Trauma Exposure in Anxious Primary Care Patients.

The present study examined rates of trauma exposure, clinical characteristics associated with trauma exposure, and the effect of trauma exposure on treatment outcome in a large sample of primary care patients without posttraumatic stress disorder (PTSD). Individuals without PTSD (N = 1263) treated as part of the CALM program (Roy-Byrne et al., 2010) were assessed for presence of trauma exposure. Those with and without trauma exposure were compared on baseline demographic and diagnostic information, symptom severity, and responder status six months after beginning treatment. Trauma-exposed individuals (N = 662, 53%) were more likely to meet diagnostic criteria for Obsessive Compulsive Disorder and had higher levels of somatic symptoms at baseline. Individuals with and without trauma exposure did not differ significantly on severity of anxiety, depression, or mental health functioning at baseline. Trauma exposure did not significantly impact treatment response. Findings suggest that adverse effects of trauma exposure in those without PTSD may include OCD and somatic anxiety symptoms. Treatment did not appear to be adversely impacted by trauma exposure. Thus, although trauma exposure is prevalent in primary care samples, results suggest that treatment of the presenting anxiety disorder is effective irrespective of trauma history.

Genome-wide association study of obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a common, debilitating neuropsychiatric illness with complex genetic etiology. The International OCD Foundation Genetics Collaborative (IOCDF-GC) is a multi-national collaboration established to discover the genetic variation predisposing to OCD. A set of individuals affected with DSM-IV OCD, a subset of their parents, and unselected controls, were genotyped with several different Illumina SNP microarrays. After extensive data cleaning, 1465 cases, 5557 ancestry-matched controls and 400 complete trios remained, with a common set of 469,410 autosomal and 9657 X-chromosome single nucleotide polymorphisms (SNPs). Ancestry-stratified case-control association analyses were conducted for three genetically-defined subpopulations and combined in two meta-analyses, with and without the trio-based analysis. In the case-control analysis, the lowest two P-values were located within DLGAP1 (P=2.49 × 10(-6) and P=3.44 × 10(-6)), a member of the neuronal postsynaptic density complex. In the trio analysis, rs6131295, near BTBD3, exceeded the genome-wide significance threshold with a P-value=3.84 × 10(-8). However, when trios were meta-analyzed with the case-control samples, the P-value for this variant was 3.62 × 10(-5), losing genome-wide significance. Although no SNPs were identified to be associated with OCD at a genome-wide significant level in the combined trio-case-control sample, a significant enrichment of methylation QTLs (P<0.001) and frontal lobe expression quantitative trait loci (eQTLs) (P=0.001) was observed within the top-ranked SNPs (P<0.01) from the trio-case-control analysis, suggesting these top signals may have a broad role in gene expression in the brain, and possibly in the etiology of OCD.

Functioning and disability levels in primary care out-patients with one or more anxiety disorders.

BACKGROUND: Anxiety disorders are the most prevalent mental health disorders and are associated with substantial disability and reduced well-being. It is unknown whether the relative impact of different anxiety disorders is due to the anxiety disorder itself or to the co-occurrence with other anxiety disorders. This study compared the functional impact of combinations of anxiety disorders in primary care out-patients. METHOD: A total of 1004 patients with panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD) or post-traumatic stress disorder (PTSD) provided data on their mental and physical functioning, and disability. Multivariate regressions compared functional levels for patients with different numbers and combinations of disorders. RESULTS: Of the patients, 42% had one anxiety disorder only, 38% two, 16% three and 3% all four. There were few relative differences in functioning among patients with only one anxiety disorder, although those with SAD were most restricted in their work, social and home activities and those with GAD were the least impaired. Functioning levels tended to deteriorate as co-morbidity increased. CONCLUSIONS: Of the four anxiety disorders examined, GAD appears to be the least disabling, although they all have more in common than in distinction when it comes to functional impairment. A focus on unique effects of specific anxiety disorders is inadequate, as it fails to address the more pervasive impairment associated with multiple anxiety disorders, which is the modal presentation in primary care.

Bringing up bashful baby. Developmental pathways to social phobia.

Shyness is a risk factor for, or an early manifestation of, more enduring problems with social anxiety. But the majority of shy children do not develop social phobia, and factors that further increase risk are poorly understood, underscoring the complexity of this relationship. Studies uniformly show that social phobia (particularly the generalized subtype) runs in families, and twin studies suggest that a moderate component of this familial tendency is genetic in origin. Understanding the genetic etiology of other neuropsychiatric disorders characterized by abnormal social interest, social communication (e.g., autism), or both may prove informative for social phobia. The contribution of unique experiences to the development of social phobia is clear from genetic studies, but studies to date have failed to elucidate what kinds of experiences might be involved. Given patient reports that socially traumatic conditioning experiences have often occurred, detailed evaluation of these kinds of experiences in monozygotic twins discordant for social phobia would be a particularly informative research strategy. Nongenetic familial factors probably have more limited effects on the development of social phobia, although the impact of parental modeling of, and acquiescence to, childhood social fears deserves to be further investigated. These factors may be particularly salient for the expression of social phobia in children whose genes render them susceptible. If so, it should be possible to design early interventions to prevent the progression from phobia proneness (e.g., designated on the basis of family history) to phobic disorder.

Recent developments in child and adolescent social phobia.

The following article discusses research trends in childhood and adolescent social phobia during the past year. Of particular importance are findings regarding prevalence rates, cognitive variables and social skills deficits, temperamental influences, and the use of selective serotonin reuptake inhibitors (SSRIs). Recent prevalence rates of social anxiety disorder in children and adolescents range from 0.5% to 4.0%. Findings regarding the role of cognitive processes and social skills deficits in childhood social phobia are supported. Recent longitudinal data investigating the stability of extremes of behavioral inhibition have found that it persists from childhood into adolescence. Initial data regarding the use of SSRIs suggest that they may be a promising treatment option.

MMPI-2 scores of Puerto Rican, Mexican, and U.S. Latino college students: a research note.

In this brief report, we present MMPI-2 basic validity and clinical scale data of Latino-descent persons from Puerto Rico (n = 290), Mexico (n = 1,920), and the United States (n = 28). All were administered one of three Spanish translations of the MMPI-2. A review of the mean scores of these respective groups indicates similarities across all scales. Differences among these three groups, with the exception of the Mf scale (which is keyed to sex), were well within the one standard deviation band. More importantly, these findings are promising given the fact that three different translations of the MMPI-2 were applied.

Assessing bilingual and monolingual Latino students with translations of the MMPI-2: initial data.

This article presents the results of 2 studies conducted with Spanish versions of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) with Latino students. Study 1 compared the results of 2 administrations of the MMPI-2, one in English and the other in Spanish. Study 2 compared the results of administrations of 2 Spanish versions of the MMPI-2, the official Mexican adaptation and the Version Hispana. In both cases, scale score differences were not found. Comparability, as operationally defined by test-retest reliability, was found to be higher for the group that was administered the English and Spanish versions than the group administered the 2 Spanish versions. Overall, the results were found to suggest correspondence. Yet, the authors warn against concluding "perfect" correspondence because other key groups need to be studied, including psychiatric patients and persons from the Latino community. Also, the determination of linguistic equivalence needs further refinement.

The shyness spectrum.

Debate continues regarding the relationship between shyness and social phobia. Some have proposed that this relationship is best understood by adopting a spectrum approach where increasing levels of shyness eventually merge into the clinical disorder of social phobia. This paper begins to explore the validity of this spectrum by reviewing similarities and differences between shyness and social phobia and investigating how shyness relates to social phobia subtypes. This paper will also explore precursors to social phobia, namely childhood behavioral inhibition.

Subtypes of social phobia and comorbidity with depression and other anxiety disorders.

Epidemiological studies have identified two subtypes of social phobia: speaking-only social phobia which is characterized by the fear of public speaking situations and complex social phobia which is characterized by the fear of multiple social situations. Speaking-only social phobia most closely corresponds to the DSM-IV's 'nongeneralized social phobia' while complex social phobia resembles 'generalized social phobia'. In contrast to the speaking-only social phobia, the complex form is usually more disabling, familial and longer-lasting. In addition, the complex form has a lower chance of spontaneous recovery and carries a higher risk of comorbidity and impairment. Overall, both types of social phobia tend to be underdiagnosed and under-treated. Effective treatments which can manage not only complex social phobia, but also its spectrum of comorbid conditions, are required.