Showing papers on "Generalized anxiety disorder published in 2003"
TL;DR: Compounds that have a different spectrum of therapeutic efficacy in anxiety disorders such as panic attacks, generalized anxiety disorder or obsessive-compulsive disorder were poorly effective as anxiolytics in the open field test, suggesting that this paradigm may not model features of anxiety disorders.
2,665 citations
TL;DR: The underlying structure of the genetic and environmental risk factors for the common psychiatric and drug abuse disorders in men and women is very similar.
Abstract: Background: Patterns of comorbidity suggest that the common psychiatric and substance use syndromes may be divisible into 2 broad groups of internalizing and externalizing disorders. We do not know how genetic and environmental risk factors contribute to this pattern of comorbidity or whether the etiologic structure of these groups differ in men and women. Methods: Lifetime diagnoses for 10 psychiatric syndromes were obtained at a personal interview in more than 5600 members of male-male and female-female twin pairs ascertained from a population-based registry. Multivariate twin modeling was performed using the program Mx. Results: We first fit models to the following 7 syndromes: major depression, generalized anxiety disorder, phobia, alcohol dependence, drug abuse/dependence, adult antisocial behavior, and conduct disorder. The full model, which could be constrained to equality in male and female subjects, identified 2 genetic factors. The first had strongest loadings on alcohol dependence, drug abuse/dependence, adult antisocial behavior, and conduct disorder; the second, on major depression, generalized anxiety disorder, and phobia. Alcohol dependence and drug abuse/dependence had substantial disorder-specific genetic risk factors. Shared environmental factors were most pronounced for conduct disorder and adult antisocial behavior. No clear internalizing/externalizing structure was seen for the unique environmental common factors. We then fit models to 5 internalizing syndromes. The full model, which could also be constrained to equality in men and women, revealed one genetic factor loading most heavily on major depression and generalized anxiety disorder and another loading most strongly on animal and situational phobia. Conclusions: The underlying structure of the genetic and environmental risk factors for the common psychiatric and drug abuse disorders in men and women is very similar. Genetic risk factors predispose to 2 broad groups of internalizing and externalizing disorders. Within the internalizing disorders, 2 genetic factors are seen that predispose to disorders dominated by anxious-misery and fear. Substance use disorders have disorder-specific genetic risks. The externalizing disorders of conduct disorder and adult antisocial behavior are significantly influenced by the shared environment. The pattern of lifetime comorbidity of common psychiatric and substance use disorders results largely from the effects of genetic risk factors. Arch Gen Psychiatry. 2003;60:929-937
1,711 citations
TL;DR: In this article, the authors examined possible sexual orientation-related differences in morbidity, distress, and mental health services use, finding that gay-bisexual men exhibited higher prevalence of depression, panic attacks, and psychological distress than heterosexual men.
Abstract: Recent estimates of mental health morbidity among adults reporting same-gender sexual partners suggest that lesbians, gay men, and bisexual individuals may experience excess risk for some mental disorders as compared with heterosexual individuals. However, sexual orientation has not been measured directly. Using data from a nationally representative survey of 2,917 midlife adults, the authors examined possible sexual orientation-related differences in morbidity, distress, and mental health services use. Results indicate that gay-bisexual men evidenced higher prevalence of depression, panic attacks, and psychological distress than heterosexual men. Lesbian-bisexual women showed greater prevalence of generalized anxiety disorder than heterosexual women. Services use was more frequent among those of minority sexual orientation. Findings support the existence of sexual orientation differences in patterns of morbidity and treatment use.
1,023 citations
TL;DR: The present article focuses in particular upon the multifarious and complex roles of individual modulators, often as a function of the specific receptor type and neuronal substrate involved in their actions; novel targets for the management of anxiety disorders; the influence of neurotransmitters and other agents upon performance in the VCT; data acquired from complementary pharmacological and genetic strategies and, finally, several open questions likely to orientate future experimental- and clinical-research.
926 citations
TL;DR: Religiosity is a complex, multidimensional construct with substantial associations with lifetime psychopathology, and some dimensions of religiosity are related to reduced risk specifically for internalizing disorders, and others to reducedrisk specifically for externalizing disorders while still others are less specific in their associations.
Abstract: Objective: The role of religion in mental illness remains understudied. Most prior investigations of this relationship have used measures of religiosity that do not reflect its complexity and/or have examined a small number of psychiatric outcomes. This study used data from a general population sample to clarify the dimensions of religiosity and the relationships of these dimensions to risk for lifetime psychiatric and substance use disorders. Method: Responses to 78 items assessing various aspects of broadly defined religiosity were obtained from 2,616 male and female twins from a general population registry. The association between the resulting religiosity dimensions and the lifetime risk for nine disorders assessed at personal interview was evaluated by logistic regression. Of these disorders, five were “internalizing” (major depression, phobias, generalized anxiety disorder, panic disorder, and bulimia nervosa), and four were “externalizing” (nicotine dependence, alcohol dependence, drug abuse or dependence, and adult antisocial behavior). Results: Seven factors were identified: general religiosity, social religiosity, involved God, forgiveness, God as judge, unvengefulness, and thankfulness. Two factors were associated with reduced risk for both internalizing and externalizing disorders (social religiosity and thankfulness), four factors with reduced risk for externalizing disorders only (general religiosity, involved God, forgiveness, and God as judge), and one factor with reduced risk for internalizing disorders only (unvengefulness). Conclusions: Religiosity is a complex, multidimensional construct with substantial associations with lifetime psychopathology. Some dimensions of religiosity are related to reduced risk specifically for internalizing disorders, and others to reduced risk specifically for externalizing disorders, while still others are less specific in their associations. These results do not address the nature of the causal link between religiosity and risk for illness.
535 citations
TL;DR: The psychometric properties of the Spence Children's Anxiety Scale were examined with 875 adolescents and showed support for a model in which the first-order factors loaded significantly on a single second-order factor of anxiety in general.
519 citations
TL;DR: The need for screening and treatment for mental health and substance use problems among HIV-positive patients to improve adherence to antiretroviral medications is suggested.
395 citations
TL;DR: It may be that sex differences in the clinical course of anxiety disorders hold prognostic implications for patients with these illnesses and support nosological distinctions among the various types of anxiety.
Abstract: Anxiety disorders are chronic illnesses that occur more often in women than men. Previously, we found a significant sex difference in the 5-year clinical course of uncomplicated panic disorder that was attributable to a doubling of the illness relapse rate in women compared to men. However, we have not detected a sex difference in the clinical course of panic with agoraphobia, generalized anxiety disorder (GAD), or social phobia (SP), which are conditions generally thought to be more chronic than uncomplicated panic disorder. Given that a longer follow-up period may be required to detect differences in clinical course for more enduring illnesses, we conducted further analyses on this same cohort after a more protracted interval of observation to determine whether sex differences would emerge or be sustained. Data were analyzed from the Harvard/Brown Anxiety Research Program (HARP), a naturalistic, longitudinal study that repeatedly assessed patients at 6 to 12 month intervals over the course of 8 years. Data regarding remission and relapse status were collected from 558 patients and treatment was observed but not prescribed. Cumulative remission rates were equivalent among men and women with all diagnoses. Patients who experienced remission were more likely to improve during the first 2 years of study. Women with GAD continued remitting late into the observation period and experienced fewer overall remission events by 8 years. However, the difference in course failed to reach statistical significance. Relapse rates for women were comparable to those for men who suffered from panic disorder with agoraphobia, GAD, and SP. Again, initial relapse events were more likely to occur within the first 2 years of observation. However, relapse events for uncomplicated panic in women were less restricted to the first 2 years of observation and by 8 years, the relapse rates for uncomplicated panic was 3-fold higher in women compared with men. Anxiety disorders are chronic in the majority of men and women, although uncomplicated panic is characterized by frequent remission and relapse events. Short interval follow-up shows sex differences in the remission and relapse rates for some but not all anxiety disorders. These findings suggest important differences in the clinical course among the various anxiety disorders and support nosological distinctions among the various types of anxiety. It may be that sex differences in the clinical course of anxiety disorders hold prognostic implications for patients with these illnesses.
361 citations
TL;DR: This study investigated theoretical claims that different emotional disorders are associated with different patterns of cognitive bias, both in terms of the cognitive processes involved and the stimulus content that is preferentially processed by comparing clinically anxious and clinically depressed children and adolescents on a range of cognitive tasks.
Abstract: This study investigated theoretical claims that different emotional disorders are associated with different patterns of cognitive bias, both in terms of the cognitive processes involved and the stimulus content that is preferentially processed. These claims were tested by comparing clinically anxious (generalized anxiety disorder [GAD], posttraumatic stress disorder [PTSD]) and clinically depressed children and adolescents on a range of cognitive tasks measuring attention, memory, and prospective cognition, with both threat-related and depressogenic stimulus materials. The results did reveal some relative specificity of processing in that the anxious participants exhibited a greater selective attentional bias for threat relative to depressogenic material with no such difference being apparent in the depressed sample. However, this bias was only clear-cut on a dot-probe measure of attentional processing and not on a modified Stroop measure, and indeed threat-related bias on the 2 tasks was uncorrelated. On the prospective cognition task, anxious participants exhibited an other-referent bias in their risk estimations regarding future negative events that was absent in the depressed sample. No specificity effects were evident on the memory task. The results are discussed in terms of the strengths and weaknesses of carrying out direct comparisons across groups and tasks versus drawing conclusions from overall patterns across multiple studies.
337 citations
TL;DR: Familiarity of the anxiety at intake and positive family history for anxiety predicted poorer functioning at the end of the study, and fluoxetine was useful and well tolerated except for mild and transient headaches and gastrointestinal side effects.
Abstract: Objective To assess the efficacy and tolerability of fluoxetine for the acute treatment of children and adolescents with generalized anxiety disorder, separation anxiety disorder, and/or social phobia. Method Anxious youths (7–17 years old) who had significant functional impairment were randomized to fluoxetine (20 mg/day) ( n = 37) or placebo ( n = 37) for 12 weeks. Results Fluoxetine was effective in reducing the anxiety symptoms and improving functioning in all measures. Using intent-to-treat analysis, 61% of patients taking fluoxetine and 35% taking placebo showed much to very much improvement. Despite this improvement, a substantial group of patients remained symptomatic. Fluoxetine was well tolerated except for mild and transient headaches and gastrointestinal side effects. Youths with social phobia and generalized anxiety disorder responded better to fluoxetine than placebo, but only social phobia moderated the clinical and functional response. Severity of the anxiety at intake and positive family history for anxiety predicted poorer functioning at the end of the study. Conclusions Fluoxetine is useful and well tolerated for the acute treatment of anxious youths. Investigations regarding the optimization of treatment to obtain full anxiety remission and the length of treatment necessary to prevent recurrences are warranted.
337 citations
TL;DR: Functional neuroimaging studies indicate that certain and uncertain expectation are mediated by different neural pathways-the former having been associated with activity in the rostral anterior cingulate cortex and posterior cerebellum, the latter with activation changes in the ventromedial prefrontal cortex and mid-cingulate cortex.
TL;DR: The findings are consistent with and extend the findings of previous reports by providing the first available information on the association between physician-diagnosed asthma and DSM-IV mental disorders in a representative sample of adults.
Abstract: specific phobia (OR, 2.93; 95% CI, 1.71-5.0), generalized anxiety disorder (OR, 5.51; 95% CI, 2.29-13.22), and bipolar disorder (OR, 5.64; 95% CI, 1.95-16.35). Current nonsevere asthma was associated with the increased likelihood of any affective disorder (OR, 2.42; 95% CI, 1.03-5.72); and lifetime nonsevere asthma was associated with increased odds of any anxiety disorder (OR, 1.51; 95% CI, 1.0-2.32), anxiety disorder not otherwise specified (OR, 2.08; 95% CI, 1.03-4.23), and any somatoform disorder (OR, 1.7; 95% CI, 1.14-2.53). Conclusions:Toourknowledge,thesefindingsareconsistent with and extend the findings of previous reports by providing the first available information on the associationbetweenphysician-diagnosedasthmaandDSM-IV mental disorders in a representative population sample of adults. Our results suggest an association between asthmaandarangeofmentaldisorders.Longitudinalstudies that can examine the sequence of onset and the role of genetic and environmental factors in the association between asthma and affective and anxiety disorders are needed next to further elucidate possible shared causative mechanisms. Arch Gen Psychiatry. 2003;60:1125-1130
TL;DR: The prevalence of anxiety disorders in patients with chronic obstructive pulmonary disease (COPD) as well as the impact of comorbid anxiety on quality of life in Patients with COPD are reviewed.
Abstract: Objective This article reviews the prevalence of anxiety disorders in patients with chronic obstructive pulmonary disease (COPD) as well as the impact of comorbid anxiety on quality of life in patients with COPD. Published studies on three types of treatments for anxiety are then reviewed: psychopharmacology, psychotherapy, and pulmonary rehabilitation programs. Materials and methods A PubMed search was conducted of the literature from 1966 through 2002 using the keywords anxiety, chronic obstructive pulmonary disease, respiratory diseases, obstructive lung diseases, and pulmonary rehabilitation. Any articles that discussed the prevalence of anxiety symptoms or anxiety disorders among patients with COPD, the impact of anxiety on patients with COPD, or the treatment of anxiety in COPD patients were included in this review. Results Anxiety disorders, especially generalized anxiety disorder (GAD) and panic disorder, occur at a higher rate in patients with COPD compared with the general population. Not surprisingly, anxiety has a significant and negative impact on quality of life of COPD patients. Nonetheless, few studies have examined pharmacological, psychotherapeutic, or pulmonary rehabilitation treatments for anxiety disorders in the context of COPD. Trials of nortriptyline, buspirone, and sertraline have been found to reduce symptoms of anxiety. Similarly, cognitive-behavioral programs that focus on relaxation and changes in thinking also produced declines in anxious symptoms. Finally, multicomponent pulmonary rehabilitation programs can also result in reductions in anxious symptoms. Conclusions Studies examining the treatment of anxiety disorders in patients with COPD are promising, yet their efficacy needs to be established. The long-term effects of treatment of anxiety disorders on quality of life of COPD patients have yet to be explored.
TL;DR: The present study examined the usefulness of the Penn State Worry Questionnaire as a means of screening for generalized anxiety disorder (GAD) using receiver operating characteristic analyses and found the accuracy of the PSWQ in screening for GAD was examined.
TL;DR: Results show that the treatment group, relative to the wait-list group, had greater posttest improvement on all dependent variables and that treated participants made further gains over the 2-year follow-up phase of the study.
Abstract: A recently developed cognitive-behavioral treatment for generalized anxiety disorder (GAD) targets intolerance of uncertainty by the reevaluation of positive beliefs about worry, problem-solving training, and cognitive exposure. As previous studies have established the treatment's efficacy when delivered individually, the present study tests the treatment in a group format as a way to enhance its cost-benefit ratio. A total of 52 GAD patients received 14 sessions of cognitive-behavioral therapy in small groups of 4 to 6 participants. A wait-list control design was used, and standardized clinician ratings and self-report questionnaires assessed GAD symptoms, intolerance of uncertainty, anxiety, depression, and social adjustment. Results show that the treatment group, relative to the wait-list group, had greater posttest improvement on all dependent variables and that treated participants made further gains over the 2-year follow-up phase of the study.
TL;DR: It is concluded that research with young children will benefit from more specific assessments of anxiety-related behaviours in addition to less differentiated assessments of 'internalising' symptoms, as evidence for phenotypic and genetic overlap as well as differentiation between aspects of anxious behaviours in young children is provided.
Abstract: Background: From middle childhood onwards, substantial evidence points to phenotypic differentiation between anxiety diagnostic categories such as generalised anxiety, separation anxiety, specific phobia, and obsessive-compulsive disorders. However, little is known about the genetics of these categories and especially about the phenotypic and genetic structure of related behaviours in pre-school children. Methods: We examined the phenotypic differentiation and genetics of mother-reported anxiety-related behaviours in 4,564 four-year-old twin pairs, from a population-based sample. Results: Confirmatory factor analyses provided support for five correlated factors: General Distress, Separation Anxiety, Fears, Obsessive-Compulsive Behaviours, and Shyness/Inhibition. Genetic influences were found on all five factors, but the pattern of influences differed considerably across them, with particularly high heritability estimates for Obsessive-Compulsive Behaviours and Shyness/Inhibition, and substantial shared environmental influence on Separation Anxiety. Multivariate genetic analyses revealed moderate genetic correlations between the five factors. Genetic overlap was particularly pronounced between General Distress and the other anxiety-related behaviours, accounting for about half of their covariance. Genetic variance on Obsessive-Compulsive Behaviours was the least correlated with the other scales. The shared environmental influences correlated highly across the factors, accounting for the greatest proportion of covariation between Separation Anxiety, Fears and Obsessive-Compulsive Behaviours. The non-shared environment influences were largely variable specific. Conclusions: These data provide evidence for phenotypic and genetic overlap as well as differentiation between aspects of anxiety-related behaviours in young children. We conclude that research with young children will benefit from more specific assessments of anxiety-related behaviours in addition to less differentiated assessments of 'internalising' symptoms.
TL;DR: Overall, the authors found that women with phobias had better outcomes and that men with psychiatric disorders in general, men with major depression, and men with antisocial personality disorder had worse outcomes.
Abstract: OBJECTIVE: Previous research has demonstrated that psychiatric disorders are common among people who abuse alcohol and drugs, but few studies have examined the relationship of psychiatric disorders to drug treatment outcome. The authors conducted such an examination. METHOD: They successfully reinterviewed 401 drug-dependent subjects (94% of the baseline in-treatment sample) and determined their drug abuse status at follow-up 12 months later. RESULTS: Analyses indicated that several baseline psychiatric disorders predicted worse outcomes at follow-up. Major depression predicted using a larger number of substances and having more drug dependence diagnoses and symptoms. Alcohol dependence predicted more dependence diagnoses, antisocial personality disorder predicted using a larger number of substances, and generalized anxiety disorder predicted having more dependence diagnoses. Outcomes among men were more closely associated with psychiatric status than outcomes among women, except for phobias, which predic...
TL;DR: Pregabalin is an effective, rapidly acting, and safe treatment for generalized anxiety disorder in short-term treatment and does not appear to have the withdrawal symptoms associated with the benzodiazepines.
Abstract: Objective: Current drug therapies for generalized anxiety disorder have limitations. In a controlled trial, the novel agent pregabalin was studied for the treatment of patients with generalized anxiety disorder.
TL;DR: Anxiety disorders were associated with a specific pattern of cardiac disorders, hypertension, gastrointestinal problems, genitourinary difficulties, and migraine; individuals presenting with anxiety disorders or medical illness need therefore to be evaluated carefully for comorbidity.
Abstract: In contrast to the literature on the association of
depression with medical illness, less is known about the
comorbidity among anxiety and somatic disorders. Although
associations between anxiety disorders and medical illnesses
have been reported, prior studies have not adjusted for the
effects of gender, substance abuse/dependence, and depression.
This study examined the patterns of comorbidity of anxiety
disorders and physical illnesses. A total of 262 probands were selected from treatment
settings or were randomly recruited from the community.
DSM-III-R diagnoses were obtained based on direct interview
(SADS) or family history information, and lifetime history of
numerous medical illnesses were obtained. Patients with a lifetime anxiety disorder reported higher
rates of several medical illnesses than did persons without
anxiety. After controlling for the effects of gender, comorbid
substance abuse/dependence and/or depression, significant
associations were found between anxiety disorder and cardiac
disorders (OR = 4.6), hypertension (OR = 2.4), gastrointestinal
problems (OR = 2.4), genitourinary disorders (OR = 3.5), and
migraine (OR = 5.0). A similar pattern was observed for probands
with panic or generalized anxiety disorder (GAD). Anxiety disorders were associated with a specific pattern
of cardiac disorders, hypertension, gastrointestinal problems,
genitourinary difficulties, and migraine; individuals presenting
with anxiety disorders or medical illness need therefore to be
evaluated carefully for comorbidity.
TL;DR: The hypothesis that pregabalin is effective and safe in short-term therapy for GAD is supported and more studies are needed to determine the best dosing regimen to optimize efficacy and tolerability.
Abstract: Pregabalin is a novel compound under development for the treatment of several types of anxiety disorders. To obtain an initial evaluation of the efficacy and safety of pregabalin in the treatment of generalized anxiety disorder (GAD), we conducted a double-blind, fixed-dose, parallel-group, placebo and active-controlled multicenter 4-week study that compared 271 patients randomized to receive pregabalin 50 mg tid (N = 70), pregabalin 200 mg tid (N = 66), placebo (N = 67), or lorazepam 2 mg tid (N = 68), followed by a 1-week double-blind taper. The primary efficacy parameter was change from baseline to endpoint (last observation carried forward) in the Hamilton Anxiety Scale (HAM-A) total score; adjusted mean change scores on the HAM-A were significantly improved for pregabalin 200 mg tid (difference of 3.90 between drug and placebo; p = 0.0013 [ANCOVA], df = 252) and for lorazepam (difference of 2.35; p = 0.0483 [ANCOVA], df = 252), with the significant difference between the pregabalin 200 mg tid and placebo groups seen at week 1 of treatment (p = 0.0001 [ANCOVA], df = 238). Safety analysis, which included assessment of spontaneously reported adverse events, laboratory monitoring, and withdrawal symptoms, showed pregabalin to be generally well-tolerated. The most common adverse events seen with pregabalin 200 mg tid were somnolence and dizziness. They were usually mild or moderate in intensity and were often transient. Pregabalin-treated patients had a higher completion rate than lorazepam-treated patients. This study supports the hypothesis that pregabalin is effective and safe in short-term therapy for GAD. More studies are needed to determine the best dosing regimen to optimize efficacy and tolerability.
TL;DR: Results support the use of the PSWQ in screening individuals likely to meet criteria for GAD who present for treatment at an anxiety disorders specialty clinic.
TL;DR: Results of both completer and intent-to-treat analyses revealed significant improvement in worry, anxiety, depression, and quality of life following CBT relative to MCC, but posttreatment scores for patients in CBT failed to indicate return to normative functioning.
Abstract: This study addressed the efficacy of cognitive-behavioral therapy (CBT), relative to minimal contact control (MCC), in a sample of 85 older adults (age 60 years and over) with generalized anxiety disorder (GAD). All participants completed measures of primary outcome (worry and anxiety), coexistent symptoms (depressive symptoms and specific fears), and quality of life. Results of both completer and intent-to-treat analyses revealed significant improvement in worry, anxiety, depression, and quality of life following CBT relative to MCC. Forty-five percent of patients in CBT were classified as responders, relative to 8% in MCC. Most gains for patients in CBT were maintained or enhanced over 1-year follow-up. However, posttreatment scores for patients in CBT failed to indicate return to normative functioning.
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TL;DR: Increased recognition of anxiety disorders among patients with epilepsy and evaluation of the potential impact of these disorders on functional outcome and the beneficial and detrimental effects of antiepileptic drugs in clinical practice are needed.
TL;DR: In this paper, older adults with generalized anxiety disorder (GAD) were randomly assigned to cognitive-behavioral therapy (CBT), a discussion group (DG) organized around worry-provoking topics, or a waiting period.
Abstract: Older adults with generalized anxiety disorder (GAD; N = 75; M age = 67.1 years) were randomly assigned to cognitive-behavioral therapy (CBT), a discussion group (DG) organized around worry-provoking topics, or a waiting period. Participants in both active conditions improved relative to the waiting list. Although CBT participants improved on more measures than DG participants, the authors found only I significant difference immediately after treatment and no differences at 6-month follow-up. Effect sizes were smaller than in younger samples, but CBT showed large effects and DG showed medium-sized effects Overall, results indicate that brief treatment of late-life GAD is beneficial, but they provide only limited support for the superiority of CBT to a credible comparison intervention.
TL;DR: Investigation concerning the unique features present in women with anxiety disorders are needed and may represent the best strategy to increase identification and optimize treatment interventions for women afflicted with these long-neglected psychiatric disorders.
Journal Article•
TL;DR: Proposed models for the neural circuitry of normal anxiety as well as the anxiety disorders are discussed.
Abstract: Present understanding of the neural circuitry of anxiety has come from a variety of sources, including animal, clinical, and most recently, neuroimaging studies. Evidence from these sources has converged to form a translational bridge from animal models to human pathophysiology. In particular, the classical fear conditioning paradigm has served as a foundation for this bridge. Proposed models for the neural circuitry of normal anxiety as well as the anxiety disorders are discussed. A brief review of specific findings from neuroimaging studies of posttraumatic stress disorder, specific phobia, social phobia, obsessive-compulsive disorder, and generalized anxiety disorder is also provided.
TL;DR: Affective spectrum disorder aggregates strongly in families, and MDD displays a significant familial coaggregation with other forms of ASD, taken collectively, suggest that forms of ASD may share heritable pathophysiologic features.
Abstract: Background: Affective spectrum disorder (ASD) represents a group of psychiatric and medical conditions, each known to respond to several chemical families of antidepressantmedicationsandhencepossiblylinkedby common heritable abnormalities. Forms of ASD include major depressive disorder (MDD), attention-deficit/ hyperactivity disorder, bulimia nervosa, cataplexy, dysthymic disorder, fibromyalgia, generalized anxiety disorder, irritable bowel syndrome, migraine, obsessivecompulsivedisorder,panicdisorder,posttraumaticstress disorder,premenstrualdysphoricdisorder,andsocialphobia. Two predictions of the ASD hypothesis were tested: thatASD,takenasasingleentity,wouldaggregateinfamilies and that MDD would coaggregate with other forms of ASD in families. Methods: Probands with and without MDD, together with their first-degree relatives, were interviewed using theStructuredClinicalInterviewforDSM-IVandasupplementalinterviewforotherformsofASD.Thefamilialaggregation and coaggregation of disorders were analyzed using proband predictive logistic regression models, including a novel bivariate model for the presence or absence of each of 2 disorders in a relative as predicted by the presence or absence of each of 2 disorders in the associated proband. Results: In the 178 interviewed relatives of 64 probands with MDD and 152 relatives of 58 probands without MDD, the estimated odds ratio (95% confidence interval)forthefamilialaggregationofASDasawholewas 2.5 (1.4-4.3; P=.001) and for the familial coaggregation ofMDDwithatleastoneotherformofASDwas1.9(1.13.2; P=.02). Conclusions: Affective spectrum disorder aggregates strongly in families, and MDD displays a significant familial coaggregation with other forms of ASD, taken collectively. These results suggest that forms of ASD may share heritable pathophysiologic features. Arch Gen Psychiatry. 2003;60:170-177
TL;DR: Postpartum generalized anxiety has a higher prevalence than postpartum depression, and nearly one third of these women endorsed symptoms of depression.
Abstract: Objective: This study investigated the prevalence and nature of generalized anxiety symptoms in women who were eight weeks postpartum.
Method: A community-based sample of 68 postpartum women completed an interview assessing generalized anxiety disorder and depression and a self-report measure of worry associated with concerns relevant to postpartum women.
Results: Three women (4.4%) met DSM-IV criteria for generalized anxiety disorder, and an additional 19 women (27.9%) endorsed subsyndromal difficulties with generalized anxiety. Approximately one third of these women endorsed symptoms of depression. In contrast, only two woman met criteria for major depressive disorder.
Conclusion: Postpartum generalized anxiety has a higher prevalence than postpartum depression.
TL;DR: It is demonstrated that paroxetine is an efficacious and well-tolerated treatment for generalized anxiety disorder and for all three domains of the Sheehan Disability Scale, significantly greater improvement was seen with parxetine than placebo.
Abstract: Objective: This study assessed the efficacy of two fixed doses of paroxetine in the treatment of generalized anxiety disorder. Method: Outpatients (N=566) with generalized anxiety disorder and no other axis I disorder were eligible if they scored ≥20 on the Hamilton Rating Scale for Anxiety (with a score of 2 or higher on the anxious mood and tension items). Following a 1-week placebo run-in phase, patients were randomly assigned to 8 weeks of treatment with paroxetine, 20 or 40 mg/day, or placebo. The primary outcome measure was the change from baseline in total score on the Hamilton anxiety scale. Response was defined as a rating of “very much improved” or “much improved” on the Clinical Global Impression global improvement measure; remission was defined as a Hamilton anxiety scale score ≤7. Change in functional impairment was measured with the Sheehan Disability
TL;DR: Investigated differences in comorbidity in children ages 8 to 13 with primary diagnoses of generalized anxiety disorder, separation anxiety disorder (SAD), or social phobia (SP), and found children with primary SAD were found to have the highest number ofComorbid diagnoses.
Abstract: Investigated differences in comorbidity in children ages 8 to 13 (N = 199) with primary diagnoses of generalized anxiety disorder (GAD), separation anxiety disorder (SAD), or social phobia (SP). Children with primary SAD were found to have the highest number of comorbid diagnoses. Specific phobias were more common in children with primary SAD than in those with primary SP, whereas neither group differed from children with primary GAD. Mood disorders were more common in children with GAD or SP than in children with primary SAD. Comorbid externalizing disorders, although present in 17% of the sample, were not found to vary across diagnostic groups. Functional enuresis was most common in children with primary SAD. Results are discussed with respect to diagnostic and treatment issues.