Epidemiology of anxiety disorders in the 21st century.

Anxiety disorders, including panic disorder with or without agoraphobia, generalized anxiety disorder, social anxiety disorder, specific phobias, and separation anxiety disorder, are the most prevalent mental disorders and are associated with immense health care costs and a high burden of disease. According to large population-based surveys, up to 33.7% of the population are affected by an anxiety disorder during their lifetime. Substantial underrecognition and undertreatment of these disorders have been demonstrated. There is no evidence that the prevalence rates of anxiety disorders have changed in the past years. In cross-cultural comparisons, prevalence rates are highly variable. It is more likely that this heterogeneity is due to differences in methodology than to cultural influences. Anxiety disorders follow a chronic course; however, there is a natural decrease in prevalence rates with older age. Anxiety disorders are highly comorbid with other anxiety disorders and other mental disorders.

Los trastornos de ansiedad, que incluyen el trastorno de pánico con o sin agorafobia, el trastorno de ansiedad generalizada, el trastorno de ansiedad social, las fobias específicas y el trastorno de ansiedad por separación son los trastornos mentales más prevalentes y están asociados con inmensos costos de atención de salud y una alta carga de enfermedad. De acuerdo con investigaciones basadas en grandes poblaciones, hasta un 33,7% de la población presenta un trastorno de ansiedad durante su vida. Se ha demostrado que el subdiagnóstico y el subtratamiento de estos trastornos es significativo. No existe evidencia acerca del cambío en las frecuencias de prevalencia de los trastornos de ansiedad en los últimos años. En comparaciones interculturales las frecuencias de prevalencía son altamente variables. Es más probable que esta heterogeneidad se deba a diferencias en la metodología más que a influencias culturales. Los trastornos de ansiedad siguen un curso crónico; sin embargo, hay una disminución natural en las frecuencias de prevalencia a mayor edad. Los trastornos de ansiedad son altamente comórbidos con otros trastornos ansiosos y otros trastornos mentales.

Les troubles anxieux, dont le trouble panique avec ou sans agoraphobie, le trouble anxieux généralisé, l'anxiété sociale, les phobies spécifiques et l'anxiété de séparation, sont les troubles mentaux les plus prévalents avec des coûts immenses en termes de santé et une charge élevée. D'après de grandes études basées sur la population, jusqu'à 33,7 % de la population souffre d'un trouble anxieux au cours de la vie. Ces pathologies sont manifestement sous-diagnostiquées et sous-traitées. Leur prévalence n'a pas montré de modification ces dernières années et est très variable dans les comparaisons interculturelles. Cette hétérogénéité est probablement plus due à des biais méthodologiques qu'à des influences culturelles. L'évolution des troubles anxieux est chronique mais leur prévalence diminue cependant naturellement avec l'âge. Leur comorbidité avec les autres troubles anxieux et les autres maladies mentales est très élevée.

Disorder-specific emotional imagery for differential and quantitative assessment of agoraphobia.

Visual emotional stimulation is supposed to elicit psycho-vegetative reactions, which are similar to as the ones elicited by exposure to actual experience. Visual stimulation paradigms have been widely used in studies on agoraphobia with and without panic disorder. However, the applied imagery has hardly ever been disorder- and subject- specific. 51 patients with an ICD-10 and DSM-IV diagnosis of agoraphobia with or without panic disorder (PDA) and matching healthy controls have been examined. Subjects were confronted with 146 picture showing characteristic agoraphobic situations (high places, narrow places, crowds, public transport facilities, or wide places) or pictures associated with acute physical emergency (panic) situations, which had been pre-selected by anxiety experts. Participants were asked to rate emotional arousal induced by the respective images on the Self- Assessment Manikin scale (SAM). Data on PDA severity (PAS) depressive symptoms (MADRS) and sociodemographic data were recorded. Saliva cortisol levels were measured before and after exposure in a second test applying the individually mostly feared stimuli combined with emotionally neutral pictures for every single patient. 117 of the PDA-specific images were rated significantly more fear-eliciting by patients than by healthy individuals. Sub-categorization into agoraphobia clusters showed differential effects of clusters with regard to gender distribution, severity of PDA and cortisol secretion during exposure. In this study disorder specific and individual characteristics of agoraphobia were assessed for use in future trials applying emotional imagery. It could be used for the differential assessment of PDA and associated neurobiological and psychological phenomena and in neuroimaging paradigms.

Manifesto for a European anxiety disorders research network.

Despite the size, burden and costs of anxiety disorders, many patients remain unrecognised, and the effectiveness of evidence-based interventions in routine clinical practice can be disappointing. The European College of Neuropsychopharmacology (ECNP) has established the ECNP Network Initiative (ECNP-NI) to help meet the goal of extending current understanding of the causes of central nervous system disorders, thereby contributing to improvements in clinical outcomes and reducing the associated societal burden. The Anxiety Disorders Research Network (ADRN) has been adopted within the ECNP-NI: this consensus statement summarises its overall aims and objectives.

The quantification inventory for somatoform syndromes (QUISS): a novel instrument for the assessment of severity.

BACKGROUND: To date, specific scales for the assessment of severity of somatoform disorders are still rare. Characteristic cognitive and behavioural domains, representing severity are not incorporated in the existing scales. Results with the novel quantification inventory for somatoform syndromes (QUISS) are presented in this paper. METHODS: The QUISS has been developed as a qualified severity scale for patients fulfilling diagnostic criteria according to DSM-IV or/and ICD-10. It was designed to be particularly suitable for application in clinical trials and for monitoring the efficacy of psychotherapy and pharmacotherapy. Not only number, severity and frequency of somatoform symptoms, but also common cognitive and behavioural domains of somatoform disorders have been included into this instrument. Both an 18-item patient- and observer-rated version are available taking about 20 min to complete. The questionnaire was applied to patients with somatoform disorder (N = 96), major depression (N = 24), and panic disorder (N = 16). RESULTS: The psychometric properties of the scale are satisfactory. The QUISS showed high objectivity (Cronbach's alpha = 0.90 for both versions; inter-scale correlations r = 0.64-0.88; p < 0.05), good test-retest- (r = 0.87; p < 0.05) and inter-rater-reliability (r = 0.89; p < 0.05). External validity (moderately high correlations of QUISS-T to SOMS 7T (r = 0.54), significant discrimination to major depression p < 0.05) was satisfactory. Factor structure revealed five relevant factors. CONCLUSIONS: The QUISS could be a useful instrument in somatoform disorders for the assessment of syndrome severity and treatment outcome in scientific and clinical settings.

WCA recommendations for the long-term treatment of obsessive-compulsive disorder in adults.

What are the latest psychotherapeutic and pharmacotherapeutic treatment recommendations for obsessive-compulsive disorder (OCD)? OCD is a relatively common disorder with a lifetime prevalence of approximately 2% in the general population. It often has an early onset, usually in childhood or adolescence, and frequently becomes chronic and disabling if left untreated. High associated healthcare utilization and costs, and reduced productivity resulting in loss of earning, pose a huge economic burden to OCD patients and their families, employers, and society. OCD is characterized by the presence of obsessions and compulsions that are time-consuming, cause marked distress, or significantly interfere with a person's functioning. Most patients with OCD experience symptoms throughout their lives and benefit from long-term treatment. Both psychotherapy and pharmacotherapy are recommended, either alone or in combination, for the treatment of OCD. Cognitive-behavioral therapy is the psychotherapy of choice. Pharmacologic treatment options include the tricyclic antidepressant clomipramine and the selective serotonin reuptake inhibitors (SSRIs) citalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline. These have all shown benefit in acute treatment trials; clomipramine, fluvoxamine, fluoxetine, and sertraline have also demonstrated benefit in long-term treatment trials (at least 24 weeks), and clomipramine, sertraline, and fluvoxamine have United States Food and Drug Administration approvals for use in children and adolescents. Available treatment guidelines recommend first-line use of an SSRI (ie, fluoxetine, fluvoxamine, paroxetine, sertraline, or citalopram) in preference to clomipramine, due to the latter's less favorable adverse-event profile. Further, pharmacotherapy for a minimum of 1-2 years is recommended before very gradual withdrawal may be considered.

"As needed" pharmacotherapy combined with stimulus control treatment in chronic insomnia--assessment of a novel intervention strategy in a primary care setting.

Discontinuous, nonnightly hypnotic therapy in the treatment of chronic insomnia is likely to offer benefits such as maintained efficacy while preventing unnecessary long-term nightly use associated with the risk of tolerance and dependence. Based on the favorable results seen in four zolpidem studies using increasing degrees of flexibility in drug intake schedule, we developed the concept further and investigated "as needed" zolpidem pharmacotherapy amended by the optional use of stimulus control in conditions close to the "real life" practice. In a prospective, observational open study in 550 primary care settings throughout Germany, 2690 patients with chronic insomnia (mean age 59 years, 66% female, 50% with pharmacotherapy pretreatment) were treated with zolpidem according to an "as-needed" (pro re nata) administration treatment schedule (up to five tablets per week, intake nights chosen by the patient), amended by the optional use of behavioral therapy (stimulus control) during drug-free nights. After the three weeks' treatment period, in two thirds of patients (63%) the weekly number of tablets used was reduced in contrast to baseline. The average zolpidem tablet number taken decreased by 28% (from 3.7 to 2.6 per week; p < 0.00001) without any significant impact on the treatment efficacy assessed through the CGI. The subjective latency to sleep onset was reduced from a mean of 74 27 min (p < 0.00001) and total sleep time increased from 5.0 to 6.8 h (p < 0.00001). Efficacy of treatment was rated as very good or good in 93% by the investigators. Adverse events were observed only in 1.2% of patients and were generally of mild nature. No serious adverse event occurred. These results underline the validity of the zolpidem "as needed" treatment concept. It is feasible in a safe and effective manner also in a primary care setting and can be amended by stimulus control. Further research is warranted on the contributions of both treatment components to effectiveness and on the efficacy and safety issues of long-term use.