[Characteristics of central nervous system activity in patients with complications of arterial hypertension and dependence on psychomotor status and treatment]

Changes in certain CNS characteristics were used as indicators of the efficacy of antihypertensive therapy (AHT) both targeted (T-AHT) and empirical (E-AHT) designed to suppress activity of the sympathetic component of vegetative nervous system (VNS) and renin-angiotensin-aldosterone system (RAAS) in patients of different psychic status and AH. A group of 835 men (mean age 54.2+-1.8yr) was divided into cholerics, sanguinics, melancholics and phlegmatics with a high and low anxiety level (HA and LA). 416 healthy men served as controls. The following parameters were estimated: mobility of cortical processes, balance between sympathetic and parasympathetic activities, blood corrisol and aldosterone levels, oxygen utilization coefficient, resistance to breath holding, severity of dyscirculatory encephalopathy and the fraction of patients with AH complications during 12 month T-AHT for the suppression of sympathetic activity in cholerics and sanguinics by beta-adrenoblockers and PAA C- ACE inhibitors in phlegmatics and melancholics and during E-AHT (ACE inhibitors in cholerics and sanguinics, BAB in phlegmatics and melancholics). The functional activity of CNS in phlegmatics and melancholics before and during AHT was lower and severity of encephalopathy and the number ofAH complications higher than in cholerics and sanguinics. . The changes wiere more pronounced in patients with HA than in those with LA. Unlike E-AHT T-AHT (anxiolytics for cholerics and sanguinics with HA, antidepressants for phlegmatics and melancholics with HA) normalized the study parameters and decreased the frequency of complications by 2-3 times.

Audiovisual material as educational innovation strategy to reduce anxiety response in students of human anatomy

This study presents the design, effect and utility of using audiovisual material containing real images of dissected human cadavers as an innovative educational strategy (IES) in the teaching of Human Anatomy. The goal is to familiarize students with the practice of dissection and to transmit the importance and necessity of this discipline, while modulating their anxiety. The study included 303 first-year Human Anatomy students, randomly assigned to two groups (Traditional and Educational Innovation). Their state of anxiety was measured using the State-Trait-Anxiety Inventory. Repeated measures ANOVA with between-subject factors was applied. The between-subject factor was Educational Innovation (EI). Two levels were established for this factor. The within-subject factor was Time, four levels being considered here. The results show that the effects of the Educational Innovation factor, Time factor and EI × Time interaction were statistically significant. These results provide an additional element of efficacy to the use of videos as an IES. That is, the use of video material as an introduction into an anxiety-provoking situation which resembles real-life viewing and interaction with human cadavers for the first time significantly diminishes the anticipatory reaction of dread against which novel students have not had the opportunity to develop any cognitive strategy of emotional control.

Effect of a procedural video CD and study guide on the practical fixed prosthodontic performance of Iranian dental students

Dental students in programs around the world typically pass preclinical courses before entering the clinic and working on actual patients. Since fixed prosthodontics is a preclinical course that requires a great deal of effort, students may experience a substantial amount of stress that may affect their self-confidence and/or clinical performance. In this study, an instructional video CD (VCD) and study guide depicting the step-by-step procedures involved in a metal-ceramic tooth preparation and provisional crown fabrication was prepared. Students at the Faculty of Dentistry, Tehran University of Medical Sciences, Tehran, Iran, were divided randomly into two groups. Group A students trained as usual with live patients, and Group B students were given a copy of the VCD and study guide following a lecture. The students in Group B were encouraged to read the study guide and watch the VCD after live demonstrations. Then, both groups practiced individually on mannequins. At the end of the course, the students completed a sixteen-item questionnaire about their stress level, self-confidence, and knowledge base. The results showed that the students exposed to the extra media performed significantly better on some practical phases, e.g., laboratory procedures. A moderate, insignificant correlation was detected between exposure to media and decreasing the students' stress and self-esteem. We concluded that supplementary teaching aids such as a VCD and study guide may improve the clinical performance of dental students to some extent, but the live demonstration is still preferred by students.

Utility of bispectral index monitoring during intravenous sedation in the dental office

PURPOSE

This research sought to compare two different systems to monitor sedated patients undergoing implant surgery in the dental office: the bispectral index (BIS) and the Ramsay scale. This information was used to establish an optimal BIS range for surgery in these patients and to calculate differences in drug consumption in both groups.

MATERIALS AND METHODS

Consecutive patients undergoing implant surgery were studied and randomly assigned to two groups. Patients were sedated using intravenous propofol, fentanyl, and midazolam. The sedation level in group A was measured using the Ramsay scale. In group B, the Ramsay scale and the BIS were used together. Heart rate, blood pressure, and peripheral oxygen saturation were monitored in all patients. The levels of anxiety, satisfaction, and drug consumption were compared between groups.

RESULTS

Forty-three patients were included; 20 were placed in group A and 23 were included in group B. There were no differences in the hemodynamic and respiratory parameters monitored or in anxiety or satisfaction levels in both groups. In group B patients, the BIS values stabilized around 85; the Ramsay scale stabilized around 3 in both groups and remained at these levels until the end of the procedure. Drug consumption was significantly lower in the BIS group.

CONCLUSION

The optimal BIS value during intravenous sedation in sedated ambulatory patients in dental surgery should be within the 80 to 85 range. BIS monitoring allows for reduced consumption of propofol, fentanyl, and midazolam.

Development of a measure of the concerns held by people with implanted cardioverter defibrillators: The ICDC

OBJECTIVES

To develop a questionnaire to measure the extent and severity of the concerns of people with an implanted cardioverter defibrillator.

DESIGN

Items were generated from patient interviews, expert review and the research literature on patients' worries and concerns. A pilot version was administered to a series of ICD patients and repeated for test-retest reliability 6 weeks later. Psychometric tests including the screen test, factor analysis and various reliability assessments were undertaken. It was predicted that the greater the extent and severity of concerns, the greater the anxiety experienced by the ICD patient. Scores were compared with a validated measure of anxiety and depression administered at the same time.

RESULTS

Fifty-seven (64%) patients completed and returned the questionnaire and a further 22 (100% of those asked) completed the 6-week retest. Reliability and validity appeared to be good and two factors were identified. Both total score and the individual factor scores correlated moderately with anxiety.

CONCLUSIONS

The questionnaire appears to reflect patients' concerns and, as predicted, these were associated with the patients' anxiety level. The scale requires further testing to reveal if it is of use both clinically and for research purposes.

[Anxiety, depression and polymorphism of the gene encoding superoxide dismutase in patients with chronic obstructive pulmonary disease]

Chronic obstructive pulmonary disease (COPD) is a severe systemic disease leading to circulatory and respiratory failure. COPD is also a risk factor for the onset of anxiety and mood disturbances. Identification of the correlates of emotional disturbances in the course of COPD can make it possible, on the one hand, to prevent mental and behavioral disorders early in the course of this serious somatic disease, and on the other hand, to institute appropriate treatment. The aim of the study was to determine the correlation between the polymorphism of manganese superoxide dismutase signal peptide and the severity of anxiety and depression in COPD patients.

MATERIAL AND METHODS

The study group consisted of 57 patients with grade I, II and III COPD according to GOLD criteria. The control group consisted of 63 healthy nicotine addicts. In all the subjects, the genotype of position 9 of manganese superoxide dismutase signal peptide was determined, depression severity was measured with Beck Depression Scale, and anxiety as a trait and as a state was measured with Spielberg State/Trait Anxiety Inventory (STAI).

RESULTS

Among COPT patients, 16 subjects were found to have Ala/Ala genotype, 23 Val/Ala and 18 Val/Val. In the smokers' group Ala/Ala genotype was found in 29 cases, Val/Ala in 27 and Val/Val in 7. The distribution of genotype frequencies differed between the groups. In COPD patients, the mean depression severity assessed according to Beck Scale amounted to (16.52 +/- 5.63) and was higher than in smokers without COPD (13.85 +/- 4.24, p = 0.003828). The average severity of anxiety as a trait and as a state did not differ significantly in both groups. Among COPD patients, the mean severity of depressive disorders in subjects with Val/ Val genotype was 21.27 +/- 4.32 and was significantly higher than in those with Val/Ala (15.22 +/- 5.29) and Ala/Ala (12.87 +/- 3.72) genotypes. The severity of anxiety as a trait in COPD patients reached 7.72 +/- 1.21 in the subgroup with Val/Val genotype and was also higher than in those with Val/Ala genotype (6.69 +/- 1.48) and with Ala/Ala genotype (5.87 +/- 1.14). A similar correlation was observed for anxiety as a state (subjects with Val/Val genotype 6.78 +/- 1.06, with Val/Ala genotype 6.18 +/- 1.01 and with Ala/ Ala genotype 5.88 +/- 1.41). Among healthy smokers, the mean severities of depression, anxiety as a trait and anxiety as a state did not differ in subjects with different genotypes.

CONCLUSIONS

The study has demonstrated that the severity of depression is higher in COPD patients than in the group of healthy smokers. In the group of patients with COPD, Val/Val genotype at position 9 of MnSOD signal peptide is associated with more severe depression, anxiety as a trait and anxiety as a state in comparison with patients who have Val/Ala and Ala/Ala genotypes. No similar correlations were found in healthy smokers.

How an age of anxiety became an age of depression

CONTEXT

During the 1950s and 1960s, anxiety was the emblematic mental health problem in the United States, and depression was considered to be a rare condition. One of the most puzzling phenomena regarding mental health treatment, research, and policy is why depression has become the central component of the stress tradition since then.

METHODS

This article reviews statistical trends in diagnosis, treatment, drug prescriptions, and textual readings of diagnostic criteria and secondary literature.

FINDINGS

The association of anxiety with diffuse and amorphous conceptions of "stress" and "neuroses" became incompatible with professional norms demanding diagnostic specificity. At the same time, the contrasting nosologies of anxiety and depression in the Diagnostic and Statistical Manual of Mental Disorders III (DSM-III) extended major depressive disorder to encompass far more patients than any particular anxiety disorder. In addition, antidepressant drugs were not associated with the stigma and alleged side effects of the anxiolytic drugs.

CONCLUSION

Various factors combined between the 1970s and the 1990s to transform conditions that had been viewed as "anxiety" into "depression." New interests in the twenty-first century, however, might lead to the reemergence of anxiety as the signature mental health problem of American society.

[Distorted cognition of bodily sensations in subtypes of social anxiety]

The purpose of this study was to investigate the relationship between subtypes of social anxiety and distorted cognition of bodily sensations. The package of questionnaires including the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS) was administered to 582 undergraduate students. To identify subtypes of social anxiety, cluster analysis was conducted using scores of the SPS and SIAS. Five clusters were identified and labeled as follows: Generalized type characterized by intense anxiety in most social situations, Non-anxious type characterized by low anxiety levels in social situations, Averaged type whose anxiety levels are averaged, Interaction anxiety type who feels anxiety mainly in social interaction situations, and Performance anxiety type who feels anxiety mainly in performance situations. Results of an ANOVA indicated that individuals with interaction type fear the negative evaluation from others regarding their bodily sensations whereas individuals with performance type overestimate the visibility of their bodily sensations to others. Differences in salient aspects of cognitive distortion among social anxiety subtypes may show necessity to select intervention techniques in consideration of subtypes.

Prediction of postoperative pain after mandibular third molar surgery

AIMS

To evaluate the predictive potential of preoperative psychological and psychophysiological variables in estimating severity of postoperative pain following mandibular third molar surgery (MTMS).

METHODS

Following ethical committee approval and informed consent, 40 consecutive patients scheduled for MTMS were included. Preoperative psychometric indicators of anxiety, depression, and vulnerability were evaluated by patient questionnaires. Thermal thresholds and heat pain perception (1 second phasic stimuli: 44 degrees C to 48 degrees C) were evaluated with quantitative sensory testing techniques. Standardized surgery was performed during local anesthesia. Postoperative pain management was with rescue paracetamol and ibuprofen. The patients were instructed to record each day their pain at rest and during dynamic conditions, and their requirement of analgesics for 14 days following surgery.

RESULTS

Thirty-eight patients completed the study. Eight patients were readmitted because of pain. During the postoperative period, one or more episodes of moderate to severe pain (> 30 on a visual analog scale) was reported by 60% (23/38) at rest, 63% (24/38) during mouth-opening, and 73% (28/38) during eating. In a multiple regression model, the combination of psychological vulnerability and heat pain perception rendered a predictive model that could account for 15 to 30% of the variance in postoperative pain during resting and dynamic conditions (P = .03 to .001).

CONCLUSION

Implementation of clinically relevant preoperative screening methods may offer more efficacious postoperative pain therapies to pain-susceptible individuals undergoing mandibular third molar surgery. J Orofac Pain 2010;24:189-196.

[Evaluation of anxiety and depression levels in patients with myocardial infarction]

OBJECTIVES

Patients with myocardial infarction (MI) may experience anxiety and depression. This study was designed to determine anxiety and depression levels in patients with MI.

STUDY DESIGN

The study included 506 patients (199 women, 307 men; mean age 55.7+/-6.9 years) who were admitted to the cardiology department for MI. Data were collected using a questionnaire to identify patient characteristics and the Hospital Anxiety and Depression Scale (HADS). The HADS has been validated as a sensitive screening tool for anxiety and depression in MI patients in the Turkish population.

RESULTS

Clinically severe anxiety was found in all the patients (100%). Depression scores showed a clinically normal level in 45 patients (8.9%), borderline level in 289 patients (57.1%), and severe level in 172 patients (34%). The mean HADS score was 11.4+/-2.9, being 12.2+/-4.1 and 10.6+/-4.1 for anxiety and depression, respectively. Among patient characteristics, age was significantly associated with both anxiety and depression subscales (p<0.001), and education level (p<0.05), total family income (p<0.01), health insurance (p<0.05), and the number of myocardial infarctions (p<0.05) were significantly associated with the depression subscale. In regression analysis, age (beta=-0.128), education level (beta=0.082), and working status (beta=-0.79) independently affected both anxiety and depression, and total family income (beta=-0.128) and health insurance (beta=-0.086) significantly affected depression.

CONCLUSION

Our data suggest that planning nursing interventions to decrease anxiety and depression levels and implementation of cardiac rehabilitation programs are of particular importance in patients with MI.

[Measurement of anxiety with C.D. Spielberger's test in patients with cardiac arrhythmias]

INTRODUCTION

Atrial fibrillation is a common supraventrical arrhythmia. The onset of fibrillation is marked by fear of loss of health or life. Symptoms of depression occur concurrently. This study was undertaken to measure anxiety in patients with atrial fibrillation grouped according to gender, age, and education.

MATERIAL AND METHODS

The test anxiety inventory of C.D. Spielberger was administered to 52 patients aged 41 to 80 years, treated for atrial fibrillation at the Internal Ward of the District Hospital in Białogard.

RESULTS

Anxiety as a state was observed more frequently in males and in patients with vocational and secondary education. Anxiety was not a trait of atrial fibrillation. Psychotherapeutic interventions used in cardiac rehabilitation are not recommended in atrial fibrillation. However, relaxation techniques could be of benefit in reducing the intensity of anxiety as a state.

[Assessment of anxiety in women during puerperium]

PURPOSE

Many women experience various emotional disorders during puerperium characterized by high levels of anxiety.

THE AIM OF THIS STUDY

To analyse the level of anxiety in women during puerperium depending on age, education, marital status, number of pregnancies, route of delivery, and family situation.

MATERIAL AND METHODS

We enrolled 120 women between day 10 and 15 of puerperium without any previous psychiatric disorders. Pregnancy, delivery, and puerperium were without any morbidity and the newborns were healthy. The level of anxiety was measured using C. D. Spilberger's State-Trait Anxiety Inventory (STAI).

RESULTS

The level of anxiety as a trait in women during puerperium was within normal limits, whereas the level of anxiety as a state was elevated. Primipara and women up to 20 years of age require special attention during psycho-preventive treatment due to increased level of anxiety as a trait during puerperium. Employment and family situation determine the level of anxiety as a state after delivery.

CONCLUSIONS

Identification of women with a higher level of anxiety as a state during puerperium may provoke early medical intervention in this group of women and thus contribute to improvement in the quality of life of the woman and conditions for future development of the neonate.

Will a 1-page informational handout decrease patients' most common fears of anesthesia and surgery?

OBJECTIVE

The objective of this study was to determine whether an informational handout alone could measurably reduce some of the most common fears patients have about anesthesia and surgery.

DESIGN

An anonymous, volunteer survey package consisting of demographic information, a 1-page informational handout discussing common fears that patients have, and 2 identical surveys that assessed the patients' level of fear before and after reading the handout.

SETTING

Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas.

PARTICIPANTS

A total of 387 random volunteer patients awaiting their clinic visit with a provider in the Anesthesiology Pre-Operation Clinic of Wilford Hall Medical Center properly filled out the survey package.

METHODS

Patients were asked to rate their fears with respect to (1) the qualification of their anesthesia providers, and the potential for (2) death or serious illness, (3) awareness, (4) postoperative pain, (5) access to pain medications postoperatively, and (6) postoperative nausea and vomiting. The patients rated their fears for each of the 6 categories using a Likert scale as either none, mild, moderate, or severe, which corresponded to scores of 0, 1, 2, or 3, respectively, for a maximum fear score of 18. The patients were then asked to read a 1-page objective informational handout that addressed each of these potential fears. After reading the informational handout, the patients then repeated the fear survey.

RESULTS

Three hundred eighty-seven patients properly completed the survey packages. There were 160 (41.3%) patients who demonstrated a reduction in fear scores, with a 49.6% (p < 0.001) reduction between the mean initial fear score of 6.81 (CI 6.11 to 7.52) and mean final scores of 3.43 (CI 2.84 to 4.02). The most commonly reported fear was death (n = 196, 50.6%), and those patients with no prior surgeries (n = 63, 17.3%) had the highest initial mean fear score of 5.13 (CI 3.79 to 6.37) and the largest reduction in their fear score with 36.1% (p < 0.001). Those patients between the ages of 26 years old and 39 years old had the high initial mean fear score of 5.39 (CI 4.37 to 6.30), whereas patients under the age of 25 years old had the largest reduction in their fear score with 37.6% (p < 0.001). Subset analysis of patients whose mean fear scores were reduced after reading the handout were found to have statistically significant higher initial mean fear scores and a larger overall reduction in fear scores. Neither initial fear scores nor a reduction in fears scores were found to correlate with the type of surgery a patient was planning to have.

CONCLUSION

With just over 40% of patients demonstrating a statistically significant reduction in their fear levels, consideration should given to making an informational handout available on a routine basis to patients in preoperative anesthesia and surgical clinics. Additionally, it seems that younger patients (under the age of 40 years old) and those with no prior surgeries are the most likely to benefit from such a handout.

A prospective test of anxiety sensitivity as a moderator of the relation between gender and posttraumatic symptom maintenance among high anxiety sensitive young adults

The primary aim of this study was to evaluate the individual and combined influence of anxiety sensitivity (AS) and gender on the longitudinal prediction of posttraumatic symptoms. A large nonclinical sample of young adults (n=404) was prospectively followed over approximately 18 months. The primary findings indicated that gender and AS were uniquely associated with posttraumatic symptom levels during the follow-up period. Moreover, AS appeared more strongly (positively) related to posttraumatic stress symptoms during the follow-up period among females than males. These data provide novel prospective evidence regarding the interplay of relatively well-established risk factors implicated in the maintenance of posttraumatic stress symptoms.

[Remitted anxiety states: a specific variant of generalized anxiety disorder]

Two hundreds and four patients with generalized anxiety disorder (GAD) have been divided into 2 groups: 107 patients with remitted course (a main group) and 97 patients with the typical development of GAD (a comparison group). It has been shown that the main group is characterized by the lower intensity of anxiety affect and reactivity and the lesser duration of exacerbations. The remissions, when the tension of anxiety is completely absent or has a subclinical character, last from 2-3 weeks to 2-3 months. In the treatment, patients with remitted disorders prefer psychotherapy (44,9%) or combined therapy (psychotherapy and pharmacotherapy) - 38,85% of cases. Despite of some peculiarities remitted anxiety disorders should be considered as a variant of GAD thus confirming their unity.

General beliefs about the world as defensive mechanisms against death anxiety

Death ideation and death anxiety represent the cognitive and affective dimensions of death attitudes, respectively. General beliefs about the world are proposed to be useful defensive mechanisms protecting persons against the death anxiety provoked by death ideation. SEM is employed to test the proposed mediation model, using a sample of 133 Hong Kong Chinese university students. Results showed that death ideation was significantly and inversely linked to belief in social cynicism, reward for application, and fate control. Moreover, higher levels of belief in fate control and lower levels of religiosity predicted greater death anxiety. Only belief in fate control partially mediated the relationship between death ideation and death anxiety. Discussion focused on how social axioms serve as useful defensive mechanisms against death anxiety.

A typology of behavior problems in preschool children

The purpose of this study was to produce a typology of behavior problems in preschool children. Distinct subtypes were identified through the use of cluster analytic techniques on data from the Behavior Assessment System for Children (BASC)-Parent Rating Scales. Analyses were based on archival data collected on a sample of 268 children, aged 2 to 5 years, who were referred to determine their suitability for a day treatment program. Five distinct and reliable subtypes of preschool children's behavior problems emerged. Ratings of adaptive and social skills based on the BASC Adaptive Scales and measures from the Parenting Stress Index served as external variables to assess the distinctiveness of the derived subtypes. The findings provide evidence for the reliability and validity of the subtypes identified in this study that are consistent with the findings of previous subtyping investigations focusing on school-aged children.

"The rust of life": impact of anxiety on cardiac patients

Anxiety has both functionally appropriate and inappropriate consequences. Among patients with cardiac disease, anxiety can be functionally appropriate when it prompts an individual to quickly seek treatment for acute cardiac signs and symptoms. But anxiety may have medical or psychological consequences when it is persistent or severe, including difficulty adhering to prescribed treatments and making recommended lifestyle changes, adoption of or failure to change risky behaviors, increased risk for acute cardiac events, and increased risk for in-hospital complications after admission for acute coronary syndrome. Yet, because anxiety is a universal emotion that is managed without consequence by many people, its importance is often ignored by healthcare providers. The impact of psychosocial (with a major emphasis on anxiety) and behavioral variables on biological outcomes was examined systematically. The research included (1) examination and comparison of the intensity of anxiety in international samples of various critically, acutely, and chronically ill cardiac patients; (2) determination of differences between men and women in the expression of anxiety; (3) investigation of factors predictive of anxiety levels, including perceived control; (4) studies of healthcare providers' knowledge of anxiety assessment and providers' practices in assessing and managing anxiety; and (5) determination of the impact of anxiety on clinical outcomes in cardiac patients. The goal of this program of research is to improve patients' outcomes on a widespread basis by placing anxiety in the forefront of clinical cardiac practice.

Child-rearing anxiety and its correlates among Japanese mothers screened at 18-month infant health checkups

OBJECTIVE

To examine the level of child-rearing anxiety and to explore the variables correlated with child-rearing anxiety in a city in Japan.

DESIGN

Cross-sectional study.

SAMPLE

From July to September 2003, 371 mothers who visited community health centers in a city in Tokyo Metropolis for their child's 18-month health checkups.

MEASUREMENTS

Child-rearing anxiety was measured by the child-rearing anxiety scale. Questions in a self-reported questionnaire were on maternal variables, including maternal background information, child variables, and family system variables such as the presence of social support, and utilization of parenting support services. Also included within the questionnaire was the General Health Questionnaire-12.

RESULTS

Hierarchical multiple linear regression analysis revealed that mothers with higher child-rearing anxiety had less childcare satisfaction, more depressive symptoms, more worries about the child, less support from the husband, and less social support.

CONCLUSION

To identify mothers with high child-rearing anxiety in Japan, the infant health checkups should be utilized as an opportunity for screening, focusing on variables regarding mothers. Public health nurses can provide the necessary support after gaining an understanding of issues confronting mothers to prevent child-rearing anxiety and child abuse.

Five-Factor Personality Dimensions, Mood States, and Cognitive Performance in Older Adults

In this study we examined the impact of personality traits and negative mood state on performance in several cognitive domains in a sample of 398 elderly community-dwelling individuals. Multiple linear regression analyses were used to examine the variance in cognitive measures explained by state depression and anxiety after controlling for the effects of demographic characteristics and five-factor model personality traits. Personality traits were found to contribute significantly to cognitive function, explaining 2-7% of the variance in ability across domains. Examination of the contributions of individual five-factor traits showed that Openness had a significant relationship with all indexes of verbal memory and with general cognitive ability. State anxiety and depression variables were found to play a very small part, however, in contributing to cognitive function.

The validity of DSM-IV passive-aggressive (negativistic) personality disorder

Passive-Aggressive (Negativistic) Personality Disorder (NEGPD), listed in Appendix B of the DSM-IV, is not an officially recognized personality disorder. Its future as a discrete disorder is uncertain (Widiger, 2003). Yet, NEGPD occupies a role in some theoretical formulations of personality pathology (Millon & Davis, 1996), and many clinicians believe that passive-aggressive traits are not adequately represented by other PDs (Westen, 1997). In this study, 1158 psychiatric outpatients were assessed for Axis I and Axis II disorders. Thirty-five (3.02%) met criteria for NEGPD. Participants with NEGPD did not differ significantly from those without NEGPD on demographic variables. The internal consistency of the DSM-IV's seven NEGPD items was 0.50. Corrected item- total correlations for the 7 criteria averaged 0.27. Participants with NEGPD had higher rates of lifetime anxiety disorders, and almost 90% had an additional PD. An exploratory factor analysis suggested a two- factor solution that accounted for 43.4% of the variance. The first factor reflected the belief that life is unfair, while the second factor seemed to reflect modes of anger expression. A confirmatory factor analysis showed that the two-factor model fit the data better than a unidimensional model. We discuss implications of these results for the future of the NEGPD diagnosis.

Development and validation of an Overall Anxiety Severity And Impairment Scale (OASIS)

Establishing severity and impairment associated with anxiety is important in many settings. We developed a brief (five-item) continuous measure, the Overall Anxiety Severity and Impairment Scale (OASIS), which can be used across anxiety disorders, with multiple anxiety disorders, and with subthreshold anxiety symptoms. Seven hundred eleven college students completed the OASIS and additional self-report assessments of anxiety-related concerns and symptoms. A subset of students completed several measures again 1 month later. Results of a split-sample analysis suggested a single-factor structure, with all five items having salient loadings. The OASIS demonstrated excellent 1-month test-retest reliability, and convergent and divergent validity. The OASIS merits consideration as a brief measure of anxiety-related severity and impairment that can be used across anxiety disorders.