Anxiety sensitivity and depression in multiple chemical sensitivities and asthma

Patients with sensitivities to multiple chemicals report symptoms of cognitive dysfunction, respiratory distress, and mood disturbance. Lifetime and current psychiatric disorders, personality traits associated with symptom reporting, and tests of cognitive function were compared between 30 subjects with Multiple Chemical Sensitivities (MCS), 19 asthmatics, and 31 healthy controls. Relative to asthmatics and controls, more MCS subjects met criteria for current depression and somatization disorder. MCS subjects and asthmatics scored significantly higher than controls on scales of chemical odor intolerance and anxiety sensitivity, both of which were significant predictors of physical symptoms. Few differences on objective neuropsychological tests were noted. However, MCS subjects with comorbid depression performed significantly worse on a verbal memory test relative to asthmatics but not to controls. Anxiety and depression are significant contributors to the physical and cognitive symptoms of MCS subjects.

A DSM-IV Axis I comorbidity study of males (n = 120) with paraphilias and paraphilia-related disorders

One hundred and twenty consecutively evaluated outpatient males with paraphilias (PAs; n = 88, including 60 sex offenders) and paraphilia-related disorders (PRDs; n = 32) were systematically assessed for certain developmental variables and DSM-IV-defined Axis I comorbidity. In comparison with the PRDs, the PA group was statistically significantly more likely to self-report a higher incidence of physical (but not sexual) abuse, fewer years of completed education, a higher prevalence of school-associated learning and behavioral problems, more psychiatric/substance abuse hospitalizations, and increased employment-related disability as well as more lifetime contact with the criminal justice system. In both groups, the most prevalent Axis I disorders were mood disorders (71.6%), especially early onset dysthymic disorder (55%) and major depression (39%). Anxiety disorders (38.3%), especially social phobia (21.6%), and psychoactive substance abuse (40.8%), especially alcohol abuse (30%), were reported as well. Cocaine abuse was statistically significantly associated with PA males (p = .03). There was a statistically significant correlation between the lifetime prevalence of Axis I nonsexual diagnoses and hypersexual diagnoses (PAs and PRDs). The prevalence of retrospectively diagnosed attention deficit hyperactivity disorder (ADHD) was 35.8%, the third most prevalent Axis I disorder. ADHD (p = .01), especially ADHD-combined subtype (p = .009), was statistically significantly associated with PA status. ADHD was statistically significantly associated with conduct disorder, and both of these Axis I disorders were associated with the propensity for multiple PAs and a higher likelihood of incarceration. When the diagnosis of ADHD was controlled, the differences reported above between PAs and PRDs either became statistically nonsignificant or remained as only statistical trends. Thus, ADHD and its associated developmental sequellae and Axis I comorbidities was the single most common nonsexual Axis I diagnosis that statistically significantly distinguished males with socially deviant sexual arousal (PAs) from a nonparaphilic hypersexual comparison group (PRDs). Sex offender paraphiliacs were more likely to be diagnosed with conduct disorder, alcohol abuse, cocaine abuse, and generalized anxiety disorder. The prevalence of any ADHD in the sex offender paraphiliacs was 43.3%, and nearly 25% of offenders were diagnosed with ADHD-combined subtype.

Generalized anxiety disorder and clinical worry episodes in young women

BACKGROUND

This article presents epidemiological data on the prevalence of DSM-IV generalized anxiety disorder (GAD) and sub-threshold GAD (fulfilling three out of four GAD criteria) in young women together with data on co-morbidity and psychosocial functioning. The prevalence of clinically relevant worry and its predictive validity for the diagnosis of GAD were also examined.

METHOD

Young women (N = 2064), aged between 18 and 25, from a representative German community sample were diagnosed with a structured clinical interview (ADIS-L, German research version). An additional interview questioned all the participants about the frequency/intensity and uncontrollability of diverse worry topics.

RESULTS

Thirty-seven participants (1.8%) fulfilled the criteria of current GAD (1 week point prevalence) and 56 received a lifetime diagnosis (2.7%); a further 50 participants (2.3%) were diagnosed with sub-threshold GAD. Co-morbidity between GAD and other disorders was high for current (68%) and lifetime GAD (91%). GAD, as well as sub-threshold GAD, showed clearly reduced levels of psychosocial functioning. Whereas worries of low intensity and high controllability were ubiquitous in all subsamples, clinically defined worrying was rarely present in healthy subjects (0.89%) and of adequate predictive accuracy for GAD.

CONCLUSIONS

Full GAD and sub-threshold GAD were moderately frequent in young women. Although DSM-IV worry criteria proved to be highly useful, the strictness of the complete GAD-criteria should not lead to absence of attention from subclinical generalized anxiety states in research and practice.

A longitudinal evaluation of behavioural and psychological symptoms of probable Alzheimer's disease

BACKGROUND

Non-cognitive symptoms are a frequent feature of Alzheimer's disease (AD). Much of the literature that has accumulated pertains to cross-sectional prevalence of these symptoms. There has been relatively little attention paid to the longitudinal course of Behavioural and Psychological Symptoms of Dementia (BPSD).

AIMS

The purpose of this study is to examine the longitudinal course of BPSD in a group of patients with mild AD.

METHODS

A retrospective review of a database was performed to identify patients with NINCDS/ADRDA criteria for probable AD and who had been evaluated three times at yearly interval over a two-year period. Fifty-two subjects were identified with probable AD that had completed follow-up for 24 months. The BEHAVE-AD was used to evaluate BPSD and data was analysed using a Markov analysis.

RESULTS

Activity disturbance is a common and relatively persistent symptom in the mild stages of AD. Anxiety, paranoid ideation, and aggression were moderately persistent. Affective symptoms were not persistent with less than half the patients having the symptoms a year later.

CONCLUSIONS

Activity disturbance is common and persistent in early AD. Paranoid and delusional ideation shows moderate persistence and depressive symptoms infrequently last longer than a year. These findings may have clinical relevance for the pharmacological and non-pharmacological management of BPSD.

Reliability and validity of the Turkish version of the adolescent dissociative experiences scale

The Adolescent Dissociative Experiences Scale (A-DES) is designed to measure dissociation in adolescents. The present study aimed to assess the reliability, validity, and psychometric characteristics of the Turkish version of the A-DES. The Turkish version of the A-DES was administered to 20 patients with a dissociative disorder, 24 patients with post-traumatic stress disorder (PTSD), 31 patients with anxiety disorder, 31 patients with mood disorder, 24 patients with attention deficit-hyperactivity disorder (ADHD), and 201 non-clinical participants. The internal consistency and the test-retest correlation of the A-DES were excellent. The mean total score of A-DES was 6.2 in dissociative disorder, 3.9 in PTSD, 2.1 in anxiety disorder, 2.4 in mood disorder, 2.5 in ADHD groups and 2.4 in non-clinical participants. There was a statistically significant difference between dissociative patients and other diagnostic groups on the A-DES total score. The good psychometric characteristics of the A-DES among Turkish participants support its cross-cultural validity.

The role of bibliotherapy in health anxiety: an experimental study

Despite its high prevalence and implications for health care resources, health anxiety is generally considered difficult and expensive to manage. Structured self-help materials (bibliotherapy) using a cognitive behaviour therapy (CBT) treatment approach have been shown to be clinically effective. This experimental study investigated the effects of bibliotherapy on patients who had been identified as demonstrating health concerns. The 40 participants (patients drawn from GP surgeries) were randomly allocated to two groups, one receiving bibliotherapy and the other not. Half the patients had a medically diagnosed problem. Anxiety was assessed before and after the bibliotherapy intervention, which took the form of a cognitive-behavioural self-help booklet for health anxiety sufferers. Patients in the bibliotherapy group showed reduced levels of anxiety at post-test, even when they also had an identifiable physical problem. These results are consistent with the idea that self-help materials can be an effective and accessible intervention in CBT, although further research is recommended.

Tripartite dimensions of emotion in a child clinical sample: measurement strategies and implications for clinical utility

Several measurement strategies to assess the tripartite model of emotion in child and adolescent samples have been developed. However, no studies have comparatively examined the most suitable strategies in clinical samples of children and adolescents. This study involved the evaluation of 2 distinct measures of tripartite constructs relative to anxiety and depression criterion variables in a clinical sample of 226 children in Grades 1 through 12. Results indicated that the measures performed similarly overall, but some differences were pronounced enough to suggest that the measures indexed slightly different aspects of the same constructs. These differences appear consistent with the scale design of each instrument. Implications for measurement of these constructs in future research are highlighted.

The relationship between somatic and PTSD symptoms among Bhutanese refugee torture survivors: examination of comorbidity with anxiety and depression

Previous research has indicated a relationship between posttraumatic stress disorder (PTSD) and somatic complaints. We examined whether this relationship is a result of shared comorbidity with anxiety and depression. Local doctors interviewed a random, community sample of 526 tortured and 526 nontortured Bhutanese refugees living in U.N. refugee camps in Nepal. The interview covered demographics, torture, somatic complaints, and PTSD, depression, and anxiety measures. Number of PTSD symptoms, independent of depression and anxiety, predicted both number of reported somatic complaints and number of organ systems involving such complaints. Physicians need to screen for PTSD when survivors of extreme stressors present nonspecific somatic complaints.

Symptoms of anxiety disorders and teacher-reported school functioning of normal children

Correlations between scores on the Spence Children's Anxiety Scale, a questionnaire for measuring symptoms of anxiety disorders and a report of school functioning by teachers were computed for 317 primary school children and 13 teachers in The Netherlands. Analysis showed a small but significant negative correlation between scores for total anxiety and school functioning (r = -.20, p < .001). The finding is consistent with the notion that high symptoms indicating anxiety disorders in children are accompanied by less optimal functioning in school.

The long-term mental health effects of nuclear trauma in recent Russian immigrants in the United States

The long-term mental health sequelae (15 years) of the 1986 Chernobyl nuclear disaster in the former Soviet Union (FSU) were assessed in survivors migrated to the United States, as part of an ongoing study. Using a retrospective, cross-sectional design with standardized Russian mental health measures, a sample of 261 Russians residing in the New York tristate area were tested for multiple domains of mental health functioning. Multivariate analyses pointed to aspects of the accident and its negative repercussions as reliable predictors of current psychological distress. Russians who had lived closer to the disaster, and had greater exposure to it, currently experience higher levels of anxiety (p < .0004) and posttraumatic reactions (p < .03) than those who had lived at a further distance. These findings are consistent with reports of long-term sequelae in Chernobyl survivors migrated to Israel (Remennick, 2002), as well as those remaining in the FSU (Havenaar et al., 1997). Implications of long-term traumatic sequelae, especially in the complex perimigration context, are discussed.

The relationship of thought-action fusion to pathologicial worry and generalized anxiety disorder

Meta-cognitive beliefs associated with pathological worry and generalized anxiety disorder (GAD) may encompass the likelihood subtype of thought-action fusion (TAF), the belief that one's thoughts can influence outside events. In the current study of 494 undergraduate college students, positive correlations between scores on the Penn State Worry Questionnaire (PSWQ) and the two Likelihood subscales of the TAF Scale were found, and participants endorsing at least some DSM-IV diagnostic criteria for GAD scored significantly higher on both TAF-Likelihood subscales than participants reporting no GAD symptoms. However, these TAF scales did not predict GAD diagnostic status with PSWQ included as a predictor. In contrast to previous research, the TAF-Moral scale did not correlate with worry. Relationships between TAF, pathological worry, and meta-cognition are discussed in relation to GAD.

Diagnostic efficiency of symptoms in the diagnosis of DSM-IV: generalized anxiety disorder in youth

BACKGROUND

Evaluated five probability indices, including odds ratios, to determine relative contribution of Uncontrollable Excessive Worry (DSM-IV criterion A and criterion B) and Physiological Symptoms associated with uncontrollable excessive worry (DSM-IV criterion C) for diagnosing DSM-IV generalized anxiety disorder in youth.

METHOD

One hundred eleven youths (6 to 17 years old) and their parents who presented to a childhood anxiety disorders specialty clinic were administered a semi-structured diagnostic interview schedule. Separate evaluations were conducted for children and adolescents.

RESULTS

Results showed that symptoms comprising DSM-IV's generalized anxiety disorder diagnosis vary relative to one another in the degree to which they contribute to the diagnosis, with certain symptoms having relatively higher diagnostic value than other symptoms. The relative value of symptoms also appeared to vary with children's and adolescents' reports, and parents' reports about their children and adolescents.

CONCLUSIONS

Despite variations in symptoms' values, with only a few exceptions, almost all symptoms were still quite useful for diagnosis, whether reported by children, adolescents, or their parents.

Childhood adversity and anxiety versus dysthymia co-morbidity in major depression

BACKGROUND

Childhood adversity places individuals with major depression at risk for anxiety and dysthymia co-morbidity. The goal of the present paper is to broaden this area of research by examining specificity between the type of adversity (e.g. abuse versus neglect/indifference) and the resulting co-morbid disorder (e.g. anxiety versus dysthymia co-morbidity).

METHOD

The volunteer sample consisted of 76 women meeting Diagnostic and Statistical Manual (DSM-IV) criteria for major depression. Of these, 28 were diagnosed with a co-morbid anxiety disorder and 21 were diagnosed with co-morbid dysthymia. Childhood physical abuse, sexual abuse, psychological abuse, antipathy and indifference were assessed using a contextual interview and rating system.

RESULTS

Severe sexual abuse and psychological abuse were significantly and preferentially associated with co-morbid anxiety, while severe physical abuse was significantly and preferentially associated with co-morbid dysthymia. Indifference and antipathy were significantly associated with both co-morbid anxiety and dysthymia. Multivariate analyses revealed that severe sexual abuse was the adverse childhood experience most strongly associated with co-morbid anxiety.

CONCLUSIONS

These results suggest that particular adverse experiences in childhood do set up specific vulnerabilities to the expression of anxiety versus dysthymia co-morbidity in adulthood major depression. Cognitive mediators of these associations are discussed as avenues of future research.

Generalised anxiety disorder: treatment options

In recent years generalised anxiety disorder (GAD) has become a much better defined disorder, with specific criteria distinguishing it from the other anxiety disorders; however, it still lacks the same public and scientific interests as some of the other anxiety disorders such as panic and social phobia. Nevertheless, refinement in the treatment of GAD is becoming more evident through the conduct of clinical trials. Up until the mid-1980's, treatment consisted primarily of benzodiazepines. However, as a result of growing characterisation of their abuse potential, other therapeutic options were explored. Benzodiazepines became seen as an effective short-term therapy, and buspirone and some of the newer antidepressants have become the treatment of choice for patients with GAD requiring long-term treatment. Buspirone was the first available alternative to the benzodiazepines in the US; however, the initial excitement over this agent was somewhat dampened because of its mild efficacy combined with a slow onset of action. The antidepressants were seen as beneficial for the treatment of GAD because of the high comorbidity with depression, thus allowing a better outcome for these patients. The antidepressants that offer both a good adverse effect profile and efficacy are the selective serotonin reuptake inhibitors including paroxetine, and the serotonin-norepinephrine reuptake inhibitors such as venlafaxine. Clinicians should also consider the potential benefits of psychotherapy as an adjunct to medication. There are a number of potentially new pharmacotherapies being investigated, including newer serotonin 5-HT1A receptor agonists, cholecystokinin receptor antagonists, neurokinin receptor antagonists, gabapentin and its analogues, and gamma-aminobutyric acid (GABA)A receptor modulators. However, these compounds are all in the early stages of investigation, and there are no new therapies expected to be released in the near future. Nonetheless, in the search for the ideal anxiolytic, a more positive outlook is allowed by imminent future research for new treatment options in patients with GAD.

Relationship among body image, exercise behavior, and exercise dependence symptoms

OBJECTIVE

The purpose of the present study was to examine the relationship among body image, exercise behavior, body mass index (BMI), and primary exercise dependence symptoms in physically active individuals.

METHOD

Male and female university students (N = 474) completed self-report measures of exercise behavior, height, weight, exercise dependence symptoms, social physique anxiety, and body satisfaction.

RESULTS

Hierarchical multiple regressions with forced block entry by gender were conducted to examine the effects of exercise behavior, BMI, and exercise dependence symptoms on body satisfaction and social physique anxiety. For females, BMI was the strongest positive predictor of body dissatisfaction and social physique anxiety. For males, exercise behavior was the strongest negative predictor of body dissatisfaction and social physique anxiety.

DISCUSSION

It was concluded that after controlling for the effects of BMI and exercise behavior, primary exercise dependence symptoms were not strong predictors on body image, especially for females.

The Ohio Midlife Women's Study

The Ohio Midlife Women's Study was longitudinal with measurements occurring at three, 9-month intervals. Our purpose in doing this research was to examine predictors, moderators, and outcome variables associated with the transition to midlife in Caucasian and African American women. Predictor variables included loss and gain of resources. Moderators included menopause symptoms, menopausal status, attitude toward menopause, coping, and demographic characteristics. Outcome variables included anxiety, depression, and health promoting activities. To obtain the proposed final sample of 160 midlife women, an initial sample of 103 African American and 105 Caucasian "healthy" women were recruited in the community. Consistent predictors of anxiety were loss of resources, coping effectiveness, and education. Consistent predictors of depression were loss of resources and education. Health promoting activities were consistently predicted by attitude toward menopause and coping effectiveness. Stress is a better predictor of negative health outcomes than menopausal status.

The Pediatric Anxiety Rating Scale (PARS): development and psychometric properties

OBJECTIVE

To describe the development and psychometric properties of the Pediatric Anxiety Rating Scale (PARS), a clinician-rated instrument for assessing the severity of anxiety symptoms associated with common DSM-IV anxiety disorders (social phobia, separation anxiety disorder, and generalized anxiety disorder) in children.

METHOD

As part of a multisite study of the efficacy of fluvoxamine, 128 children (aged 6-17) and their parents were interviewed weekly with the PARS. Data from multiple raters on a subsample of children (using live and videotaped interviews) were used to evaluate interrater reliability. Internal consistency, test-retest reliability, and validity (convergent, divergent) also were evaluated.

RESULTS

The PARS showed high interrater reliability, adequate test-retest reliability, and fair internal consistency. Convergent and divergent validity were satisfactory. PARS scores were sensitive to treatment and paralleled change in other measures of anxiety symptoms and global improvement.

CONCLUSIONS

The PARS is a useful clinician-rated instrument for assessing pediatric anxiety symptoms, severity, and impairment, particularly in treatment studies. Further study of the psychometric properties is warranted.

[Psychological evaluation of patients with a nodular goiter before and after surgical treatment]

INTRODUCTION

Association between endocrine and mental disorders has been recognized a long time ago, as well as their mutual dependence. The aim of this study was to evaluate the psychological structure of patients with thyroid nodule before and after surgical treatment.

MATERIAL AND METHODS

In order to establish the type and degree of psychological disorders, we have examined 60 patients with thyroid nodule before and after surgical treatment by using DSM-IV classification of mental disorders and psychological instruments: semistructured psychiatric interview, MMPI, Zung Depression Scale and a list of panic symptoms. Patients with nonautonomous ("cold") nodules presented as euthyroid, and those with autonomous ("hot") nodules (after a period of drug therapy if they were hyperthyroid), required surgery. After a period of drug therapy two groups of patients were compared: group 1--euthyroid with "cold" nodules and group 2--euthyroid with "hot" nodules. Before surgical treatment both groups underwent psychological evaluation. Group 2 presented with: anxiety, depression and panic disorder with or without agoraphobia (72%, 46%, 28%) while group 1 presented with following results: 48%, 23%, 14% respectively. After surgical treatment patients from group 1 presented with psychologic disorders in less than 1%.

DISCUSSION AND CONCLUSION

In some physical disorders, psychologic factors contribute directly or indirectly to the etiology, in others, psychologic symptoms are the direct results of a lesion affecting neural or endocrine organs. One of the key etiological factors is often a short-time or long-time stress and its direct consequence is altered functioning of various hormonal systems. Unexpected high percentage of psychological disorders in patients with thyroid disorders suggests that psychological evaluation before and after surgical treatment is unavoidable for good assessment and choice of treatment.

Agoraphobia without a history of panic disorder may be part of the panic disorder syndrome

Agoraphobia without a history of panic attacks is a disorder lacking strong support. Data from the Australian National Survey were explored in respect to panic disorder with or without agoraphobia (PDA, PD), and agoraphobia without a history of panic disorder (AG). Panic disorder, agoraphobia, and panic disorder with agoraphobia occurred in 3.5% of the adult population. People with this group of disorders were more likely to be female and more likely to seek help than people with other anxiety disorders. Significant anxiety symptoms and unease about safety when out and about occur in all three disorders. People with the double disorder PDA report more comorbid disorders, are more disabled, and have higher neuroticism scores than people with PD or AG. People with AG are older and consult less than people with PD or PDA. Agoraphobia has been devalued as a cause of human suffering. This idea is wrong. Agoraphobia is as common, comorbid, and disabling as PD, but less disabling than the double disorder of PDA.

Anxiety sensitivity in adolescents at risk for psychopathology

Examined the associations of adolescents' self-reported anxiety sensitivity with semi-structured, interview-based anxiety and depressive symptoms and anxiety disorders. The sample included 121 adolescents and their parents who participated in a larger epidemiological, high-risk family study of substance abuse and anxiety disorders (Merikangas, Dierker, & Szatmari, 1998). A series of hierarchical multiple regressions revealed the incremental validity of anxiety sensitivity, beyond the contribution of self-rated anxiety, to anxiety symptoms and comorbid anxiety disorders. Furthermore, familial risk for anxiety moderated the association between anxiety sensitivity and number of anxiety symptoms as well as number of comorbid anxiety disorders. Analyses of high- and low-risk groups demonstrated that the association between anxiety sensitivity and anxiety symptoms and disorders was evident in high-risk adolescents only. Although self-reported anxiety was associated with depressive symptoms, anxiety sensitivity was not. Results from this investigation further support the utility of assessing anxiety sensitivity in an adolescent population and suggest it as a trait marker of anxiety among at-risk individuals.

Validity of the Beck Depression Inventory, Hospital Anxiety and Depression Scale, SCL-90, and Hamilton Depression Rating Scale as Screening Instruments for Depression in Stroke Patients

Most instruments used to assess poststroke depression have never been specifically validated in stroke patients. This study evaluated the depression screening abilities of three questionnaires and one observer-rated scale in 202 consecutive patients 1 month after they experienced their first-ever ischemic stroke. At their respective optimum cutoff values, the sensitivity of the self-rated scales varied between 80% and 90%, while the specificity was about 60%. For the observer-rated scale (Hamilton Depression Rating Scale), sensitivity was 78.1%, and specificity was 74.6%. The instruments clearly performed better in men than in women. Despite this difference, it was concluded that all scales were acceptable screening instruments for poststroke depression.