) for anxiety-disordered children decreases anxiety-enhancing pa
Zvolensky, Michael J; Bakhshaie, Jafar; Garza, Monica; Valdivieso, Jeanette; Ortiz, Mayra; Bogiaizian, Daniel; Robles, Zuzuky; Vujanovic, Anka
The present investigation examined the interactive effects of anxiety sensitivity and subjective social status in relation to anxiety and depressive symptoms and psychopathology among 143 Latinos (85.7% female; Mage=39.0, SD=10.9; 97.2% used Spanish as their first language) who attended a community-based primary healthcare clinic. Results indicated that the interaction between anxiety sensitivity and subjective social status was significantly associated with number of mood and anxiety disorders, panic, social anxiety, and depressive symptoms. The form of the significant interactions indicated that individuals reporting co-occurring higher levels of anxiety sensitivity and lower levels of subjective social status evidenced the greatest levels of psychopathology and panic, social anxiety, and depressive symptoms. The present findings suggest that there is merit in focusing further scientific attention on the interplay between anxiety sensitivity and subjective social status in regard to understanding, and thus, better intervening to reduce anxiety/depressive vulnerability among Latinos in primary care.
Spinhoven, Philip; Penninx, Brenda W; van Hemert, Albert M; de Rooij, Mark; Elzinga, Bernet M
The present study aims to assess comorbidity of posttraumatic stress disorder (PTSD) in anxiety and depressive disorders and to determine whether childhood trauma types and other putative independent risk factors for comorbid PTSD are unique to PTSD or shared with anxiety and depressive disorders. The sample of 2402 adults aged 18-65 included healthy controls, persons with a prior history of affective disorders, and persons with a current affective disorder. These individuals were assessed at baseline (T0) and 2 (T2) and 4 years (T4) later. At each wave, DSM-IV-TR based anxiety and depressive disorder, neuroticism, extraversion, and symptom severity were assessed. Childhood trauma was measured at T0 with an interview and at T4 with a questionnaire, and PTSD was measured with a standardized interview at T4. Prevalence of 5-year recency PTSD among anxiety and depressive disorders was 9.2%, and comorbidity, in particular with major depression, was high (84.4%). Comorbidity was associated with female gender, all types of childhood trauma, neuroticism, (low) extraversion, and symptom severity. Multivariable significant risk factors (i.e., female gender and child sexual and physical abuse) were shared among anxiety and depressive disorders. Our results support a shared vulnerability model for comorbidity of anxiety and depressive disorders with PTSD. Routine assessment of PTSD in patients with anxiety and depressive disorders seems warranted.
McNaughton, N; Corr, P J
We discuss comorbidity, continuity, and discontinuity of anxiety-related disorders from the perspective of a two-dimensional neuropsychology of fear (threat avoidance) and anxiety (threat approach). Pharmacological dissection of the "neurotic" disorders justifies both a categorical division between fear and anxiety and a subdivision of each mapped to a hierarchy of neural modules that process different immediacies of threat. It is critical that each module can generate normal responses, sympt...
Orchard, Faith; Apetroaia, Adela; Clarke, Kiri; Creswell, Cathy
Negative (or a lack of positive) interpretation of ambiguous social situations has been hypothesised to maintain social anxiety disorder in children, yet there is currently limited evidence to support this. Cognitive Bias Modification of Interpretation (CBM-I) provides a means to explore the causal influence of interpretation bias on social anxiety disorder, and has been associated with a reduction in social anxiety symptoms in adults. Seven to twelve year old children with a diagnosis of soc...
A research project that aimed to investigate how anxiety disorders affect a group of four women, living in Glasgow, and their relationships with space. Women’s experiences of living with anxiety have historically been underrepresented; existing literature on the subject of anxiety disorders and space has predominantly been based on the experiences of western men living with agoraphobia. By focusing solely on the spatial restrictions experienced by agoraphobics, existing literature articulates...
van der Veen, D.C.; van Zelst, W. H.; Schoevers, R. A.; Comijs, H. C.; Oude Voshaar, Richard
Background: Comorbid anxiety disorders are common in late-life depression and negatively impact treatment outcome. This study aimed to examine personality characteristics as well as early and recent life-events as possible determinants of comorbid anxiety disorders in late-life depression, taking pr
Moree, Brittany N.; Davis, Thompson E., III
Anxiety disorders have been found to be highly comorbid with autism spectrum disorders (ASDs). Even so, the identification and dissemination of empirically supported treatments for anxiety in adults or children who have ASD has lagged behind the larger evidence-based trend. This review examines the efficacy of cognitive-behavioral therapy as a…
van Mill, Josine G.; Vogelzangs, Nicole; Hoogendijk, Witte J. G.; Penninx, Brenda W. J. H.
Objectives: We aimed to examine the associations between sleep disturbances and work functioning in an epidemiologic cohort study in subjects with or without depressive or anxiety disorders. Methods: There were 707 subjects included in our analyses with depressive or anxiety disorders and 728 subjec
Glashouwer, Klaske A.; Vroling, Maartje S.; de Jong, Peter J.; Lange, Wolf-Gero; de Keijser, Jos
Background and Objectives: Negative automatic associations towards the self and social cues are assumed to play an-important role in social anxiety disorder. We tested whether social anxiety disorder patients (n = 45) showed stronger dysfunctional automatic associations than non-clinical controls (n
Glashouwer, K.A.; Vroling, M.S.; Jong, P.J. de; Lange, W.G.; Keijser, J. de
Background and Objectives Negative automatic associations towards the self and social cues are assumed to play an important role in social anxiety disorder. We tested whether social anxiety disorder patients (n = 45) showed stronger dysfunctional automatic associations than non-clinical controls (n
Reigada, Laura C.; Fisher, Paige H.; Cutler, Cynthia; Warner, Carrie Masia
Anxiety disorders in children and adolescents are largely undetected and the majority of youth do not receive services. Given the deleterious consequences of anxiety disorders, early identification and intervention have public health implications. In order to increase identification and treatment of anxious youth, expansion to nonpsychiatric…
Hovens, J. G. F. M.; Giltay, E. J.; Wiersma, J. E.; Spinhoven, P.; Penninx, B. W. J. H.; Zitman, F. G.
Hovens JGFM, Giltay EJ, Wiersma JE, Spinhoven P, Penninx BWJH, Zitman FG. Impact of childhood life events and trauma on the course of depressive and anxiety disorders. Objective: Data on the impact of childhood life events and childhood trauma on the clinical course of depressive and anxiety disorde
Roemer, Lizabeth; Orsillo, Susan M.
Research suggests that experiential avoidance may play an important role in generalized anxiety disorder (GAD; see Roemer, L., & Orsillo, S.M. (2002). "Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models." "Clinical…
Bermúdez, María Olga Escandell; Sánchez, José Juan Castro; del Sol, María; Sevilla, Fortea
Autism spectrum disorders (ASD) are characterized by a series of deficits in social interaction and communication and restricted, repetitive, and stereotyped behavior patterns. In addition, a high percentage of ADS is associated with anxiety disorders. The goal of this study is to assess the perception of anxiety in a group of children and…
Grondhuis, Sabrina N.; Aman, Michael G.
Anxiety disorders are among the most common comorbid conditions in children and adolescents with autism spectrum disorders (ASDs), although assessment presents unique challenges. Many symptoms of anxiety appear to overlap with common presentations of autism. Furthermore, deficits in language and cognitive functioning make it difficult for such…
F.J.A. van Steensel; S.M. Bögels; C.D. Dirksen
Comorbid anxiety disorders are common in children with autism spectrum disorders (ASD). However, studies comparing children with ASD to clinically anxious children are rare. This study investigated anxiety problems and health-related quality of life in children with high-functioning ASD and comorbid
Anxiety disorders are among the most prevalent psychiatric problems in children and adolescents. The present article summarizes the main evidence that has accumulated on the pathogenesis of childhood anxiety disorders during the past two decades. Various risk and vulnerability factors (e.g., genetics, behavioral inhibition, disgust sensitivity,…
Legerstee, Jeroen S.; Tulen, Joke H. M.; Kallen, Victor L.; Dieleman, Gwen C.; Treffers, Philip D. A.; Verhulst, Frank C.; Utens, Elisabeth M. W. J.
Threat-related selective attention was found to predict the success of the treatment of childhood anxiety disorders through administering a pictorial dot-probe task to 131 children with anxiety disorders prior to cognitive behavioral therapy. The diagnostic status of the subjects was evaluated with a semistructured clinical interview at both pre-…
Full Text Available Objective: The relationship between psychological factors and cardiac diseases has been concerned for a long but our knowledge about the cognitive profiles which could be important etiological factor in cardiac disease and comorbid psychiatric disorders is limited. In this study, we aimed to compare the cognitive profiles of coronary artery disease patients with or without comorbid anxiety disorder. Method: A total of 35 coronary artery disease patients with anxiety disorder and 20 coronary artery disease patients without comorbid anxiety disorders were enrolled into the study. Beck Anxiety Inventory and the Young Schema Questionnaire-Short Form 3 were applied to each participant. Results: Disconnection, rejection, impaired autonomy self-manifestation, extreme vigilance, unrelenting standards, other-directedness, and impaired limits schema domain scores were significantly higher in coronary artery disease patients with anxiety disorder comorbidity compared to coronary artery disease patients without anxiety disorder. Conclusion: Our study has revealed significant differences in cognitive profiles of coronary artery disease patients with comorbidity of anxiety disorders. These findings show the importance of cognitive profiles which were observed in coronary artery disease patients with anxiety disorders. Schema-focused approach might be useful in the treatment of such patients. Further studies with schema-focused therapy approaches are needed to illustrate the issue.
Vande Voort, Jennifer L.; Svecova, Jana; Jacobson, Amy Brown; Whiteside, Stephen P.
The objective of this study was to facilitate the bidirectional communication between researchers and clinicians about the treatment of childhood anxiety disorders, including obsessive-compulsive disorder. Forty-four children were assessed before and after cognitive behavioral treatment with the parent versions of the Spence Child Anxiety Scale…
Nail, Jennifer E.; Christofferson, Jennifer; Ginsburg, Golda S.; Drake, Kelly; Kendall, Philip C.; McCracken, James T.; Birmaher, Boris; Walkup, John T.; Compton, Scott N.; Keeton, Courtney; Sakolsky, Dara
Background: Global academic difficulties have often been reported in youth with anxiety disorders, however, little is known about the specific academic deficits in this population. Objective: To (a) evaluate the prevalence of seven specific academic impairments in children and adolescents with anxiety disorders, (b) determine whether these…
Vreeburg, Sophie A.; Zitman, Frans G.; van Pelt, Johannes; DeRijk, Roel H.; Verhagen, Jolanda C. M.; van Dyck, Richard; Hoogendijk, Witte J. G.; Smit, Johannes H.; Penninx, Brenda
Objective: To examine the association between several subtypes of anxiety disorders and various cortisol indicators in a large cohort study. Anxiety disorders have been suggested to be linked to hypothalamic-pituitary-adrenal (HPA) axis activity, although results are scarce and inconsistent. No earl
Sjoerds, Z.; van Tol, M.J.; van den Brink, W.; van der Wee, N.J.A.; Aleman, A.; Beekman, A.T.F.; Penninx, B.W.J.H.; Veltman, D.J.
Background. A family history (FH) of alcohol dependence (AD) not only increases the risk for AD, but is also associated with an increased risk for mood and anxiety disorders. However, it is unknown how a FH of AD affects neural substrates in patients with mood and anxiety disorders. In this study we
Bearss, Karen; Taylor, Christopher A.; Aman, Michael G.; Whittemore, Robin; Lecavalier, Luc; Miller, Judith; Pritchett, Jill; Green, Bryson; Scahill, Lawrence
Anxiety is common in youth with autism spectrum disorder. Despite this common co-occurrence, studies targeting anxiety in this population are hindered by the under-developed state of measures in youth with autism spectrum disorder. Content validity (the extent to which an instrument measures the domain of interest) and an instrument's relevance to…
Albano, Anne Marie
This special series on intensive treatments for anxiety disorders in youth reminds us that these are challenging conditions and there is much more work to be done to address some of the limitations to and challenges of treating anxiety disorders in children using CBT. The treatments described in this series are intensive in their delivery and…
de Wit, Leonore M.; Fokkema, Marjolein; van Straten, Annemieke; Lamers, Femke; Cuijpers, Pim; Penninx, Brenda W. J. H.
Objective: There is evidence of more obesity among persons with depressive and depressive and anxiety disorders. However, the nature and the underlying mechanisms of the association are still unclear. This study examines the association between depressive and anxiety disorders and obesity, physical
Bekhuis, Ella; Boschloo, Lynn; Rosmalen, Judith G M; Schoevers, Robert A
OBJECTIVE: Previous studies have shown that depressive and anxiety disorders are strongly related to somatic symptoms, but much is unclear about the specificity of this association. This study examines the associations of specific depressive and anxiety disorders with somatic symptoms, and whether t
Cortes, Adriana M.; Saltzman, Kassey M.; Weems, Carl F.; Regnault, Heather P.; Reiss, Allan L.; Carrion, Victor G.
Objective: The current study was conducted to determine if post-traumatic stress disorder (PTSD) symptomatology predicted later development of non-PTSD anxiety disorders in children and adolescents victimized by interpersonal trauma. Methods: Thirty-four children with a history of interpersonal trauma and no initial diagnosis of anxiety disorder…
May, Tamara; Cornish, Kim; Rinehart, Nicole J.
Children with autism spectrum disorder (ASD) have high levels of anxiety. It is unclear whether they exhibit threat-related attentional biases commensurate with anxiety disorders as manifest in non-ASD populations, such as facilitated attention toward, and difficulties disengaging engaging from, threatening stimuli. Ninety children, 45 cognitively…
I.E. Lindhout; M.T. Markus; T.H.G. Hoogendijk; F. de Boer
Both temperament and parental child-rearing style are found to be associated with childhood anxiety disorders in population studies. This study investigates the contribution of not only temperament but also parental child-rearing to clinical childhood anxiety disorders. It also investigates whether
Plaisier, I.; Beekman, A.T.F.; de Graaf, R.; Smit, J. H.; van Dyck, R.; Penninx, Brenda
Background: Depressive and anxiety disorders affect work functioning and cause high labour costs. Aims: To examine and compare psychopathological characteristics of depressive and anxiety disorders in their effect on work functioning. Method: In 1876 working participants of the Netherlands Study of
Reid, K. A.; Smiley, E.; Cooper, S.-A.
Background: Anxiety disorders are known to be common in the general population. Previous studies with adults with intellectual disabilities (IDs) report a prevalence of general anxiety disorder ranging from less than 2% to 17.4%. Little is known about associated factors in this population. This study investigates point prevalence of anxiety…
Full Text Available Abstract Background Multiple studies have demonstrated that rates of smoking and nicotine dependence are increased in individuals with anxiety disorders. However, significant variability exists in the epidemiological literature exploring this relationship, including study design (cross-sectional versus prospective, the population assessed (random sample versus clinical population and diagnostic instrument utilized. Methods We undertook a systematic review of population-based observational studies that utilized recognized structured clinical diagnostic criteria (Diagnostic and Statistical Manual of Mental Disorders (DSM or International Classification of Diseases (ICD for anxiety disorder diagnosis to investigate the relationship between cigarette smoking, nicotine dependence and anxiety disorders. Results In total, 47 studies met the predefined inclusion criteria, with 12 studies providing prospective information and 5 studies providing quasiprospective information. The available evidence suggests that some baseline anxiety disorders are a risk factor for initiation of smoking and nicotine dependence, although the evidence is heterogeneous and many studies did not control for the effect of comorbid substance use disorders. The identified evidence however appeared to more consistently support cigarette smoking and nicotine dependence as being a risk factor for development of some anxiety disorders (for example, panic disorder, generalized anxiety disorder, although these findings were not replicated in all studies. A number of inconsistencies in the literature were identified. Conclusions Although many studies have demonstrated increased rates of smoking and nicotine dependence in individuals with anxiety disorders, there is a limited and heterogeneous literature that has prospectively examined this relationship in population studies using validated diagnostic criteria. The most consistent evidence supports smoking and nicotine dependence as
Kayhan, Fatih; Küçük, Adem; Satan, Yılmaz; İlgün, Erdem; Arslan, Şevket; İlik, Faik
Background We aimed to investigate the current prevalence of sexual dysfunction (SD), mood, anxiety, and personality disorders in female patients with fibromyalgia (FM). Methods This case–control study involved 96 patients with FM and 94 healthy women. The SD diagnosis was based on a psychiatric interview in accordance with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. Mood and anxiety disorders were diagnosed using the Structured Clinical Interview. Personality disorders were diagnosed according to the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders. Results Fifty of the 96 patients (52.1%) suffered from SD. The most common SD was lack of sexual desire (n=36, 37.5%) and arousal disorder (n=10, 10.4%). Of the 96 patients, 45 (46.9%) had a mood or anxiety disorder and 13 (13.5%) had a personality disorder. The most common mood, anxiety, and personality disorders were major depression (26%), generalized anxiety disorder (8.3%), and histrionic personality disorder (10.4%). Conclusion SD, mood, and anxiety disorders are frequently observed in female patients with FM. Pain plays a greater role in the development of SD in female patients with FM. PMID:26937190
Möller, Eline L; Majdandžić, Mirjana; Craske, Michelle G; Bögels, Susan M
The current shift in the DSM towards the inclusion of a dimensional component allows clinicians and researchers to demonstrate not only the presence or absence of psychopathology in an individual, but also the degree to which the disorder and its symptoms are manifested. This study evaluated the psychometric properties and utility of a set of brief dimensional scales that assess DSM-based core features of anxiety disorders, for children and their parents. The dimensional scales and the Screen for Child Anxiety Related Emotional Disorders (SCARED-71), a questionnaire to assess symptoms of all anxiety disorders, were administered to a community sample of children (n = 382), aged 8-13 years, and their mothers (n = 285) and fathers (n = 255). The dimensional scales assess six anxiety disorders: specific phobia, agoraphobia, panic disorder, social anxiety disorder, generalized anxiety disorder, and separation anxiety disorder. Children rated their own anxiety and parents their child's anxiety. The dimensional scales demonstrated high internal consistency (α > 0.78, except for father reported child panic disorder, for reason of lack of variation), and moderate to high levels of convergent validity (rs = 0.29-0.73). Children who exceeded the SCARED cutoffs scored higher on the dimensional scales than those who did not, providing preliminary support for the clinical sensitivity of the scales. Given their strong psychometric properties and utility for both child and parent report, addition of the dimensional scales to the DSM-5 might be an effective way to incorporate dimensional measurement into the categorical DSM-5 assessment of anxiety disorders in children.
Brumariu, Laura E; Obsuth, Ingrid; Lyons-Ruth, Karlen
Little is known about the links between anxiety disorders and parent-child attachment disorganization and quality of peer relationships in late adolescence. This study examined the quality of attachment and peer relationships among adolescents with and without anxiety disorders in a sample of 109 low- to moderate-income families. Psychopathology was assessed with the SCID-I. Attachment disorganization and dysfunction in peer relationships were measured using semi-structured interviews and behavioral observations. Adolescents with anxiety disorders and comorbid conditions showed higher levels of attachment disorganization across three measurement approaches, as well as higher levels of dysfunction in peer relationships than those with no Axis I diagnosis. Adolescents without anxiety disorders but with other Axis I disorders differed only in the quality of school relationships from those with no diagnoses. The pattern of results suggests that pathological anxiety, in the context of other comorbidities, may be a marker for more pervasive levels of social impairment.
E. Noordik; J.J.L. van der Klink; E.F. Klingen; K. Nieuwenhuijsen; F.J.H. van Dijk
ABSTRACT: BACKGROUND: Anxiety disorders are associated with functional disability, sickness absence, and decreased productivity. Effective treatments of anxiety disorders can result in remission of symptoms. However the effects on work related outcomes are largely unknown. Exposure in vivo is potent
Noordik, Erik; van der Klink, Jac J. L.; Klingen, Elmer F.; Nieuwenhuijsen, Karen; van Dijk, Frank J. H.
Background: Anxiety disorders are associated with functional disability, sickness absence, and decreased productivity. Effective treatments of anxiety disorders can result in remission of symptoms. However the effects on work related outcomes are largely unknown. Exposure in vivo is potentially well
Full Text Available Lívia Santana1, Leonardo F Fontenelle1–31Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Brazil; 2Department of Psychiatry and Mental Health, Institute of Community Health, Universidade Federal Fluminense, Brazil; 3D’Or Institute for Research and Education (IDOR, Rio de Janeiro, BrazilObjective: This paper aimed at describing the most consistent correlates and/or predictors of nonadherence to treatment of patients with different anxiety disorders.Method: The authors retrieved studies indexed in PubMed/MedLine, PsycINFO, and ISI Web of Knowledge using the following search terms: attrition OR dropout OR attrition rates OR patient dropouts OR treatment adherence AND anxiety disorders. Research was limited to articles published before January 2010.Results: Sixteen studies were selected that investigated the impact of sociodemographic, clinical, or cognitive variables on adherence to treatment for anxiety disorders. While no consistent pattern of sociodemographic or clinical features associated with nonadherence emerged, all studies that investigated cognitive variables in panic disorder, social anxiety disorder, and obsessive-compulsive disorder found that expectations and opinions about treatment were related to adherence.Conclusion: The findings of this study suggest that it is essential to consider anxiety disorder patients’ beliefs about illness and treatment strategies to increase their compliance with the therapeutic plan.Keywords: attrition, dropout, OCD, obsessive-compulsive disorder, social anxiety disorder
Aleksandr Anatolyevich Shatenshtein
Full Text Available Patients and methods. The results of clinical and psychodiagnostic examination using the Minnesota Multiphasic Personality Inventory (MMPI were analyzed in 210 therapeutic inpatients from 4 groups of psychosomatic diseases (coronary heart disease, hypertensive disease, duodenal ulcer disease, asthma, and bronchitis with an asthmatic component and 3 groups of diseases in whose genesis the psychosomatic mechanisms (pneumonia, gastritis, renal diseases played a lesser role. Healthy individuals (n=38 served as a control group. The correlation coefficients between the first scale reflecting the number of somatic complaints and the magnitude of their hypochondriacal fixation and the second one characterizing the degree of anxiety and depressive disorders were calculated within each disease group. Results. In psychosomatic diseases, the correlation coefficients between the first and second MMPI scales proved to be insignificant and substantially lower than those in the healthy individuals. This suggests that in such patients, a larger number of somatic complaints and their enhanced hypochondriacal fixation alleviate anxiety and depressive disorders, which may be regarded as an indication that there is psychosomatic defense that lessens anxiety due to a somatic disease. In somatic diseases that are not referring to as psychosomatic ones, the correlation coefficient between the first and second scales is highly significant and considerably higher than that in the healthy individuals and particularly higher than in the group of psychosomatic diseases. In the patients of these groups, an increase in anxiety and depression aggravates autonomic dysregulation reflecting in the larger number of hypochondriacal complaints. This direct relationship between autonomic functions and the level of anxiety and depression may be a risk factor for developing these disorders.
Gonzalez, Ketty P.; And Others
Thirty-nine boys in classes for students with behavioral disturbances were given questionnaires on trait anxiety, social anxiety, empathy, depression, and self-esteem, while teachers rated their aggression. Results showed that anxiety and empathy scores were not correlated with aggression, while social anxiety was positively correlated with trait…
Yun Ling; Nefs, Harold T.; Nexhmedin Morina; Ingrid Heynderickx; Willem-Paul Brinkman
In virtual reality exposure therapy (VRET) for anxiety disorders, sense of presence in the virtual environment is considered the principal mechanism that enables anxiety to be felt. Existing studies on the relation between sense of presence and level of anxiety, however, have yielded mixed results on the correlation between the two. In this meta-analysis, we reviewed publications on VRET for anxiety that included self-reported presence and anxiety. The comprehensive search of the literature i...
Cheng, Bochao; Huang, Xiaoqi; Li, Shiguang; Hu, Xinyu; Luo, Ya; Wang, Xiuli; Yang, Xun; Qiu, Changjian; Yang, Yanchun; Zhang, Wei; Bi, Feng; Roberts, Neil; Gong, Qiyong
Post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and social anxiety disorder (SAD) all bear the core symptom of anxiety and are separately classified in the new DSM-5 system. The aim of the present study is to obtain evidence for neuroanatomical difference for these disorders. We applied voxel-based morphometry (VBM) with Diffeomorphic Anatomical Registration Through Exponentiated Lie to compare gray matter volume (GMV) in magnetic resonance images obtained for 30 patients with PTSD, 29 patients with OCD, 20 patients with SAD, and 30 healthy controls. GMV across all four groups differed in left hypothalamus and left inferior parietal lobule and post hoc analyses revealed that this difference is primarily due to reduced GMV in the PTSD group relative to the other groups. Further analysis revealed that the PTSD group also showed reduced GMV in frontal lobe, temporal lobe, and cerebellum compared to the OCD group, and reduced GMV in frontal lobes bilaterally compared to SAD group. A significant negative correlation with anxiety symptoms is observed for GMV in left hypothalamus in three disorder groups. We have thus found evidence for brain structure differences that in future could provide biomarkers to potentially support classification of these disorders using MRI.
Rudaz, M.; Becker, E.S.; Margraf, J; Ledermann, T; Meyer, A.H.; Craske, M.G.
This study evaluated the role of two cognitive vulnerability factors, anxiety sensitivity and dysfunctional attitudes, in the prediction of the manifestation and onset of social anxiety disorder relative to specific phobia and relative to healthy controls. Women, aged between 18 and 24 years, were studied at baseline and 18 months later using the Anxiety Disorders Interview Schedule-Lifetime-ADIS-IV-L and the Anxiety Sensitivity Index-ASI and the Dysfunctional Attitude Scale-DAS. First, 52 wo...
Möller, Eline L.; Bögels, Susan M.
Abstract With DSM‐5, the American Psychiatric Association encourages complementing categorical diagnoses with dimensional severity ratings. We therefore examined the psychometric properties of the DSM‐5 Dimensional Anxiety Scales, a set of brief dimensional scales that are consistent in content and structure and assess DSM‐5‐based core features of anxiety disorders. Participants (285 males, 255 females) completed the DSM‐5 Dimensional Anxiety Scales for social anxiety disorder, generalized an...
The acute pharmacological treatment of anxiety disorders is barely specific with the exception of the obsessive-compulsive disorder: it responds preferentially to potent serotoninergic antidepressants only. For all other anxiety disorders all antidepressants regardless of their mechanism of action could be equally efficient thanks to their common class effect and are considered to be the pharmacological treatment of first choice. Benzodiazepines that also share a common class effect are recommended as possible and temporary adjuvants. Augmentation strategies for the cases of refractory anxiety disorders are also non-specific: lithium, antipsychotics, anticonvulsants.
Silove, Derrick; Rees, Susan
DSM-5 has lifted the age criterion in the definition of separation anxiety disorder thereby overturning the long-standing convention of restricting the diagnosis to childhood. Previously, adults with separation anxiety symptoms were assigned to other conventional categories such as panic disorder, agoraphobia or generalized anxiety disorder. Over the past two decades, an evolving body of research has identified separation anxiety disorder in adulthood, with 20-40% of adult psychiatric outpatients being assigned that diagnosis. In the US, the lifetime prevalence of the disorder in adulthood is 6.6%. The removal of the age restriction on diagnosis has important implications for clinical practice. Whereas parents (particularly mothers) of children with separation anxiety disorder commonly attracted the diagnosis of agoraphobia, the latter are more likely now to be diagnosed with the adult form of separation anxiety disorder, focusing attention on the importance of intervening with both members of the dyad to overcome mutual reinforcement of symptoms. In addition, adults with separation anxiety disorder have been found to manifest high levels of disability and they tend to show a poor response to conventional psychological and pharmacological treatments. There is an urgent need therefore to devise novel psychological and pharmacological interventions for the adult form of the disorder. The reformulation of separation anxiety disorder in DSM-5 therefore requires a paradigm shift in which clinicians are alerted to identifying and treating the condition in all age groups. Research across countries is needed to examine the new formulation of separation anxiety disorder amongst populations of diverse ethnic and cultural backgrounds.
Stratford, Hannah J; Cooper, Myra J; Di Simplicio, Martina; Blackwell, Simon E; Holmes, Emily A
Comorbid anxiety is common in bipolar spectrum disorders [BPSD], and is associated with poor outcomes. Its clinical relevance is highlighted by the "anxious distress specifier" in the revised criteria for Bipolar Disorders in the Diagnostic and Statistical Manual 5th Edition [DSM-5]. This article reviews evidence for the effectiveness of psychological therapy for anxiety in adults with BPSD (bipolar I, II, not otherwise specified, cyclothymia, and rapid cycling disorders). A systematic search yielded 22 treatment studies that included an anxiety-related outcome measure. Cognitive behavioural therapy [CBT] for BPSD incorporating an anxiety component reduces anxiety symptoms in cyclothymia, "refractory" and rapid cycling BPSD, whereas standard bipolar treatments have only a modest effect on anxiety. Preliminary evidence is promising for CBT for post-traumatic stress disorder and generalised anxiety disorder in BPSD. Psychoeducation alone does not appear to reduce anxiety, and data for mindfulness-based cognitive therapy [MBCT] appear equivocal. CBT during euthymic phases has the greatest weight of evidence. Where reported, psychological therapy appears acceptable and safe, but more systematic collection and reporting of safety and acceptability information is needed. Development of psychological models and treatment protocols for anxiety in BPSD may help improve outcomes.
Gmaj, Bartłomiej; Januszko, Piotr; Kamiński, Jan; Drozdowicz, Ewa; Kopera, Maciej; Wołyńczyk-Gmaj, Dorota; Szelenberger, Waldemar; Wojnar, Marcin
Anxiety disorders are a social problem due to their prevalence and consequences. It is crucial to explore the influence of anxiety on cognitive processes. In this study we recorded EEG activity from 73 subjects (35 patients, 38 controls, matched for age and education) during performance of the Continuous Attention Task. We used low resolution electromagnetic tomography (LORETA) for evaluation of mechanisms of impaired cognitive performance in anxiety disorders. Analysis showed that patients with anxiety disorders committed more errors than the controls, had a short latency of P300 and higher amplitude of ERPs at all steps of stimulus processing. Furthermore, we showed that there was a relationship between the scores of Hamilton Anxiety Scale and Beck Depression Inventory, and amplitudes and latencies of ERPs. The results of LORETA analysis showed that enhanced neural responses were found within circuits mediating visual information processing, sustained attention and anxiety. Also, we found higher current density within areas playing an important role in the brain fear network - anterior cingulate and anterior part of insula. Electrophysiological neuroimaging showed greater recruitment of cognitive resources in anxiety disorders, evidenced by higher current density and activation of greater number of brain areas. Despite the strategy employed to compensate for cognitive problems, the anxiety patients did not achieve the same performance as controls. Present study demonstrates that anxiety disorders influence processing of neutral stimuli and this influence is observable at both behavioral and electrophysiological level. The data suggests instability of neural systems responsible for information selection, working memory, engagement and focusing of attention.
Thase, Michael E; Chen, Dalei; Edwards, John; Ruth, Adam
Anxiety symptoms are prevalent in patients with major depressive disorder. A post-hoc analysis of two phase III trials was conducted to evaluate the efficacy of vilazodone on depression-related anxiety. Using the 17-item Hamilton Depression Rating Scale (HAMD17) Anxiety/Somatization subscale, patients were classified as anxious or nonanxious. Improvements in depressive symptoms were based on least squares mean changes in HAMD17 and Montgomery-Asberg Depression Rating Scale total scores. Anxiety symptoms in the anxious subgroup were evaluated using Hamilton Anxiety Rating Scale (HAMA) total and subscale (Psychic Anxiety, Somatic Anxiety) scores, HAMD17 Anxiety/Somatization subscale and item (Psychic Anxiety, Somatic Anxiety) scores, and the Montgomery-Asberg Depression Rating Scale Inner Tension item score. Most of the pooled study population [82.0% (708/863)] was classified with anxious depression. After 8 weeks of treatment, least squares mean differences between vilazodone and placebo for changes in HAMA total and HAMD17 Anxiety/Somatization subscale scores were -1.82 (95% confidence interval -2.81 to -0.83; Pmajor depressive disorder who exhibit somatic and/or psychic symptoms of anxiety.
Gadow, Kenneth D.; Roohi, Jasmin; DeVincent, Carla J.; Hatchwell, Eli
Background: Autism spectrum disorder (ASD) is associated with high rates of psychiatric disturbance to include attention-deficit/hyperactivity disorder (ADHD), tic disorder, and anxiety disorders. The aim of the present study was to examine the association between a variable number tandem repeat (VNTR) functional polymorphism located in the…
Beghi, E; Allais, G; Cortelli, P; D'Amico, D; De Simone, R; d'Onofrio, F; Genco, S; Manzoni, G C; Moschiano, F; Tonini, M C; Torelli, P; Quartaroli, M; Roncolato, M; Salvi, S; Bussone, G
Psychiatric comorbidity (prevalence and types) was tested in a naturalistic sample of adult patients with pure migraine without aura, and in two control groups of patients, one experiencing pure tension-type headache and the other combined migraine and tension-type headaches. The study population included 374 patients (158, 110 and 106) from nine Italian secondary and tertiary centres. Psychiatric comorbidity was recorded through structured interview and also screened with the Mini International Neuropsychiatry Interview (MINI). Only anxiety and depression were investigated. Psychiatric disorders were reported by 49 patients (14.6%; 10.9% of patients with migraine, 12.8% of those with tension-type headache and 21.4% of those with combined migraine and tension-type headaches). The MINI interview detected a depressive episode in 59.9% of patients with migraine, 68.3% of patients with tension-type headache and 69.6% of patients with combined migraine and tension-type headaches. Depression subtypes were significantly different across groups (p=0.03). Anxiety (mostly generalised) was reported by 18.4% of patients with migraine, 19.3% of patients with tension-type headache, and 18.4% of patients with combined migraine and tension-type headaches. The values for panic disturbance were 12.7, 5.5 and 14.2, and those for obsessive-compulsive disorders were 2.3, 1.1 and 9.4% (p=0.009). Based on these results, psychopathology of primary headache can be a reflection of the burden of the disease rather than a hallmark of a specific headache category.
黄建军; 柏晓利; 杨蕴萍
目的:探讨焦虑障碍患者共病人格障碍的情况.方法:对127例符合DSM-IV轴I焦虑障碍的患者进行了DSM-IV轴II人格障碍的诊断评估,并进行汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、疾病严重程度(CGI-SI)、社会功能缺陷(SDSS)等评定.结果:①焦虑障碍与人格障碍的共病率为73.2％;②共病者焦虑障碍的发病年龄更早(P＜0.01),焦虑障碍病程更长(P＜0.05),疾病更加严重(P＜0.01),其焦虑、抑郁水平更高(P＜0.05;P＜0.05),社会功能更差(P＜0.01).结论:焦虑障碍与人格障碍有较高的共病率,焦虑障碍与人格障碍共病患者的临床特征更加复杂.%Objective: To get the prevalence rate of personality disorders in patients with anxiety disorders and to get the clinical features of these comorbid patients, the authors conducted a survey among a cohort of patients with anxiety disorder. Methods: Personality disorders of 127 patients meeting DSM-Ⅳcriteria of anxiety disorders were assessed by structured clinical interview for DSM-Ⅳ Axis Ⅱ, the Hamilton Anxiety Scale, the Hamilton Depression Scale, the Clinical Global Impression-Severity of Ⅰllness, and the Social Disability Screening Schedule. Results: The prevalence rate of personality disorders in patients with anxiety disorders was 73.2%. Compared with patients with anxiety disorders only, the patients with comorbid anxiety disorders and personality disorders had earlier age of onset of anxiety disorders (P<0.01), longer duration of anxiety disorder (P<0.05), greater severity of illness (P<0.01), worse impaired social function (P<0.01) and higher level of anxiety and depression (P<0.05; P<0.05). Conclusion: The prevalence rate of personality disorders in anxiety disorders is high in our research, and the clinical features of the comorbidity are complex.
In Japan, the impact of DSM-5 has been greater than we had imagined. The Japanese Society of Psychiatry and Neurology organized a group for translation and the members spent many hours in this volunteer effort over a 2-year period. This highlights the significance of and expectations for DSM-5 in clinical practice in Japan. Regarding anxiety disorders, the highlights of changes from DSM-IV-TR to DSM-5 are as follows. Firstly, the DSM-5 chapter on anxiety disorder no longer includes obsessive-compulsive disorder (which is included with obsessive-compulsive and related disorders) or posttraumatic stress disorder and acute stress disorder(which are included with trauma- and stressor-related disorders). However, the sequential order of these chapters in DSM-5 reflects the close relationships among them. Secondly, in DSM-IV, selective mutism and separation anxiety disorder were classified in the section "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence." They are now classified as an anxiety disorder. Through these two changes, at the beginning of the chapter, it can be clearly noted that anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Thirdly, panic disorder and agoraphobia are not associated in DSM-5. Thus, the former DSM-IV diagnoses of panic disorder with agoraphobia, panic disorder without agoraphobia, and agoraphobia without a history of panic disorder are now replaced by two diagnoses, panic disorder and agoraphobia, each with separate criteria. The co-occurrence of panic disorder and agoraphobia is now coded with two diagnoses. This change recognizes that a marked number of individuals with agoraphobia do not experience panic symptoms. For the present, this change ends the. controversy over the hierarchy between panic disorder and agoraphobia. The diagnostic criteria for agoraphobia are derived from the DSM-IV descriptors for agoraphobia, although the clarification
Tully, Phillip J; Cosh, Suzanne M
Generalized anxiety disorder prevalence and comorbidity with depression in coronary heart disease patients remain unquantified. Systematic searching of Medline, Embase, SCOPUS and PsycINFO databases revealed 1025 unique citations. Aggregate generalized anxiety disorder prevalence (12 studies, N = 3485) was 10.94 per cent (95% confidence interval: 7.8-13.99) and 13.52 per cent (95% confidence interval: 8.39-18.66) employing Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria (random effects). Lifetime generalized anxiety disorder prevalence was 25.80 per cent (95% confidence interval: 20.84-30.77). In seven studies, modest correlation was evident between generalized anxiety disorder and depression, Fisher's Z = .30 (95% confidence interval: .19-.42), suggesting that each psychiatric disorder is best conceptualized as contributing unique variance to coronary heart disease prognosis.
Durham, Tory A; Elhai, Jon D; Fine, Thomas H; Tamburrino, Marijo; Cohen, Gregory; Shirley, Edwin; Chan, Philip K; Liberzon, Israel; Galea, Sandro; Calabrese, Joseph R
The present study investigated symptom relations between two highly comorbid disorders--posttraumatic stress disorder (PTSD) and generalized anxiety disorder (GAD)--by exploring their underlying dimensions. Based on theory and prior empirical research it was expected that the dysphoria factor of PTSD would be more highly related to GAD. As part of a longitudinal project of mental health among Ohio National Guard Soldiers, 1266 subjects were administered the Posttraumatic Stress Disorder Checklist (PCL) and Generalized Anxiety Disorder-7 scale (GAD-7). Confirmatory factor analyses (CFAs) were conducted to examine two models of PTSD and to determine which PTSD factors were more related to the GAD factor. The results indicate that the GAD factor was significantly more highly correlated with PTSD's dysphoria factor than with all other PTSD factors, including PTSD's reexperiencing factor, avoidance factor, and hyperarousal factor. Results indicate GAD was not significantly more highly correlated with numbing than most other factors of PTSD. The results are consistent with prior research. Implications of the results are discussed in regards to PTSD in DSM-5, comorbidity and diagnostic specificity.
Are Worry and Rumination Specific Pathways Linking Neuroticism and Symptoms of Anxiety and Depression in Patients with Generalized Anxiety Disorder, Major Depressive Disorder and Mixed Anxiety-Depressive Disorder?
Merino, Hipólito; Ferreiro, Fátima
This study examines the relationships between neuroticism (higher-order vulnerability factor), the cognitive styles of worry, brooding and reflection (second-order vulnerability factors) and symptoms of anxiety and depression in three groups of patients: patients with Generalized Anxiety Disorder (GAD), with Major Depressive Disorder (MDD) and with Mixed Anxiety-Depressive Disorder (MADD). One hundred and thirty four patients completed a battery of questionnaires including measures of neuroticism, worry, rumination (brooding and reflection), anxiety and depression. Multiple mediation analyses indicate that worry may act as a mediating mechanism linking neuroticism and anxiety symptoms in the three diagnostic groups, whereas brooding-rumination may play a mediating role between neuroticism and depressive symptoms in patients with MDD and MADD and, with less certainty, in patients with GAD. Overall, our findings suggest that neuroticism may increase the risk of anxious and depressive symptoms via specific links involving either worry or brooding, respectively, and that both worry and brooding may operate in the three groups examined, irrespectively of whether anxiety or depression are the main emotions or whether they coexist without any clear predominance; consequently, we hypothesize the existence of "specific transdiagnostic" mechanisms. PMID:27243462
Are Worry and Rumination Specific Pathways Linking Neuroticism and Symptoms of Anxiety and Depression in Patients with Generalized Anxiety Disorder, Major Depressive Disorder and Mixed Anxiety-Depressive Disorder?
Full Text Available This study examines the relationships between neuroticism (higher-order vulnerability factor, the cognitive styles of worry, brooding and reflection (second-order vulnerability factors and symptoms of anxiety and depression in three groups of patients: patients with Generalized Anxiety Disorder (GAD, with Major Depressive Disorder (MDD and with Mixed Anxiety-Depressive Disorder (MADD. One hundred and thirty four patients completed a battery of questionnaires including measures of neuroticism, worry, rumination (brooding and reflection, anxiety and depression. Multiple mediation analyses indicate that worry may act as a mediating mechanism linking neuroticism and anxiety symptoms in the three diagnostic groups, whereas brooding-rumination may play a mediating role between neuroticism and depressive symptoms in patients with MDD and MADD and, with less certainty, in patients with GAD. Overall, our findings suggest that neuroticism may increase the risk of anxious and depressive symptoms via specific links involving either worry or brooding, respectively, and that both worry and brooding may operate in the three groups examined, irrespectively of whether anxiety or depression are the main emotions or whether they coexist without any clear predominance; consequently, we hypothesize the existence of "specific transdiagnostic" mechanisms.
Merino, Hipólito; Senra, Carmen; Ferreiro, Fátima
This study examines the relationships between neuroticism (higher-order vulnerability factor), the cognitive styles of worry, brooding and reflection (second-order vulnerability factors) and symptoms of anxiety and depression in three groups of patients: patients with Generalized Anxiety Disorder (GAD), with Major Depressive Disorder (MDD) and with Mixed Anxiety-Depressive Disorder (MADD). One hundred and thirty four patients completed a battery of questionnaires including measures of neuroticism, worry, rumination (brooding and reflection), anxiety and depression. Multiple mediation analyses indicate that worry may act as a mediating mechanism linking neuroticism and anxiety symptoms in the three diagnostic groups, whereas brooding-rumination may play a mediating role between neuroticism and depressive symptoms in patients with MDD and MADD and, with less certainty, in patients with GAD. Overall, our findings suggest that neuroticism may increase the risk of anxious and depressive symptoms via specific links involving either worry or brooding, respectively, and that both worry and brooding may operate in the three groups examined, irrespectively of whether anxiety or depression are the main emotions or whether they coexist without any clear predominance; consequently, we hypothesize the existence of "specific transdiagnostic" mechanisms.
Li, Y; Shi, S; Yang, F.; Gao, J.; Li,Youhui; M. Tao; Wang, G.; Zhang, K; Gao, C.; Liu, L.; Li, Kan; Li, Keqing; Liu, Y.; Wang, Xumei; Zhang, J.
Background Studies conducted in Europe and the USA have shown that co-morbidity between major depressive disorder (MDD) and anxiety disorders is associated with various MDD-related features, including clinical symptoms, degree of familial aggregation and socio-economic status. However, few studies have investigated whether these patterns of association vary across different co-morbid anxiety disorders. Here, using a large cohort of Chinese women with recurrent MDD, we examine the prevalence a...
Martin, Ryan J; Usdan, Stuart; Cremeens, Jennifer; Vail-Smith, Karen
We assessed the occurrence of co-morbid psychiatric disorders (i.e., problem drinking, anxiety, and depression) among college students who met the threshold for disordered gambling. The participants included a large sample of undergraduate students (n = 1,430) who were enrolled in an introductory health course at a large, southeastern university in Spring 2011 and completed an online assessment that included scales to assess disordered gambling, problem drinking, anxiety, and depression. We calculated screening scores, computed prevalence rates for each disorder, and calculated Pearson correlations and Chi square tests to examine correlations and co-morbid relationships between the four disorders. Analyses indicated that all disorders were significantly associated (p college students who experience disordered gambling (and other psychiatric disorders) are at increased risk of experiencing co-occurring disorders, it might be useful for college health professionals to concurrently screen and intervene for co-occurring disorders.
Waite, Polly; Codd, Jon; Creswell, Cathy
Background Theory and treatment of anxiety disorders in young people are commonly based on the premise that interpretation biases found in anxious adults are also found in children and adolescents. Although there is some evidence that this may be the case, studies have not typically taken age into account, which is surprising given the normative changes in cognition that occur throughout childhood. The aim of the current study was to identify whether associations between anxiety disorder status and interpretation biases differed in children and adolescents. Methods The responses of children (7–10 years) and adolescents (13–16 years) with and without anxiety disorders (n=120) were compared on an ambiguous scenarios task. Results Children and adolescents with an anxiety disorder showed significantly higher levels of threat interpretation and avoidant strategies than non-anxious children and adolescents. However, age significantly moderated the effect of anxiety disorder status on interpretation of ambiguity, in that adolescents with anxiety disorders showed significantly higher levels of threat interpretation and associated negative emotion than non-anxious adolescents, but a similar relationship was not observed among children. Conclusions The findings suggest that theoretical accounts of interpretation biases in anxiety disorders in children and adolescents should distinguish between different developmental periods. For both ages, treatment that targets behavioral avoidance appears warranted. However, while adolescents are likely to benefit from treatment that addresses interpretation biases, there may be limited benefit for children under the age of ten. PMID:26363617
Sagna, Atami; Gallo, Joseph J; Pontone, Gregory M
Depression and anxiety disorders have a substantial impact on the quality of life, the functioning and mortality of older adults with Parkinson's disease (PD). The purpose of this systematic review was to examine the factors associated with the prevalence of depression and anxiety disorders among individuals with PD aged 60 years and older. Following a literature search in PubMed, PsycINFO, CINAHL, and EMBASE, 5 articles met the inclusion criteria (adults aged 60 years and older, individuals with PD, and with depression and anxiety disorders, and English-language peer reviewed articles) and were included in this review. These studies were conducted in the U.S (n = 3), in Italy (n = 1) and the U.K (n = 1). Findings indicated that autonomic symptoms, motor fluctuations, severity and frequency of symptoms, staging of the disease, and PD onset and duration were associated with the prevalence of depression and anxiety disorders among older adults suffering from PD. Despite the limited number of studies included in the review, depression and anxiety disorders are often unrecognized and untreated and the comorbidity greatly exacerbates PD symptoms. The identification of factors associated with the development of depression and anxiety disorders could help in designing preventive interventions that would decrease the risk and burden of depression and anxiety disorders among older adults with PD.
Full Text Available Introduction. Social phobia is the most prevalent and chronic type of anxiety disorder worldwide and it affects occupational, educational, and social affairs of the individual. Social phobia is also known for its association with depression and substance use disorder. Objective. The aim of this study was to assess the prevalence and associated factors of social phobia among high school students in Ethiopia. Methods. Cross-sectional study was conducted among 386 randomly selected students. Data were collected using pretested and self-administered questionnaire. Social phobia was assessed by using Social Phobia Inventory (SPIN. Logistic regression was used to analyze the data with 95% confidence interval and variables with p value less than 0.05 were considered as statistically significant. Results. From 386 study participants, 106 (27.5% of them were positive for social phobia. Being female (AOR = 3.1; 95% CI: 1.82–5.27, current alcohol drinking (AOR = 1.75; 95% CI: 1.03–2.98, poor social support (AOR = 2.40; 95% CI: 1.17–4.92, and living with single parent (AOR = 5.72; 95% CI: 2.98–10.99 were significantly associated with social phobia. Conclusion. The proportion of social phobia was higher compared to previous evidences. School-based youth-friendly mental health services might be helpful to tackle this problem.
Bandelow, Borwin; Reitt, Markus; Röver, Christian; Michaelis, Sophie; Görlich, Yvonne; Wedekind, Dirk
To our knowledge, no previous meta-analysis has attempted to compare the efficacy of pharmacological, psychological and combined treatments for the three main anxiety disorders (panic disorder, generalized anxiety disorder and social phobia). Pre-post and treated versus control effect sizes (ES) were calculated for all evaluable randomized-controlled studies (n = 234), involving 37,333 patients. Medications were associated with a significantly higher average pre-post ES [Cohen's d = 2.02 (1.90-2.15); 28,051 patients] than psychotherapies [1.22 (1.14-1.30); 6992 patients; P < 0.0001]. ES were 2.25 for serotonin-noradrenaline reuptake inhibitors (n = 23 study arms), 2.15 for benzodiazepines (n = 42), 2.09 for selective serotonin reuptake inhibitors (n = 62) and 1.83 for tricyclic antidepressants (n = 15). ES for psychotherapies were mindfulness therapies, 1.56 (n = 4); relaxation, 1.36 (n = 17); individual cognitive behavioural/exposure therapy (CBT), 1.30 (n = 93); group CBT, 1.22 (n = 18); psychodynamic therapy 1.17 (n = 5); therapies without face-to-face contact (e.g. Internet therapies), 1.11 (n = 34); eye movement desensitization reprocessing, 1.03 (n = 3); and interpersonal therapy 0.78 (n = 4). The ES was 2.12 (n = 16) for CBT/drug combinations. Exercise had an ES of 1.23 (n = 3). For control groups, ES were 1.29 for placebo pills (n = 111), 0.83 for psychological placebos (n = 16) and 0.20 for waitlists (n = 50). In direct comparisons with control groups, all investigated drugs, except for citalopram, opipramol and moclobemide, were significantly more effective than placebo. Individual CBT was more effective than waiting list, psychological placebo and pill placebo. When looking at the average pre-post ES, medications were more effective than psychotherapies. Pre-post ES for psychotherapies did not differ from pill placebos; this finding cannot be explained by heterogeneity, publication bias or allegiance effects. However, the decision on whether to choose
Lavender, Jason M; De Young, Kyle P; Wonderlich, Stephen A; Crosby, Ross D; Engel, Scott G; Mitchell, James E; Crow, Scott J; Peterson, Carol B; Le Grange, Daniel
The role of anxiety has been emphasized in etiological/maintenance models of anorexia nervosa. This study identified daily patterns of anxiety in anorexia nervosa and examined the likelihood of the occurrence of eating disorder behaviors in each trajectory, the daily temporal distribution of eating disorder behaviors in each trajectory, and the extent to which the tendency to exhibit particular anxiety trajectories was associated with baseline diagnostic and trait-level personality variables. Women with full or subthreshold anorexia nervosa (N = 118) completed a 2-week ecological momentary assessment (EMA) protocol during which they reported on a variety of behavioral and affective variables, including anxiety and eating disorder behaviors. Using latent growth mixture modeling to classify EMA days (N = 1,526) based on anxiety ratings, we identified 7 distinct daily anxiety trajectories. Overall differences between trajectories were found for rates of binge eating, self-induced vomiting, body checking, skipping meals, and dietary restriction. Furthermore, distinct daily temporal distributions of eating disorder behaviors were found across the trajectories, with peaks in the probability of behaviors frequently coinciding with high levels of anxiety. Finally, traits of personality pathology (affective lability, self-harm, social avoidance, and oppositionality) and the presence of a co-occurring mood disorder were found to be associated with the tendency to experience particular daily anxiety trajectories (e.g., stable high anxiety). Findings support the presence of within-person variability in daily anxiety patterns in anorexia nervosa and also provide evidence for an association between these anxiety patterns and eating disorder behaviors.
Shihata, Sarah; McEvoy, Peter M; Mullan, Barbara A
Uncertainty is central to anxiety-related pathology and intolerance of uncertainty (IU) appears to be a transdiagnostic risk and maintaining factor. The aim of the present study was to evaluate a hierarchical model to identify the unique contributions of trait and disorder-specific IU (i.e., uncertainty specific to generalised anxiety disorder, social anxiety, obsessive compulsive disorder, and panic disorder) to disorder-specific symptoms, beyond other disorder-specific cognitive vulnerabilities (i.e., negative metacognitive beliefs, fear of negative evaluation, inflated responsibility, and agoraphobic cognitions, respectively). Participants (N=506) completed a battery of online questionnaires. Structural equation modelling was used to evaluate model fit, as well as direct and indirect pathways. Trait and disorder-specific IU were significantly associated with multiple cognitive vulnerability factors and disorder symptoms. Indirect effects between trait IU and symptoms were observed through disorder-specific IU and cognitive vulnerabilities. The relative contribution of trait IU and disorder-specific IU to symptoms varied and theoretical and clinical implications are highlighted. Limitations include the cross-sectional design and reliance on self-report. Avenues for further research include a need for replication and extension of the model in different samples and using experimental and multi-method research methods.
Reck, Corinna; Noe, Daniela; Gerstenlauer, Jakob; Stehle, Eva
Low maternal self-confidence may damage the early mother-infant relationship and negatively influence infant development. The goal of this study was to test whether a current and previous history of DSM-IV anxiety and depressive disorders is associated with maternal self-confidence two weeks after delivery. Postpartum anxiety disorder and depression was diagnosed according to DSM-IV criteria in a community sample of 798 women. The data showed a significant link between current postpartum anxiety and depressive disorders and maternal self-confidence. Furthermore, women with a depression or anxiety disorder in their previous psychiatric history scored lower in maternal self-confidence. There is a need for appropriate preventive programmes to promote maternal self-confidence. With such programmes it is possible to prevent infant developmental disorders which might result from reduced feelings of maternal self-confidence and associated maternal interaction behaviour.
Corchs, Felipe; Nutt, David J; Hince, Dana A; Davies, Simon J C; Bernik, Marcio; Hood, Sean D
The relationships between serotonin and fear and anxiety disorders have been much studied yet many important questions remain, despite selective serotonin reuptake inhibitors having been the primary treatments for these disorders for some time. In order to explore this issue we performed a pooled analysis of six of our studies in remitted patients with a fear/anxiety disorder who were exposed to syndrome-specific aversive stimulation under acute tryptophan depletion. We based our analysis on the hypothesis that the inconsistencies observed in the studies could be predicted by Deakin and Graeff's theory about the dual role of serotonin in responses to threats, whereby serotonin is critical to prevent fear (panic) but not anxiety. In accordance with this view, our results give support to a dissociation of the disorders traditionally grouped under fear and anxiety-related disorders in terms of different roles of serotonin in modulation of responses to aversive stimulation. Implications for future studies and psychiatric nosology are discussed.
Helenius, Dorte; Munk-Jørgensen, Povl; Steinhausen, Hans-Christoph
The present study investigated how often anxiety disorders with different ages of onset occurred in affected families compared to control families. Furthermore, the study addressed the impact of sex, region of residence, year and month of birth, and parental age at birth. The sample included N=1373...... region. Psychiatric diagnoses were also obtained for parents, siblings, and offspring. A family load component was obtained by using various mixed regression models. Anxiety disorders occurred significantly more often in case than in control families. Having a mother, father, or a sibling......, provide further and solid evidence for the family aggregation of anxiety disorders....
Full Text Available The tendency of psychotherapy modern concepts referring to the short-term forms having been taken into account, we carried out the research aimed at the study of short-term form personality-oriented psychotherapy effect on the anxiety disorder dynamics. 103 patients with neurotic disorders were examined in the neurosis and psychotherapy department of the Bekhterev Psychoneurological Research Institute. The findings revealed the situational and personal anxiety level to be objectively decreased in the short-term group psychotherapy course. The short-term group psychotherapy was proved to bean effective method in anxiety disorders treatment considering indications and limitations.
McLean, Carmen P.; Asnaani, Anu; Litz, Brett T; Hofmann, Stefan G.
Women have consistently higher prevalence rates of anxiety disorders, but less is known about how gender affects age of onset, chronicity, comorbidity, and burden of illness. Gender differences in DSM-IV anxiety disorders were examined in a large sample of adults (N = 20,013) in the United States using data from the Collaborative Psychiatric Epidemiology Studies (CPES). The lifetime and 12-month male:female prevalence ratios of any anxiety disorder were 1:1.7 and 1:1.79, respectively. Women h...
Goldstein-Piekarski, A N; Williams, L M; Humphreys, K
Anxiety disorders are highly comorbid with each other and with other serious mental disorders. As our field progresses, we have the opportunity to pursue treatment study designs that consider these comorbidities. In this perspective review, we first characterized the prevalence of multiple anxiety disorder comorbidity by reanalyzing national survey data, then conducted an English-language PubMed search of studies analyzing the impact of exclusion criteria on treatment outcome data. In the prevalence data, 60% of people with an anxiety disorder had one or more additional anxiety or depression diagnosis. Because our commonly applied exclusion criteria focus on a single diagnosis and do not consider a multiple comorbidity profile, the impact of the criteria may be to exclude up to 92% of anxiety disorder treatment seekers. Moreover, the findings do not suggest a consistent relationship between the number of exclusion criteria and the effect size of treatment outcomes. Thus, future studies might consider a more trans-diagnostic rationale for determining exclusion criteria, one that is generalizable to real-world settings in which multiple diagnoses commonly co-occur. The findings also encourage a more systematic reporting of rationales for the choice of-and the implications of-each exclusion criterion.
Sørensen, Lin; Plessen, Kerstin J; Nicholas, Jude
Background: The present study investigated the impact of coexisting anxiety disorder in children with ADHD on their ability to regulate behavior. Method: Parent reports on the Behavior Rating Inventory of Executive Function (BRIEF) in a comorbid group of children with ADHD and anxiety (n = 11) were...... compared to BRIEF reports in a group of children with a "pure" ADHD (n = 23), a "pure" anxiety (n = 24) and a group without any diagnosis (n = 104) in a 2 (ADHD vs. no ADHD) x 2 (anxiety vs. no anxiety) design. Results: The children with ADHD and anxiety disorder scored significantly higher on the Inhibit...... scale than children within the other three groups. Main effects of diagnosis appeared in ADHD children on the Inhibit, Emotional Control, and Working Memory scales, and on the Shift and Emotional Control scales in anxious children. Conclusion: The results indicate that a behavioral dysregulation in ADHD...
Hope R Ferdowsian
Full Text Available BACKGROUND: In humans, traumatic experiences are sometimes followed by psychiatric disorders. In chimpanzees, studies have demonstrated an association between traumatic events and the emergence of behavioral disturbances resembling posttraumatic stress disorder (PTSD and depression. We addressed the following central question: Do chimpanzees develop posttraumatic symptoms, in the form of abnormal behaviors, which cluster into syndromes similar to those described in human mood and anxiety disorders? METHODOLOGY/PRINCIPAL FINDINGS: In phase 1 of this study, we accessed case reports of chimpanzees who had been reportedly subjected to traumatic events, such as maternal separation, social isolation, experimentation, or similar experiences. We applied and tested DSM-IV criteria for PTSD and major depression to published case reports of 20 chimpanzees identified through PrimateLit. Additionally, using the DSM-IV criteria and ethograms as guides, we developed behaviorally anchored alternative criteria that were applied to the case reports. A small number of chimpanzees in the case studies met DSM-IV criteria for PTSD and depression. Measures of inter-rater reliability, including Fleiss' kappa and percentage agreement, were higher with use of the alternative criteria for PTSD and depression. In phase 2, the alternative criteria were applied to chimpanzees living in wild sites in Africa (n = 196 and chimpanzees living in sanctuaries with prior histories of experimentation, orphanage, illegal seizure, or violent human conflict (n = 168. In phase 2, 58% of chimpanzees living in sanctuaries met the set of alternative criteria for depression, compared with 3% of chimpanzees in the wild (p = 0.04, and 44% of chimpanzees in sanctuaries met the set of alternative criteria for PTSD, compared with 0.5% of chimpanzees in the wild (p = 0.04. CONCLUSIONS/SIGNIFICANCE: Chimpanzees display behavioral clusters similar to PTSD and depression in their key
Demerdzieva, Aneta; Pop-Jordanova, Nada
Frontal alpha asymmetry (the relative difference in power between two signals in different hemispheres) has been suggested as biomarker for anxiety. The goal of this study was to evaluate alpha asymmetry in the frontal region for young people (7-18 years) with generalized anxiety disorder, diagnosed according to two statistic manuals (DMS-IV-R and ICD-10), the medical history and the neuropsychological assessment. The QEEG recording and analysis of the obtained results from alpha spectra power and log of alpha spectra power are made in four conditions (eyes open, eyes closed, VCPT and ACPT). The obtained results for alpha power in general showed higher cortical activity in the right hemisphere, associated with negative emotions. The calculated alpha asymmetry separate for eyes open, eyes closed, VCPT and ACPT conditions showed the right activation in all four conditions. In addition, the right frontal asymmetry was specific for the Fp(1)-Fp(2) region, while a greater left frontal activation was recorded for the F(7)-F(8) region. The log of alpha power in general was additionally analyzed. The calculated asymmetry score in general (in a way that the left log transformed score was subtracted from the right) confirmed a greater right activation. Testing the power of the whole alpha band (μV(2)) in general, for all four conditions and for frontal region confirmed the right alpha asymmetries in all participants. The right alpha asymmetry in the frontal region was specific only for the Fp(1)-Fp(2) region (frontopolar region). The only greater left frontal activation was registered between the F(7)-F(8) region. Our findings are supported by many other studies using specific localization methods like fMRI or LORETA source localization.
Full Text Available Abstract Background In Morocco, no epidemiological study has been conducted to show the current prevalence of mental disorders in the general population. The aim of the present study was to assess the prevalence and comorbidity of anxiety disorders in Moroccan subjects. Methods We used cross-sectional study, with a representative sample of Casablanca city. Direct interviews used the Mini International Neurpsychiatric Interview in its validated Moroccan Arabic version Results Among 800 subjects, 25.5% met criteria of at least one current anxiety disorder: Panic Disorder (2%, Agoraphobia (7.6% Social phobia (3.4, Obsessive Compulsive Disorder (6.1%, Post Traumatic Stress Disorder (3.4%, Generalized Anxiety Disorder (4.3% Conclusion The results are generally similar to those of Western countries. Future studies need to replicate these results and to concentrate on their impact on the quality of life and the cost of such conditions in the community.
Full Text Available Abstract Introduction: Previous studies have implicated impaired verbal fluency as being associated with anxiety disorders in adolescents. Objectives: To replicate and extend previously reported evidence by investigating whether performance in phonemic verbal fluency tasks is related to severity of anxiety symptoms in young children with anxiety disorders. We also aim to investigate whether putative associations are independent from co-occurring attention deficit hyperactivity disorder (ADHD symptoms. Methods: Sixty children (6-12 years old with primary diagnoses of anxiety disorders participated in this study. Severity of symptoms was measured using clinician-based, parent-rated and self-rated validated scales. Verbal fluency was assessed using a simple task that measures the number of words evoked in 1-minute with the letter F, from which we quantified the number of isolated words, number of clusters (groups of similar words and number of switches (transitions between clusters and/or between isolated words. Results: There was a significant association between the number of clusters and anxiety scores. Further analysis revealed associations were independent from co-occurring ADHD symptoms. Conclusion: We replicate and extend previous findings showing that verbal fluency is consistently associated with severity in anxiety disorders in children. Further studies should explore the potential effect of cognitive training on symptoms of anxiety disorders.
Kampmann, Isabel L; Emmelkamp, Paul M G; Hartanto, Dwi; Brinkman, Willem-Paul; Zijlstra, Bonne J H; Morina, Nexhmedin
This randomized controlled trial investigated the efficacy of a stand-alone virtual reality exposure intervention comprising verbal interaction with virtual humans to target heterogeneous social fears in participants with social anxiety disorder. Sixty participants (Mage = 36.9 years; 63.3% women) diagnosed with social anxiety disorder were randomly assigned to individual virtual reality exposure therapy (VRET), individual in vivo exposure therapy (iVET), or waiting-list. Multilevel regression analyses revealed that both treatment groups improved from pre-to postassessment on social anxiety symptoms, speech duration, perceived stress, and avoidant personality disorder related beliefs when compared to the waiting-list. Participants receiving iVET, but not VRET, improved on fear of negative evaluation, speech performance, general anxiety, depression, and quality of life relative to those on waiting-list. The iVET condition was further superior to the VRET condition regarding decreases in social anxiety symptoms at post- and follow-up assessments, and avoidant personality disorder related beliefs at follow-up. At follow-up, all improvements were significant for iVET. For VRET, only the effect for perceived stress was significant. VRET containing extensive verbal interaction without any cognitive components can effectively reduce complaints of generalized social anxiety disorder. Future technological and psychological improvements of virtual social interactions might further enhance the efficacy of VRET for social anxiety disorder.
Full Text Available Fatih Kayhan,1 Adem Küçük,2 Yılmaz Satan,3 Erdem İlgün,4 Şevket Arslan,5 Faik İlik6 1Department of Psychiatry, Faculty of Medicine, Selçuk University, 2Department of Rheumatology, Faculty of Medicine, Necmettin Erbakan University, 3Department of Psychiatry, Konya Numune State Hospital, 4Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Mevlana University, 5Department of Internal Medicine, Faculty of Medicine, Necmettin Erbakan University, 6Department of Neurology, Faculty of Medicine, Başkent University, Konya, Turkey Background: We aimed to investigate the current prevalence of sexual dysfunction (SD, mood, anxiety, and personality disorders in female patients with fibromyalgia (FM. Methods: This case–control study involved 96 patients with FM and 94 healthy women. The SD diagnosis was based on a psychiatric interview in accordance with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. Mood and anxiety disorders were diagnosed using the Structured Clinical Interview. Personality disorders were diagnosed according to the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders. Results: Fifty of the 96 patients (52.1% suffered from SD. The most common SD was lack of sexual desire (n=36, 37.5% and arousal disorder (n=10, 10.4%. Of the 96 patients, 45 (46.9% had a mood or anxiety disorder and 13 (13.5% had a personality disorder. The most common mood, anxiety, and personality disorders were major depression (26%, generalized anxiety disorder (8.3%, and histrionic personality disorder (10.4%. Conclusion: SD, mood, and anxiety disorders are frequently observed in female patients with FM. Pain plays a greater role in the development of SD in female patients with FM. Keywords: anxiety, depression, fibromyalgia, sexual dysfunction
Orchard, Faith; Apetroaia, Adela; Clarke, Kiri; Creswell, Cathy
Highlights • Children with social anxiety disorder were assigned to CBM-I training or no training. • We measured the effects on interpretation bias and social anxiety. • CBM-I was not associated with greater change in interpretations than no training. • Social anxiety symptoms and diagnoses were not influenced by CBM-I training. • More intensive CBM-I training may be required.
Treadwell, K R; Kendall, P C
This study investigated the relationship between childhood anxiety disorders, the valence and content of self-statements, and the impact of treatment on the internal dialogue. Participants (151 8- to 13-year-olds) included 71 youth with anxiety disorders and 80 control participants. Positive and negative self-statements and a states-of-mind (SOM) ratio were examined. Results indicated that the negative self-statements and SOM ratio (but not positive self-statements) of children with anxiety disorders significantly predicted anxiety. Results also indicated that negative (but not positive cognition) and SOM ratio predicted improvement in anxiety after treatment and mediated treatment gains. Results of analyses to explore the content specificity hypothesis were mixed. The impact of negative self-talk on children's anxious symptomatology and favorable treatment outcome is discussed.
Minghelli, Beatriz; Morgado, Marcos; Caro, Tatiana
We investigated the prevalence of temporomandibular disorder (TMD) and its association with anxiety and depression among 1,493 Portuguese college students (age 17-69 years) at Piaget Institute. The assessment instruments were the Fonseca Anamnestic Questionnaire and the Hospital Anxiety and Depression Scale. TMD was present in 633 (42.4%) students, and anxiety or depression was present in 456 (30.5%) students. Regarding the association of TMD with anxiety and depression, 280 of the 633 students (61.4%) with TMD symptoms also had signs of anxiety or depression (P students without signs of anxiety or depression, students with such signs had an odds ratio of 3.1 (95% confidence interval: 2.42-3.84; P College students from various fields of study and regions of Portugal had a high prevalence of TMD, which was significantly associated with anxiety and depression.
Moshe, Keren; Karni, Avi; Tirosh, Emanuel
To examine the relationship between attention and anxiety and the response to methylphenidate in children with attention deficit hyperactivity disorder (ADHD), a total of 57 boys, between the ages of 7-12 years, were assessed for their attention and level of anxiety. Methylphenidate was administered for a week in a randomized double-blind drug/placebo-drug cross-over design. The levels of anxiety were evenly distributed between the inattentive and hyperactive/impulsive types. Anxiety was significantly correlated with the attention as reported by both teachers and parents. The response to methylphenidate was inversely correlated with the reported anxiety level only in boys with the hyperactive/impulsive and combined types. The higher the level of anxiety, the lower level of response to methylphenidate was observed. In the assessment and treatment of children with ADHD, the level of anxiety should be evaluated and taken into account while planning and monitoring treatment regiment.
Ling, Y.; Nefs, H.T.; Morina, N.; Heynderickx, I.; Brinkman, W.P.
In virtual reality exposure therapy (VRET) for anxiety disorders, sense of presence in the virtual environment is considered the principal mechanism that enables anxiety to be felt. Existing studies on the relation between sense of presence and level of anxiety, however, have yielded mixed results o
Ling, Y.; Nefs, H.T.; Nexhmedin, M.; Heynderickx, I.; Brinkman, W.P.
In virtual reality exposure therapy (VRET) for anxiety disorders, sense of presence in the virtual environment is considered the principal mechanism that enables anxiety to be felt. Existing studies on the relation between sense of presence and level of anxiety, however, have yielded mixed results o
Castilla-Puentes, Ruby; Sala, Regina; Ng, Bernardo; Galvez, Juan; Camacho, Alvaro
Anxiety disorders (ADs) are common in youths with bipolar disorder (BD). We examine psychiatric comorbidity, hospitalization, and treatment in youths with versus without AD and rapid cycling (four or more cycles per year). Data from the Integrated Healthcare Information Services cohort were used and included 8129 youths (ages ≤18 years). Prevalence of AD, demographic, type of AD, hospitalization, and use of psychotropics were compared between rapid and nonrapid cycling. Overall, 51% of the youths met criteria for at least one comorbid AD; they were predominantly female and were between 12 and 17 years of age. The most common comorbid ADs were generalized ADs and separation ADs. In the patients with rapid cycling, 65.5%met criteria for comorbid AD. The BD youths with AD were more likely to have major depressive disorders and other comorbid ADs, to be given more psychotropics, and to be hospitalized for depression and medical conditions more often than were those without AD. PMID:24284641
Reaven, Judy; Washington, Lindsay; Moody, Eric J.; Stern, Jessica A.; Hepburn, Susan L.; Blakeley-Smith, Audrey
In response to the high co-occurrence of anxiety symptoms in youth with autism spectrum disorder (ASD), several interventions have been developed for this population. In spite of promising findings, some youth with ASD respond only minimally to such interventions. To understand potential factors that may impact treatment response, the current…
Hollander, Eric; Braun, Ashley; Simeon, Daphne
Recently in 2006, a group of experts in obsessive compulsive disorder (OCD) and obsessive compulsive-related disorders (OCRDs) convened in Washington, DC, to review existing data on the relationships between these various disorders, and to suggest approaches to address the gaps in our knowledge, in preparation for the upcoming Diagnostic and Statistical Manual (Fifth Edition) (DSM-V). As a result of this meeting, the Research Planning Agenda for DSM-V: OCRD Work Group suggested removing OCD from the anxiety disorders, where it is currently found. This proposal is in accordance with the current International Classification of Mental Disorders (ICD-10) classification of OCD as a separate category from the anxiety disorders. Although the ICD-10 places both OCD and the anxiety disorders under the umbrella category of "neurotic, stress-related, and somatoform disorders," they are two separate categories, distinct from one another. As OCD and other putative OCRDs share aspects of phenomenology, comorbidity, neurotransmitter/peptide systems, neurocircuitry, familial and genetic factors, and treatment response, it was proposed to create a new category in DSM-V entitled OCRDs. Alternatively, the OCRDs might be conceptualized as a new category within the broader category of anxiety disorders. Future studies are needed to better define the relationships among these disorders, and to study boundary issues for this proposed category. There are both advantages and disadvantages in creating a new diagnostic category in DSM-V, and these are discussed in this article.
Green, Shulamite A.; Ben-Sasson, Ayelet; Soto, Timothy W.; Carter, Alice S.
This report focuses on the emergence of and bidirectional effects between anxiety and sensory over-responsivity (SOR) in toddlers with autism spectrum disorders (ASD). Participants were 149 toddlers with ASD and their mothers, assessed at 2 annual time points. A cross-lag analysis showed that anxiety symptoms increased over time while SOR remained…
Dubin, Ashley H.; Lieberman-Betz, Rebecca; Michele Lease, A.
As youth with autism spectrum disorder (ASD) are more likely to experience anxiety than youth in the general population, investigation of associated factors is important for diagnosis and treatment. The present study extended prior research by examining factors associated with caregiver-reported anxiety in 2662 youth (mean age = 8.82 years) with…
Grunau, Gilat L.; Ratner, Pamela A.; Hossain, Shahadut; Johnson, Joy L.
The objective of this study was to investigate the association between depression and anxiety and adolescents' smoking status, and to determine whether depression or anxiety mediate the association between Attention Deficit Hyperactivity Disorder (ADHD) and smoking. A cross-sectional survey of tobacco use was conducted in regional school districts…
Brown, Hannah M.; McAdams, Tom A.; Lester, Kathryn J.; Goodman, Robert; Clark, David M.; Eley, Thalia C.
Background: Twin studies in children reveal that familial aggregation of anxiety disorders is due to both genetic and environmental factors. Cognitive biases for threat information are considered a robust characteristic of childhood anxiety. However, little is known regarding the underlying aetiology of such biases and their role in anxiety…
van Mill, Josine G; Vogelzangs, Nicole; van Someren, Eus J W; Hoogendijk, Witte J G; Penninx, Brenda W J H
OBJECTIVE: To examine the predictive role of insomnia and sleep duration on the 2-year course of depressive and anxiety disorders. METHOD: This study is a secondary data analysis based on data from the baseline (2004-2007) and 2-year assessment of the Netherlands Study of Depression and Anxiety. Par
Waters, Allison M.; Mogg, Karin; Bradley, Brendan P.; Pine, Daniel S.
Attentional bias for angry and happy faces in 7-12 year old children with general anxiety disorder (GAD) is examined. Results suggest that an attentional bias toward threat faces depends on a certain degree of clinical severity and/or the type of anxiety diagnosis in children.
White, Susan W.; Ollendick, Thomas; Albano, Anne Marie; Oswald, Donald; Johnson, Cynthia; Southam-Gerow, Michael A.; Kim, Inyoung; Scahill, Lawrence
Anxiety is common among adolescents with autism spectrum disorders (ASD) and may amplify the core social disability, thus necessitating combined treatment approaches. This pilot, randomized controlled trial evaluated the feasibility and preliminary outcomes of the Multimodal Anxiety and Social Skills Intervention (MASSI) program in a sample of 30…
Shivers, Carolyn M.; Deisenroth, Lauren K.; Taylor, Julie Lounds
The purpose of this study was to examine patterns of anxiety among siblings of children with autism spectrum disorders (ASD), and determine the characteristics of the child with ASD and their parents that predicted anxiety. Data was collected from 1,755 siblings of children with ASD whose families participated in the Simons Simplex Collection;…
Sánchez, Jose Juan Castro; Bermúdez, M. Olga Escandell; Sevilla, M. del Sol Fortea; Hernán-Pérez, Alejandra Sanjuán
The identification of factors that influence attention deficit/hyperactivity disorder (ADHD) will help to develop intervention strategies for the personal and social adjustment of these individuals. The goal of the study is to assess the perception of anxiety in a group of children and adolescents with ADHD and the anxiety that their parents…
King, Neville J.; Heyne, David; Ollendick, Thomas H.
This article provides an overview of cognitive-behavioural strategies used in the treatment of child-anxiety problems, emphasizing the need for exposure and caregiver involvement. Most of the paper focuses on developments in empirically supported cognitive-behavioral intervention protocols for generalized anxiety disorder, separation anxiety…
Storch, Eric A; Salloum, Alison; Johnco, Carly; Dane, Brittney F; Crawford, Erika A; King, Morgan A; McBride, Nicole M; Lewin, Adam B
Despite evidence documenting high prevalence of family accommodation in pediatric obsessive-compulsive disorder, examination in other pediatric anxiety disorders is limited. Preliminary evidence suggests that family accommodation is common amongst children with anxiety disorders; however, the impact on clinical presentation and functional impairment has not been addressed. This study assessed the nature and clinical correlates of family accommodation in pediatric anxiety, as well as validating a mechanistic model. Participants included 112 anxious youth and their parents who were administered a diagnostic clinical interview and measure of anxiety severity, as well as questionnaires assessing internalizing and externalizing symptoms, family accommodation and functional impairment. Some form of accommodation was present in all families. Family accommodation was associated with increased anxiety severity and externalizing behaviors, having a diagnosis of separation anxiety, and increased functional impairment. Family accommodation partially mediated the relationship between anxiety severity and functional impairment, as well as externalizing behaviors and functional impairment. Family accommodation is common in pediatric anxiety disorders, and is associated with more severe clinical presentations and functional impairment. These findings highlight the importance of parental involvement in treatment and the need to specifically target accommodation practices during interventions to mitigate negative outcomes in anxious youth. Further studies utilizing longitudinal data are needed to validate mechanistic models.
Kendall, Philip C.; Treadwell, Kimberli R. H.
The authors investigated features of self-statements as predictors of anxiety in children with and without anxiety disorder (AD) and as a mediator of treatment of ADs in children. Children (N = 145) between the ages of 9 and 13 years participated (71 AD youth, 84 controls). Self-statements were classified by valence and content. Results indicated…
van Mill, Josine G.; Vogelzangs, Nicole; van Someren, Eus J. W.; Hoogendijk, Witte J. G.; Penninx, Brenda W. J. H.
Objective: To examine the predictive role of insomnia and sleep duration on the 2-year course of depressive and anxiety disorders. Method: This study is a secondary data analysis based on data from the baseline (2004-2007) and 2-year assessment of the Netherlands Study of Depression and Anxiety. Par
van Milligen, Bianca A.; Lamers, Femke; de Hoop, Guus T.; Smit, Johannes H.; Penninx, Brenda
Background: Poorer physical function in patients with depressive or anxiety disorders has been reported, but is often measured by self-reports which may be biased by mood. This study examined the association between depression and anxiety and physical function using objective measures in a large coh
Cobham, Vanessa E.
Objective: This study compared 3 experimental conditions: wait-list, therapist-supported bibliotherapy, and individual therapy, in the treatment of child anxiety. Method: Participants were 55 children (25 girls and 30 boys), aged 7 to 14 years diagnosed with an anxiety disorder, and their parents. Families were assigned using a modified random…
Sorensen, Lin; Plessen, Kerstin J.; Nicholas, Jude; Lundervold, Astri J.
Background: The present study investigated the impact of coexisting anxiety disorder in children with ADHD on their ability to regulate behavior. Method: Parent reports on the Behavior Rating Inventory of Executive Function (BRIEF) in a comorbid group of children with ADHD and anxiety (n = 11) were compared to BRIEF reports in a group of children…
Brendel, Kristen Esposito; Maynard, Brandy R.
Objective: This study compared the effects of direct child-parent interventions to the effects of child-focused interventions on anxiety outcomes for children with anxiety disorders. Method: Systematic review methods and meta-analytic techniques were employed. Eight randomized controlled trials examining effects of family cognitive behavior…
Zhao, Yueyin; Cheng, Yuqi; Li, Shu; Lai, Aiyun; Xie, Zhongqi; Xu, Xinyu; Lu, Zhaoping
Depressive and anxiety disorders are frequently observed in patients with Systemic Lupus Erythematosus (SLE). However, the underlying mechanisms are still unknown. We conducted this survey to understand the prevalence of depression and anxiety in SLE patients without major neuropsychiatric manifestations (non-NPSLE) and to explore the relationship between emotional disorders, symptoms, autoantibodies, disease activity, and treatments in SLE. 176 SLE patients were included, and SLE disease activity index (SLEDAI), Hamilton Depression Rating Scale (HAMD), and Hamilton Anxiety Rating Scale (HAMA) were recorded to evaluate their disease activity and emotional status. We found that depressive and anxiety disorders were common among SLE patients: 121 (68.8%) patients were in depression status while 14 (8.0%) patients could be diagnosed with depression. Accordingly, 101 (57.4%) were in anxiety status and 21 (11.9%) could be diagnosed with anxiety. Depression was associated with disease activity, and anxiety was associated with anti-P0 antibody, while both of them were associated with proteinuria. HAMA and HAMD scores were in strong positive correlation and they were independent risk factors of each other. We concluded that the high prevalence of depression and anxiety and the association between depression and SLE disease activity might reveal the covert damage of central nervous system in SLE. The role of anti-P0 antibody in SLE patients with emotional disorders warrants more researches. PMID:27747246
Alfano, Candice A.
Despite the approach of the "Diagnostic and Statistical Manual of Mental Disorders" (5th ed.), generalized anxiety disorder (GAD) of childhood continues to face questions as to whether it should be considered a distinct clinical disorder. A potentially critical issue embedded in this debate involves the role of functional impairment which has yet…
Henderson, Leigh C; Antony, Martin M; Koerner, Naomi
The Generalized Anxiety Disorder Inventory is a recently developed self-report measure that assesses symptoms of generalized anxiety disorder. Its psychometric properties have not been investigated further since its original development. The current study investigated its psychometric properties in a Canadian student/community sample. Exploratory principal component analysis replicated the original three-component structure. The total scale and subscales demonstrated excellent internal consistency reliability (α = 0.84-0.94) and correlated strongly with the Penn State Worry Questionnaire (r = 0.41-0.74, all ps Generalized Anxiety Disorder-7 (r = 0.55-0.84, all ps generalized anxiety disorder diagnosis established by diagnostic interview. The somatic subscale in particular may require revision to improve predictive validity. Revision may also be necessary given changes in required somatic symptoms for generalized anxiety disorder diagnostic criteria in more recent versions of the Diagnostic and Statistical Manual of Mental Disorders (i.e. although major changes occurred from Diagnostic and Statistical Manual of Mental Disorders-III-R to Diagnostic and Statistical Manual of Mental Disorders-IV, changes in Diagnostic and Statistical Manual of Mental Disorders-5 were minimal) and the possibility of changes in the upcoming 11th revision of the International Classification of Diseases.
Bluett, Ellen J; Homan, Kendra J; Morrison, Kate L; Levin, Michael E; Twohig, Michael P
A fair amount of research exists on acceptance and commitment therapy (ACT) as a model and a treatment for anxiety disorders and OCD spectrum disorders; this paper offers a quantitative account of this research. A meta-analysis is presented examining the relationship between psychological flexibility, measured by versions of the Acceptance and Action Questionnaire (AAQ and AAQ-II) and measures of anxiety. Meta-analytic results showed positive and significant relationships between the AAQ and general measures of anxiety as well as disorder specific measures. Additionally, all outcome data to date on ACT for anxiety and OCD spectrum disorders are reviewed, as are data on mediation and moderation within ACT. Preliminary meta-analytic results show that ACT is equally effective as manualized treatments such as cognitive behavioral therapy. Future directions and limitations of the research are discussed.
Hyland, Philip; Shevlin, Mark; Elklit, Ask
Purpose: A number of social, familial, and psychological factors have been identified to explain the onset of mood and anxiety disorders among adolescent and young adult populations. The purpose of this study is to identify the shared and unique predictors of anxiety and mood disorders by simulta......Purpose: A number of social, familial, and psychological factors have been identified to explain the onset of mood and anxiety disorders among adolescent and young adult populations. The purpose of this study is to identify the shared and unique predictors of anxiety and mood disorders...... by simultaneously testing a range of established psychosocial risk factors. Method: A national birth cohort of the Danish population born in 1984 and tracked over the course of the first 21 years of their life was used in the current study (n = 54,458). Psychosocial risk factors including paternal and maternal...
Schrijvers, D.L.; Bruijn, E.R.A. de; Destoop, M.; Hulstijn, W.; Sabbe, B.G.C.C.
Perfectionism and anxiety features are involved in the clinical presentation and neurobiology of major depressive disorder (MDD). In MDD, cognitive control mechanisms such as action monitoring can adequately be investigated applying electrophysiological registrations of the error-related negativity
Batelaan, Neeltje M; ten Have, Margreet; van Balkom, Anton J L M; Tuithof, Marlous; de Graaf, Ron
Anxiety has been linked to onset of cardiovascular disease. This study examines the differential impact of types of anxiety (panic, phobia and worry) on 3-year onset of non-fatal cardiovascular disease (CVD). By investigating anxiety disorders as opposed to anxiety symptoms and by using a reliable diagnostic instrument to assess anxiety, limitations of previous studies are considered. 5149 persons at risk for CVD were interviewed using the Composite International Diagnostic Interview. The panic-type included panic disorder and panic attacks; the phobic-type included agoraphobia and social phobia, and the worry-type included generalized anxiety disorder. CVD was self-reported and required treatment or monitoring by a doctor. Analyses were adjusted for sociodemographics, behavioral variables, and comorbid somatic and psychiatric disorders. During follow-up, 62 persons (1.2%) developed CVD. Baseline generalized anxiety disorder was strongly associated with onset of CVD (adjusted OR: 3.39). Further research should replicate findings and focus on biological underpinnings of this association.
de Vries, Ymkje Anna; de Jonge, Peter; van den Heuvel, Edwin; Turner, Erick H; Roest, Annelieke M
BACKGROUND: Antidepressants are established first-line treatments for anxiety disorders, but it is not clear whether they are equally effective across the severity range. AIMS: To examine the influence of baseline severity of anxiety on antidepressant efficacy for generalised anxiety disorder (GAD),
Hamlyn-Wright, Sarah; Draghi-Lorenz, Riccardo; Ellis, Jason
Stress, anxiety and depression are raised amongst parents of children with a developmental disorder. However, the processes by which stress leads to depression and anxiety are poorly understood. In a cross-sectional survey, levels of parental stress, depression and anxiety were compared between parents of children with an autistic disorder,…
Moskowitz, Lauren J.; Mulder, Emile; Walsh, Caitlin E.; McLaughlin, Darlene Magito; Zarcone, Jennifer R.; Proudfit, Greg Hajcak; Carr, Edward G.
Despite the increased risk for anxiety disorders in children with autism spectrum disorders (ASD), there is a lack of research on the assessment and treatment of anxiety in this population, particularly for those with an intellectual disability (ID). The present study evaluated a multimethod strategy for the assessment of anxiety and problem…
Hellström, Lone; Bech, Per; Nordentoft, Merete;
trial of an early modified IPS intervention in addition to treatment-as-usual compared to treatment-as-usual alone for 324 participants diagnosed with an affective disorder or anxiety disorder living in the Capital Region of Denmark. The primary outcome is competitive employment or education at 24......Anxiety and affective disorders can be disabling and have a major impact on the ability to work. In Denmark, people with a mental disorder, and mainly non-psychotic disorders, represent a substantial and increasing part of those receiving disability pensions. Previous studies have indicated...... that Individual Placement and Support (IPS) has a positive effect on employment when provided to people with severe mental illness. This modified IPS intervention is aimed at supporting people with recently diagnosed anxiety or affective disorders in regaining their ability to work and facilitate their return...
Morrison, Amanda S; Mateen, Maria A; Brozovich, Faith A; Zaki, Jamil; Goldin, Philippe R; Heimberg, Richard G; Gross, James J
Social anxiety disorder (SAD) is associated with elevated negative and diminished positive affective experience. However, little is known about the way in which individuals with SAD perceive and respond emotionally to the naturally-unfolding negative and positive emotions of others, that is, cognitive empathy and affective empathy, respectively. In the present study, participants with generalized SAD (n = 32) and demographically-matched healthy controls (HCs; n = 32) completed a behavioral empathy task. Cognitive empathy was indexed by the correlation between targets' and participants' continuous ratings of targets' emotions, whereas affective empathy was indexed by the correlation between targets' and participants' continuous self-ratings of emotion. Individuals with SAD differed from HCs only in positive affective empathy: they were less able to vicariously share others' positive emotions. Mediation analyses revealed that poor emotional clarity and negative interpersonal perceptions among those with SAD might account for this finding. Future research using experimental methodology is needed to examine whether this finding represents an inability or unwillingness to share positive affect.
Aderka, Idan M; Haker, Ayala; Marom, Sofi; Hermesh, Haggai; Gilboa-Schechtman, Eva
In the present study, we sought to examine information seeking among individuals with social anxiety disorder (SAD, n = 31) and nonanxious controls (n = 32) during an impression-formation task. Participants were given an initial description of a protagonist that included polarized information on the social rank dimension (i.e., dominant or submissive) or on the affiliation dimension (i.e., friendly or unfriendly). Participants were told that their task was to rate the protagonist on social rank and affiliation traits and were given the opportunity to obtain additional information in order to make their decisions. Results indicated that compared to controls, individuals with SAD sought less information before making social rank ratings. In addition, individuals with SAD rated dominant protagonists as higher in social rank than did controls. These findings suggest that even in nonevaluative conditions, individuals with SAD may have an information-seeking bias. In addition, individuals with SAD may have a bias in forming impressions of dominant others. Implications for cognitive and interpersonal models of SAD are discussed.
Benatti, Beatrice; Camuri, Giulia; Dell'Osso, Bernardo; Cremaschi, Laura; Sembira, Ester; Palazzo, Carlotta; Oldani, Lucio; Dobrea, Cristina; Arici, Chiara; Primavera, Diego; Carpiniello, Bernardo; Castellano, Filippo; Carrà, Giuseppe; Clerici, Massimo; Baldwin, David S; Altamura, Alfredo Carlo
Anxiety disorders are common, comorbid, and disabling conditions, often underdiagnosed and under-treated, typically with an early onset, chronic course, and prolonged duration of untreated illness. The present study aimed to explore the influence of sociodemographic and clinical factors in relation to onset and latency to treatment in patients with generalized anxiety disorder (GAD), panic disorder (PD), and obsessive-compulsive disorder (OCD). A total of 157 patients with a Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text Revision (DSM-IV-TR) diagnosis of PD (n=49), GAD (n=68), and OCD (n=40) were recruited, and epidemiological and clinical variables were collected through a specific questionnaire. Statistical analyses were carried out to compare variables across diagnostic groups. PD, GAD, and OCD patients showed a duration of untreated illness of 53.9±81.5, 77.47±95.76, and 90.6±112.1 months, respectively. Significant differences between groups were found with respect to age, age of first diagnosis, age of first treatment, family history of psychiatric illness, onset-related stressful events, benzodiazepine prescription as first treatment, antidepressant prescription as first treatment, and help-seeking (self-initiated vs. initiated by others). Patients with GAD, PD, and OCD showed significant differences in factors influencing onset and latency to treatment, which may, in turn, affect condition-related outcome and overall prognosis. Further studies with larger samples are warranted in the field.
Bourgeois, Michelle L.; Brown, Timothy A.
The relationships between neuroticism, perceived emotion control, and generalized anxiety disorder (GAD) severity were examined in 293 individuals diagnosed with GAD at a specialty anxiety disorders clinic. Hierarchical regression analyses performed within a structural equation modeling framework revealed that (1) neuroticism and perceived emotion control both predicted a latent variable of GAD in the expected direction, and (2) perceived emotion control moderated the relationship between neu...
Fournier, Jay C; Cyranowski, Jill M; Rucci, Paola; Cassano, Giovanni B; Frank, Ellen
Major depressive disorder and bipolar spectrum disorders are debilitating conditions associated with severe impairment. The presence of co-occurring social phobia can make the clinical course of these disorders even more challenging. To better understand the nature of social anxiety in the context of ongoing mood disorders, we report the results of exploratory factor analyses of the Social Phobia Spectrum Self-Report Instrument (SHY), a 162-item measure designed to capture the full spectrum of manifestations and features associated with social anxiety experienced across the lifespan. We examined data from 359 adult outpatients diagnosed with major depressive disorder and 403 outpatients diagnosed with a bipolar spectrum disorder. The measure was divided into its two components: the SHY-General (SHY-G), reflecting general social anxiety features, and the SHY-Specific (SHY-S), reflecting anxiety in specific situations. Exploratory factor analyses were conducted for each using tetrachoric correlation matrices and an unweighted least squares estimator. Item invariance was evaluated for important patient subgroups. Five factors were identified for the SHY-G, representing general features of social anxiety: Fear of Social Disapproval, Childhood Social Anxiety, Somatic Social Anxiety, Excessive Agreeableness, and Behavioral Submission. Seven specific-situation factors were identified from the SHY-S: Writing in Public, Dating, Public Speaking, Eating in Public, Shopping Fears, Using Public Restrooms, and Unstructured Social Interactions. The identified dimensions provide clinically valuable information about the nature of the social fears experienced by individuals diagnosed with mood disorders and could help guide the development of tailored treatment strategies for individuals with co-occurring mood disorders and social anxiety.
McClure-Tone, Erin B.; Nawa, Norberto Eiji; Nelson, Eric E.; Detloff, Allison M.; Fromm, Stephen; Daniel S Pine; Ernst, Monique
This study examined patterns of neural response to feedback received during simulated interpersonal interactions in adolescents with anxiety disorders and healthy peers. To this aim, behavioral and neural responses during the Prisoner’s Dilemma (PD) game, an economic exchange task, were compared between adolescents with anxiety disorders (N=12) and healthy controls (n=17). Participants were deceived to believe that their co-player (a pre-programmed computer algorithm) was another study partic...
Terri Landon Bacow
Full Text Available Terri Landon Bacow1, Jill Ehrenreich May2, Leslie R Brody3, Donna B Pincus41Mount Sinai School of Medicine, New York City, NY, USA; 2Department of Psychology, University of Miami, FL, USA; 3Department of Psychology, 4Center for Anxiety and Related Disorders, Boston University, MA, USAAbstract: While Wells’ metacognitive model of generalized anxiety disorder (GAD posits that certain metacognitive processes, such as negative meta-worry (negative beliefs about worry, are more strongly associated with symptoms of GAD than other anxiety disorders in adults, research has yet to determine whether the same pattern is true for younger individuals. We examined the relationship between several metacognitive processes and anxiety disorder diagnostic status in a sample of 98 youth aged 7–17 years. Twenty youth with GAD were compared with similarly sized groups of youth with obsessive-compulsive disorder (OCD, n = 18, social phobia (SOC, n = 20, separation anxiety disorder (SAD, n = 20, and healthy controls who were not patients (NONP, n = 20 using a self-report measure of metacognition adapted for use with young people in this age range (Metacognitions Questionnaire for Children. Contrary to expectations, only one specific metacognitive process was significantly associated with an anxiety disorder diagnosis, in that the controls endorsed a greater degree of cognitive monitoring (self-reported awareness of one’s thoughts than those with SAD. In addition, there was a trend indicating that nonpatients scored higher than youth with GAD on this scale. These surprising results suggest potentially differing patterns in the relationships between symptoms and metacognitive awareness in anxious youth, depending on the type of anxiety disorder presentation.Keywords: metacognition, childhood, adolescence, anxiety, diagnosis
Full Text Available We aimed to conduct a review to investigate the prevalence of anxiety disorders among Iranian children and adolescents.We systematically reviewed the literature up to June 2014. We searched three Persian databases (Magiran, IranMedex and SID and three English databases: PubMed, Scopus and PsycINFO. All original studies that investigated the current prevalence of anxiety in a sample of Iranian children and adolescents were entered into the study. All studies conducted on special samples or in special settings were excluded. By searching English databases, we obtained 124 original studies. After removing duplicate papers, 120 articles remained. In the next step, we screened the articles based on their title. In sum, 95 Persian and English articles had relevant titles. After screening based on the abstract and full text, 26 studies remained. After screening based on the full text, all selected studies were qualitatively assessed by two evaluators separately.Twenty five studies were eligible and reported different types of anxiety disorders (i.e., generalized anxiety, separation anxiety, obsessive-compulsive disorder, phobias and panic disorder. The samples varied from 81 to 2996 among studies and their age range was 5 to 18 years. These studies were conducted in different cities of Iran. SCL-90 is a frequently used questionnaire. All anxiety disorders were mostly investigated with the prevalence rates ranging from 6.8% in Saravan to 85% in Bandar Abbas. OCD was the second common study with prevalence rates ranging from 1% in Tabriz to 11.9% in Gorgan.Our findings revealed considerable amount of anxiety disorder among Iranian children and adolescents. Given the fact that anxiety disorder has negative effects on the well-being and function of individuals and can lead to severe problems, this disorder should be considered in mental health programs designed for children and adolescents.
Br?hl, Annette Beatrix; Delsignore, Aba; Komossa, Katja; Weidt, Steffi
This is the author's accepted manuscript. The final version is printed by Elsevier in Neuroscience & Biobehavioral Reviews here: http://www.sciencedirect.com/science/article/pii/S0149763414002012. Social anxiety disorder (SAD) is one of the most frequent anxiety disorders. The landmark meta-analysis of functional neuroimaging studies by Etkin & Wager (2007) revealed primarily the typical fear circuit as overactive in SAD. Since then, new methodological developments such as functional conne...
Atefeh Ahmadi; Mohamed Sharif Mustaffa; Amirmudin Udin; AliAkbar Haghdoost
Introduction Pediatric anxiety disorders are the most common mental health disorders in the middle-childhood age group. The purpose of this study is to assess anxiety disorder symptoms, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), in a large community sample of low socioeconomic level rural children and to investigate some of the psychometric properties (internal consistency, construct and convergent validity and items rated as often or always...
Sripada, Chandra Sehkar; Angstadt, Mike; Banks, Sarah; Nathan, Pradeep J.; Liberzon, Israel; Luan Phan, K.
Individuals with generalized social anxiety disorder tend to make overly negative and distorted predictions about social events, which enhance perceptions of threat and contribute to excessive anxiety in social situations. Here, we coupled functional magnetic resonance imaging and a multiround economic exchange game (‘trust game’) to probe mentalizing, the social-cognitive ability to attribute mental states to others. Relative to interactions with a computer, those with human partners (‘mentalizing’) elicited less activation of medial prefrontal cortex in generalized social anxiety patients compared with matched healthy control participants. Diminished medial prefrontal cortex function may play a role in the social-cognitive pathophysiology of social anxiety. PMID:19521264
Janssen, E.H.C.; Ven, P.M. van de; Terluin, B.; Verhaak, P.F.M.; Marwijk, H.W.J. van; Smolders, M.; Meer, K. van der; Penninx, B.W.J.H.; Hout, H.P.J. van
Objective: Previous studies reported low and inconsistent rates of recognition of anxiety disorders by family physicians (FPs). Our objectives were to examine (a) which combination of indications within medical records most accurately reflects recognition of anxiety disorders and (b) whether patient
Janssen, Evelien H. C.; van de Ven, Peter M.; Terluin, Berend; Verhaak, Peter F. M.; van Marwijk, Harm W. J.; Smolders, Mirrian; van der Meer, Klaas; Penninx, Brenda W. J. H.; van Hout, Hein P. J.
Objective: Previous studies reported low and inconsistent rates of recognition of anxiety disorders by family physicians (FPs). Our objectives were to examine (a) which combination of indications within medical records most accurately reflects recognition of anxiety disorders and (b) whether patient
Valença Alexandre M
Full Text Available OBJECTIVE: There is evidence that asthma is associated with increased frequency of psychiatric symptoms and mental disorders. Our aim was to assess the frequency of anxiety and depressive disorders in a sample of asthmatic outpatients and observe if there is any relationship between this comorbidity and the severity of asthma. METHOD: Sixty-two consecutive patients of two outpatient asthma clinics located in university hospitals were evaluated. Psychiatric diagnoses were assessed with the Mini-International Neuropsychiatric Interview 4.4 Version. RESULTS: Twenty-seven patients (43.5% met criteria for at least one psychiatric diagnosis. The most frequent diagnoses were major depression (24%, generalized anxiety disorder (20.9% and panic disorder/agoraphobia spectrum disorders (17.7%. We found no significant differences in the prevalence of anxiety disorders and depression between the groups with mild/moderate and severe asthma. Despite the high frequency of depression and anxiety disorders, only 4 (6.5% patients were under psychiatric treatment and 13 (20.9% patients were taking benzodiazepines. Twelve of 15 (80% patients who reported present use of psychotropic medication were not under psychiatric treatment at the moment of the study. CONCLUSIONS: Our results support the high morbidity of anxiety and depressive disorders in asthmatic patients, independent of the severity of asthma.
Creswell, Cathy; Murray, Lynne; Cooper, Peter
Theory and treatment for childhood anxiety disorders typically implicates children's negative cognitions, yet little is known about the characteristics of thinking styles of clinically anxious children. In particular, it is unclear whether differences in thinking styles between children with anxiety disorders and non-anxious children vary as a function of child age, whether particular cognitive distortions are associated with childhood anxiety disorders at different child ages, and whether cognitive content is disorder-specific. The current study addressed these questions among 120 7-12 year old children (53% female) who met diagnostic criteria for social anxiety disorder, other anxiety disorder, or who were not currently anxious. Contrary to expectations, threat interpretation was not inflated amongst anxious compared to non-anxious children at any age, although older (10-12 year old) anxious children did differ from non-anxious children on measures of perceived coping. The notion of cognitive-content specificity was not supported across the age-range. The findings challenge current treatment models of childhood anxiety, and suggest that a focus on changing anxious children's cognitions is not warranted in mid-childhood, and in late childhood cognitive approaches may be better focussed on promoting children's perceptions of control rather than challenging threat interpretations.
Olatunji, Bunmi O; Cisler, Josh M; Tolin, David F
Although psychiatric comorbidity is common among patients with anxiety disorders, its impact on treatment outcome remains unclear. The present study used meta-analytic techniques to examine the relationship between diagnostic comorbidity and treatment outcome for patients with anxiety disorders. One hundred forty-eight anxiety-disordered treatment samples (combined N=3534) were examined for post-treatment effects from the PsychINFO database. Samples consisted of those exposed to both active (CBT, dynamic therapy, drug treatment, CBT+drug treatment, mindfulness) and inactive treatments (placebo/attention control, wait-list). All treatments were associated with significant improvement at post-treatment, and active treatments were associated with greater effects than were inactive treatments. However, overall comorbidity was generally unrelated to effect size at post-treatment or at follow-up. A significant negative relationship between overall comorbidity and treatment outcome was found for mixed or "neurotic" anxiety samples when examining associations between comorbidity and specific diagnoses. Conversely, there was a significant positive relationship between overall comorbidity and treatment outcome for panic disorder and/or agoraphobia and PTSD or sexual abuse survivors. These findings suggest that while diagnostic comorbidity may not impact the effects of specific anxiety disorder treatments, it appears to differentially impact outcome for specific anxiety disorder diagnoses.
Kuo, Janice R; Goldin, Philippe R; Werner, Kelly; Heimberg, Richard G; Gross, James J
Etiological models of social anxiety disorder (SAD) suggest that early childhood trauma contributes to the development of this disorder. However, surprisingly little is known about the link between different forms of childhood trauma and adult clinical symptoms in SAD. This study (1) compared levels of childhood trauma in adults with generalized SAD versus healthy controls (HCs), and (2) examined the relationship between specific types of childhood trauma and adult clinical symptoms in SAD. Participants were 102 individuals with generalized SAD and 30 HCs who completed measures of childhood trauma, social anxiety, trait anxiety, depression, and self-esteem. Compared to HCs, individuals with SAD reported greater childhood emotional abuse and emotional neglect. Within the SAD group, childhood emotional abuse and neglect, but not sexual abuse, physical abuse, or physical neglect, were associated with the severity of social anxiety, trait anxiety, depression, and self-esteem.
Frank-Briggs, Angela I; Alikor, E A D
Anxiety is a source of concern to the clinicians as it is co morbid with other mental disorders, particularly depression and learning disabilities, and it causes low self-esteem. The aim of this research was to evaluate the prevalence of anxiety disorder amongst secondary school children in Port Harcourt. A two-staged stratified sampling method was used to select the schools. Structured questionnaire based on Vanderbilt ADHD Diagnostic Teacher Rating Scale for anxiety and depression symptoms was used in evaluating the students. The questionnaires administered to the students were filled with the assistance of the researchers and the classroom teachers. Direct verbal interview was conducted for those noted to have symptoms of any of the various types of anxiety disorders and fears. Out of 885 students, 91 met the criteria for the diagnosis of anxiety/ depression disorder; prevalence was 10.28%, age range was 9-18 years. There were 37 males and 54 females giving a male: female ratio of 0.69:1. Majority 52 (57.14%) of the children lived with their parents, 28 (30.77%) of them lived with family relations and 11 (12.09%) of them were working as house helps to other families. The reasons given for being anxious were poor self image, fear of death, repeated physical and sexual abuses by their care givers and other adults. Learning disability was the major associated co morbid disorder (18.68%). Generalized anxiety was the most common type of anxiety disorder identified (32.97%). Anxiety disorders are debilitating chronic conditions. When it affects school aged children it contributes significantly to poor academic performance.
Seeley, Saren H; Mennin, Douglas S; Aldao, Amelia; McLaughlin, Katie A; Rottenberg, Jonathan; Fresco, David M
Generalized anxiety disorder (GAD) and unipolar depressive disorders (UDD) have been shown to differ from each other in dimensions of affective functioning despite their high rates of comorbidity. We showed emotional film clips to a community sample (n = 170) with GAD, GAD with secondary UDD, or no diagnosis. Groups had comparable subjective responses to the clips, but the GAD group had significantly lower heart rate variability (HRV) during fear and after sadness, compared to controls. While HRV in the GAD and control groups rose in response to the sadness and happiness clips, it returned to baseline levels afterwards in the GAD group, potentially indicating lesser ability to sustain attention on emotional stimuli. HRV in the GAD + UDD group changed only in response to sadness, but was otherwise unvarying between timepoints. Though preliminary, these findings suggest comorbid UDD as a potential moderator of emotional responding in GAD.
Jacob, Louis; Spiess, Alexandra; Kostev, Karel
Aims: The purpose of this study was to analyze the prevalence of depression, anxiety, adjustment disorders, and somatoform disorders in patients diagnosed with age-related macular degeneration (AMD) in Germany. Methods: This study included 7,580 patients between the ages of 40 and 90 diagnosed with AMD between January 2011 and December 2014 in 1,072 primary care practices (index date). The last follow-up was in July 2016. We also included 7,580 controls without AMD, which were matched (1:1) to the AMD cases by age, sex, type of health insurance (private or statutory), physician, and Charlson comorbidity score as a generic marker of comorbidity. The outcome of the study was the prevalence of depression, anxiety, adjustment disorders, and somatoform disorders recorded in the database between the index date and the end of follow-up. Results: The mean age among subjects was 75.7 years (SD=10.1 years), 34.0% were men, and 7.8% had private health insurance coverage. The Charlson comorbidity index was 2.0 (SD=1.8). Depression was the most frequent disease (33.7% in AMD patients versus 27.3% in controls), followed by somatoform disorders (19.6% and 16.7%), adjustment disorders (14.8% and 10.5%), and anxiety disorders (11.7% and 8.2%). Depression (OR=1.37, 95% CI: 1.27–1.47), anxiety (OR=1.50, 95% CI: 1.35–1.67), adjustment disorders (OR=1.50, 95% CI: 1.36–1.65), and somatoform disorders (OR=1.22, 95% CI: 1.12–1.32) were all positively associated with AMD. Conclusion: Overall, a significant association was found between AMD and depression, anxiety, adjustment disorders, and somatoform disorders.
Weiss, Jonathan A; Cappadocia, M Catherine; Tint, Ami; Pepler, Debra
Bullying victimization is commonly associated with anxiety among individuals with and without Autism Spectrum Disorder (ASD), and both bullying victimization and anxiety are more prevalent among youth with ASD than in the general population. We explored individual and contextual factors that relate to anxiety in adolescents and young adults with ASD who also experience bullying victimization. Participants included 101 mothers of adolescents and young adults diagnosed with ASD. Hierarchical multiple regression analyses were conducted to investigate the relationship between bullying victimization and anxiety in children with ASD, as well as parenting stress as a potential moderator of that relationship. Findings indicate that parenting stress moderates the association between bullying victimization and anxiety. The severity of anxiety was most strongly associated with bullying victimization when mothers reported high levels of stress. Implications for interventions that assist parents with coping and address bullying victimization are discussed.
Full Text Available Abstract Background Comorbid anxiety symptoms,in patients with a primary anxiety disorder or a mood disorder, leads to poor patient outcomes and burdens the healthcare system. This pilot study evaluated the feasibility of extended-release quetiapine fumarate (quetiapine XR for the treatment of patients with either a primary anxiety disorder or a mood disorder with comorbid anxiety symptoms compared to a placebo, as an adjunct to antidepressant therapy. Methods Thirty-nine patients with a diagnosis of a primary anxiety disorder or a mood disorder with comorbid anxiety symptoms were enrolled in this study. Patients with a stable dose of antidepressant therapy were randomized according to a 2:1 probability of receiving either quetiapine XR or a placebo adjunctive treatment for 8 weeks. The efficacy was assessed by the Hamilton Anxiety Rating Scale (HAM-A and the Clinical Global Impression of severity (CGI-S score at baseline, week 1, 4, and 8. Results A total of 35 patients were included in this intention-to treat (ITT population for the efficacy analysis (quetiapine XR: 22 patients; placebo: 13 patients. At week 4, statistically significant differences were observed on both the HAM-A score (p = 0.003 and the CGI-S score (p = 0.025, favouring the quetiapine XR (−13.00 ± 4.14 compared to placebo (−6.63 ± 5.42. However, no statistically significant difference was observed between the two groups with regard to changes from the baseline to week 8 on the HAM-A score (p = 0.332 or the CGI-S score (p = 0.833. Conclusions Augmentation of antidepressant treatment with quetiapine XR did not result in clinical improvement according to the outcome measure of anxiety using the HAM-A and CGI-S scores at week 8, among the patients with either a primary anxiety disorder or a mood disorder with comorbid anxiety symptoms. However, treatment with quetiapine XR as an adjunct to antidepressant therapy appeared to provide a short
Full Text Available Mood and anxiety disorders are the most prevalent mental disorders. People with such disorders implement self-management strategies to reduce or prevent their symptoms and to optimize their health and well-being. Even though self-management strategies are known to be essential to recovery, few researchers have examined them. The aim of this study is to explore strategies used by people recovering from depressive, anxiety, and bipolar disorders by asking 50 of them to describe their own strategies. Strategies were classified according to dimensions of recovery: social, existential, functional, physical, and clinical. Within these themes, 60 distinct strategies were found to be used synergistically to promote personal recovery as well as symptom reduction. Findings highlight the diversity of strategies used by people, whether they have depressive, anxiety, or bipolar disorders. This study underscores the importance of supporting self-management in a way that respects individual experience.
Gorenstein, Ethan E.; Papp, Lazlo A.
In the absence of data, pharmacotherapy with benzodiazepines has become the mainstay of anxiety management in the elderly population. However, the use of benzodiazepines in the elderly has many problems. Elderly persons are more sensitive to anti-anxiety medications and are subject to a variety of increased risks, including cognitive impairment,…
Reedt Dortland, Arianne Klaartje Beraldine van
The aim of this thesis was to clarify which aspects of depression and anxiety are related to an increased metabolic risk, and which factors contribute to these associations. Taken together, our findings indicate that people with more severe symptoms of depression and anxiety are at particular risk o
Full Text Available Agorastos Agorastos,1 Cüneyt Demiralay,1 Christian G Huber2 1Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 2Department of Psychiatry and Psychotherapy, University of Basel, Basel, Switzerland Abstract: The current paper presents literature relevant to the relationship of religiosity, spirituality, and personal beliefs with mental health and, in particular, anxiety disorders as an empirical narrative review, providing an overview on the most important and clinically relevant research results on the topic. The relationship between religiosity/spirituality, personal beliefs (ie, magical ideation and paranormal beliefs, and mental health has lately been studied extensively, and results have indicated significant associations among these variables. However, scientific approaches to this field are complex and multidimensional, partly leading to poor operationalization, incomparable data, and contradictory results. Literature demonstrates that higher religiosity/spirituality and magical ideation scores have often been associated with increased obsessive–compulsive traits. Similar results could not be confidently replicated for other anxiety disorders. However, it is still unclear if these differences suggest a specific association with obsessive–compulsive traits and reflect deviating etiopathogenetic and cognitive aspects between obsessive–compulsive disorder and other anxiety disorders, or if these results are biased through other factors. Religiosity/spirituality and personal beliefs constitute important parameters of human experience and deserve greater consideration in the psychotherapeutic treatment of psychiatric disorders. Keywords: spirituality, religiosity, religion, paranormal beliefs, magical ideation anxiety disorders, obsessive compulsive disorder, OCD, anxiety, coping
Evans, Rachel; Thirlwall, Kerstin; Cooper, Peter; Creswell, Cathy
Questionnaires are widely used in routine clinical practice to assess treatment outcomes for children with anxiety disorders. This study was conducted to determine whether 2 widely used child and parent report questionnaires of child anxiety symptoms and interference (Spence Child Anxiety Scale [SCAS-C/P] and Child Anxiety Impact Scale [CAIS-C/P]) accurately identify recovery from common child anxiety disorder diagnoses as measured by a 'gold-standard' diagnostic interview. Three hundred thirty-seven children (7-12 years, 51% female) and their parents completed the ADIS-IV-C/P diagnostic interview and questionnaire measures (SCAS-C/P and CAIS-C/P) before (Time 1) and after (Time 2) treatment or wait-list. Time 2 parent reported interference (CAIS-P) was found to be a good predictor of absence of any diagnoses (area under the curve [AUC] = .81). In terms of specific diagnoses, Time 2 SCAS-C/P separation anxiety subscale (SCAS-C/P-SA) identified recovery from separation anxiety disorder well (SCAS-C-SA, AUC = .80; SCAS-P-SA, AUC = .82) as did the CAIS-P (AUC = .79). The CAIS-P also successfully identified recovery from social phobia (AUC = .78) and generalized anxiety disorder (AUC = .76). These AUC values were supported by moderate to good sensitivity (.70-.78) and specificity (.70-.73) at the best identified cut-off scores. None of the measures successfully identified recovery from specific phobia. The results suggest that questionnaire measures, particularly the CAIS-P, can be used to identify whether children have recovered from common anxiety disorders, with the exception of specific phobias. Cut-off scores have been identified that can guide the use of routine outcome measures in clinical practice. (PsycINFO Database Record
Dymond, Simon; Dunsmoor, Joseph E; Vervliet, Bram; Roche, Bryan; Hermans, Dirk
Fear generalization, in which conditioned fear responses generalize or spread to related stimuli, is a defining feature of anxiety disorders. The behavioral consequences of maladaptive fear generalization are that aversive experiences with one stimulus or event may lead one to regard other cues or situations as potential threats that should be avoided, despite variations in physical form. Theoretical and empirical interest in the generalization of conditioned learning dates to the earliest research on classical conditioning in nonhumans. Recently, there has been renewed focus on fear generalization in humans due in part to its explanatory power in characterizing disorders of fear and anxiety. Here, we review existing behavioral and neuroimaging empirical research on the perceptual and non-perceptual (conceptual and symbolic) generalization of fear and avoidance in healthy humans and patients with anxiety disorders. The clinical implications of this research for understanding the etiology and treatment of anxiety is considered and directions for future research described.
Flensborg-Madsen, Trine; Tolstrup, Janne Schurmann; Sørensen, Holger Jelling
PURPOSE: The vast majority of studies investigating the association between social and psychological factors and anxiety disorders have been cross-sectional, making it difficult to draw causal conclusions. The purpose of the study was to investigate in a prospective longitudinal study whether...... social and psychological factors are associated with the later risk of being admitted to a hospital and receive a diagnosis of anxiety disorders. METHOD: The study population comprised 4,497 members of The Copenhagen Perinatal Cohort (CPC) who in 1993 answered a mailed questionnaire containing questions...... on a range of social and psychological factors. In 2007, the study population was linked to The Danish Hospital Discharge Register and the Danish Psychiatric Central Register to obtain information on registration with anxiety disorders. Multiple Cox regression analysis was used to analyze the risk of anxiety...
Suttajit, Sirijit; Kittirattanapaiboon, Phunnapa; Junsirimongkol, Boonsiri; Likhitsathian, Surinporn; Srisurapanont, Manit
Little is known about the risks of mood and anxiety disorders among Asians with alcohol use disorders and the effect of illicit drug use in this population. All participants from the 2008 Thai National Mental Health survey (N=17,140) were assessed for current major depressive disorder, anxiety disorders, and alcohol use disorders by using the Mini International Neuropsychiatric Interview (MINI) and were interviewed for illicit drug use within one year prior to their assessment. Logistic regression modeling was used to determine (a) whether alcohol use disorders were associated with major depressive disorder and anxiety disorders and (b) whether the use of illicit drugs increased these associations. Sex, age, marital status, region, and educational level were found to be significantly associated with major depressive disorder and anxiety disorders and were taken into account in the regression analysis. Compared with the general population, individuals with alcohol use disorders alone had significantly increased risks of major depressive disorder (OR 2.49, 95%CI 1.76-3.53 in men and OR 4.09, 95%CI 2.31-7.26 in women) and anxiety disorders (OR 2.21, 95%CI 1.46-3.36 in men and OR 4.34, 95%CI 2.35-8.03 in women). The risks became higher among individuals with both alcohol use disorders and illicit drug use (OR 3.62, 95% CI 1.64-8.01 in men and OR 11.53, 95%CI 1.32-100.65 in women for major depressive disorder, and OR 3.20, 95%CI 1.36-7.51 in men and OR 13.10, 95%CI 1.48-115.60 in women for anxiety disorders). In conclusion, alcohol use disorders were significantly associated with major depressive disorder and anxiety disorders. Illicit drug use was an important factor in increasing these associations, especially in women. Screening for depression, anxiety, and illicit drug use should be done in individuals with alcohol use disorders.
Full Text Available The treatment of anxiety is on the edge of a new era of combinations of pharmacologic and psychosocial interventions. A new wave of translational research has focused on the use of pharmacological agents as psychotherapy adjuvants using neurobiological insights into the mechanism of the action of certain psychological treatments such as exposure therapy. Recently, d-cycloserine (DCS an antibiotic used to treat tuberculosis has been applied to enhance exposure-based treatment for anxiety and has proved to be a promising, but as yet unproven intervention. The present study aimed to evaluate the efficacy of DCS in the enhancement of exposure therapy in anxiety disorders. A systematic review/meta-analysis was conducted. Electronic searches were conducted in the databases ISI-Web of Science, Pubmed and PsycINFO. We included only randomized, double-blind, placebo-controlled trials with humans, focusing on the role of DCS in enhancing the action of exposure therapy for anxiety disorders. We identified 328 references, 13 studies were included in our final sample: 4 on obsessive-compulsive disorder, 2 on panic disorder, 2 on social anxiety disorder, 2 on posttraumatic stress disorder, one on acrophobia, and 2 on snake phobia. The results of the present meta-analysis show that DCS enhances exposure therapy in the treatment of anxiety disorders (Cohen d = -0.34; CI: -0.54 to -0.14, facilitating the specific process of extinction of fear. DCS seems to be effective when administered at a time close to the exposure therapy, at low doses and a limited number of times. DCS emerges as a potential new therapeutic approach for patients with refractory anxiety disorders that are unresponsive to the conventional treatments available. When administered correctly, DCS is a promising strategy for augmentation of CBT and could reduce health care costs, drop-out rates and bring faster relief to patients.
Slyepchenko, Anastasiya; Carvalho, Andre F; Cha, Danielle S; Kasper, Siegfried; McIntyre, Roger S
A priority clinical and research agenda in mood and anxiety disorders is to identify determinants that influence illness trajectory and outcome. Over the past decade, studies have demonstrated a bidirectional relationship between the gut microbiome and brain function (i.e., the microbiota-gut-brain axis). Probiotic treatments and developmental analysis of the microbiome may provide potential treatments and preventative measures for depressive and anxiety disorders. This systematic literature review aims to identify original studies linking the gut microbiota to major depressive disorder and anxiety disorders. Furthermore, this review searched for original reports focusing on possible therapeutic and preventative effects of probiotics for these debilitating conditions. Accumulating data indicate that the gut microbiota communicates with the CNS through neural, endocrine and immune pathways. Studies in germ-free animals indicate that the microbiota is involved in the regulation of the stress response (e.g., hypothalamic-pituitary-adrenal axis) and in CNS development at critical stages. Probiotics attenuate anxiety and depressive-like behaviors in experimental animal models. Notwithstanding some inconsistencies and methodological limitations across trials, clinical studies suggest that probiotics may mitigate anxiety symptoms. However, future studies should investigate the anxiolytic and antidepressant effects of probiotics in more phenotypically homogeneous populations. In conclusion, the emerging concept of a gut microbiota-brain axis suggests that the modulation of the gut microbiota may provide a novel therapeutic target for the treatment and/or prevention of mood and anxiety disorders.
Andreescu, Carmen; Varon, Daniel
Anxiety disorders are frequently encountered in the elderly, but they are largely undetected and untreated. Epidemiological studies indicate a prevalence ranging from 1.2 to 15 %. With the exception of generalized anxiety disorder and agoraphobia, which can often start in late life, most anxiety disorders in older patients are chronic and have their onset earlier in life. Anxiety disorders are an often unrecognized cause of distress, disability, and mortality risk in older adults, and they have been associated with cardiovascular disease, stroke, and cognitive decline. The mechanisms of anxiety in older adults differ from that in younger adults due to age-related neuropathology, as well as the loss and isolation so prominent in late life. Our review intends to provide a comprehensive summary of the most recent research done in the field of anxiety disorders in the elderly. Recent findings in clinical research, neuroimaging, neuroendocrinology, and neuropsychology are covered. An update on treatment options is discussed, including pharmacological and non-pharmacological alternatives.
L. Boschloo; N. Vogelzangs; J.H. Smit; W. van den Brink; D.J. Veltman; A.T.F. Beekman; B.W.J.H. Penninx
This study examines comorbidity of alcohol abuse and alcohol dependence as well as its risk indicators among anxious and/or depressed persons, also considering temporal sequencing of disorders. Baseline data from the Netherlands Study of Depression and Anxiety (NESDA) were used, including 2329 perso
William W. Hale III
Full Text Available Presently most adolescent anxiety disorder screening instruments make their determination of running a high risk for an anxiety disorder on the basis of a cut-off score measured by a single screening which can lead to false positives. Therefore, the goal of this study is to examine whether a repeated administration of the SCARED screening instrument for DSM-5 anxiety disorder symptoms could help in the detection of true positives while also avoiding false positives. Participants were 923 early adolescents from the general community. The adolescents’ ages at the first annual screening ranged from 10 to 15 with an average of 12.5 years. In a prospective five-year longitudinal design, the adolescents completed the SCARED screening instrument for anxiety disorder symptoms on a yearly basis. To detect true positives and avoid false positives, the data were analyzed with Receiver Operating Characteristics (ROC cut-off score analyses. ROC cut-off score analyses revealed that the sensitivity and specificity of high risk were greatly improved for repeated screenings above those of a single screening. The findings of this study demonstrate that a screening instrument (such as the SCARED should be administered not just once but several times in order to better determine true positives and avoid false positives.
Ling, Yun; Nefs, Harold T; Morina, Nexhmedin; Heynderickx, Ingrid; Brinkman, Willem-Paul
In virtual reality exposure therapy (VRET) for anxiety disorders, sense of presence in the virtual environment is considered the principal mechanism that enables anxiety to be felt. Existing studies on the relation between sense of presence and level of anxiety, however, have yielded mixed results on the correlation between the two. In this meta-analysis, we reviewed publications on VRET for anxiety that included self-reported presence and anxiety. The comprehensive search of the literature identified 33 publications with a total of 1196 participants. The correlation between self-reported sense of presence and anxiety was extracted and meta-analyzed. Potential moderators such as technology characteristics, sample characteristics including age, gender and clinical status, disorder characteristics and study design characteristics such as measurements were also examined. The random effects analysis showed a medium effect size for the correlation between sense of presence and anxiety (r = .28; 95% CI: 0.18-0.38). Moderation analyses revealed that the effect size of the correlation differed across different anxiety disorders, with a large effect size for fear of animals (r = .50; 95% CI: 0.30-0.66) and a no to small effect size for social anxiety disorder (r = .001; 95% CI: -0.19-0.19). Further, the correlation between anxiety and presence was stronger in studies with participants who met criteria for an anxiety disorder than in studies with a non-clinical population. Trackers with six degrees of freedom and displays with a larger field of view resulted in higher effect sizes, compared to trackers with three degrees of freedom and displays with a smaller field of view. In addition, no difference in effect size was found for the type of presence measurement and the type of anxiety measurement. This meta-analysis confirms the positive relation between sense of presence and anxiety and demonstrates that this relation can be affected by various moderating factors.
Full Text Available In virtual reality exposure therapy (VRET for anxiety disorders, sense of presence in the virtual environment is considered the principal mechanism that enables anxiety to be felt. Existing studies on the relation between sense of presence and level of anxiety, however, have yielded mixed results on the correlation between the two. In this meta-analysis, we reviewed publications on VRET for anxiety that included self-reported presence and anxiety. The comprehensive search of the literature identified 33 publications with a total of 1196 participants. The correlation between self-reported sense of presence and anxiety was extracted and meta-analyzed. Potential moderators such as technology characteristics, sample characteristics including age, gender and clinical status, disorder characteristics and study design characteristics such as measurements were also examined. The random effects analysis showed a medium effect size for the correlation between sense of presence and anxiety (r = .28; 95% CI: 0.18-0.38. Moderation analyses revealed that the effect size of the correlation differed across different anxiety disorders, with a large effect size for fear of animals (r = .50; 95% CI: 0.30-0.66 and a no to small effect size for social anxiety disorder (r = .001; 95% CI: -0.19-0.19. Further, the correlation between anxiety and presence was stronger in studies with participants who met criteria for an anxiety disorder than in studies with a non-clinical population. Trackers with six degrees of freedom and displays with a larger field of view resulted in higher effect sizes, compared to trackers with three degrees of freedom and displays with a smaller field of view. In addition, no difference in effect size was found for the type of presence measurement and the type of anxiety measurement. This meta-analysis confirms the positive relation between sense of presence and anxiety and demonstrates that this relation can be affected by various moderating
Full Text Available Anxienty is closely related to sexual disorders, being their source, preserver, and consequence. Therefore, it represents an important obstacle in the course of a therapy. The role of anxiety in sexual disorders has already been widely investigated, but the question whether the above mentioned connection exists at a micro level remains unanswered. The present study focused on two specific anxiety disorders: agoraphobia and obsessive compulsive disorder. Two translated questionnaries were used: Mobility Inventory for Agoraphobia MIA (Chambless, Caputo, Jasin, & Gracely, 1985 and Padua Inventory PI (Sanavio, 1988. Participants were patients with sexual disorders who sought psychiatric help, and a group of students represented a control group. Results demonstrated a strong connection between agoraphobic and obsessive compulsive symptoms on one side and sexual disorders on the other. Among the possible explanations for this connection the circular model seems to be the most appropriate.
Full Text Available Attention is an important factor in information processing; obsessive- compulsive disorder (OCD and generalized anxiety disorder (GAD are two main emotional disorders with a chronic course. This research examined the relationship among attentional control and intrusive thoughts (worry, rumination and obsession in these disorders. It was hypothesized that attentional control is a common factor in OCD and GAD. In addition, we compared worry, rumination and obsession among OCD, GAD and non- clinical participants.The research sample included three groups: OCD (n = 25, GAD (n = 30 and non- clinical samples (n = 56. Data were collected using the Attentional Control Scale (ACS, Rumination Response Scale (RRS, Pennsylvania State Worry Questionnaire (PSWQ, Beck Depression Inventory (BDI, Beck Anxiety Inventory (BAI, Obsessive-Compulsive Inventory-Revised (OCI-R and General Health Questionnaire (GHQ-28. Data were analyzed using MANOVA and MANCOVA by SPSS-17.Multivariate Analysis of Variance revealed that the OCD and GAD groups reported greater deficits in attentional control, higher obsessive-compulsive symptoms, rumination, worry, anxiety and depression compared to the control group.This research indicated a great attentional deficit in obsessive- compulsive disorder and generalized anxiety disorder. However, no significant difference was found between these two disorders.
Gale, Shawn D; Brown, Bruce L; Berrett, Andrew; Erickson, Lance D; Hedges, Dawson W
Latent infection with the apicomplexan Toxoplasma gondii (Nicolle et Manceaux, 1908) has been associated with schizophrenia, bipolar disorder and self-harm behaviour. However, the potential relationship between T. gondii immunoglobulin G antibody (IgG) seropositivity and generalised-anxiety disorder (GAD) and panic disorder (PD) has not been investigated. The associations between serum reactivity to T. gondii and major depressive disorder (MDD), GAD and PD were evaluated in a total sample of 1 846 adult participants between the ages of 20 and 39 years from the United States Center for Disease Control's National Health and Nutrition Examination Survey (NHANES). Approximately 16% of the overall sample was seropositive for T. gondii and 7% of the sample met criteria for MDD, 2% for GAD and 2% for PD. There were no significant associations between T. gondii IgG seroprevalence and MDD (OR = 0.484, 95% CI = 0.186-1.258), GAD (OR = 0.737, 95% CI = 0.218-2.490) or PD (OR = 0.683, 95% CI = 0.206-2.270) controlling for sex, ethnicity, poverty-to-income ratio and educational attainment. However, limited evidence suggested a possible association between absolute antibody titres for T. gondii and GAD and PD but not MDD. Toxoplasma gondii seroprevalence was not associated with MDD, GAD or PD within the context of the limitations of this study, although there may be an association of T. gondii serointensity with and GAD and PD, which requires further study.
Shalev, Idan; Moffitt, Terrie E.; Braithwaite, Antony W.; Danese, Andrea; Fleming, Nicholas I.; Goldman-Mellor, Sidra; Harrington, HonaLee; Houts, Renate M.; Israel, Salomon; Poulton, Richie; Robertson, Stephen P.; Sugden, Karen; Williams, Benjamin; Caspi, Avshalom
There is evidence that persistent psychiatric disorders lead to age-related disease and premature mortality. Telomere length has emerged as a promising biomarker in studies that test the hypothesis that internalizing psychiatric disorders are associated with accumulating cellular damage. We tested the association between the persistence of internalizing disorders (depression, generalized anxiety disorder and post-traumatic stress disorder) and leukocyte telomere length (LTL) in the prospective-longitudinal Dunedin Study (N=1037). Analyses showed that the persistence of internalizing disorders across repeated assessments from ages 11 to 38 years predicted shorter LTL at age 38 years in a dose-response manner, specifically in men (β= −.137, 95% CI: −.232, −.042, p=.005). This association was not accounted for by alternative explanatory factors, including childhood maltreatment, tobacco smoking, substance dependence, psychiatric medication use, poor physical health, or low socioeconomic status. Additional analyses using DNA from blood collected at two time points (ages 26 and 38 years) showed that LTL erosion was accelerated among men who were diagnosed with internalizing disorder in the interim (β= −.111, 95% CI: −.184, −.037, p=.003). No significant associations were found among women in any analysis, highlighting potential sex differences in internalizing-related telomere biology. These findings point to a potential mechanism linking internalizing disorders to accelerated biological aging in the first half of the life course, particularly in men. Because internalizing disorders are treatable, the findings suggest the hypothesis that treating psychiatric disorders in the first half of the life course may reduce the population burden of age-related disease, and extend health expectancy. PMID:24419039
Silove, Derrick; Alonso, Jordi; Bromet, Evelyn; Gruber, Mike; Sampson, Nancy; Scott, Kate; Andrade, Laura; Benjet, Corina; Caldas de Almeida, Jose Miguel; De Girolamo, Giovanni; de Jonge, Peter; Demyttenaere, Koen; Fiestas, Fabian; Florescu, Silvia; Gureje, Oye; He, Yanling; Karam, Elie; Lepine, Jean-Pierre; Murphy, Sam; Villa-Posada, Jose; Zarkov, Zahari; Kessler, Ronald C.
Objective: The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data. Method: The sample included 38,993 adults in 18 countr
Orchard, Faith; Apetroaia, Adela; Clarke, Kiri; Creswell, Cathy
Negative (or a lack of positive) interpretation of ambiguous social situations has been hypothesised to maintain social anxiety disorder in children, yet there is currently limited evidence to support this. Cognitive Bias Modification of Interpretation (CBM-I) provides a means to explore the causal influence of interpretation bias on social anxiety disorder, and has been associated with a reduction in social anxiety symptoms in adults. Seven to twelve year old children with a diagnosis of social anxiety disorder completed CBM-I training, adapted from materials designed for socially anxious children in the community, or no training. Effects on interpretation bias and social anxiety were assessed. The adapted CBM-I training was not associated with significant changes in benign or negative interpretation. Unsurprisingly given the lack of successful interpretation training, there were no significant changes in child or parent reported social anxiety symptoms, clinician-rated severity or diagnoses and change in interpretation was not significantly associated with change in social anxiety. These findings contrast with some studies with community populations although it is possible that more intensive CBM-I training is required to fully test this hypothesis among clinical groups.
Kimberly L H Carpenter
Full Text Available In this prospective, longitudinal study of young children, we examined whether a history of preschool generalized anxiety, separation anxiety, and/or social phobia is associated with amygdala-prefrontal dysregulation at school-age. As an exploratory analysis, we investigated whether distinct anxiety disorders differ in the patterns of this amygdala-prefrontal dysregulation.Participants were children taking part in a 5-year study of early childhood brain development and anxiety disorders. Preschool symptoms of generalized anxiety, separation anxiety, and social phobia were assessed with the Preschool Age Psychiatric Assessment (PAPA in the first wave of the study when the children were between 2 and 5 years old. The PAPA was repeated at age 6. We conducted functional MRIs when the children were 5.5 to 9.5 year old to assess neural responses to viewing of angry and fearful faces.A history of preschool social phobia predicted less school-age functional connectivity between the amygdala and the ventral prefrontal cortices to angry faces. Preschool generalized anxiety predicted less functional connectivity between the amygdala and dorsal prefrontal cortices in response to fearful faces. Finally, a history of preschool separation anxiety predicted less school-age functional connectivity between the amygdala and the ventral prefrontal cortices to angry faces and greater school-age functional connectivity between the amygdala and dorsal prefrontal cortices to angry faces.Our results suggest that there are enduring neurobiological effects associated with a history of preschool anxiety, which occur over-and-above the effect of subsequent emotional symptoms. Our results also provide preliminary evidence for the neurobiological differentiation of specific preschool anxiety disorders.
J.F. van den Berg (Julia); H.J. Luijendijk (Hendrika); J.H.M. Tulen (Joke); A. Hofman (Albert); A.K. Neven (Arie); H.W. Tiemeier (Henning)
textabstractObjective: Sleep disturbance is common in psychiatric disorders. However, the relationships of core parameters in sleep research, such as total sleep time (TST), with depression and anxiety disorders are unclear and have rarely been investigated in large population-based studies. Method:
Stringer, Barbara; Meijel, Berno van; Eikelenboom, M.; Koekkoek, B.; Licht, C.; Kerkhof, A.J.; Penninx, B.W.; Beekman, A.T.
Background The presence of a comorbid borderline personality disorder (BPD) may be associated with an increase of suicidal behaviors in patients with depressive and anxiety disorders. The aim of this study is to examine the role of borderline personality traits on recurrent suicide attempts. Method
Stringer, Barbara; van Meijel, Berno; Eikelenboom, Merijn; Koekkoek, Bauke; Licht, Carmilla M. M.; Kerkhof, Ad J. F. M.; Penninx, Brenda W. J. H.; Beekman, Aartjan T. F.
Background: The presence of a comorbid borderline personality disorder (BPD) may be associated with an increase of suicidal behaviors in patients with depressive and anxiety disorders. The aim of this study is to examine the role of borderline personality traits on recurrent suicide attempts. Method
Hofmann, S.G.; Meuret, A.E.; Smits, J.A.J.; Simon, N.M.; Pollack, M.H.; Eisenmenger, K.; Shiekh, M.; Otto, M.W.
Context: Social anxiety disorder ( SAD) is common and debilitating. Although exposure therapy is one of the most effective forms of psychotherapy for this disorder, many patients remain symptomatic. Fear reduction in exposure therapy is similar to extinction learning, and early clinical data with sp
Lewinsohn, Peter M.; Holm-Denoma, Jill M.; Small, Jason W.; Seeley, John R.; Joiner, Thomas E.
A study to examine the association between childhood separation anxiety disorder (SAD) and the risk of the development of psychopathology during young adulthood was conducted. Results showed that SAD contributed to the risk for the development of internalizing disorders, which are panic and depression, but decreased the risk for externalizing…
Kearny, Regina; Pawlukewicz, Justine; Guardino, Mary
Because anxiety is the most common mental health disorder diagnosed in children, early intervention is crucial for fundamental coping. Although cognitive-behavioral therapy (CBT) is the preferred treatment method for this affective disorder, instruction for children needs to be specific for them to successfully acquire and implement essential CBT…
Hansen, Berit Hjelde; Skirbekk, Benedicte; Oerbeck, Beate; Wentzel-Larsen, Tore; Kristensen, Hanne
This study examines the persistence of sleep problems over 18 months in 76 referred children with anxiety disorders and/or attention deficit hyperactivity disorders (ADHD) and 31 nonreferred controls, and explores predictors of sleep problems at follow-up (T2) in the referred children. Diagnoses were assessed at initial assessment (T1) using the…
Roy, Amy K.; Fudge, Julie L.; Kelly, Clare; Perry, Justin S. A.; Daniele, Teresa; Carlisi, Christina; Benson, Brenda; Castellanos, F. Xavier; Milham, Michael P.; Pine, Daniel S.; Ernst, Monique
Objective: Generalized anxiety disorder (GAD) typically begins during adolescence and can persist into adulthood. The pathophysiological mechanisms underlying this disorder remain unclear. Recent evidence from resting state functional magnetic resonance imaging (R-fMRI) studies in adults suggests disruptions in amygdala-based circuitry; the…
Rodebaugh, Thomas L.; Holaway, Robert M.; Heimberg, Richard G.
Despite favorable psychometric properties, the Generalized Anxiety Disorder Questionnaire for the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.) (GAD-Q-IV) does not have a known factor structure, which calls into question use of its original weighted scoring system (usually referred to as the dimensional score).…
Boschloo, L.; Vogelzangs, N.; van den Brink, W.; Smit, J. H.; Beekman, A.T.F.; Penninx, Brenda
Background. Much is still unclear about the role of personality in the structure of common psychiatric disorders such as depressive/anxiety disorders and alcohol dependence. This study will therefore examine whether various traits of negative emotionality and impulsivity showed shared or specific as
Anczweski, Julian; Anczewska, Marta
Individuals living with anxiety disorders often face significant obstacles in their day to day lives. While trying to manage the physical and emotional symptoms associated with these disorders can be a challenge, sufferers also encounter barriers by way of social exclusion from key life domains: family life, relationships, education, employment…
This study investigated individual and incremental contributions of somatization and trait anxiety to pain report in children with pain-related functional gastrointestinal disorders. Eighty children (7-10 years) with pain-related functional gastrointestinal disorders completed the State-Trait Anxiet...
Sterling, Lindsey; Renno, Patricia; Storch, Eric A.; Ehrenreich-May, Jill; Lewin, Adam B.; Arnold, Elysse; Lin, Enjey; Wood, Jeffrey
High rates of anxiety and depression are reported among youth with autism spectrum disorders. These conditions are generally assessed using measures validated for typically developing youth. Few studies have investigated their validity for autism spectrum disorders, which is crucial for accurate assessment and the provision of proper treatment.…
Gothelf, Doron; Rubinstein, Maly; Shemesh, Eyal; Miller, Orit; Farbstein, Ilana; Klein, Anat; Weizman, Abraham; Apter, Alan; Yaniv, Isaac
Objective: To evaluate the safety, tolerability, and benefit of fluvoxamine for the treatment of major depressive disorder or anxiety disorders in children and adolescents with cancer. Method: The study was conducted from 2001 to 2004 at a pediatric hematology-oncology center. Fifteen children and adolescents with cancer were treated with…
van der Heiden, Colin; Methorst, Gerda; Muris, Peter; van der Molen, Henk T
Generalized anxiety disorder (GAD) is a prevalent and disabling disorder characterised by persistent worrying, anxiety symptoms, and tension. General practitioners and mental healthcare professionals frequently misdiagnose the presenting symptoms. This article addresses the clinical presentation of GAD and provides guidelines for discriminating GAD from other disorders, based on theoretical considerations and clinical experience. Debate relating to the validity of the definition of GAD is discussed, and suggestions are made for improving the criteria for GAD, which may guide future versions of classification systems such as the Diagnostic and Statistical Manual.
Braeken, Marijke A. K. A.; Kemp, Andrew H.; Tim Outhred; Otte, Renée A.; Monsieur, Geert J. Y. J.; Alexander Jones; Van den Bergh, Bea R. H.
OBJECTIVE: Active anxiety disorders have lasting detrimental effects on pregnant mothers and their offspring but it is unknown if historical, non-active, maternal anxiety disorders have similar effects. Anxiety-related conditions, such as reduced autonomic cardiac control, indicated by reduced heart rate variability (HRV) could persist despite disorder resolution, with long-term health implications for mothers and children. The objective in this study is to test the hypotheses that pregnant m...
Rodebaugh, Thomas L.; Heimberg, Richard G.; Taylor, Kristin P.; Lenze, Eric J.
Social anxiety disorder is associated with lower interpersonal warmth, possibly explaining its associated interpersonal impairment. Across two samples, we attempted to replicate previous findings that the disorder’s constraint of interpersonal warmth can be detected via behavioral economic tasks. We also tested the test-retest stability of task indices. Results indicated that factors associated with social anxiety disorder (and not the disorder itself), such as the severity of social anxiety ...
Brenes, Gretchen A; McCall, W Vaughn; Williamson, Jeff D; Stanley, Melinda A
This article describes the development of Biblio and Telephone Therapy or BTT, a cognitive-behavioral treatment program for late-life anxiety disorders. Although studies have examined bibliotherapy for the treatment of late-life depression, none have studied it as a format for treating late-life anxiety. The application of this treatment to 4 older adults with Generalized Anxiety Disorder (GAD) and/or Panic Disorder (PD) is described and benefits, advantages and limitations are discussed.
Full Text Available Ewa A Ogłodek,1 Anna M Szota,1 Marek J Just,2 Aleksander Araszkiewicz,1 Adam R Szromek3 1Department of Psychiatry, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Toruń, 2Department of General and Endocrine Surgery, Municipal Hospital, Piekary Śląskie, 3Department of Organization and Management, Silesian University of Technology, Gliwice, Poland Aim: Alexithymia is associated with limited cognitive processing of emotions by an individual suffering from recurrent urticaria and alexithymia and makes them focus on somatic manifestations of emotional arousal and on poorly controlled compulsive reactions to negative stimulation. Alexithymia is considered to be a personality trait, which, along with other factors, predisposes individuals toward developing somatic diseases. The aim of the study was to assess the measurement of alexithymic features in patients with recurrent urticaria and to assess the types of concurrent anxiety disorders and overall anxiety level.Methods: In order to diagnose clinical anxiety symptoms in patients, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and the Hamilton Anxiety Rating Scale were applied. Alexithymic features were measured by means of a shortened version of the Toronto Alexithymia Scale, characterized by high discrimination power, internal coherence, and reliability.Results: According to the Toronto Alexithymia Scale results, the greatest contributing factor was “inability to differentiate between feelings and bodily sensations”. This was observed in both males and females. Most frequently, the patients were found to suffer from generalized anxiety disorder and social phobia.Conclusion: Alexithymia may result from the difficulty associated with expressing emotions caused by anxiety disorders. Undergoing treatment for anxiety disorders may contribute to reduced exacerbation of urticaria. Keywords: alexithymia, anxiety, recurrent urticaria
Gillin, J C
This paper reviews recent literature which suggests that sleep disturbance in members of the general population, whether or not they have ever had a formal psychiatric disorder, is a risk factor for the onset of a formal psychiatric diagnosis at a later time. Based upon the current literature, the strongest link is between subjective insomnia, lasting at least 2 weeks, and the later onset of depression. Less well-established data suggest that lifetime reports of at least 2 weeks of insomnia, hypersomnia, or both hypersomnia and insomnia, are risk factors for the later development of depression, anxiety disorders or substance abuse. More tentatively, preliminary data suggest that increasing subjective sleep disturbance may signal a relapse in remitted depressed patients. Sleep disturbances are common manifestations of major depressive and anxiety disorders. Therefore, sleep complaints may be among the most robust prodromal symptoms reflecting partial depressive or anxiety disorders, which eventually declare themselves as full-blown clinical episodes.
Thomas L. Schwartz
Full Text Available Objective. Glutamate, an excitatory neurotransmitter in the central nervous system (CNS, may play a role in the development of anxiety. Memantine partially blocks N-methyl-D-aspartate (NMDA receptors' glutamate channels located in the CNS. This paper evaluates memantine as an augmentation therapy for treatment of anxiety. Methods. 15 consecutive partially responding anxious patients were treated with adjunctive memantine for 10 weeks. Memantine was dosed 5–20 mg/day. Result. Memantine augmentation resulted in clinically relevant reduction in anxiety symptoms when compared to baseline. Forty percent of patients achieved remission (HAM-A ≥ 7. Memantine improved sleep quality. Mean dose was 14 mg/d (range 5–20 mg/d. Typical adverse events included nausea and headache. Conclusion. The NMDA receptor antagonist memantine may be an effective augmentation therapy in patients with treatment-resistant anxiety.
Weingarden, Hilary; Renshaw, Keith D; Wilhelm, Sabine; Tangney, June P; DiMauro, Jennifer
Body dysmorphic disorder (BDD) and obsessive compulsive disorder (OCD) are associated with elevated depression, suicidality, functional impairment, and days housebound, yet little research has identified risk factors for these outcomes. Using path analysis, the present study examined anxiety and shame as risk factors for these outcomes across Internet-recruited self-report groups (BDD [n = 114], OCD [n = 114], and healthy control [HC; n = 133]). Paths from anxiety and shame to outcomes were similar and mostly significant across BDD and OCD, compared to non-significant paths for HCs, with one exception: the path from shame to depression was significant in the BDD group (b = 0.32) but non-significant in the OCD group (b = 0.07). Findings underscore similarities in BDD and OCD, supporting their reclassification into the same Obsessive Compulsive Related Disorders category. Results emphasize the importance of targeting shame, in addition to anxiety, in treatments for BDD and OCD.
Boettcher, Johanna; Aström, Viktor; Påhlsson, Daniel; Schenström, Ola; Andersson, Gerhard; Carlbring, Per
Mindfulness-based interventions have proven effective for the transdiagnostic treatment of heterogeneous anxiety disorders. So far, no study has investigated the potential of mindfulness-based treatments when delivered remotely via the Internet. The current trial aims at evaluating the efficacy of a stand-alone, unguided, Internet-based mindfulness treatment program for anxiety. Ninety-one participants diagnosed with social anxiety disorder, generalized anxiety disorder, panic disorder, or anxiety disorder not otherwise specified were randomly assigned to a mindfulness treatment group (MTG) or to an online discussion forum control group (CG). Mindfulness treatment consisted of 96 audio files with instructions for various mindfulness meditation exercises. Primary and secondary outcome measures were assessed at pre-, posttreatment, and at 6-months follow-up. Participants of the MTG showed a larger decrease of symptoms of anxiety, depression, and insomnia from pre- to postassessment than participants of the CG (Cohen's d(between)=0.36-0.99). Within effect sizes were large in the MTG (d=0.82-1.58) and small to moderate in the CG (d=0.45-0.76). In contrast to participants of the CG, participants of the MTG also achieved a moderate improvement in their quality of life. The study provided encouraging results for an Internet-based mindfulness protocol in the treatment of primary anxiety disorders. Future replications of these results will show whether Web-based mindfulness meditation can constitute a valid alternative to existing, evidence-based cognitive-behavioural Internet treatments. The trial was registered at ClinicalTrials.gov (NCT01577290).
Meier, Sandra M; Petersen, Liselotte; Mattheisen, Manuel; Mors, Ole; Mortensen, Preben B; Laursen, Thomas M
Summary Background Depression and anxiety disorders are highly comorbid conditions and a worldwide disease burden; however, large-scale studies delineating their association are scarce. In this retrospective study, we aimed to assess the effect of severe anxiety disorders on the risk and course of depression. Methods We did a population-based cohort study with prospectively gathered data in Denmark using data from three Danish population registers: The Danish Civil Registration System, the Danish Psychiatric Central Register, and the Danish National Hospital Registry. We selected the cohort from people born in Denmark between Jan 1, 1955, and Dec 31, 2002, who we followed up from Jan 1, 1994, to Dec 31, 2012. The cohort was restricted to individuals with known parents. First, we investigated the effect of specific anxiety diagnoses on risk of single depressive episodes and recurrent depressive disorder. Second, we investigated the effect of comorbid anxiety on risk of readmission for depression, adjusting for sex, age, calendar year, parental age, place at residence at time of birth, and the interaction of age with sex. Findings We included 3 380 059 individuals in our study cohort. The adjusted incidence rate ratio (IRR) for single depressive episodes was 3·0 (95% CI 2·8–3·1, pdepressive disorder was 5·0 (4·8–5·2) in patients with severe anxiety disorders compared with the general population. Compared with control individuals, the offspring of parents with anxiety disorders were more likely to be diagnosed with single depressive episodes (1·9, 1·8–2·0) or recurrent depressive disorder (2·1, 1·9–2·2). Comorbid anxiety increased the readmission rates in both patients with single depressive episodes and patients with recurrent depressive disorder. Interpretation Severe anxiety constitutes a significant risk factor for depression. Focusing on specific anxiety disorders might help to identify individuals at risk of depression, thereby providing new
de Bruin, Esther I; Verheij, Fop; Wiegman, T; Ferdinand, Robert F
Children with autism have a relatively shorter index finger (2D) compared with their ring finger (4D). It is often presumed that the 2D:4D ratio is associated with fetal testosterone levels and that high fetal testosterone levels could play a role in the aetiology of autism. It is unknown whether this effect is specific to autism. In this study, 2D:4D ratios of 144 males aged 6 to 14 years (mean age 9y 1 mo [SD 1y 11 mo]) with psychiatric disorders were compared with those of 96 males aged 6 to 13 years from the general population (mean age 9y 1 mo [SD 1y 10 mo]). Psychiatric disorders were divided into autism/Asperger syndrome (n=24), pervasive developmental disorder-not otherwise specified (PDD-NOS; n=26), attention-deficit-hyperactivity disorder (ADHD)/oppositional defiant disorder (ODD; n=68), and anxiety disorders (n=26). Males with autism/Asperger syndrome (p<0.05) and ADHD/ODD (p<0.05) had significantly lower (though not significantly; p=0.52) ratios than males with an anxiety disorder, and males with autism/Asperger syndrome had lower ratios than those in the comparison group. These results indicated that higher fetal testosterone levels may play a role, not only in the origin of autism, but also in the aetiology of PDD-NOS and of ADHD/ODD. Males with anxiety disorders might have been exposed to lower prenatal testosterone levels.
Giovanni Abrahao Salum
Full Text Available The objective of this narrative review of the literature is to describe the epidemiology, etiology, pathophysiology, diagnosis, and treatment of pediatric anxiety disorders. We aim to guide clinicians in understanding the biology of anxiety disorders and to provide general guidelines for the proper diagnoses and treatment of these conditions early in life. Anxiety disorders are prevalent, associated with a number of negative life outcomes, and currently under-recognized and under-treated. The etiology involves both genes and environmental influences modifying the neural substrate in a complex interplay. Research on pathophysiology is still in its infancy, but some brain regions, such as the amygdala and the prefrontal cortex, have been implicated in fear and anxiety. Current practice is to establish diagnosis based purely on clinical features, derived from clinical interviews with the child, parents, and teachers. Treatment is effective using medication, cognitive behavioral therapy, or a combination of both. An introduction to the neuroscience behind anxiety disorders combined with an evidence-based approach may help clinicians to understand these disorders and treat them properly in childhood.
Mellon, Robert C; Moutavelis, Adrianos G
Schoolchildren reported their parents' use of aversive control and positive reinforcement contingencies in their educational interventions, as well as parental non-responsiveness to their requests for educational assistance. They also reported their own levels of six dimensions of anxiety disorder-related phenomena. Both parental use of aversive control and non-responsiveness were directly related to overall levels of child anxiety disorder-related behavior; these correlations were more robust than those observed in previous investigations of more diffuse dimensions of parenting style and trait anxiety. Panic disorder/agoraphobia and Generalized anxiety disorder were the dimensions most strongly correlated with both parental aversive control and non-responsiveness, while Compulsive behavior was uniquely uncorrelated with parental non-responsiveness and uniquely correlated with parental use of positive reinforcement contingencies. Differences in the magnitudes of correlations between anxiety disorder-related dimensions and parental educational practices are interpreted in terms of the probable differential effectiveness of their constituent behaviors in terminating parent-mediated negative reinforcers.
Steiner, Amanda R W; Petkus, Andrew J; Nguyen, Hoang; Wetherell, Julie Loebach
Information processing bias was evaluated in a sample of 25 older adults with generalized anxiety disorder (GAD) over the course of 12 weeks of escitalopram pharmacotherapy. Using the CANTAB Affective Go/No Go test, treatment response (as measured by the Hamilton Anxiety Rating Scale, Penn State Worry Questionnaire, and Generalized Anxiety Disorder Severity Scale) was predicted from a bias score (i.e., difference score between response latencies for negative and positive words) using mixed-models regression. A more positive bias score across time predicted better response to treatment. Faster responses to positive words relative to negative words were associated with greater symptomatic improvement over time as reflected by scores on the GADSS. There was a trend toward significance for PSWQ scores and no significant effects related to HAMA outcomes. These preliminary findings offer further insights into the role of biased cognitive processing of emotional material in the manifestation of late-life anxiety symptoms.
Pitman, Seth R; Hilsenroth, Mark J
We attempted to replicate earlier findings of interpersonal subtypes in patients with anxiety disorder (Psychotherapy. 2011;48:304-310) and examine whether these subtypes are characterized by different types of pathology and respond differently to treatment. Interpersonal problems were measured by the Inventory of Interpersonal Problems (Inventory of Interpersonal Problems Manual. San Antonio, TX: Psychological Cooperation; 2000) in a sample of 31 patients with anxiety disorder. Results demonstrated the existence of 4 interpersonal subtypes. The subtypes did not differ in severity of anxiety and global levels of symptoms at pretreatment or in Reliable Change Index of anxiety symptoms over the course of treatment. However, they were significantly different in terms of overall interpersonal problems (p = 0.004). Regarding treatment variables, half of the patients in the nonassertive cluster discontinued treatment prematurely. The number of psychotherapy sessions attended was significantly different across the 4 clusters (p = 0.04), with socially avoidant patients attending significantly greater number of sessions.
Thiago da Silva Domingos
Full Text Available OBJECTIVE To investigate the effectiveness of aromatherapy massage using the essential oils (0.5% of Lavandula angustifolia and Pelargonium graveolens for anxiety reduction in patients with personality disorders during psychiatric hospitalization. METHOD Uncontrolled clinical trial with 50 subjects submitted to six massages with aromatherapy, performed on alternate days, on the cervical and the posterior thoracic regions. Vital data (heart and respiratory rate were collected before and after each session and an anxiety scale (Trait Anxiety Inventory-State was applied at the beginning and end of the intervention. The results were statistically analyzed with the chi square test and paired t test. RESULTS There was a statistically significant decrease (p < 0.001 of the heart and respiratory mean rates after each intervention session, as well as in the inventory score. CONCLUSION Aromatherapy has demonstrated effectiveness in anxiety relief, considering the decrease of heart and respiratory rates in patients diagnosed with personality disorders during psychiatric hospitalization.
Steenen, Serge A; van Wijk, Arjen J; van der Heijden, Geert J M G; van Westrhenen, Roos; de Lange, Jan; de Jongh, Ad
The effects of propranolol in the treatment of anxiety disorders have not been systematically evaluated previously. The aim was to conduct a systematic review and meta-analysis of randomised controlled trials, addressing the efficacy of oral propranolol versus placebo or other medication as a treatment for alleviating either state or trait anxiety in patients suffering from anxiety disorders. Eight studies met the inclusion criteria. These studies concerned panic disorder with or without agoraphobia (four studies, total n = 130), specific phobia (two studies, total n = 37), social phobia (one study, n = 16), and posttraumatic stress disorder (PTSD) (one study, n = 19). Three out of four panic disorder trials qualified for pooled analyses. These meta-analyses found no statistically significant differences between the efficacy of propranolol and benzodiazepines regarding the short-term treatment of panic disorder with or without agoraphobia. Also, no evidence was found for effects of propranolol on PTSD symptom severity through inhibition of memory reconsolidation. In conclusion, the quality of evidence for the efficacy of propranolol at present is insufficient to support the routine use of propranolol in the treatment of any of the anxiety disorders.
Érica Toledo Piza Peluso
Full Text Available ABSTRACT INTRODUCTION: Dizziness is one of the most prevalent symptoms in the elderly. Anxiety and depression are common in dizzy adult patients, but there is scarce information about comorbidity between vestibular disturbances and psychiatric disorders in the aged. OBJECTIVE: To assess the prevalence of anxiety and depression disorders in elderly with chronic dizziness of vestibular origin. METHODS: Transversal study that used the Brazilian version of the Composite International Diagnostic Interview 2.1 to assess anxiety and depressive disorders in elderly patients (≥60 years old with chronic dizziness. RESULTS: Most of the 44 patients included in the study were female (88.6% with a mean age of 71 years (±7.5, 68.1% had experienced dizziness for 1 year or more. The most prevalent diagnosis was benign paroxysmal positional vertigo (52.3%. The prevalence of generalized anxiety disorder and specific phobias during life were 29.5% and 22.7%, respectively, and, in the last 12 months, 18.2% and 15.9%. There was no patient with panic disorder, agoraphobia or social phobia. The prevalence of depressive disorder during life was 45.4%, and, in the last 12 months, were 11.3%. CONCLUSION: Aged patients with chronic dizziness had high prevalence of some mental disorders.
This qualitative phenomenological study explored the experiences of four children with\\ud Autistic Spectrum Disorder (ASD) and anxiety (aged 10-13 years) who took part in a\\ud mindfulness-based intervention. The research was conducted within a local authority in\\ud times of reform in both education and mental health. A systematic literature review\\ud indicated that the majority of children with ASD experience difficulties with attention,\\ud anxiety, empathy, comprehension and communication wi...
Muris, Peter; Brakel, Anna; Arntz, Arnoud; Schouten, Erik
textabstractThis longitudinal study examined the additive and interactive effects of behavioral inhibition and a wide range of other vulnerability factors in the development of anxiety problems in youths. A sample of 261 children, aged 5 to 8 years, 124 behaviorally inhibited and 137 control children, were followed during a 3-year period. Assessments took place on three occasions to measure children's level of behavioral inhibition, anxiety disorder symptoms, other psychopathological symptoms...
Nolte, Tobias; Guiney, Jo; Fonagy, Peter; Mayes, Linda C; Luyten, Patrick
Anxiety disorders represent a common but often debilitating form of psychopathology in both children and adults. While there is a growing understanding of the etiology and maintenance of these disorders across various research domains, only recently have integrative accounts been proposed. While classical attachment history has been a traditional core construct in psychological models of anxiety, contemporary attachment theory has the potential to integrate neurobiological and behavioral findings within a multidisciplinary developmental framework. The current paper proposes a modern attachment theory-based developmental model grounded in relevant literature from multiple disciplines including social neuroscience, genetics, neuroendocrinology, and the study of family factors involved in the development of anxiety disorders. Recent accounts of stress regulation have highlighted the interplay between stress, anxiety, and activation of the attachment system. This interplay directly affects the development of social-cognitive and mentalizing capacities that are acquired in the interpersonal context of early attachment relationships. Early attachment experiences are conceptualized as the key organizer of a complex interplay between genetic, environmental, and epigenetic contributions to the development of anxiety disorders - a multifactorial etiology resulting from dysfunctional co-regulation of fear and stress states. These risk-conferring processes are characterized by hyperactivation strategies in the face of anxiety. The cumulative allostatic load and subsequent "wear and tear" effects associated with hyperactivation strategies converge on the neural pathways of anxiety and stress. Attachment experiences further influence the development of anxiety as potential moderators of risk factors, differentially impacting on genetic vulnerability and relevant neurobiological pathways. Implications for further research and potential treatments are outlined.
Full Text Available Anxiety disorders represent a common but often debilitating form of psychopathology in both children and adults. While there is a growing understanding of the aetiology and maintainance of these disorders across various research domains, only recently have integrative accounts been proposed. While classical attachment history has been a traditional core construct in psychological models of anxiety, contemporary attachment theory has the potential to integrate neurobiological and behavioral findings within a multidisciplinary developmental framework.The current paper proposes a modern attachment theory-based developmental model grounded in relevant literature from multiple disciplines including social neuroscience, genetics, neuroendocrinology, and the study of family factors involved in the development of anxiety disorders. Recent accounts of stress regulation have highlighted the interplay between stress, anxiety and activation of the attachment system. This interplay directly affects the development of social cognitive and mentalizing capacities that are acquired in the interpersonal context of early attachment relationships. Early attachment experiences are conceptualised as the key organiser of a complex interplay between genetic, environmental and epigentic contributions to the development of anxiety disorders – a multifactorial aetiology resulting from dysfunctional co-regulation of fear and stress states. These risk-conferring processes are characterised by hyperactivation strategies in the face of anxiety.In the model, the cumulative allostatic load and subsequent wear and tear effects associated with hyperactivation strategies converge on the neural pathways of anxiety and stress. Attachment experiences further influence the development of anxiety as potential moderators of risk factors, differentially impacting on genetic vulnerability and relevant neurobiological pathways. Implications for further research and potential treatments
Relapse prevention and residual symptoms: a closer analysis of placebo-controlled continuation studies with escitalopram in major depressive disorder, generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder
Bech, Per; Lönn, Sara L; Overø, Kerstin F
-Severity of Illness scores and relapse status in 4 studies published from 2005 to 2007, 1 each in major depressive disorder (MDD), generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD), were analyzed using mixed-effects model repeated measures as a function of Montgomery......-Asberg Depression Rating Scale (MADRS) scores on items 1, 3, and 7 at randomization. RESULTS: All studies showed a statistically significant (P symptoms (MADRS score...... > 0) and without residual symptoms (MADRS score = 0) at the start of continuation treatment were defined by how patients scored on 3 core items of the MADRS: depressed mood (observed), inner or psychic tension, and lassitude. At randomization, patients with a residual symptom were globally more ill...
Otowa, Takeshi; Hek, Karin; Lee, Minyoung; Byrne, Enda M.; Mirza, Saira S.; Nivard, Michel G.; Bigdeli, Timothy; Aggen, Steven H.; Adkins, Daniel; Wolen, Aaron; Fanous, Ayman; Keller, Matthew C.; Castelao, Enrique; Kutalik, Zoltan; Van der Auwera, Sandra; Homuth, Georg; Nauck, Matthias; Teumer, Alexander; Milaneschi, Yuri; Hottenga, Jouke-Jan; Direk, Nese; Hofman, Albert; Uitterlinden, Andre; Mulder, Cornelis L.; Henders, Anjali K.; Medland, Sarah E.; Gordon, Scott; Heath, Andrew C.; Madden, Pamela A.F.; Pergadia, Michelle; van der Most, Peter J.; Nolte, Ilja M.; van Oort, Floor V.A.; Hartman, Catharina A.; Oldehinkel, Albertine J.; Preisig, Martin; Grabe, Hans Jörgen; Middeldorp, Christel M.; Penninx, Brenda WJH; Boomsma, Dorret; Martin, Nicholas G.; Montgomery, Grant; Maher, Brion S.; van den Oord, Edwin J.; Wray, Naomi R.; Tiemeier, Henning; Hettema, John M.
Anxiety disorders, namely generalized anxiety disorder, panic disorder, and phobias, are common, etiologically complex conditions with a partially genetic basis. Despite differing on diagnostic definitions based upon clinical presentation, anxiety disorders likely represent various expressions of an underlying common diathesis of abnormal regulation of basic threat-response systems. We conducted genome-wide association analyses in nine samples of European ancestry from seven large, independent studies. To identify genetic variants contributing to genetic susceptibility shared across interview-generated DSM-based anxiety disorders, we applied two phenotypic approaches: (1) comparisons between categorical anxiety disorder cases and super-normal controls, and (2) quantitative phenotypic factor scores derived from a multivariate analysis combining information across the clinical phenotypes. We used logistic and linear regression, respectively, to analyze the association between these phenotypes and genome-wide single nucleotide polymorphisms. Meta-analysis for each phenotype combined results across the nine samples for over 18 000 unrelated individuals. Each meta-analysis identified a different genome-wide significant region, with the following markers showing the strongest association: for case-control contrasts, rs1709393 located in an uncharacterized non-coding RNA locus on chromosomal band 3q12.3 (P=1.65×10−8); for factor scores, rs1067327 within CAMKMT encoding the calmodulin-lysine N-methyltransferase on chromosomal band 2p21 (P=2.86×10−9). Independent replication and further exploration of these findings are needed to more fully understand the role of these variants in risk and expression of anxiety disorders. PMID:26754954
Pavlov, Allison; Kameg, Kirstyn; Cline, Tom W; Chiapetta, Laurel; Stark, Stacy; Mitchell, Ann M
Music therapy has been identified as a non-pharmacological adjunct therapy to treat anxiety. This QI project aimed to assess the effects of music therapy on anxiety in a sample of patients hospitalized with a thought disorder. Participants were assessed pre- and post-group using a visual analog scale for anxiety. The intervention significantly reduced VAS scores from 3.1 pre-intervention to .897 immediately post-intervention (p = 0.008). This data suggests that music therapy may be beneficial in the short term for this population and is a low risk intervention that provides positive outcomes without the risks associated with medications, seclusion, and restraint.