Modifiable risk and protective factors for anxiety disorders among adults: A systematic review.

Anxiety disorders are highly prevalent in the general population and associated with high rates of impairment and disability. This burden highlights the need to identify risk factors that individuals can modify without professional intervention. A systematic review was conducted to identify studies that examined modifiable risk and protective factors for anxiety disorders among adults in the general population. Searches were conducted in PubMed, PsycINFO and MEDLINE using medical subject headings and text words related to risk factors, protective factors, and each anxiety disorder. Screening, data extraction, and quality assessment were performed by three study authors. Modifiable risk and protective factors from 19 studies across seven countries were identified. Risk factors identified included cigarette smoking, alcohol use, cannabis use, negative appraisals of life events, avoidance, and occupational factors. Protective factors included social support, coping, and physical activity. Cigarette smoking was the most studied risk factor. Support was found for cigarette smoking as a risk factor for agoraphobia and panic disorder. Mixed results were found for generalized anxiety disorder and specific phobia. Across disorders, smoking frequency was associated with greater risk. Results indicate an important gap in the literature in that few studies have examined modifiable risk factors for anxiety disorders.

Disgust and fear: common emotions between eating and phobic disorders.

Eating disorders (ED) are prevalent mental illnesses composed mainly of anorexia nervosa, bulimia nervosa and binge eating disorders. Anxiety disorders are another set of mental illnesses, with phobic disorder (PD) being the most prevalent disorder. ED and PD are highly comorbid. The aim of this study is to assess, in 131 individuals attending an outpatient clinic for different health issues, the level of fear related to situations generating avoidance such as in social anxiety and specific phobias according to the fear questionnaire (FQ), the level of disgust according to the disgust scale (DS-R) and the vulnerability towards ED according to the SCOFF scale to demonstrate that high levels of both fear and disgust increase the vulnerability towards ED. The study demonstrated that the level of disgust increased when fear increases (r = 0.377, p < 0.001 for the first part of the FQ; r = 0.225, p = 0.01 for the second part of the FQ). Moreover, individuals with vulnerability towards having an ED presented a higher level of disgust than individuals without this vulnerability (p = 0.009). Furthermore, individuals with vulnerability towards ED have a higher level of anxiety related to PD subtypes (p = 0.008 for agoraphobia; p = 0.001 for injection/blood phobia) as well as to social anxiety (p = 0.01), independently from having a depressive or another anxiety disorder. In the multivariate analysis, a history of psychiatric consultation has been the only significantly different parameter between individuals with or without vulnerability towards ED (p = 0.0439). Accordingly, fear and disgust are negative emotions that seem to be clinically associated which better explains the comorbidity of ED with PD. LEVEL OF EVIDENCE: Level III. Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.

Development of a very brief scale for detecting and measuring panic disorder using two items from the Panic Disorder Severity Scale-Self Report.

OBJECTIVE: To minimize the burden in detecting and monitoring Panic Disorder and Agoraphobia by developing a very brief scale with selected items from the Panic Disorder Severity Scale-Self Report (PDSS-SR), and to investigate the proposed scale's psychometric properties in a comorbid sample. METHODS: A sample of 5103 patients from the Internet Psychiatry Clinic in Sweden, diagnosed and treated with Internet-based cognitive behavioral therapy for panic disorder (n = 1390), social anxiety disorder (n = 1313) or depression (n = 2400), responded to the PDSS-SR. Six criteria related to factor structure, sensitivity to change and clinical representativeness were used to select items. Psychometric analyses for the selected very brief scale were performed. RESULTS: Items 2 (distress during panic attacks) and 4 (agoraphobic avoidance), were selected to create the very brief PDSS-SR version. Correlations with the full scale were high at screening, pre and post, and for change (0.87-0.93). Categorical Omega was ⍵C = 0.74. With a cut-off of 3 points, the scale could detect panic disorder in a psychiatric sample with a sensitivity of 85% and a specificity of 66%. LIMITATIONS: Limitations include lack of healthy controls and lack of blinding on secondary outcome measures. CONCLUSION: The proposed 2-item PDSS-SR version is a good candidate for a very brief panic disorder questionnaire, both for detecting cases and for measuring change. This is especially useful in clinical settings when measuring more than one condition at a time.

Situational fears: Association with negative affect-related smoking cognition among treatment seeking smokers.

Despite the consistent clinically-significant relation between smoking and anxiety and its disorders, there is limited understanding of how specific fears relate to smoking processes. To isolate therapeutic targets for smoking-anxiety treatment development, there is a need to identify the underlying situational fears most related to smoking processes. Thus, the present study examined the association between interoceptive, agoraphobic, and social fears in terms of clinically significant negative affect-related smoking cognitions including negative affect reduction expectancies, coping motives, and perceived internal barriers to cessation. Participants were 469 treatment seeking smokers (48.2% female, Mage = 36.59, SD = 13.58) enrolled in a smoking cessation trial and completed baseline measures of smoking cognitions and situational fears. Results indicated that the there was a significant effect for social fears, relative to interoceptive and agoraphobic fears, for each of the studied clinically relevant smoking variables. Overall, this study offers initial empirical evidence that social fears are significantly and consistently related to several clinically-significant types of smoking cognition.

The psychological development of panic disorder: implications for neurobiology and treatment / O desenvolvimento psicológico do transtorno de pânico: implicações para a neurobiologia e o tratamento

OBJECTIVES: The aim of this study was to survey the available literature on psychological development of panic disorder with or without agoraphobia [PD(A)] and its relationship with the neurobiology and the treatment of panic. METHODS: Both a computerized (PubMed) and a manual search of the literature were performed. Only English papers published in peer-reviewed journals and referring to PD(A) as defined by the diagnostic classifications of the American Psychiatric Association or of the World Health Organization were included. CONCLUSIONS: A staging model of panic exists and is applicable in clinical practice. In a substantial proportion of patients with PD(A), a prodromal phase and, despite successful treatment, residual symptoms can be identified. Both prodromes and residual symptoms allow the monitoring of disorder evolution during recovery via the rollback phenomenon. The different stages of the disorder, as well as the steps of the rollback, have a correspondence in the neurobiology and in the treatment of panic. However, the treatment implications of the longitudinal model of PD(A) are not endorsed, and adequate interventions of enduring effects are missing.

OBJETIVO: O objetivo deste estudo foi fazer um levantamento da literatura disponível sobre o desenvolvimento psicológico do transtorno do pânico com ou sem agorafobia [TP(A)] e sua relação com a neurobiologia e o tratamento do pânico. MÉTODOS: A busca da literatura foi realizada tanto manualmente quanto via computador (PubMed). Somente os artigos publicados em inglês em revistas revisadas por especialistas e abordando o TP(A) de acordo com as classificações diagnósticas da Associação Americana de Psiquiatria ou da Organização Mundial de Saúde foram incluídos. CONCLUSÕES: Existe um modelo de classificação por estágios do pânico aplicável na prática clínica. A fase prodrômica e, a despeito de tratamentos bem-sucedidos, os sintomas residuais podem ser identificados em uma proporção substancial de pacientes com TP(A). Tanto os pródromos quanto os sintomas residuais permitem monitorar a evolução do transtorno durante a recuperação por meio do fenômeno de reversão. Os diferentes estágios do transtorno, bem como as etapas da reversão, possuem uma correspondência na neurobiologia e no tratamento do pânico. Contudo, as implicações do tratamento do modelo longitudinal do TP(A) não são endossadas e são necessárias intervenções adequadas de efeito duradouro.

Anxiety and joint hypermobility association: a systematic review / Associação entre ansiedade e hipermobilidade articular: uma revisão sistemática

BACKGROUND: Anxiety disorders are often associated with several non-psychiatric medical conditions. Among the clinical conditions found in association with anxiety stands out the joint hypermobility (JH). OBJECTIVES: To carry out a systematic review of the clinical association between anxiety disorders and JH. METHOD: A survey was conducted in MEDLINE, PsychINFO, LILACS e SciELO databases up to December 2011. We searched for articles using the keywords 'anxiety', 'joint' and 'hypermobility' and Boolean operators. The review included articles describing empirical studies on the association between JH and anxiety. The reference lists of selected articles were systematically hand-searched for other publications relevant to the review. RESULTS: Seventeen articles were included in the analysis and classified to better extract data. We found heterogeneity between the studies relate to the methodology used. Most of the studies found an association between anxiety features and JH. Panic disorder/agoraphobia was the anxiety disorder associated with JH in several studies. Etiological explanation of the relationship between anxiety and JH is still controversial. CONCLUSION: Future research in large samples from the community and clinical setting and longitudinal studies of the association between anxiety and HA and the underlying biological mechanisms involved in this association are welcome.

INTRODUÇÃO: Os transtornos de ansiedade estão frequentemente associados a vários quadros clínicos não psiquiátricos. Dentre os quadros clínicos associados à ansiedade destaca-se a hipermobilidade articular (HA). Objetivo: Realizar uma revisão sistemática da associação entre os transtornos de ansiedade e a HA. MÉTODO: Foi realizada uma pesquisa nos bancos de dados MEDLINE, PsychINFO, LILACS e SciELO em busca de artigos publicados até dezembro de 2011. Usamos as palavras-chave anxiety , joint e hypermobility e os operadores boolianos. A revisão incluiu artigos que descrevem estudos empíricos sobre a associação entre ansiedade e HA. As listas de referências dos artigos selecionados foram sistematicamente pesquisadas à mão em busca de publicações relevantes para a revisão. RESULTADOS: Dezessete artigos foram incluídos na análise e classificados para uma melhor extração dos dados. Encontramos heterogeneidade entre os estudos relacionada à metodologia utilizada. A maioria dos estudos encontrou associação entre as características de ansiedade e HA. Transtorno do pânico com agorafobia foi o transtorno de ansiedade associado à HA em vários estudos. A explicação etiológica da relação entre ansiedade e HA permanece controversa. CONCLUSÃO: Estudos futuros com amostras maiores de indivíduos da comunidade e de cenários clínicos e estudos longitudinais da associação entre ansiedade e HA e dos mecanismos biológicos subjacentes envolvidos nessa associação são bem-vindos.

Association of smoking and nicotine dependence with severity and course of symptoms in patients with depressive or anxiety disorder.

BACKGROUND: Previous research has indicated a strong association of smoking with depression and anxiety disorders, but the direction of the relationship is uncertain. Most research has been done in general population samples. We investigated the effect of smoking and nicotine dependence on the severity and course of depressive and anxiety symptoms in psychiatric patients. METHODS: Data came from the Netherlands Study of Depression and Anxiety (NESDA) including participants with a current diagnosis of depression and/or an anxiety disorder (N=1725). The course of smoking status and symptoms of depression, general anxiety, social anxiety, and agoraphobia were measured at baseline and after one and two years. Age, gender, education, alcohol use, physical activity, and negative life events were treated as covariates. RESULTS: At baseline, the symptoms of depression, general anxiety, and agoraphobia were more severe in nicotine-dependent smokers than in never-smokers, former smokers, and non-dependent smokers. These differences remained after adjusting for covariates. Smaller differences were observed for severity of social anxiety which were no longer significant after controlling for covariates. Over a two-year follow-up, the improvement of depressive and anxiety symptoms was slower in nicotine-dependent smokers than in the other groups even after controlling for covariates. There were no differences between the groups in the course of symptoms of social anxiety and agoraphobia over time. CONCLUSIONS: In psychiatric patients, smoking is associated with higher severity of depressive and anxiety symptoms, and with slower recovery, but only when smokers are nicotine-dependent.

Psychopathology in adolescent offspring of parents with panic disorder, major depression, or both: a 10-year follow-up.

OBJECTIVE: The authors examined the specificity and course of psychiatric disorders from early childhood through adolescence in offspring of parents with confirmed panic disorder and major depressive disorder. METHOD: The authors examined rates of psychiatric disorders at 10-year-follow-up (mean age, 14 years) in four groups: offspring of referred parents with panic and depression (N=137), offspring of referred parents with panic without depression (N=26), offspring of referred parents with depression without panic (N=48), and offspring of nonreferred parents with neither disorder (N=80). Follow-up assessments relied on structured interviews with the adolescents and their mothers; diagnoses were rated present if endorsed by either. RESULTS: Parental panic disorder, independently of parental depression, predicted lifetime rates in offspring of multiple anxiety disorders, panic disorder, agoraphobia, social phobia, and obsessive-compulsive disorder. Parental depression independently predicted offspring bipolar, drug use, and disruptive behavior disorders. Parental panic and depression interacted to predict specific phobia and major depressive disorder. Phobias were elevated in all at-risk groups, and depression was elevated in both offspring groups of parents with depression (with or without panic disorder), with the highest rates in the offspring of parents with depression only. Parental depression independently predicted new onset of depression, parental panic disorder independently predicted new onset of social phobia, and the two interacted to predict new onset of specific phobia and generalized anxiety disorder. CONCLUSIONS: At-risk offspring continue to develop new disorders as they progress through adolescence. These results support the need to screen and monitor the offspring of adults presenting for treatment of panic disorder or major depressive disorder.

Subtipo respiratório versus não respiratório no transtorno de pânico com agorafobia: avaliação com terapia cognitivo-comportamental / Respiratory versus non respiratory subtypes of panic disorder with agoraphobia: cognitive behavioral therapy assessment

OBJETIVO: verificar a resposta dos pacientes com transtorno de pânico com agorafobia à modelo proposto de terapia cognitivo-comportamental (TCC) nos dois subtipos respiratórios de transtorno de pânico: o subtipo respiratório (SR) e subtipo não respiratório (SNR) Amostra randomizada por sorteio com 50 pacientes diagnosticados segundo o Manual Diagnóstico e Estatístico dos Transtornos Mentais. A medicação: antidepressivos tricíclicos ou inibidores seletivos de recaptação da serotonina. Setenta e sete ponto seis porcento da amostra de pacientes de ambos os grupos apresentaram o SR e 22,4 % o SNR. Os pacientes do SR, responderam satisfatoriamente ao tratamento com técnicas da TCC, reduzindo ansiedade, sintomas respiratórios e os ataques de pânico. Os pacientes do SR melhoraram, segundo a escala de avaliação global do funcionamento, de 55,8 para 70,9 em comparação com o SNR.

The objective of the present study was to verify the response of patients with panic disorder (agoraphobia) to existing cognitive-behavior therapy models (CBT) of two respiratory subtypes of panic disorder (PD): respiratory subtype (RS) and non respiratory subtype (NRS). We randomly selected a sample of 50 patients diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders. The medication used was tricycle or selective serotonin reuptake inhibitor antidepressants. Seventy-seven point six percent of the patients from both groups showed RS and 22.4% the NRS. The RS patients responded satisfactorily to the treatment with techniques of CBT decreasing anxiety, breathing symptoms and panic attacks. According to the global functioning assessment scale, RS patients improved from 55.8 to 70.9 in comparison with NRS ones.

Rupturas na aliança terapêutica e expressão verbal de necessidades do cliente: um estudo de caso / Psychotherapeutic alliance ruptures and verbal expression of client's needs: a case study

Apresentamos um estudo de caso cujo objectivo foi explorar a associação entre as rupturas na aliança terapêutica e a expressão verbal de necessidades do cliente em psicoterapia. Foi analisado um caso de insucesso de um cliente diagnosticado com Transtorno de Pânico com Agorafobia, através do Rupture Resolution Rating System (3R's) e do Sistema de Observação de Responsividade Terapêutica Os dados resultantes da aplicação dos dois sistemas de observação foram analisados com o software de análise de séries temporais SMA. Os resultados indicam que um aumento da Expressão Verbal de Necessidades numa sessão está associada a uma diminuição dos marcadores de ruptura após três e quatro sessões e um aumento dos marcadores de rupturas numa sessão está associado a um aumento da EVN após quatro sessões. Esta associação foi mais evidente entre as rupturas de confronto, particularmente do marco de insatisfação com as actividades da terapia, e a expressão de necessidades directamente relacionadas com a terapia.

We present a case study whose main goal was to explore the relationship between therapeutic alliance's ruptures and the client's verbal expression of needs in psychotherapy. We intensively analyzed an unsuccessful case of a client with Panic Disorder with Agoraphobia. The sessions were analyzed using the Ruptures Resolution Rating System (3R's) and the Sistema de Observação de Responsividade Terapêutica . The results indicate that an increase in the Verbal Expression of Needs (EVN) is associated with a decrease of the ruptures three and four sessions later and that an increase in ruptures is associated with an increase of EVN four sessions later. There was a more clear association between the confrontation ruptures, particularly the expression of dissatisfaction about therapeutic activities, and a specific type of EVN:the client's expression of direct requests related to therapy.

An examination of the structure of posttraumatic stress disorder in relation to the anxiety and depressive disorders.

The nature and structure of posttraumatic stress disorder (PTSD) has been the subject of much interest in recent times. This research has been represented by two streams, the first representing a substantive body of work which focuses specifically on the factor structure of PTSD and the second exploring PTSD's relationship with other mood and anxiety disorders. The present study attempted to bring these two streams together by examining structural models of PTSD and their relationship with dimensions underlying other mood and anxiety disorders. PTSD, anxiety and mood disorder data from 989 injury survivors interviewed 3-months following their injury were analyzed using a series of confirmatory factor analyses (CFA) to identify the optimal structural model. CFA analyses indicated that the best fitting model included PTSD's re-experiencing (B1-5), active avoidance (C1-2), and hypervigilance and startle (D4-5) loading onto a Fear factor (represented by panic disorder, agoraphobia and social phobia) and the PTSD dysphoria symptoms (numbing symptoms C3-7 and hyperarousal symptoms D1-3) loading onto an Anxious Misery/Distress factor (represented by depression, generalized anxiety disorder and obsessive compulsive disorder). The findings have implications for informing potential revisions to the structure of the diagnosis of PTSD and the diagnostic algorithm to be applied, with the aim of enhancing diagnostic specificity.

Imipramine for vestibular dysfunction in panic disorder: a prospective case series / Imipramina para disfunção vestibular em transtorno do pânico: uma série de casos prospectiva

OBJECTIVE: The purpose of this study was to evaluate the efficacy and effectiveness of imipramine on the treatment of comorbid chronic dizziness and panic disorder. METHOD: Nine patients with panic disorder and agoraphobia associated with chronic dizziness underwent otoneurological screening and were treated with a 3-months course of imipramine. Anxiety levels were measured with the Hamilton Anxiety Scale (HAM-A), dizziness levels were evaluated using the Dizziness Handicap Inventory (DHI), and panic severity and treatment outcome were assessed with the Clinical Global Impression Scale (CGI). RESULTS: At the baseline 33.3 percent (n=3) had a bilateral peripheral deficit vestibulopathy, the mean scores for HAM-A were 27.2±10.4, for DHI were 51.7±22.7, and for CGI-S were 4.8±0.9. All patients had a significant reduction in their HAM-A (11.1±5.5, p=0.008), DHI (11.5±8.1, p=0.008) and CGI-I (1.8±0.7, p=0.011) levels after 3-months imipramine treatment (mean=72.2±23.2 mg/day). CONCLUSION: This study found a decrease in anxiety levels and in the impact of dizziness in the patients' quality of life after a 3-months treatment course with imipramine.

OBJETIVO: O objetivo deste estudo foi avaliar a eficácia e efetividade da imipramina no tratamento da tontura crônica e do transtorno de pânico comórbidos. MÉTODO: Nove pacientes com transtorno do pânico e agorafobia associada com tontura crônica foram submetidos à avaliação otoneurológica e tratados durante 3 meses com imipramina. Os níveis de ansiedade foram medidos através da Escala Hamilton de Ansiedade (HAM-A); os de tontura foram avaliados usando o Dizziness Handicap Inventory (DHI), e a gravidade do pânico e sua resposta pela Escala de Impressão Clínica Global (CGI). RESULTADOS: Na avaliação inicial, 33,3 por cento (n=3) da amostra apresentavam vestibulopatia periférica deficitária bilateral; as médias foram: da HAM-A 27,2±10,4, do DHI 51,7±22,7 e do CGI-S 4,8±0,9. Todos tiveram uma redução significativa nos escores de HAM-A (11,1±5,5, p=0,008), DHI (11,5±8,1, p=0,008) e CGI-I (1,8±0,7, p=0,011), após 3 meses de tratamento com imipramina (média=72,2±23,2 mg/dia). CONCLUSÃO: Este estudo encontrou uma diminuição dos níveis de ansiedade e do impacto da tontura na qualidade de vida dos pacientes após um curso de 3 meses de tratamento com imipramina.

Efficacy of a specific model for cognitive-behavioral therapy among panic disorder patients with agoraphobia: a randomized clinical trial / Eficácia de um modelo específico de terapia cognitivo-comportamental em pacientes com transtorno de pânico com agorafobia: um ensaio clinico randomizado

CONTEXT AND OBJECTIVE: Cognitive-behavioral therapy is frequently indicated for panic disorder. The aim here was to evaluate the efficacy of a model for cognitive-behavioral therapy for treating panic disorder with agoraphobia. DESIGN AND SETTING: Randomized clinical trial at Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro. METHODS: A group of 50 patients with a diagnosis of panic disorder with agoraphobia was randomized into two groups to receive: a) cognitive-behavioral therapy with medication; or b) medication (tricyclic antidepressants or selective serotonin reuptake inhibitors). RESULTS: Although there was no difference between the groups after the treatment in relation to almost all variables with the exception of some items of the Sheehan disability scale and the psychosocial and environmental problems scale, the patients who received the specific therapy presented significant reductions in panic attacks, anticipatory anxiety, agoraphobia avoidance and fear of body sensations at the end of the study, in relation to the group without the therapy. On the overall functioning assessment scale, overall wellbeing increased from 60.8 percent to 72.5 percent among the patients in the group with therapy, thus differing from the group without therapy. CONCLUSION: Although both groups responded to the treatment and improved, we only observed significant differences between the interventions on some scales. The association between specific cognitive-behavioral therapy focusing on somatic complaints and pharmacological treatment was effective among this sample of patients with panic disorder and the response was similar in the group with pharmacological treatment alone.

CONTEXTO E OBJETIVO: A terapia cognitivo-comportamental é frequentemente indicada para o transtorno de pânico. O objetivo foi avaliar a eficácia de um modelo de terapia cognitivo-comportamental no tratamento do transtorno de pânico com agorafobia. TIPO DE ESTUDO E LOCAL: Ensaio clínico aleatório no Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro. MÉTODOS: Um grupo de 50 pacientes com diagnóstico de transtorno de pânico com agorafobia foi randomizado em dois grupos para receber a) terapia cognitivo-comportamental com medicação ou b) medicação (antidepressivos tricíclicos ou inibidores seletivos da recaptação da serotonina) sem terapia. RESULTADOS: Embora não se tenha observado diferença entre os grupos após o tratamento em quase todas as variáveis, com exceção de alguns itens da Escala de Incapacitação de Sheehan e da Escala de Problemas Psicossociais e Ambientais, ao final do estudo os pacientes que receberam a terapia específica apresentaram significativa redução dos ataques de pânico, ansiedade antecipatória, esquiva agorafóbica e medo das sensações corporais em relação ao grupo sem a terapia. Na escala de avaliação global do funcionamento aumentou o bem-estar global de 60,8 por cento para 72,5 por cento entre os pacientes do primeiro grupo, diferentemente do segundo grupo. CONCLUSÃO: Embora ambos os grupos tenham respondido ao tratamento e melhorado, observamos diferença significativa entre as duas intervenções apenas em poucas escalas. A associação de terapia cognitivo-comportamental específica centrada nas queixas corporais, associada ao tratamento farmacológico, foi eficaz nesta amostra de pacientes com transtorno de pânico e agorafobia e semelhante ao grupo apenas com tratamento farmacológico.

Agoraphobic cognitions in old and young patients with panic disorder.

OBJECTIVES: To compare the agoraphobic cognitions of younger and older patients suffering from panic disorder with agoraphobia by means of existing questionnaires. METHOD: Agoraphobic cognitions were assessed using the Agoraphobic Cognitions Questionnaire (ACQ) in 205 patients confirmed with confirmed panic disorder with agoraphobia (Diagnostic and Statistical Manual, Fourth Edition, Text Revision) and analyzed at the item level applying a Bonferroni correction. RESULTS: The 48 patients who were older than 60 years had a significantly lower mean (SD) ACQ total score than their younger counterparts (1.6 [0.5] versus 2.1 [0.6]; t = 5.7, df = 203, p < 0.001), with their scores on the items fear of going crazy, acting foolishly, losing control, passing out, and brain tumors (p < 0.004) being significantly lower. CONCLUSION: The differential effect at the ACQ item level suggests that some cognitions seem less relevant for agoraphobic panic disorder in later life. Future research should explore whether and which agerelated cognitions are missed in the current questionnaires.

Adenosine A(2A) receptor gene: evidence for association of risk variants with panic disorder and anxious personality.

Adenosine A(2A) receptors are suggested to play an important role in different brain circuits and pathways involved in anxiety reactions. A variant within the corresponding ADORA2A gene (rs5751876) increased the risk for panic disorder (PD), for elevated anxiety during challenge tests in healthy probands and for anxiety-related arousal in blood-injury phobia. These multiple effects may mirror a more general effect of the SNP on basic personality traits. In the present study we therefore aimed to replicate the original finding in a large PD sample and extend it by investigating an additional proband sample characterized for different anxiety-related personality scores. In addition, as rs5751876 is assumed not to be the disease variant itself but to be in linkage disequilibrium (LD) with the true functional polymorphism other SNPs of potentially functional relevance were identified by re-sequencing the whole gene including several newly identified regions of putative regulatory potential and analysed for their impact on PD and anxious personality. We were indeed able to replicate rs5751876 as risk factor for PD, particularly PD with agoraphobia. Rs5751876 and several other variants in high LD (rs5751862, rs2298383 and rs3761422) as well as the corresponding haplotypes were also associated with different anxiety-related personality scores (Bonferroni corrected P(all) < 0.05). Of these variants, rs2298383 shows functional potential based on in silico analyses and might therefore represent the true underlying causal variant. Our data provide further support for an important role of ADORA2A variants in the pathogenesis of anxiety disorders and anxious personality reflecting their potential as basic susceptibility factors.

The relationship between anxiety disorders and substance use among adolescents in the community: specificity and gender differences.

Using a sample of 781 adolescents (ages 13-17, 52.8% male) from a community survey, this study examined gender differences in the co-occurrence of specific anxiety disorders with substance use in adolescents. The associations between anxiety disorders and substance use differed according to the particular anxiety disorders and forms of substance use being examined, as well as by gender. Social phobia was associated with cigarette smoking among boys only. For girls, social phobia appeared to be negatively associated with drug use. For the other anxiety disorders, the associations with substance use tended to be stronger among girls. These findings highlight the need to improve clinical recognition of the anxiety disorders and to improve treatment access for afflicted adolescents. Future studies based on longitudinal data could further elucidate the relationships among anxiety disorders, gender, and substance use.

Should psychological distress screening in the community account for self-perceived health status?

OBJECTIVE: Psychological distress questionnaires are often used as screening instruments for mental disorders in clinical and epidemiologic settings. Poor physical health may affect the screening properties of a questionnaire. We evaluate the effect of self-perceived health status on the screening performance of the Kessler K10 and K6 scales in a community sample. METHODS: We used data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2). Psychological distress was measured by the 6-item (K6) and the 10-item (K10) Kessler instrument. Depression and anxiety disorders were assessed using the World Mental Health Composite International Diagnostic Interview (1-month estimates). Optimal cut-off points regarding health status were determined by finding the K6 and K10 values that allowed for the best balance between sensitivity and specificity. Stratum-specific likelihood ratios (SSLRs) were computed to define strata with discriminating power. RESULTS: There was a strong association between the screening performance of the K6 and K10 scales and self-perceived health status: for the K10 scale, a cut-off point of 5/6 yielded the best balance between sensitivity and specificity for subjects with excellent or very good health status, while a cut-off point of 14/15 yielded the best balance between sensitivity and specificity for subjects with poor health status. CONCLUSIONS: The combination of the K6 and K10 scales, with a self-rated health status item, may improve screening properties of the 2 scales.

CBT for anxiety and associated somatic complaints in pediatric medical settings: an open pilot study.

OBJECTIVE: To examine the initial feasibility and potential efficacy of a cognitive-behavioral intervention for youth with anxiety disorders and non-medical somatic symptoms. BACKGROUND: Based on a strong relationship between somatic complaints and anxiety disorders, screening youngsters seeking medical care due to physical symptoms with no organic basis may enhance the recognition of anxiety disorders and facilitate access to appropriate services. METHOD: Seven boys and girls, ages 8 through 15, with medically unexplained gastrointestinal complaints and anxiety disorders received a 12-session cognitive-behavioral intervention targeting anxiety and physical symptoms. Assessments were conducted at baseline and following treatment. RESULTS: All participants were classified as treatment responders. Three of the seven participants no longer met diagnostic criteria for their principal anxiety disorder. Children's physical discomfort decreased from a moderate to minimal level based on self- and parent-reports. CONCLUSIONS: Our modified cognitive-behavioral approach has promise for reducing anxiety and somatic symptoms in children seeking medical care.

Screening capacity of the Multidimensional Anxiety Scale for Children (MASC) for DSM-IV anxiety disorders.

BACKGROUND: The Multidimensional Anxiety Scale for Children (MASC) is a widely used self-report questionnaire for the assessment of anxiety symptoms in children and adolescents. METHODS: This study used receiver operating characteristic analyses to investigate the predictive value of the MASC total and scale scores for DSM-IV anxiety diagnoses in a referred sample. Eight- to 18-year-olds (n=212) were assessed with the MASC and Anxiety Disorders Interview Schedule for Children (ADIS-C). RESULTS: The MASC total score did not exceed the threshold for being judged as fair in predicting any ADIS-C/DSM-IV anxiety diagnosis. The Separation Anxiety scale and the Physical Symptoms scale predicted Panic Disorder (PAD) and Agoraphobia fairly accurately. The Social Anxiety scale predicted Social Phobia, and the Separation Anxiety scale predicted PAD to a moderate degree. The MASC scale Harm Avoidance did not predict any ADIS-C/DSM-IV diagnosis. CONCLUSIONS: These results suggest that the MASC may not be a valid screening instrument for DSM-IV diagnoses.