Showing papers on "Generalized anxiety disorder published in 2007"
TL;DR: A large primary carebased anxiety study is analyzed to ascertain commonalities among anxiety diagnoses that are traditionally considered to be discrete and to determine whether a single measure can be used as a first step, common metric.
Abstract: Anxiety is as common as depression; however, it has received less attention and is often undetected and undertreated. The authors administered a 7-item anxiety scale to 965 primary care patients, w...
3,090 citations
01 Feb 2007
TL;DR: Combination Pharmacotherapy and Psychotherapy for the Treatment of Major Depressive and Anxiety Disorders and their Combination with Medication is combined.
Abstract: 1. Childhood Attention-Deficit / Hyperactivity Disorder: Nonpharmacologic Treatments and their Combination with Medication 2. Pharmacological Treatments for Attention Deficit / Hyperactivity Disorder 3. Psychosocial Treatments for Conduct Disorder in Children and Adolescents 4. Treatments for Dementia 5. Psychopharmacological Treatments for Substance Use Disorders 6. Psychosocial Treatments for Substance Use Disorders 7. Pharmacological Treatment of Schizophrenia 8. Psychosocial Treatments for Schizophrenia 9. Pharmacological Treatments for Unipolar Depression 10. Psychosocial Treatments for Major Depressive Disorder 11. Psychosocial Treatments for Bipolar Disorder 12. Pharmacological Treatments for Bipolar Disorder 13. Psychological Treatments for Panic Disorders, Phobias, and Generalized Anxiety Disorder 14. Pharmacological Treatments for Panic Disorder, Generalized Anxiety Disorder, Specific Phobia, and Social Anxiety Disorder 15. Cognitive-Behavioral Treatment of Obsessive- Compulsive Disorder 16. Pharmacological Treatment for Obsessive-Compulsive Disorder 17. Psychopharmacological Treatment of Posttraumatic Stress Disorder 18. Psychosocial Treatments for Posttraumatic Stress Disorder 19. Psychotherapy and Pharmacotherapy for Sexual Dysfunctions 20. Treatments for Pathological Gambling and Other Impulse Control Disorders 21. Treatments for Eating Disorders 22. Treatments for Insomnia and Restless Legs Syndrome 23. Psychological Treatments for Personality Disorders 24. Psychopharmacological Treatment of Personality Disorders 25. Combination Pharmacotherapy and Psychotherapy for the Treatment of Major Depressive and Anxiety Disorders
1,066 citations
TL;DR: It appears that children meriting a well-defined diagnosis of GAD are missed by the current rules for the diagnosis of OAD, and future studies should examine whether OAD deserves reconsideration as a nosological entity.
Abstract: Background: Few longitudinal studies of child and adolescent psychopathology have examined the links between specific childhood anxiety disorders and adolescent psychiatric disorder. In this paper we test the predictive specificity of separation anxiety disorder (SAD), overanxious disorder (OAD), generalized anxiety disorder (GAD), and social phobia.
Methods: Data come from the Great Smoky Mountains Study (GSMS). A representative population sample of children – ages 9, 11, and 13 years at intake – was followed to age 19. Diagnoses of both childhood (before age 13 years) and adolescent psychiatric disorders (age 13 to 19 years) were available from 906 participants.
Results: Childhood SAD predicted adolescent SAD, whereas OAD was associated with later OAD, panic attacks, depression and conduct disorder (CD). GAD was related only to CD. Social phobia in childhood was associated with adolescent OAD, social phobia, and attention-deficit/hyperactivity disorder (ADHD).
Conclusions: Anxiety disorders in childhood are predictors of a range of psychiatric disorders in adolescence. It appears that children meriting a well-defined diagnosis are missed by the current rules for the diagnosis of GAD. Future studies should examine whether OAD deserves reconsideration as a nosological entity.
657 citations
TL;DR: Initial clinical testing indicates that the GAI is a new 20-item self-report or nurse-administered scale that measures dimensional anxiety in elderly people that has sound psychometric properties and is able to discriminate between those with and without any anxiety disorder and between those without and without DSM-IV GAD.
Abstract: Background: Anxiety symptoms and anxiety disorders are highly prevalent among elderly people, although infrequently the subject of systematic research in this age group. One important limitation is the lack of a widely accepted instrument to measure dimensional anxiety in both normal old people and old people with mental health problems seen in various settings. Accordingly, we developed and tested of a short scale to measure anxiety in older people. Methods:We generated a large number of potential items de novo and by reference to existing anxiety scales, and then reduced the number of items to 60 through consultation with a reference group consisting of psychologists, psychiatrists and normal elderly people. We then tested the psychometric properties of these 60 items in 452 normal old people and 46 patients attending a psychogeriatric service. We were able to reduce the number of items to 20. We chose a 1-week perspective and a dichotomous response scale. Results: Cronbach's alpha for the 20-item Geriatric Anxiety Inventory (GAI) was 0.91 among normal elderly people and 0.93 in the psychogeriatric sample. Concurrent validity with a variety of other measures was demonstrated in both the normal sample and the psychogeriatric sample. Inter-rater and test-retest reliability were found to be excellent. Receiver operating characteristic analysis indicated a cut-point of 10/11 for the detection of DSM-IV Generalized Anxiety Disorder (GAD) in the psychogeriatric sample, with 83% of patients correctly classified with a specificity of 84% and a sensitivity of 75%. Conclusions: The GAI is a new 20-item self-report or nurse-administered scale that measures dimensional anxiety in elderly people. It has sound psychometric properties. Initial clinical testing indicates that it is able to discriminate between those with and without any anxiety disorder and between those with and without DSM-IV GAD.
633 citations
TL;DR: Challenging the prevailing notion that generalized anxiety usually precedes depression and eventually develops into depression, these findings show that the reverse pattern occurs almost as often.
Abstract: Context The close association between generalized anxiety disorder (GAD) and major depressive disorder (MDD) prompts questions about how to characterize this association in future diagnostic systems. Most information about GAD-MDD comorbidity comes from patient samples and retrospective surveys. Objective To revisit the sequential and cumulative comorbidity between GAD and MDD using data from a prospective longitudinal cohort. Design Prospective longitudinal cohort study. Setting New Zealand. Participants The representative 1972-1973 Dunedin birth cohort of 1037 members was followed up to age 32 years with 96% retention. Main Outcome Measures Research diagnoses of anxiety and depression were made at ages 11, 13, 15, 18, 21, 26, and 32 years. Mental health services were reported on a life history calendar. Results Sequentially, anxiety began before or concurrently in 37% of depression cases, but depression began before or concurrently in 32% of anxiety cases. Cumulatively, 72% of lifetime anxiety cases had a history of depression, but 48% of lifetime depression cases had anxiety. During adulthood, 12% of the cohort had comorbid GAD + MDD, of whom 66% had recurrent MDD, 47% had recurrent GAD, 64% reported using mental health services, 47% took psychiatric medication, 8% were hospitalized, and 11% attempted suicide. In this comorbid group, depression onset occurred first in one third of the participants, anxiety onset occurred first in one third, and depression and anxiety onset began concurrently in one third. Conclusions Challenging the prevailing notion that generalized anxiety usually precedes depression and eventually develops into depression, these findings show that the reverse pattern occurs almost as often. The GAD-MDD relation is strong, suggesting that the disorders could be classified in 1 category of distress disorders. Their developmental relation seems more symmetrical than heretofore presumed, suggesting that MDD is not necessarily primary over GAD in diagnostic hierarchy. This prospective study suggests that the lifetime prevalence of GAD and MDD may be underestimated by retrospective surveys and that comorbid GAD + MDD constitutes a greater mental health burden than previously thought.
602 citations
Katholieke Universiteit Leuven1, The Chinese University of Hong Kong2, Leipzig University3, Mental Health Services4, Academy for Urban School Leadership5, Nagasaki International University6, Utrecht University7, University of Otago8, University College Hospital, Ibadan9, University of Cape Town10, Stony Brook University11, Harvard University12, Group Health Cooperative13
TL;DR: Although prevalence rates of back/neck pain were generally lower than in previous reports, mental disorders were associated with chronic back/ neck pain and the strength of association was stronger for mood and anxiety disorders than for alcohol abuse/dependence.
Abstract: This paper reports cross-national data concerning back or neck pain comorbidity with mental disorders. We assessed (a) the prevalence of chronic back/neck pain, (b) the prevalence of mental disorders among people with chronic back/neck pain, (c) which mental disorder had strongest associations with chronic back/neck pain, and (d) whether these associations are consistent across countries. Population surveys of community-dwelling adults were carried out in 17 countries in Europe, the Americas, the Middle East, Africa, Asia, and the South Pacific (N=85,088). Mental disorders were assessed with the Composite International Diagnostic Interview, third version (CIDI 3.0): anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, posttraumatic stress disorder, and social anxiety disorder), mood disorders (major depression and dysthymia), and alcohol abuse or dependence. Back/neck pain was ascertained by self-report. Between 10% and 42% reported chronic back/neck pain in the previous 12 months. After adjusting for age and sex, mental disorders were more common among persons with back/neck pain than among persons without. The pooled odds ratios were 2.3 [95% CI=2.1-2.5] for mood disorders, 2.2 [95% CI=2.1-2.4] for anxiety disorders, and 1.6 [95% CI=1.4-1.9] for alcohol abuse/dependence in people with versus without chronic back/neck pain. Although prevalence rates of back/neck pain were generally lower than in previous reports, mental disorders were associated with chronic back/neck pain. The strength of association was stronger for mood and anxiety disorders than for alcohol abuse/dependence. The association of mental disorders with back/neck pain showed a consistent pattern across both developed and developing countries.
560 citations
TL;DR: When comparing across diagnoses, outcomes for generalized anxiety disorder and posttraumatic stress disorder were superior to those for social anxiety disorder, but no other differences emerged.
Abstract: The efficacy of cognitive behavioral treatments (CBT) for anxiety in adults has been supported by multiple meta-analyses. However, most have focused on only 1 diagnosis, thereby disallowing diagnostic comparisons. This study examined the efficacy of CBT across the anxiety disorders. One hundred eight trials of CBT for an anxiety disorder met study criteria. Cognitive therapy and exposure therapy alone, in combination, or combined with relaxation training, were efficacious across the anxiety disorders, with no differential efficacy for any treatment components for any specific diagnoses. However, when comparing across diagnoses, outcomes for generalized anxiety disorder and posttraumatic stress disorder were superior to those for social anxiety disorder, but no other differences emerged. CBT effects were superior to those for no-treatment and expectancy control treatments, although tentative evidence suggested equal effects of CBT when compared with relaxation-only treatments.
553 citations
TL;DR: Heightened intensity of emotions was better characterized separately, suggesting it may relate more strongly to dispositional emotion generation or emotionality than other measures of emotion function and dysregulation.
470 citations
TL;DR: Work stress appears to precipitate diagnosable depression and anxiety in previously healthy young workers, and helping workers cope with work stress or reducing work stress levels could prevent the occurrence of clinically significant depression and Anxiety.
Abstract: In the United States and the European Union, 30–40% of workers are exposed to work stress, and these rates appear to have increased since the 1990s (National Institute of Occupational Health and Safety, 1999; European Foundation for the Improvement of Living and Working Conditions, 2005). Stressful work conditions predict poor mental health and there is growing concern that such conditions contribute to the population burden of psychiatric morbidity (Parkes, 1990; Phelan et al. 1991; Bromet et al. 1992; Stansfeld et al. 1997; Niedhammer et al. 1998; Stansfeld et al. 1999; Mausner-Dorsch and Eaton, 2000; Tennant, 2001; Paterniti et al. 2002). Yet, inference from past research is limited by several methodological shortcomings, which we aimed to address using data from a birth cohort followed from childhood to adulthood.
With notable exceptions (Bromet et al. 1988; Mausner-Dorsch and Eaton, 2000; Cropley et al. 1999; Shields, 1999; Wang et al. 2004), past research has focused on symptoms of psychological distress (Phelan et al. 1991; Bromet et al. 1992; Niedhammer et al. 1998; Tennant, 2001; Paterniti et al. 2002; Stansfeld et al. 1997; Stansfeld et al. 1999), showing elevated rates in workers who report high job demands, low job control or insufficient work social support. However, the relationship between these work conditions and clinically-significant psychiatric disorders associated with healthcare and lost productivity costs is not known. Here, we study the risk of psychiatric disorder assessed using standardized diagnostic instruments. Additionally, past research has primarily focused on depressive symptomatology (Phelan et al. 1991; Bromet et al. 1992; Niedhammer et al. 1998; Tennant, 2001; Paterniti et al. 2002; Wang et al. 2004), while there is evidence of strong comorbidity and shared risk factors between major depression and generalized anxiety disorder (Mineka et al. 1998; Moffitt et al. 2007). Thus, workers exposed to stressful work conditions could be at increased risk of depression or anxiety and in this study we examine both major depressive disorder and generalized anxiety disorder.
We address three additional methodological problems. First, the effects of work stress on mental health need to be separated from the effects of low occupational status (Stansfeld et al. 1999; Paterniti et al. 2002) and our analyses are adjusted for participants’ socio-economic position. Second, the association between work stress and mental health may be due to reporting bias wherein depressed or anxious workers describe their job characteristics in a negative light (Stansfeld et al. 1997; Paterniti et al. 2002), and our analyses control for participants’ negative affective style. Third, individuals who experience depression and anxiety disorders in childhood are at increased risk of psychiatric disorder in adulthood (Kim-Cohen et al. 2003) and could be selected into stressful jobs. Thus, the association between work stress and mental health problems in adulthood could be spurious, reflecting past psychiatric disorder. To our knowledge this hypothesis has not yet been tested and we examine it 1) by controlling for participants’ prospective psychiatric diagnoses prior to their labor-market entry (ages 11–18) and 2) by testing the association between work stress and new cases of depression and anxiety at age 32.
464 citations
Journal Article•
TL;DR: In this article, the influence of work stress on diagnosed depression and anxiety in young working adults was tested by the Dunedin study, a 1972-1973 longitudinal birth cohort assessed most recently in 2004-2005 at age 32 (n=972, 96% of 1015 cohort members still alive).
Abstract: Background. Rates of depression have been rising, as have rates of work stress. We tested the influence of work stress on diagnosed depression and anxiety in young working adults. Method. Participants were enrolled in the Dunedin study, a 1972-1973 longitudinal birth cohort assessed most recently in 2004-2005, at age 32 (n=972, 96% of 1015 cohort members still alive). Work stress (psychological job demands, work decision latitude, low work social support, physical work demands) was ascertained by interview. Major depressive disorder (MDD) and generalized anxiety disorder (GAD) were ascertained using the Diagnostic Interview Schedule (DIS) and diagnosed according to DSM-IV criteria. Results. Participants exposed to high psychological job demands (excessive workload, extreme time pressures) had a twofold risk of MDD or GAD compared to those with low job demands. Relative risks (RRs) adjusting for all work characteristics were: 1·90 [95% confidence interval (CI) 1·22-2·98] in women, and 2·00 (95 % CI 1·13-3·56) in men. Analyses ruled out the possibility that the association between work stress and disorder resulted from study members' socio-economic position, a personality tendency to report negatively, or a history of psychiatric disorder prior to labour-market entry. Prospective longitudinal analyses showed that high-demand jobs were associated with the onset of new depression and anxiety disorder in individuals without any pre-job history of diagnosis or treatment for either disorder. Conclusions. Work stress appears to precipitate diagnosable depression and anxiety in previously healthy young workers. Helping workers cope with work stress or reducing work stress levels could prevent the occurrence of clinically significant depression and anxiety.
409 citations
TL;DR: A two-item version of the Connor-Davidson Resilience Scale is introduced, the CD-RISC2, which it is hypothesized has internal consistency, test-retest reliability, convergent validity, and divergent validity as well as significant correlation with the full scale.
Abstract: Resilience may be an important component of the prevention of neuropsychiatric disease. Resilience has proved to be quantifiable by scales such as the Connor-Davidson Resilience Scale (CD-RISC). Here, we introduce a two-item version of this scale, the CD-RISC2. We hypothesize that this shortened version of the scale has internal consistency, test-retest reliability, convergent validity, and divergent validity as well as significant correlation with the full scale. Additionally, we hypothesize that the CD-RISC2 can be used to assess pharmacological modification of resilience. We test these hypotheses by utilizing data from treatment trials of post-traumatic stress disorder, major depression, and generalized anxiety disorder with setraline, mirtazapine, fluoxetine, paroxetine, venlafaxine XR, and kava as well as data from the general population, psychiatric outpatients, and family medicine clinic patients.
TL;DR: This is the first evidence in juveniles that generalized anxiety disorder-associated patterns of pathologic fear circuit activation are particularly evident during certain attention states, and underscores the importance of attention and its interaction with emotion in shaping the function of the adolescent human fear circuit.
Abstract: Context Considerable work implicates abnormal neural activation and disrupted attention to facial-threat cues in adult anxiety disorders. However, in pediatric anxiety, no research has examined attention modulation of neural response to threat cues. Objective To determine whether attention modulates amygdala and cortical responses to facial-threat cues differentially in adolescents with generalized anxiety disorder and in healthy adolescents. Design Case-control study. Setting Government clinical research institute. Participants Fifteen adolescents with generalized anxiety disorder and 20 controls. Main Outcome Measures Blood oxygenation level–dependent signal as measured via functional magnetic resonance imaging. During imaging, participants completed a face-emotion rating task that systematically manipulated attention. Results While attending to their own subjective fear, patients, but not controls, showed greater activation to fearful faces than to happy faces in a distributed network including the amygdala, ventral prefrontal cortex, and anterior cingulate cortex ( P Conclusions This is the first evidence in juveniles that generalized anxiety disorder–associated patterns of pathologic fear circuit activation are particularly evident during certain attention states. Specifically, fear circuit hyperactivation occurred in an attention state involving focus on subjectively experienced fear. These findings underscore the importance of attention and its interaction with emotion in shaping the function of the adolescent human fear circuit.
TL;DR: The associations between marital distress and Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) Axis I psychiatric disorders were evaluated in a United States population-based survey of married individuals in which there was no upper age exclusionary criterion.
Abstract: The associations between marital distress and Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) Axis I psychiatric disorders were evaluated in a United States population-based survey of married individuals in which there was no upper age exclusionary criterion (N = 2,213). Marital distress was associated with (a) broad-band classifications of anxiety, mood, and substance use disorders and (b) all narrow-band classifications of specific disorders except for panic disorder, with the strongest associations obtained between marital distress and bipolar disorder, alcohol use disorders, and generalized anxiety disorder. The association between marital distress and major depressive disorder increased in magnitude with increasing age; there was no evidence that the association between marital distress and other psychiatric disorders was moderated by gender or age. Results support continued research on the association between couple functioning and mental health.
TL;DR: PHQ-BED criteria are associated with substantial impairment, psychiatric comorbidity, and obesity and effectively discriminate obese individuals with psychological problems from obese subjects without similar problems.
TL;DR: Anxiety disorders are common in patients with MS, but are frequently overlooked and under-treated, and Clinicians should evaluate all MS subjects for anxiety disorders, as they represent a treatable cause of disability in MS.
Abstract: Objective To assess prevalence rates and clinical correlates of anxiety disorders in patients with multiple sclerosis (MS).Methods Demographic and neurological data were collected on 140 consecutive clinic attendees, and their lifetime and point prevalences of anxiety disorders were determined with the Structured Clinical Interview for DSM-IV disorders (SCID-IV). All subjects completed the self-report Hospital Anxiety and Depression Scale (HADS). Suicidal intent was rated with the Beck Suicide Scale (BSS), psychosocial stressors and supports were quantified with Social Stress and Support Interview (SSSI), and cognition assessed with Neuropsychological Screening Battery for MS.Results The lifetime prevalence of any anxiety disorder was 35.7%, with panic disorder (10%), obsessive compulsive disorder (8.6%), and generalized anxiety disorder (18.6%), the most common diagnoses obtained. Subjects with an anxiety disorder were more likely to be female, have a history of depression, drink to excess, report higher...
TL;DR: A large number of women with emotional distress illustrate the need for psychosocial counseling and support in this early treatment phase, and whether the diagnosis of PTSD is appropriate in this group of cancer patients is critically evaluated.
Abstract: This study aimed at the identification of acute and post-traumatic stress responses, and comorbid mental disorders in breast cancer patients. Structured clinical interviews for DSM-IV (SCID) were conducted post-surgery with 127 patients (t1). Screening measures were used to assess post-traumatic stress responses, anxiety, and depression at t1 and at 6 months follow-up (t2). Based on the SCID, prevalence rates were 2.4% for both, cancer-related ASD and PTSD. Experiences most frequently described as traumatic were the cancer diagnosis itself and subsequent feelings of uncertainty. Patients with lifetime PTSD (8.7%) were more likely to meet the criteria for cancer-related ASD or PTSD (OR=14.1). Prevalence estimates were 7.1% for Adjustment Disorder, 4.7% for Major Depression, 3.1% for Dysthymic Disorder and 6.3% for Generalized Anxiety Disorder. Using the screening instruments, IES-R, PCL-C and HADS, we found PTSD in 18.5% at t1 and 11.2-16.3% at t2. The estimates of anxiety and depression reveal rates of 39.6% (t1) and 32.7% (t2) for anxiety, as well as 16.0% (t1) and 13.3% (t2) for depression (t1) (cut-off> or =8). The diagnosis of a life-threatening illness has been included as a potential trauma in the DSM-IV. However, it has to be critically evaluated whether subjective feelings of uncertainty like fears of treatment count among traumatic stressors, and thus, whether the diagnosis of PTSD is appropriate in this group of cancer patients. However, a large number of women with emotional distress illustrate the need for psychosocial counseling and support in this early treatment phase.
TL;DR: Stress was found to correlate with high anxiety levels for the autism group, particularly the ability to cope with change, anticipation, sensory stimuli and unpleasant events, which has important implications for clinicians in terms of both assessment and treatment.
Abstract: Clinical reports suggest that anxiety is a pertinent issue for adults with autism. We compared 34 adults with autism with 20 adults with intellectual disabilities, utilizing informant-based measures of anxiety and stress. Groups were matched by age, gender and intellectual ability. Adults with autism were almost three times more anxious than the comparison group and gained significantly higher scores on the anxiety subscales of panic and agoraphobia, separation anxiety, obsessive-compulsive disorder and generalized anxiety disorder. In terms of sources of stress, significant differences between the two groups were also found, and stress was found to correlate with high anxiety levels for the autism group, particularly the ability to cope with change, anticipation, sensory stimuli and unpleasant events. That is, the more anxious the individual with autism, the less likely they were able to cope with these demands. This has important implications for clinicians in terms of both assessment and treatment.
TL;DR: Although genetic risk factors indexed by the personality trait of N contribute substantially to risk for both MD and GAD, the majority of genetic covariance between the two disorders results from factors not shared with N.
Abstract: Background. Prior studies report high levels of co-morbidity between major depression (MD) and generalized anxiety disorder (GAD) and suggest that these disorders are closely related genetically. The personality trait of neuroticism (N) is substantially correlated with risk for MD and GAD. Method. Bivariate twin models were applied to lifetime diagnoses of modified DSM-IV diagnosis of MD and GAD obtained at personal interview in 1998–2003 with 37 296 twins from the populationbased Swedish Twin Registry. A trivariate Cholesky model with N, MD and GAD was applied to a subset (23 280 members of same-sex twin pairs) who completed a self-report questionnaire assessing N in 1972–1973. Results. In the best-fit bivariate model, the genetic correlation between MD and GAD was estimated at +1 . 00 in females and +0 . 74 in males. Individual-specific environmental factors were also shared between the two disorders with an estimated correlation of +0 . 59 in males and +0 . 36 in females. In the best-fit trivariate Cholesky model, genetic factors indexed by N impacted equally on risk for MD and GAD in males and females. However, in both sexes, genetic risk factors indexed by N contributed only around 25% to the genetic correlation between MD and GAD. Conclusion. Genetic risk factors for lifetime MD and GAD are strongly correlated, with higher correlations in women than in men. Although genetic risk factors indexed by the personality trait of N contribute substantially to risk for both MD and GAD, the majority of genetic covariance between the two disorders results from factors not shared with N.
TL;DR: Prevention and treatment of anxiety disorders might be more effective if the available knowledge about sex and gender specificity was implemented and treatment effect studies could be improved by greater consideration ofsex and gender throughout the research process.
TL;DR: Although patients in both treatment groups improved, patients receiving CBGT had significantly lower scores on clinician- and patient-rated measures of social anxiety, suggesting that MBSR may have some benefit in the treatment of generalized SAD.
TL;DR: Significant improvements occurred in social anxiety symptoms and quality of life, yielding large effect size gains, and earlier changes in experiential avoidance predicted later changes in symptom severity.
Abstract: Despite the demonstrated efficacy of cognitive-behavior therapy (CBT) for social anxiety disorder (SAD), many individuals do not respond to treatment or demonstrate residual symptoms and impairment posttreatment. Preliminary evidence indicates that acceptance-based approaches (e.g., acceptance and commitment therapy; ACT) can be helpful for a variety of disorders and emphasize exposure-based strategies and processes. Nineteen individuals diagnosed with SAD participated in a 12-week program integrating exposure therapy and ACT. Results revealed no changes across a 4-week baseline control period. From pretreatment to follow-up, significant improvements occurred in social anxiety symptoms and quality of life, yielding large effect size gains. Significant changes also were found in ACT-consistent process measures, and earlier changes in experiential avoidance predicted later changes in symptom severity. Results suggest the acceptability and potential efficacy of ACT for SAD and highlight the need for future research examining both the efficacy and mechanisms of change of acceptance-based programs for SAD.
TL;DR: That GAD and co-morbid MDD+GAD share many risk markers suggests that the presence of GAD may signal a pathway toward relatively more severe internalizing disorder.
Abstract: BACKGROUND: The close association between generalized anxiety disorder (GAD) and major depressive disorder (MDD) prompts questions about how to characterize them in future diagnostic systems. We tested whether risk factors for MDD and GAD are similar or different. METHOD: The representative 1972-73 Dunedin birth cohort of 1037 males and females was followed to age 32 with 96% retention. Adult GAD and MDD were diagnosed at ages 18, 21, 26, and 32 years, and juvenile anxiety/depression were also taken into account. Thirteen prospective risk measures indexed domains of family history, adverse family environment, childhood behavior, and adolescent self-esteem and personality traits. RESULTS: Co-morbid MDD+GAD was antedated by highly elevated risk factors broadly across all domains. MDD+GAD was further characterized by the earliest onset, most recurrence, and greatest use of mental health services and medication. Pure GAD had levels of risk factors similar to the elevated levels for co-morbid MDD+GAD; generally, pure MDD did not. Pure GAD had risks during childhood not shared by pure MDD, in domains of adverse family environment (low SES, somewhat more maltreatment) and childhood behavior (internalizing problems, conduct problems, somewhat more inhibited temperament). Pure MDD had risks not shared by pure GAD, in domains of family history (of depression) and personality (low positive emotionality). CONCLUSIONS: Specific antecedent risk factors for pure adult MDD versus GAD may suggest partly different etiological pathways. That GAD and co-morbid MDD+GAD share many risk markers suggests that the presence of GAD may signal a pathway toward relatively more severe internalizing disorder. Language: en
TL;DR: In an open trial of a newly developed acceptance-based behavior therapy for GAD, 16 treated clients demonstrated significant reductions in clinician-rated severity of GAD and reports of anxiety and depressive symptoms and fear and avoidance of their internal experience, as well as significant improvements in reports of quality of life, at both posttreatment and 3-month follow-up.
TL;DR: Results highlight the role of psychiatric and substance use disorders in progression from first drink to AD, underscore the continuity of risk associated with CD and indicate that (with the exception of CD) different factors play a role in transition to AD than in initiation of alcohol use.
Abstract: AIMS: To identify childhood risk factors that predict (a) age of first drink and (b) time from first use to alcohol dependence (AD) onset, using survival analysis. PARTICIPANTS: The sample consisted of 1269 offspring (mean age = 20.1 years) of male twins from the Vietnam Era Twin Registry; 46.2% were offspring of alcohol-dependent fathers. MEASUREMENTS: DSM-IV psychiatric diagnoses and substance use behaviors were assessed by structured telephone interview. FINDINGS: First drink occurred on average at 15.7 years; AD onset at 19.1 years. A Cox proportional hazard regression analysis revealed conduct disorder (CD) as the most potent predictor of early alcohol initiation (HR 2.48; CI 1.85-3.32). Attention deficit hyperactivity disorder (ADHD), maternal AD, paternal AD, male gender and parental divorce were also associated with early first use (HR 1.20-1.52; CI 1.04-1.39-1.18-1.96). A Cox proportional hazard regression analysis modeling first drink to AD identified nicotine dependence (HR 3.91; CI 2.48-6.17) and generalized anxiety disorder (GAD) (HR 3.45; CI 2.08-5.72) as robust predictors of progression to AD. CD (HR 1.75; CI 1.10-2.77) and cannabis abuse (HR 1.88; CI 1.22-2.90) were also associated with rapid transition to AD. CONCLUSIONS: Results highlight the role of psychiatric and substance use disorders in progression from first drink to AD, underscore the continuity of risk associated with CD and indicate that (with the exception of CD) different factors play a role in transition to AD than in initiation of alcohol use. Distinctions between stages are interpreted in a developmental framework. Language: en
TL;DR: Results support this hypothesis and indicate that predisaster negative affect predicted disaster-related posttraumatic stress symptoms and generalized anxiety disorder symptoms, and predisaster trait anxiety predicted postdisaster depressive symptoms.
Abstract: On the basis of theory and previous research, it was hypothesized that predisaster child trait anxiety would predict disaster-related posttraumatic stress symptoms and generalized anxiety disorder symptoms, even after controlling for the number of hurricane exposure events. Results support this hypothesis and further indicate that predisaster negative affect predicted disaster-related posttraumatic stress symptoms and generalized anxiety disorder symptoms. Also, Katrina-related posttraumatic stress disorder symptoms were predicted by the number of hurricane exposure events and sex (being female). Predisaster generalized anxiety disorder symptoms predicted postdisaster generalized anxiety disorder symptoms, and predisaster trait anxiety predicted postdisaster depressive symptoms. Findings are discussed in terms of their relevance for developing interventions to mitigate the impact of disasters in youths.
TL;DR: Although N/ BI evidenced the most change of the constructs examined, initial levels of N/BI predicted less improvement in 2 of the 3 disorder constructs and explained all the temporal covariation of the DSM-IV disorder constructs.
Abstract: The temporal stability and directional relations among dimensions of temperament (e.g., neuroticism) and selected Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) disorder constructs (depression, generalized anxiety disorder, social phobia) were examined in 606 outpatients with anxiety and mood disorders, assessed on 3 occasions over a 2-year period. Neuroticism/behavioral inhibition (N/BI) and behavioral activation/positive affect (BA/P) accounted for the cross-sectional covariance of the DSM-IV constructs. Although N/BI evidenced the most change of the constructs examined, initial levels of N/BI predicted less improvement in 2 of the 3 disorder constructs. Unlike the DSM-IV disorder constructs, the temporal stability of N/BI increased as a function of initial severity. Moreover, N/BI explained all the temporal covariation of the DSM-IV disorder constructs. The results are discussed in regard to conceptual models of temperament that define N/BI and BA/P as higher order dimensions accounting for the course and covariation of emotional disorder psychopathology.
University of Otago1, Group Health Cooperative2, University Medical Center Groningen3, Shanghai Mental Health Center4, Katholieke Universiteit Leuven5, Harvard University6, Mental Health Services7, Stony Brook University8, Leipzig University9, Academy for Urban School Leadership10, University of Limpopo11
TL;DR: This first cross-national study of the relationship between asthma and mental disorders confirms that a range of common mental disorders occurs with greater frequency among persons with asthma.
TL;DR: Assessing the extent to which anxiety disorders contribute to an increase in suicidal behaviour after controlling for both observed and non-observed sources of confounding suggested that anxiety disorders accounted for 7–10% of the suicidality in the cohort.
Abstract: Background. The aim of this study was to estimate the extent to which anxiety disorders contribute to an increase in suicidal behaviour after controlling for both observed and non-observed sources of confounding.Methods. Data were collected from the Christchurch Health and Development Study (CHDS), a 25-year longitudinal study of over 1000 participants. Measures of anxiety disorders [phobia, generalized anxiety disorder (GAD), panic disorder], major depression (MD), substance use disorders, conduct/antisocial personality disorder, stressful life events, unemployment, and suicidal ideation/attempts for subjects aged 16-18, 18-21 and 21-25 years were used to fit random and fixed effects regression models of the associations between anxiety disorders and suicidal behaviours.Results. Anxiety disorders were strongly associated with suicidal ideation/attempts. Any single anxiety disorder increased the odds of suicidal ideation by 7.96 times [95% confidence interval (CI) 5.69-11.13] and increased the rate of suicide attempts by 5.85 times (95% CI 3.66-9.32). Control for co-occurring mental disorders, non-observed fixed confounding factors and life stress reduced these associations [suicidal ideation odds ratio (OR) 2.80, 95% CI 1.71-4.58; suicide attempts incidence rate ratio (IRR) 1.90, 95% CI 1.07-3.39]. Rates of suicidal behaviour also increased with the number of anxiety disorders. Estimates of the population attributable risk suggested that anxiety disorders accounted for 7-10% of the suicidality in the cohort.Conclusions. Anxiety disorders may be a risk factor for suicidality, even after controlling for confounding, with risks increasing with multiple anxiety disorders. Management of anxiety disorders may be an important component in strategies to reduce population rates of suicide. Language: en
TL;DR: Non-organic factors, including pre-morbid personality traits and post-injury psychological reactions to disability and trauma, are implicated in the generation and maintenance of post-TBI psychiatric disorder.
Abstract: Primary objective: Survivors of traumatic brain injury (TBI) are at increased risk for development of severe, long-term psychiatric disorders. However, the aetiology of these disorders remains unclear. This article systematically reviews the most current prevalence rates and evidence for causality, in terms of established criteria.Main outcome and results: Psychiatric syndromes are consistently present at an elevated rate following TBI. Survivors of TBI are particularly susceptible to major depression, generalized anxiety disorder and post-traumatic stress disorder. Evidence for a biological gradient is generally lacking, although this criterion may not be appropriate in the case of TBI. The temporal pattern of onset is variable and reliable critical periods for the post-injury development of a psychiatric disorder remain to be identified; however, individuals appear to remain at risk for years following injury.Conclusions: Non-organic factors, including pre-morbid personality traits and post-injury psych...
TL;DR: Relaxation training, cognitive-behavioral therapy, and, to a lesser extent, supportive therapy and cognitive therapy have support for treating subjective anxiety symptoms and disorders, and relaxation training represents an efficacious, relatively low-cost intervention.
Abstract: This project identified evidence-based psychotherapy treatments for anxiety disorders in older adults. The authors conducted a review of the geriatric anxiety treatment outcome literature by using specific coding criteria and identified 17 studies that met criteria for evidence-based treatments (EBTs). These studies reflected samples of adults with generalized anxiety disorder (GAD) or samples with mixed anxiety disorders or symptoms. Evidence was found for efficacy for 4 types of EBTs. Relaxation training, cognitive-behavioral therapy (CBT), and, to a lesser extent, supportive therapy and cognitive therapy have support for treating subjective anxiety symptoms and disorders. CBT for late-life GAD has garnered the most consistent support, and relaxation training represents an efficacious, relatively low-cost intervention. The authors provide a review of the strengths and limitations of this research literature, including a discussion of common assessment instruments. Continued investigation of EBTs is needed in clinical geriatric anxiety samples, given the small number of available studies. Future research should examine other therapy models and investigate the effects of psychotherapy on other anxiety disorders, such as phobias and posttraumatic stress disorder in older adults.