From fears of evaluation to social anxiety: The longitudinal relationships and neural basis in healthy young adults

Background: Social anxiety disorder (SAD) is a common mental health problem, and its core cognitive manifestation is the persistent fear of being evaluated, including both negatively (FNE) and positively (FPE). This study aimed to examine the longitudinal relationships of FNE, FPE and SAD and explore their neural basis. Methods: Three samples were retrieved in this study. First, the data of 649 college students who completed a survey and fMRI scan were used to explore the neural basis of FNE, FPE, and SAD symptoms. Next, the data of 450 participants who completed the same survey twice were used to examine the longitudinal relationships of the variables. Finally, the overlapping of the two samples (N = 288) who completed two surveys and the fMRI scan were used to establish a brain-behavior model. Results: Both FNE and FPE predicted SAD, and SAD also predicted FPE. The neural signals of subregions in prefrontal cortex were correlated with the scores of FNE, FPE and SAD. Abnormal prefrontal signals influenced SAD symptoms via fears of evaluation. Conclusions: Our findings explain the behavioral and neural underpinnings of social anxiety from a fear of evaluation angle. This contributes to a better theorical understanding of SAD and clinical practice. (AU)

Generalized and social anxiety disorder interactomes show distinctive overlaps with striosome and matrix interactomes.

Mechanisms underlying anxiety disorders remain elusive despite the discovery of several associated genes. We constructed the protein-protein interaction networks (interactomes) of six anxiety disorders and noted enrichment for striatal expression among common genes in the interactomes. Five of these interactomes shared distinctive overlaps with the interactomes of genes that were differentially expressed in two striatal compartments (striosomes and matrix). Generalized anxiety disorder and social anxiety disorder interactomes showed exclusive and statistically significant overlaps with the striosome and matrix interactomes, respectively. Systematic gene expression analysis with the anxiety disorder interactomes constrained to contain only those genes that were shared with striatal compartment interactomes revealed a bifurcation among the disorders, which was influenced by the anterior cingulate cortex, nucleus accumbens, amygdala and hippocampus, and the dopaminergic signaling pathway. Our results indicate that the functionally distinct striatal pathways constituted by the striosome and the matrix may influence the etiological differentiation of various anxiety disorders.

Candidate Factors Maintaining Social Anxiety in the Context of Psychotic Experiences: A Systematic Review.

Social anxiety is common in psychosis and associated with impaired functioning, poorer quality of life, and higher symptom severity. This study systematically reviewed factors maintaining social anxiety in people with attenuated, transient, or persistent psychotic experiences. Other correlates of social anxiety were also examined. MEDLINE, Embase, CENTRAL, and PsycINFO were searched for relevant literature up to October 19, 2020. Forty-eight articles were eligible for narrative synthesis: 38 cross-sectional studies, 8 prospective studies, 1 uncontrolled trial, and 1 qualitative study. From 12060 participants, the majority was general population (n = 8771), followed by psychosis samples (n = 2532) and those at high risk of psychosis (n = 757). The methodological quality and risk of bias were assessed using the Mixed Methods Appraisal Tool. Ninety percent of studies were rated as high to very-high quality. Poorer quality studies typically failed to adequately control for confounds and provided insufficient information on the measurement validity and reliability. Prominent psychological factors maintaining social anxiety included self-perceptions of stigma and shame. Common correlates of social anxiety included poorer functioning and lower quality of life. In conclusion, stigma and shame could be targeted as a causal mechanism in future interventional studies. The integration of findings from this review lead us to propose a new theoretical model to guide future intervention research.

Comparison of social anxiety between Japanese adults who stutter and non-stuttering controls.

PURPOSE: Adults who stutter (AWS) often develop social anxiety disorder. This study was to provide comparative data on the Liebowitz Social Anxiety Scale-Japanese version (LSAS-J) from AWS and non-stuttering adult controls. METHODS: LSAS-J, a 24-item self-reported survey of social phobia and avoidance across various daily situations, was administered to 130 AWS (Mean Age = 41.5 years, SD = 15.8, 111 males) and 114 non-stuttering adults (Mean Age = 39.5, SD = 14.9, 53 males). The test-retest reliability and internal consistency of the LSAS-J were assessed. A between-subject multivariate analysis of variance (MANOVA) was also conducted to determine whether attitude toward social anxiety differed between AWS and AWNS, or by age (<40 and ≥ 40 years old), or sex (female and male). RESULTS: AWS reported higher scores on both fear subscales of the LSAS-J. Age had no significant influence on the social anxiety levels reported by either participant group. Sex differences were found in the fear subscales, with females scoring higher on both fear subscales, although these were only marginally significant (p = .06). LSAS-J showed good test-retest reliability and high Cronbach's alpha coefficient, indicating that it is an internally consistent measure of attitudes about social anxiety. CONCLUSION: Given the similarly high incidence of social anxiety in adults in Japan who stutter compared with those in other countries, social anxiety should be identified and assessed during clinical decision making and before decisions are made about stuttering treatment. LSAS-J is an easy tool to administer, and showed reliable results of social phobia and avoidance for AWS.

Effect of Stress Management Training on Stigma and Social Phobia in HIV-Positive Women.

The purpose of this study was to investigate the effect of stress management training on stigma and social phobia among HIV-positive women. This quasi-experimental pre- and posttest study was performed on a single group of 55 HIV-positive females Hamadan city, Iran, in 2018. The samples were taken through a convenience sampling method and the data collection tool were Berger HIV Stigma and Connor Social Phobia Scale. The mean scores of the stigma were 119.98 ± 21.15 and 94.78 ± 16.34 and social phobia were 24 ± 17.4 and 11.2 ± 9.68 before and after the intervention, respectively. The results of the paired sample t test indicated a significant difference in the stigma and social phobia mean scores before and after the intervention in HIV-positive women (P < .05). The results of the study revealed that stigma and social phobia are big challenges for HIV-positive women since these people are always judged by others and are subjected to labeling and rejection.

The unique contribution of blushing to the development of social anxiety disorder symptoms: results from a longitudinal study.

BACKGROUND: Self-conscious emotional reactivity and its physiological marker - blushing has been proposed to be an etiological mechanism of social anxiety disorder (SAD), but so far, untested in longitudinal designs. This study tested, for the first time, whether self-conscious emotional reactivity (indexed as physiological blushing) contributes to the development of SAD symptoms over and above social behavioral inhibition (BI), which has been identified as the strongest predictor of SAD development in early childhood. METHODS: One hundred fifteen children (45% boys) and their mothers and fathers participated at ages 2.5, 4.5, and 7.5 years. Social BI was observed at all time points in a stranger approach task, and physiological blushing (blood volume, blood pulse amplitude, and temperature increases) was measured during a public performance (singing) and watching back the performance at ages 4.5 and 7.5. Child early social anxiety was reported by both parents at 4.5 years, and SAD symptoms were diagnosed by clinicians and reported by both parents at 7.5 years. RESULTS: Higher social BI at 2.5 and 4.5 years predicted greater social anxiety at 4.5 years, which, in turn, predicted SAD symptoms at 7.5 years. Blushing (temperature increase) at 4.5 years predicted SAD symptoms at 7.5 years over and above the influence of social BI and early social anxiety. CONCLUSIONS: That blushing uniquely contributes to the development of SAD symptoms over and above social BI suggests two pathways to childhood SAD: one that entails early high social BI and an early onset of social anxiety symptoms, and the other that consists of heightened self-conscious emotional reactivity (i.e. blushing) in early childhood.

Psychiatric Disorders in the Adolescent Offspring of Mothers with Thyroid Problems During Pregnancy.

Maternal thyroid problems during pregnancy have been linked to neurocognitive impairments in children. While studies suggest that disorders of maternal thyroid function during pregnancy are associated with symptoms of mental health problems in children, little is known about the risk of clinically significant psychiatric disorders in adolescence. A sample of 2451 Canadian adolescents enrolled in the Ontario Child Health Study completed the Mini International Neuropsychiatric Interview for Children and Adolescents at 12-17 years of age. Their mothers self-reported thyroid problems during pregnancy. Gestational thyroid problems were associated with offspring oppositional defiant disorder (ODD; OR 3.73; 95% CI 1.69-8.24), conduct disorder (CD; OR 12.95; 95% CI 5.12-32.75), and social anxiety disorder (SAD; OR 6.25; 95% CI 2.53-15.47). Neither sex nor gestational age moderated associations between prenatal thyroid dysfunction and the majority of outcomes. School performance mediated 8% of the association between thyroid problems and SAD, 21% for CD and 53% for ODD.

Social anxiety disorder among patients with multiple sclerosis: a population-based case-control study in Ecuador. / Trastorno de ansiedad social en pacientes con esclerosis múltiple: estudio poblacional de casos y controles en Ecuador.

INTRODUCTION: Several studies have found that individuals with multiple sclerosis (MS) experience relatively high rates of anxiety and depression; however, there are few reports about social anxiety in individuals with MS. AIM: To analyze the prevalence of social anxiety disorder and other psychiatric comorbidities in MS patients compared to matched controls. SUBJECTS AND METHODS: We included 50 patients with MS that were seen during regularly scheduled visits and 50 sex- and age-matched participants from the general population within a six-month interval. All included participants completed the Social Phobia Inventory (SPIN) and the Depression, Anxiety and Stress Scale with 21 items (DASS-21). We defined clinically significant social anxiety symptoms as SPIN scores = 19. RESULTS: The MS patients' mean age was 41.9 years (54% female). The self-reported psychosocial assessments showed that MS participants were more likely to present positive social anxiety symptoms (OR = 7.37; 95% CI = 1.99-27.30; p < 0.001), depression (OR = 3.76; 95% CI = 1.41-10.10; p = 0.006), stress (OR = 2.67; 95% CI = 1.09-6.52; p = 0.029), and general anxiety (OR = 4.70; 95% CI = 1.93-11.40; p < 0.001) than the general population. There were moderate correlations between social anxiety and depression (p = 0,006), general anxiety (p = 0,001), and stress (p < 0,001) in MS patients. CONCLUSIONS: Patients with MS had a higher risk of presenting social anxiety symptoms than a matched control group in a Hispanic population.

TITLE: Trastorno de ansiedad social en pacientes con esclerosis múltiple: estudio poblacional de casos y controles en Ecuador.Introducción. Varios estudios han encontrado que individuos con esclerosis múltiple (EM) presentan tasas altas de ansiedad y depresión; sin embargo, hay pocos informes sobre ansiedad social en individuos con EM. Objetivo. Analizar la prevalencia del trastorno de ansiedad social y otras comorbilidades psiquiátricas en pacientes con EM en comparación con los controles pareados. Sujetos y métodos. Durante un intervalo de seis meses, incluimos a 50 pacientes con EM que fueron observados durante visitas programadas regularmente y a 50 participantes de la población general pareados por sexo y edad. Todos los participantes completaron el inventario de fobia social (SPIN) y la escala de depresión, ansiedad y estrés de 21 ítems. Definimos síntomas de ansiedad social clínicamente significativos los que tenían un resultado en el SPIN mayor o igual a 19. Resultados. La edad media de los pacientes con EM era de 41,9 años (el 54%, mujeres). Las evaluaciones psicológicas notificadas demostraron que los participantes con EM tenían más probabilidad de presentar síntomas positivos de ansiedad social (OR = 7,37; IC 95% = 1,99-27,30; p < 0,001), depresión (OR = 3,76; IC 95% = 1,41-10,10; p = 0,006), estrés (OR = 2,67; IC 95% = 1,09-6,52; p = 0,029) y ansiedad general (OR = 4,70; IC 95% = 1,93-11,40; p < 0,001) que la población general. Se observaron correlaciones moderadas entre ansiedad social y depresión (p = 0,006), ansiedad general (p = 0,001) y estrés (p < 0,001) en los pacientes con EM. Conclusiones. Los pacientes con EM tienen un riesgo más elevado de presentar síntomas de ansiedad social que la población hispana en general.

Maladaptive Daydreaming Is Associated With Intensified Psychosocial Problems Experienced by Female Survivors of Childhood Sexual Abuse.

We measured maladaptive daydreaming (MD) and psychosocial indices among 194 participants, aged 18-56 years: 99 female survivors of childhood sexual abuse (CSA) and 95 control respondents with no reported history of sexual abuse. Our data show that survivors of CSA scored higher on MD compared to controls. Survivors of CSA with probable MD scored higher on psychological distress, social phobia, and social isolation compared to survivors of CSA without suspected MD, implying that MD might exacerbate the psychosocial problems linked with CSA. MD psychological screening of female survivors of CSA and the development of a treatment module for MD could improve the quality of clinical services provided to survivors.

Phase I trial of a standalone internet social anxiety treatment for adolescents who stutter: iBroadway.

BACKGROUND: iGlebe is a fully automated internet treatment program for adults who stutter that has been shown, in some cases, to reduce anxiety and effectively manage social anxiety disorder for many participants. No such automated internet treatment program exists for adolescents who stutter. AIMS: The present paper reports a Phase I trial of an adolescent version of the adult program: iBroadway. METHODS & PROCEDURES: Participants were 29 adolescents in the age range 12-17 years who were seeking cognitive-behaviour therapy (CBT) for anxiety associated with stuttering. The design was a non-randomized Phase I trial with outcome assessments at pre-treatment and immediately post-treatment after 5 months of access to the program. No contact by a clinical psychologist occurred during participant use of the program. Outcomes were a range of psychological, quality-of-life and stuttering severity measures. OUTCOMES & RESULTS: The compliance rate for the seven iBroadway modules over 5 months was extremely favourable for internet CBT, at 52.4%. There was evidence of treatment effects for (1) the number of DSM-IV mental health diagnoses with the Diagnostic Interview Schedule for Children; (2) the Unhelpful Thoughts and Beliefs About Stuttering scale; (3) the Subjective Units of Distress Scale; and (4) parent-reported speech satisfaction. CONCLUSIONS & IMPLICATIONS: Further development of iBroadway, the adolescent version of iGlebe, with Phase II trialling is warranted.

Temporal associations between social anxiety and depressive symptoms and the role of interpersonal stress in adolescents.

BACKGROUND: Adolescence is characterized by an increased vulnerability for internalizing psychopathologies such as depression and anxiety. A positive association between anxiety and depression has consistently been found in research. However, the specific direction of this association is less clear. In this study, we investigated the temporal associations between (social) anxiety and depressive symptoms. Furthermore, the role of dependent interpersonal stress as a potential mediating factor in these temporal associations was examined. METHODS: Data were part of a larger longitudinal study on the emotional development of adolescents, which was initiated in February 2013. The total sample consisted of 2011 adolescents between the ages of 11 and 19. Data were analyzed using cross-lagged models. RESULTS: Bidirectional positive associations were found between social anxiety symptoms and depressive symptoms. However, dependent interpersonal stress was not a mediator in the link between social anxiety and depression. Our results indicate that dependent interpersonal stress seems to be particularly related to depressive symptoms and not to social anxiety symptoms. CONCLUSIONS: Findings suggest that bidirectional associations between social anxiety and depressive symptoms exist. This implies that clinicians should be specifically vigilant for the development of depressive symptoms in socially anxious adolescents and the development of social anxiety symptoms in depressed adolescents. Our findings further highlight the importance of targeting dependent interpersonal stress in the context of depression.

Personality Trait Interactions in Risk for and Protection against Social Anxiety Symptoms.

Previous attempts to identify personality traits that enhance inclination to social anxiety (SA) have been limited by a tendency to focus on selected traits in isolation, rather than examining their interactions. Additional research is needed to better understand whether and how these dimensions are linked to SA. In a prospective study, it was examined how interactions between the Big Five personality factors predict SA symptoms. A total of 135 individuals, aged 18-50 years, were recruited. Personality traits were measured at baseline, and SA symptoms were assessed one month later. Results showed that low emotional stability was an independent predictor of higher levels of SA. Additionally, two significant interactions emerged: the interactions between extraversion and openness, and between openness and agreeableness predicted SA symptoms. At high openness, higher extraversion was associated with significantly lower levels of SA, suggesting that the interaction provides incrementally greater protection against SA. Thus, extraverts are likely to be protected against social anxiety symptoms, but more so the more open they are. Moreover, at high levels of agreeableness, low openness has been shown to be uniquely predictive for higher levels of SA symptoms, indicating that the combined effect of openness with agreeableness may be more important to SA than either trait in isolation. These findings highlight the importance of testing interaction effects of personality traits on psychopathology.

Is there a prodrom period in patients with social anxiety disorder? A discussion on the hypothesis of social anxiety disorder development secondary to attention-deficit/hyperactivity disorder.

The association between social anxiety disorder (SAD) and attention-deficit/hyperactivity disorder (ADHD) is poorly established. In fact, increasing and converging evidences suggest that there is a close relationship between the two disorders. High comorbidity rate between these two disorders, follow-up studies showing high rates of later development of SAD in ADHD and treatment studies in which ADHD medications have been helpful for both conditions all indicate this relationship. Recently, we have published a hypothesis regarding the development of SAD secondary to ADHD. In this hypothesis, we recognized that patients with SAD seem to go through a prodromal period that we labeled as "pre-social anxiety." Detecting patients in this period before meeting full-blown SAD criteria provides early intervention and prevention of SAD. New, comprehensive follow-up studies which will investigate whether ADHD causes later SAD secondarily are needed. In the current review, taken into account our developmental hypothesis, we will discuss whether high comorbidity of SAD and ADHD is a chance finding (i.e., the two disorders are found in cases with no causal relationship between them) or can SAD develop secondarily due to childhood ADHD. Is there a prodrom period in patients with SAD as in cancer or psychosis patients? We are going to summarize the overlapping features of SAD and ADHD in terms of child/parents interaction and family issues, aversive childhood experiences, social skill deficits, and development of cognitive distortions.

Emotional neglect in childhood shapes social dysfunctioning in adults by influencing the oxytocin and the attachment system: Results from a population-based study.

Early life maltreatment (ELM) is the major single risk factor for impairments in social functioning and mental health in adulthood. One of the most prevalent and most rapidly increasing forms of ELM is emotional neglect. According to bio-behavioral synchrony assumptions, the oxytocin and attachment systems play an important mediating role in the interplay between emotional neglect and social dysfunctioning. Therefore, the aim of the present study was to investigate whether fear and avoidance of social functioning, two important and highly prevalent facets of social dysfunctioning in adulthood, are shaped by emotional neglect, plasma oxytocin levels and attachment representations. We assessed emotional neglect as well as other forms of ELM with the Childhood Trauma Questionnaire, current attachment representations with the Adult Attachment Projective Picture System, and fear and avoidance of social situations with the Liebowitz Social Anxiety Scale in a population-based sample of N = 121 men and women. Furthermore, 4.9 ml blood samples were drawn from each participant to assess peripheral plasma oxytocin levels. Applying a sequential mediation model, results revealed that emotional neglect was associated with lower plasma oxytocin levels which in turn were associated with insecure attachment representations which were related to elevated fear and avoidance of social situations (a1d21b2: F3,117 = 20.84, P < .001). Plasma oxytocin and current attachment representations hence fully and sequentially mediate the effects of emotional neglect on social fear and avoidance, two important facets of adult social dysfunctioning, confirming bio-behavioral synchrony assumptions.

Parenting Interacts with Oxytocin Polymorphisms to Predict Adolescent Social Anxiety Symptom Development: A Novel Polygenic Approach.

Guided by a developmental psychopathology framework, research has increasingly focused on the interplay of genetics and environment as a predictor of different forms of psychopathology, including social anxiety. In these efforts, the polygenic nature of complex phenotypes such as social anxiety is increasingly recognized, but studies applying polygenic approaches are still scarce. In this study, we applied Principal Covariates Regression as a novel approach to creating polygenic components for the oxytocin system, which has recently been put forward as particularly relevant to social anxiety. Participants were 978 adolescents (49.4% girls; Mage T1 = 13.8 years). Across 3 years, questionnaires were used to assess adolescent social anxiety symptoms and multi-informant reports of parental psychological control and autonomy support. All adolescents were genotyped for 223 oxytocin single nucleotide polymorphisms (SNPs) in 14 genes. Using Principal Covariates Regression, these SNPs could be reduced to five polygenic components. Four components reflected the underlying linkage disequilibrium and ancestry structure, whereas the fifth component, which consisted of small contributions of many SNPs across multiple genes, was strongly positively associated with adolescent social anxiety symptoms, pointing to an index of genetic risk. Moreover, significant interactions were found with this polygenic component and the environmental variables of interest. Specifically, adolescents who scored high on this polygenic component and experienced less adequate parenting (i.e., high psychological control or low autonomy support) showed the highest levels of social anxiety. Implications of these findings are discussed in the context of individual-by-environment models.

Subcortical brain volumes, cortical thickness and cortical surface area in families genetically enriched for social anxiety disorder - A multiplex multigenerational neuroimaging study.

BACKGROUND: Social anxiety disorder (SAD) is a disabling psychiatric condition with a genetic background. Brain alterations in gray matter (GM) related to SAD have been previously reported, but it remains to be elucidated whether GM measures are candidate endophenotypes of SAD. Endophenotypes are measurable characteristics on the causal pathway from genotype to phenotype, providing insight in genetically-based disease mechanisms. Based on a review of existing evidence, we examined whether GM characteristics meet two endophenotype criteria, using data from a unique sample of SAD-patients and their family-members of two generations. First, we investigated whether GM characteristics co-segregate with social anxiety within families genetically enriched for SAD. Secondly, heritability of the GM characteristics was estimated. METHODS: Families with a genetic predisposition for SAD participated in the Leiden Family Lab study on SAD; T1-weighted MRI brain scans were acquired (n = 110, 8 families). Subcortical volumes, cortical thickness and cortical surface area were determined for a-priori determined regions of interest (ROIs). Next, associations with social anxiety and heritabilities were estimated. FINDINGS: Several subcortical and cortical GM characteristics, derived from frontal, parietal and temporal ROIs, co-segregated with social anxiety within families (uncorrected p-level) and showed moderate to high heritability. INTERPRETATION: These findings provide preliminary evidence that GM characteristics of multiple ROIs, which are distributed over the brain, are candidate endophenotypes of SAD. Thereby, they shed light on the genetic vulnerability for SAD. Future research is needed to confirm these results and to link them to functional brain alterations and to genetic variations underlying these GM changes. FUND: Leiden University Research Profile 'Health, Prevention and the Human Life Cycle'.

Background cortisol versus social anxiety as correlates of HPA-axis recovery from stress in boys with Autism Spectrum Disorder.

Children with Autism Spectrum Disorder (ASD) show dysregulation of the expected Hypothalamus-Pituitary-Adrenal (HPA) axis and elevated cortisol responses to stress and response patterns, but little has been reported regarding their recovery from stress in terms of cortisol concentrations. This response was investigated in a sample of 32 young males with ASD aged between 9 and 18 years (M = 14.3 yr, SD = 2.7 yr), using a standardised experimental protocol combined with individualised stressor and non-stressor tasks. Results indicated that about half of the sample demonstrated unexpected HPA axis response patterns, and that recovery from stress cortisol concentrations were significantly associated with a single symptom of Social Phobia and Morning cortisol. These findings suggest that one of the key diagnostic criteria for ASD may be strongly influential in the HPA axis responses of boys with ASD and that training regimesto assist them to form less fearful associations with their non-ASD peers may be central to the academic and social progress of these boys.

Association between kinesiophobia and walking gait characteristics in physically active individuals with anterior cruciate ligament reconstruction.

BACKGROUND: Individuals with anterior cruciate ligament reconstruction (ACLR) demonstrate persistent alterations in walking gait characteristics that contribute to poor long-term outcomes. Higher kinesiophobia, or fear of movement/re-injury, may result in the avoidance of movements that increase loading on the ACLR limb. RESEARCH QUESTION: Determine the association between kinesiophobia and walking gait characteristics in physically active individuals with ACLR. METHODS: We enrolled thirty participants with a history of unilateral ACLR (49.35 ±â€¯27.29 months following ACLR) into this cross-sectional study. We used the Tampa Scale for Kinesiophobia (TSK-11) to measure kinesiophobia. We collected walking gait characteristics during a 60-s walking trial, which included gait speed, peak vertical ground reaction force (vGRF), instantaneous vGRF loading rate, peak internal knee extension moment (KEM), and knee flexion excursion. We calculated lower extremity kinetic and kinematic measures on the ACLR limb, and limb symmetry indices between ACLR and contralateral limbs (LSI= [ACLR/contralateral]*100). We used linear regression models to determine the association between TSK-11 score and each walking gait characteristic. We determined the change in R2 (ΔR2) when adding TSK-11 scores into the linear regression model after accounting for demographic covariates (sex, Tegner activity score, graft type, time since reconstruction, history of concomitant meniscal procedure). RESULTS: We did not find a significant association between kinesiophobia and self-selected gait speed (ΔR2 0.038, P = 0.319). Kinesiophobia demonstrated weak, non-significant associations with kinetic and kinematic outcomes on the ACLR limb and all LSI outcomes (ΔR2 range = 0.001-0.098). SIGNIFICANCE: These data do not support that kinesiophobia is a critical factor contributing to walking gait characteristics in physically active individuals with ACLR.

Positive and negative symptoms in schizophrenia and their relation to depression, anxiety, hope, self-stigma and personality traits - a cross-sectional study.

OBJECTIVE: The purpose of the investigation was to explore the relationship between positive or negative symptoms, social anxiety, hope, personality, and self-stigma in patients with schizophrenia spectrum disorders. METHOD: 57 outpatients took part in this cross-sectional study. The structured interview M.I.N.I. International Neuropsychiatric Interview was used to confirm the diagnosis. All patients completed the Liebowitz Social Anxiety Scale, Internalized Stigma of Mental Illness Scale, Beck Depression Inventory-II, Beck Anxiety Inventory, Adult Dispositional Hope Scale, and Temperament and Character Inventory - Revised. The disorder severity was evaluated by Clinical Global Impression - Severity scale, and Positive and Negative Syndrome Scale. The patients were in a stabilized state that did not require hospitalization or modifications in the treatment. RESULTS: Both positive and negative symptoms of schizophrenia positively correlated with the length of the disorder, global severity of the disorder, the severity of the general and social anxiety symptoms, the severity of self-stigma, and negatively with personality traits Self-directedness and Cooperativeness. Only negative symptoms significantly positively correlated with the severity of depressive symptoms and personality trait Harm-avoidance and negatively with the hope and personality trait Persistence. Comorbidity with social phobia is associated with statistically significantly higher mean scores on the total score of schizophrenic symptomatology, negative subscale average rating, and general psychopathological items measured by PANSS. Patient with comorbid depression would experience a higher level of negative symptomatology than patients without such comorbidity.