Separation Anxiety Disorder in Panic Disorder Patients with and without Comorbid Agoraphobia.

Objective: Previous studies have focused on the relationship between childhood separation anxiety disorder (SAD) and adult panic disorder (PD)-agoraphobia. It is not clear enough whether SAD, which continues into adulthood, is associated with PD with and without comorbid agoraphobia in adult patients. Our primary hypothesis was that PD patients with comorbid agoraphobia had a higher rate of SAD that continues into adulthood than those without agoraphobia. We also hypothesized that adulthood SAD symptoms were more likely to be associated with PD-agoraphobia than PD without agoraphobia.Method: 151 patients who were diagnosed with PD with (n = 106), and without comorbid agoraphobia (n = 45) were compared using Panic and Agoraphobia Scale, Structured Clinical Interview for Separation Anxiety Symptoms, Separation Anxiety Symptom Inventory, Adult Separation Anxiety Questionnaire, and State-Trait Anxiety Inventory. We performed Student's t-test, Pearson correlation test, and multiple linear regression analysis in this study.Results: PD patients with comorbid agoraphobia were more likely to have SAD both in childhood and adulthood (p = .028), than those without agoraphobia. There were mild to moderate significant correlations between PD severity and state anxiety (p = .002), trait anxiety (p = .006), and SAD in childhood (p = .049), and in adulthood (p = .001). SAD in adulthood (ß = 0.278, Exp(B) = 0.136, p = .003), and state anxiety (ß = 0.236, Exp(B) = 0.164, p = .012) significantly predicted the severity of PD in patients with comorbid agoraphobia.Conclusion: SAD that continues in adulthood may be related to the severity of PD in patients with agoraphobia. Our findings might provide some evidence of the role of SAD in adulthood in patients with adult-onset PD-agoraphobia.

The characteristics of the comorbidity between social anxiety and separation anxiety disorders in adult patients.

Objective: In the present study, we compared social anxiety disorder (SAD) patients with (n = 31) and without childhood and adulthood separation anxiety disorder (SeAD) (n = 50) with respect to suicidal behavior, avoidant personality disorder (AvPD), other anxiety disorders (ADs), and major depression as well as some sociodemographic variables. Methods: In assessment of patients, we used Structured Clinical Interview for Separation Anxiety Symptoms, childhood and adulthood Separation Anxiety Symptom Inventories, Liebowitz Social Anxiety Scale, The SCID-II Avoidant Personality Disorder Module, Beck Depression Inventory, and Beck Scale for Suicidal Ideation. Results: SAD patients with SeAD had higher comorbidity rates of AvPD, other lifetime ADs and panic disorder, and current major depression than those without SeAD. The current scores of SAD, depression, and suicide ideation and the mean number of AvPD symptoms were significantly higher in comorbid group compared to pure SAD subjects. The SAD and SeAD scores had significant associations with current depression, suicide ideations, and AvPD. The mean number of AvPD criteria and the current severity of depression were significantly associated with the comorbidity between SAD and SeAD. Conclusion: Our findings might indicate that the comorbidity of SeAD with SAD may increase the risk of the severity of AvPD and current depression.

The importance of avoidant personality in social anxiety disorder with and without attention-deficit/hyperactivity disorder.

In the present study, our primary aim was to compare the generalized social anxiety (GSAD) patients with and without attention-deficit/hyperactivity disorder (ADHD) in terms of avoidant personality disorder (AVPD), and some clinical variables. We also investigated the relationship of AVPD and depression with ADHD and GSAD. We hypothesized that ADHD may be associated with AVPD in patients with GSAD. Seventy-six patients with GSAD were evaluated for depression, AVPD, and childhood and adulthood diagnoses of ADHD. The GSAD patients with (n = 34) and without adulthood ADHD (n = 30) were compared with respect to some sociodemographic and clinical variables. GSAD patients with adulthood ADHD had significantly higher comorbid diagnosis of AVPD, more avoidant personality and depression symptoms than those without ADHD. Pearson's correlation coefficient in total sample (n = 76) showed that the mean number of AVPD criteria was significantly associated with the severity of Beck Depression Inventory, Wender Utah Rating Scale (WURS), and inattention symptoms of ADHD. There were no correlations between the total and subscale scores of Liebowitz Social Anxiety Scale and the mean number of AVPD criteria. The scores of WURS significantly predicted the mean number of AVPD criteria (ß = 0.305, p= 0.007). The severity of current depression (ß = 0.143, p = 0.30) and inattention symptoms of adulthood ADHD (ß = 0.112, p = 0.46) were not associated with the severity of AVPD symptoms. These results might demonstrate that comorbid AVPD in adult SAD patients was related to a childhood ADHD independent from depression, and inattention symptoms of ADHD in adulthood.

The Association of Lifetime Suicide Attempts With Anxiety Disorders in Patients With Bipolar Disorder.

The association of lifetime suicidal behaviors with anxiety disorders (ADs) in patients with bipolar disorder (BD) has been controversial. In this study, we hypothesized that certain types of ADs were related to the occurrence of past suicide attempts (SAs) independent of the severity of the BD, including the presence of past affective episodes. Lifetime diagnoses of BD and ADs were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Disorders (SCID-I). Of the total sample of 200 patients with BD, 32.0% had at least 1 past SA. The mean number of previous hospitalizations, a history of social AD, and a history of posttraumatic stress disorder were strongly associated with past SAs in patients with bipolar I disorder. The presence of lifetime social AD was associated with lifetime SAs independent of previous depressive episodes. Therefore, we suggest that social AD itself is associated with a greater risk for SAs in patients with BD independent of the presence of depression.

Comorbid obsessive-compulsive disorder with bipolar disorder: A distinct form?

We examined whether the patients with Bipolar Disorder (BD) and Obsessive-Compulsive Disorder (OCD) comorbidity may represent a distinct form of BD. The subjects diagnosed with BD (n=48), OCD (n=61), and BD with OCD (n=32) were compared in terms of several socio-demographic and clinical characteristics. Previous history of suicidal attempts was more likely to be higher in BD-OCD group compared to the other two groups. A more episodic course of OCD, higher rates of rapid cycling, and the seasonality were found in BD-OCD patients. The frequency of bipolar II and NOS subtypes was more prevalent in patients with BD-OCD than in OCD patients. The first diagnosed illness was BD in the majority of BD-OCD cases. It was found that first affective episode was major depression in half of BD-OCD patients. Age at onset of BD was found to be earlier in BD-OCD group compared to pure BD patients. Bipolarity may not have a specific effect on the phenomenology of OC symptoms. The episodic course of OCD, seasonality, rapid cycling, earlier onset of BD, and impulsivity in BD-OCD patients may be indicative for a distinct form of BD.