1
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Cardinale EM, Bezek J, Morales S, Filippi C, Smith AR, Haller S, Valadez EA, Harrewijn A, Phillips D, Chronis-Tuscano A, Brotman MA, Fox NA, Pine DS, Leibenluft E, Kircanski K. Cross-sectional and Longitudinal Associations of Anxiety and Irritability With Adolescents' Neural Responses to Cognitive Conflict. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:436-444. [PMID: 35358745 PMCID: PMC9764223 DOI: 10.1016/j.bpsc.2022.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 04/12/2023]
Abstract
BACKGROUND Psychiatric symptoms are commonly comorbid in childhood. The ability to disentangle unique and shared correlates of comorbid symptoms facilitates personalized medicine. Cognitive control is implicated broadly in psychopathology, including in pediatric disorders characterized by anxiety and irritability. To disentangle cognitive control correlates of anxiety versus irritability, the current study leveraged both cross-sectional and longitudinal data from early childhood into adolescence. METHODS For this study, 89 participants were recruited from a large longitudinal research study on early-life temperament to investigate associations of developmental trajectories of anxiety and irritability symptoms (from ages 2 to 15) as well as associations of anxiety and irritability symptoms measured cross-sectionally at age 15 with neural substrates of conflict and error processing assessed at age 15 using the flanker task. RESULTS Results of whole-brain multivariate linear models revealed that anxiety at age 15 was uniquely associated with decreased neural response to conflict across multiple regions implicated in attentional control and conflict adaptation. Conversely, irritability at age 15 was uniquely associated with increased neural response to conflict in regions implicated in response inhibition. Developmental trajectories of anxiety and irritability interacted in relation to neural responses to both error and conflict. CONCLUSIONS Our findings suggest that neural correlates of conflict processing may relate uniquely to anxiety and irritability. Continued cross-symptom research on the neural correlates of cognitive control could stimulate advances in individualized treatment for anxiety and irritability during child and adolescent development.
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Affiliation(s)
| | - Jessica Bezek
- National Institute of Mental Health, Bethesda, Maryland
| | - Santiago Morales
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland; Department of Psychology, University of Southern California, Los Angeles, California
| | | | | | - Simone Haller
- National Institute of Mental Health, Bethesda, Maryland
| | - Emilio A Valadez
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | - Anita Harrewijn
- National Institute of Mental Health, Bethesda, Maryland; Department of Clinical Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Andrea Chronis-Tuscano
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | | | - Nathan A Fox
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland
| | - Daniel S Pine
- National Institute of Mental Health, Bethesda, Maryland
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2
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The lifetime impact of stress on fear regulation and cortical function. Neuropharmacology 2023; 224:109367. [PMID: 36464208 DOI: 10.1016/j.neuropharm.2022.109367] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022]
Abstract
A variety of stressful experiences can influence the ability to form and subsequently inhibit fear memory. While nonsocial stress can impact fear learning and memory throughout the lifespan, psychosocial stressors that involve negative social experiences or changes to the social environment have a disproportionately high impact during adolescence. Here, we review converging lines of evidence that suggest that development of prefrontal cortical circuitry necessary for both social experiences and fear learning is altered by stress exposure in a way that impacts both social and fear behaviors throughout the lifespan. Further, we suggest that psychosocial stress, through its impact on the prefrontal cortex, may be especially detrimental during early developmental periods characterized by higher sociability. This article is part of the Special Issue on 'Fear, Anxiety and PTSD'.
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3
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Liu J, Shi M. What Are the Characteristics of User Texts and Behaviors in Chinese Depression Posts? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6129. [PMID: 35627666 PMCID: PMC9141684 DOI: 10.3390/ijerph19106129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 12/10/2022]
Abstract
Social media platforms provide unique insights into mental health issues, but a large number of related studies have focused on English text information. The purpose of this paper is to identify the posting content and posting behaviors of users with depression on Chinese social media. These clues may suggest signs of depression. We created two data sets consisting of 130 users with diagnosed depression and 320 other users that were randomly selected. By comparing and analyzing the two data sets, we can observe more closely how users reveal their signs of depression on Chinese social platforms. The results show that the distribution of some Chinese speech users with depression is significantly different from that of other users. Emotional sadness, fear and disgust are more common in the depression class. For personal pronouns, negative words and interrogative words, there are also great differences between the two data sets. Using topic modeling, we found that patients mainly discussed seven topics: negative emotion fluctuation, disease treatment and somatic responses, sleep disorders, sense of worthlessness, suicidal extreme behavior, seeking emotional support and interpersonal communication. The depression class post negative polarity posts much more frequently than other users. The frequency and characteristics of posts also reveal certain characteristics, such as sleep problems and reduced self-disclosure. In this study, we used Chinese microblog data to conduct a detailed analysis of the users showing depression signs, which helps to identify more patients with depression. At the same time, the study can provide a further theoretical basis for cross-cultural research of different language groups in the field of psychology.
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Affiliation(s)
| | - Mengshi Shi
- School of Management, Shanghai University, Shanghai 201800, China;
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4
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Toenders YJ, Kottaram A, Dinga R, Davey CG, Banaschewski T, Bokde ALW, Quinlan EB, Desrivières S, Flor H, Grigis A, Garavan H, Gowland P, Heinz A, Brühl R, Martinot JL, Paillère Martinot ML, Nees F, Orfanos DP, Lemaitre H, Paus T, Poustka L, Hohmann S, Fröhner JH, Smolka MN, Walter H, Whelan R, Stringaris A, van Noort B, Penttilä J, Grimmer Y, Insensee C, Becker A, Schumann G, Schmaal L. Predicting Depression Onset in Young People Based on Clinical, Cognitive, Environmental, and Neurobiological Data. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:376-384. [PMID: 33753312 DOI: 10.1016/j.bpsc.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adolescent onset of depression is associated with long-lasting negative consequences. Identifying adolescents at risk for developing depression would enable the monitoring of risk factors and the development of early intervention strategies. Using machine learning to combine several risk factors from multiple modalities might allow prediction of depression onset at the individual level. METHODS A subsample of a multisite longitudinal study in adolescents, the IMAGEN study, was used to predict future (subthreshold) major depressive disorder onset in healthy adolescents. Based on 2-year and 5-year follow-up data, participants were grouped into the following: 1) those developing a diagnosis of major depressive disorder or subthreshold major depressive disorder and 2) healthy control subjects. Baseline measurements of 145 variables from different modalities (clinical, cognitive, environmental, and structural magnetic resonance imaging) at age 14 years were used as input to penalized logistic regression (with different levels of penalization) to predict depression onset in a training dataset (n = 407). The features contributing the highest to the prediction were validated in an independent hold-out sample (three independent IMAGEN sites; n = 137). RESULTS The area under the receiver operating characteristic curve for predicting depression onset ranged between 0.70 and 0.72 in the training dataset. Baseline severity of depressive symptoms, female sex, neuroticism, stressful life events, and surface area of the supramarginal gyrus contributed most to the predictive model and predicted onset of depression, with an area under the receiver operating characteristic curve between 0.68 and 0.72 in the independent validation sample. CONCLUSIONS This study showed that depression onset in adolescents can be predicted based on a combination multimodal data of clinical characteristics, life events, personality traits, and brain structure variables.
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Affiliation(s)
- Yara J Toenders
- Orygen, The University of Melbourne, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - Akhil Kottaram
- Orygen, The University of Melbourne, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Richard Dinga
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Christopher G Davey
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Arun L W Bokde
- Discipline of Psychiatry, School of Medicine and Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
| | - Erin Burke Quinlan
- Centre for Population Neuroscience and Precision Medicine (PONS), Institute of Psychiatry, Psychology & Neuroscience, SGDP Centre, King's College London, United Kingdom
| | - Sylvane Desrivières
- Centre for Population Neuroscience and Precision Medicine (PONS), Institute of Psychiatry, Psychology & Neuroscience, SGDP Centre, King's College London, United Kingdom
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Antoine Grigis
- NeuroSpin, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Hugh Garavan
- Departments of Psychiatry and Psychology, University of Vermont, Burlington, Vermont
| | - Penny Gowland
- Sir Peter Mansfield Imaging Centre School of Physics and Astronomy, University of Nottingham, University Park, Nottingham, United Kingdom
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Rüdiger Brühl
- Physikalisch-Technische Bundesanstalt, Braunschweig and Berlin, Germany
| | - Jean-Luc Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM U A10 "Trajectoires développementales en psychiatrie;" Université Paris-Saclay, Ecole Normale supérieure Paris-Saclay, CNRS, Centre Borelli; Gif-sur-Yvette, France
| | - Marie-Laure Paillère Martinot
- Institut National de la Santé et de la Recherche Médicale, INSERM U A10 "Trajectoires développementales en psychiatrie;" Université Paris-Saclay, Ecole Normale supérieure Paris-Saclay, CNRS, Centre Borelli; Gif-sur-Yvette, France; Department of Child and Adolescent Psychiatry, Pitié-Salpêtrière Hospital, AP-HP.Sorbonne Université, Paris, France
| | - Frauke Nees
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Kiel, Germany
| | | | - Herve Lemaitre
- NeuroSpin, CEA, Université Paris-Saclay, Gif-sur-Yvette, France; Institut des Maladies Neurodégénératives, UMR 5293, CNRS, CEA, Université de Bordeaux, Bordeaux, France
| | - Tomáš Paus
- Departments of Psychology and Psychiatry, University of Toronto, Toronto, Ontario, Canada; Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital Toronto, Toronto, Ontario, Canada
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen23, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Juliane H Fröhner
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Michael N Smolka
- Department of Psychiatry and Neuroimaging Center, Technische Universität Dresden, Dresden, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Robert Whelan
- School of Psychology and Global Brain Health Institute, Trinity College Dublin, Ireland
| | | | - Betteke van Noort
- MSB Medical School Berlin, Hochschule für Gesundheit und Medizin, Siemens Villa, Berlin, Germany
| | - Jani Penttilä
- Department of Social and Health Care, Psychosocial Services Adolescent Outpatient Clinic Kauppakatu Lahti, Finland
| | - Yvonne Grimmer
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Corinna Insensee
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen23, Germany
| | - Andreas Becker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen23, Germany
| | - Gunter Schumann
- PONS Research Group, Department of Psychiatry and Psychotherapy, Campus Charite Mitte, Humboldt University, Berlin and Leibniz Institute for Neurobiology, Magdeburg, Germany, and Institute for Science and Technology of Brain-inspired Intelligence (ISTBI), Fudan University, Shanghai, P.R. China
| | | | - Lianne Schmaal
- Orygen, The University of Melbourne, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Co-Developmental Trajectories of Specific Anxiety Symptoms from Middle Childhood to Early Adolescence: Associations with Psychological Well-Being and Academic Achievement. J Youth Adolesc 2021; 50:1140-1156. [PMID: 33675506 DOI: 10.1007/s10964-021-01411-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 01/02/2023]
Abstract
Different types of specific anxiety symptoms commonly co-occur but also display distinct developmental trajectories over time in children and adolescents. Nevertheless, little is known about the co-developmental trajectories of specific anxiety symptoms among youth during the transition into adolescence and how identified trajectories are associated with important psychological and academic outcomes. This study thus aimed to determine the (a) heterogeneous co-developmental trajectories of five specific anxiety symptoms (generalized anxiety, separation anxiety, social anxiety, school anxiety, and panic disorder) from middle childhood to early adolescence, and (b) associations between the identified, distinct trajectories and youth's psychological well-being and academic achievement. A total of 715 Chinese elementary school students (45.6% girls, Mage = 8.96, SD = 0.76) completed measures on six occasions across three years, using 6-month intervals. Parallel process latent class growth modeling revealed five distinct anxiety trajectory groups: "congruent-low" (49.8%), "moderately low with predominant social anxiety" (18.5%), "moderately low with predominant school anxiety" (12.6%), "moderately high with predominant generalized and social anxiety" (8.6%), and "congruent-high" (10.5%). The lowest psychological well-being and academic achievement were observed for youth who persistently experienced the co-occurrence of two or more specific anxiety symptoms, followed by those who persistently experienced one predominant anxiety symptom, and finally, youth who persistently experienced low levels of all five specific anxiety symptoms. The identification of five heterogeneous groups with differential outcomes highlights the importance of individual differences considerations in understanding the co-developmental patterns of specific anxiety symptoms from middle childhood to early adolescence and the need for more sophisticated intervention programs tailored to members of specific groups to promote optimal psychological well-being and academic success.
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6
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Schanche E, Vøllestad J, Visted E, Svendsen JL, Osnes B, Binder PE, Franer P, Sørensen L. The effects of mindfulness-based cognitive therapy on risk and protective factors of depressive relapse - a randomized wait-list controlled trial. BMC Psychol 2020; 8:57. [PMID: 32503649 PMCID: PMC7275325 DOI: 10.1186/s40359-020-00417-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 05/04/2020] [Indexed: 12/18/2022] Open
Abstract
Background The aim of this randomized wait-list controlled trial was to explore the effects of Mindfulness–Based Cognitive Therapy (MBCT) on risk and protective factors for depressive relapse within the domains of cognition, emotion and self-relatedness. Methods Sixty-eight individuals with recurrent depressive disorder were randomized to MBCT or a wait-list control condition (WLC). Results Completers of MBCT (N = 26) improved significantly on measures assessing risk and protective factors of recurrent depression compared to WLC (N = 30) on measures of rumination (d = 0.59, p = .015), emotion regulation (d = 0.50, p = .028), emotional reactivity to stress (d = 0.32, p = .048), self-compassion (d = 1.02, p < .001), mindfulness (d = 0.59, p = .010), and depression (d = 0.40, p = .018). In the Intention To Treat sample, findings were attenuated, but there were still significant results on measures of rumination, self-compassion and depression. Conclusions Findings from the present trial contribute to evidence that MBCT can lead to reduction in risk factors of depressive relapse, and strengthening of factors known to be protective of depressive relapse. The largest changes were found in the domain of self-relatedness, in the form of large effects on the participants’ ability to be less self-judgmental and more self-compassionate. Trial registration ISRCTN, ISRCTN18001392. Registered 29 June 2018
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Affiliation(s)
- Elisabeth Schanche
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.
| | - Jon Vøllestad
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Solli District Psychiatric Centre (DPS), Nesttun, Norway
| | - Endre Visted
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Kronstad District Psychiatric Centre (DPS), Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Julie Lillebostad Svendsen
- Kronstad District Psychiatric Centre (DPS), Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Berge Osnes
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Bjørgvin District Psychiatric Centre (DPS), Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Per Einar Binder
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Petter Franer
- Kronstad District Psychiatric Centre (DPS), Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lin Sørensen
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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7
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Can clinical psychology students benefit from brief and intensive mindfulness training? COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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8
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Toenders YJ, van Velzen LS, Heideman IZ, Harrison BJ, Davey CG, Schmaal L. Neuroimaging predictors of onset and course of depression in childhood and adolescence: A systematic review of longitudinal studies. Dev Cogn Neurosci 2019; 39:100700. [PMID: 31426010 PMCID: PMC6969367 DOI: 10.1016/j.dcn.2019.100700] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 11/24/2022] Open
Abstract
Major depressive disorder (MDD) often emerges during adolescence with detrimental effects on development as well as lifetime consequences. Identifying neurobiological markers that are associated with the onset or course of this disorder in childhood and adolescence is important for early recognition and intervention and, potentially, for the prevention of illness onset. In this systematic review, 68 longitudinal neuroimaging studies, from 34 unique samples, that examined the association of neuroimaging markers with onset or changes in paediatric depression published up to 1 February 2019 were examined. These studies employed different imaging modalities at baseline; structural magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), functional MRI (fMRI) or electroencephalography (EEG). Most consistent evidence across studies was found for blunted reward-related (striatal) activity (fMRI and EEG) as a potential biological marker for both MDD onset and course. With regard to structural brain measures, the results were highly inconsistent, likely caused by insufficient power to detect complex mediating effects of genetic and environmental factors in small sample sizes. Overall, there were a limited number of samples, and confounding factors such as sex and pubertal development were often not considered, whereas these factors are likely to be relevant especially in this age range.
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Affiliation(s)
- Yara J Toenders
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Laura S van Velzen
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Ivonne Z Heideman
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, Victoria 3053, Australia
| | - Christopher G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia
| | - Lianne Schmaal
- Orygen, The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, Victoria 3052, Australia; Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, Victoria 3052, Australia.
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9
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Mental health of adolescents: variations by borderline intellectual functioning and disability. Eur Child Adolesc Psychiatry 2019; 28:1231-1240. [PMID: 30759281 DOI: 10.1007/s00787-019-01278-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Abstract
Adolescence is a period of elevated stress for many young people, and it is possible that the challenges of adolescence are different for vulnerable groups. We aimed to document the depressive and anxiety symptoms, emotional-behavioural difficulties and suicidal/self-harming behaviours among adolescents with borderline intellectual functioning (BIF) or a disability, compared to those with neither disability nor BIF. Data were drawn from the nationally representative Longitudinal Study of Australian Children. Participants were 2950 adolescents with complete data for waves 3-6 (years 2008-2014), aged 14-15 years in 2014. Anxiety and depression symptoms and self-harming/suicidal thought/behaviours were self-reported. Emotional-behavioural difficulties items came from the Strengths and Difficulties Questionnaire, and were parent-, and adolescent-reported. Results of logistic regression analyses indicate that the emotional-behavioural difficulties of adolescents with either a disability or BIF, were worse than for those with neither disability nor BIF. While adolescents with a disability reported more anxiety symptoms, no clear associations were observed for self-harming/suicidal thoughts/behaviours or depressive symptoms for those with either BIF or a disability. Adolescents with BIF or a disability are at higher risk of poor mental health than those with neither disability nor BIF, and it is vital that factors contributing to these differences are identified in order to reduce these mental health inequalities.
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10
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Simon E, Driessen S, Lambert A, Muris P. Challenging anxious cognitions or accepting them? Exploring the efficacy of the cognitive elements of cognitive behaviour therapy and acceptance and commitment therapy in the reduction of children's fear of the dark. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2019; 55:90-97. [PMID: 30690747 PMCID: PMC6972696 DOI: 10.1002/ijop.12540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 08/10/2018] [Indexed: 11/17/2022]
Abstract
Anxiety is highly prevalent in pre‐adolescent children. Distorted cognitions are characteristic for dysfunctional levels of anxiety. However, applying cognitive elements in pre‐adolescent children cannot be fully ascertained, as it is not until adolescence before children can apply logical and abstract reasoning in a sophisticated manner. Cognitive behaviour therapy (CBT) and acceptance and commitment therapy (ACT) both target distorted cognitions. Whereas CBT encourages children to change the content of negative cognitions by applying cognitive restructuring, ACT stimulates youth to have a more accepting attitude towards these thoughts by applying cognitive defusion. The current study examined the efficacy of applying cognitive elements and compared the cognitive elements of CBT and ACT in pre‐adolescent children. We included no behavioural elements to specifically study the developmental appropriateness of the cognitive elements in this age group. Highly anxious children, aged 8–12 years were randomised to a 30‐minute cognitive restructuring (n = 21) or cognitive defusion intervention (n = 22). Subjective fear of the dark levels, behavioural darkness toleration, and comprehension and fun associated with the interventions were assessed. Both interventions had a significantly positive impact on children's fear of the dark. Cognitive restructuring led to more favourable results on subjective fear than cognitive defusion, no differences were found for darkness toleration.
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Affiliation(s)
- Ellin Simon
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, The Netherlands
| | - Sabine Driessen
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, The Netherlands
| | - Ann Lambert
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, The Netherlands
| | - Peter Muris
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.,Psychology, Stellenbosch University, Stellenbosch, South Africa
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Lahey BB, Krueger RF, Rathouz PJ, Waldman ID, Zald DH. A hierarchical causal taxonomy of psychopathology across the life span. Psychol Bull 2017; 143:142-186. [PMID: 28004947 PMCID: PMC5269437 DOI: 10.1037/bul0000069] [Citation(s) in RCA: 249] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We propose a taxonomy of psychopathology based on patterns of shared causal influences identified in a review of multivariate behavior genetic studies that distinguish genetic and environmental influences that are either common to multiple dimensions of psychopathology or unique to each dimension. At the phenotypic level, first-order dimensions are defined by correlations among symptoms; correlations among first-order dimensions similarly define higher-order domains (e.g., internalizing or externalizing psychopathology). We hypothesize that the robust phenotypic correlations among first-order dimensions reflect a hierarchy of increasingly specific etiologic influences. Some nonspecific etiologic factors increase risk for all first-order dimensions of psychopathology to varying degrees through a general factor of psychopathology. Other nonspecific etiologic factors increase risk only for all first-order dimensions within a more specific higher-order domain. Furthermore, each first-order dimension has its own unique causal influences. Genetic and environmental influences common to family members tend to be nonspecific, whereas environmental influences unique to each individual are more dimension-specific. We posit that these causal influences on psychopathology are moderated by sex and developmental processes. This causal taxonomy also provides a novel framework for understanding the heterogeneity of each first-order dimension: Different persons exhibiting similar symptoms may be influenced by different combinations of etiologic influences from each of the 3 levels of the etiologic hierarchy. Furthermore, we relate the proposed causal taxonomy to transdimensional psychobiological processes, which also impact the heterogeneity of each psychopathology dimension. This causal taxonomy implies the need for changes in strategies for studying the etiology, psychobiology, prevention, and treatment of psychopathology. (PsycINFO Database Record
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Affiliation(s)
| | | | - Paul J Rathouz
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine
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Lee KS, Choi OJ, Kim JH. A Longitudinal Study on the Effects of Negative Rearing Experiences on Adolescents' Social Withdrawal and Aggression. Korean J Fam Med 2017; 38:276-283. [PMID: 29026488 PMCID: PMC5637219 DOI: 10.4082/kjfm.2017.38.5.276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/07/2016] [Accepted: 07/14/2016] [Indexed: 11/18/2022] Open
Abstract
Background Children who have experienced negative rearing behaviors show a lack of self-confidence due to emotional instability and are reserved in interpersonal relationships. This can lead to failure in social adaptation and a high risk of depression, suicide, criminal acts, and anti-social behaviors. Therefore, this study aims to analyze the effects of experiencing negative parental rearing behaviors, such as neglect and abuse, on adolescents' social withdrawal and aggression, by utilizing multivariate latent growth models. Methods Data from the Korean Children and Youth Panel Study (KCYPS), a survey conducted by the National Youth Policy Institute targeting a cohort of three different age groups (grade 1, grade 4, and grade 7), from 2010 to 2016 was used. Multi-stage stratified sampling methods were used in the KCYPS, which surveyed the students and parents of the selected grade levels. This study analyzed the data for grade 7, from second year (grade 8) to fourth year (grade 10). Results Negative rearing experiences had a significant effect on social withdrawal and aggression, and this influence was shown to persist over the long term. Conclusion This study examined the long-term developmental trajectory in the relationship between risk factors for adolescent development. Furthermore, the relationship between risk factors was shown to have not only short term but long-term effects as well, which reinforces the limitations of previous studies.
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Affiliation(s)
- Kyung-Suk Lee
- Department of Counseling Psychology, Seoul University of Buddhism, Seoul, Korea
| | - Ok-Joo Choi
- Department of Social Welfare, Konkuk University, Seoul, Korea
| | - Joon-Ho Kim
- Department of Business Administration, Sejong University, Seoul, Korea
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Benas JS, McCarthy AE, Haimm CA, Huang M, Gallop R, Young JF. The Depression Prevention Initiative: Impact on Adolescent Internalizing and Externalizing Symptoms in a Randomized Trial. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2016; 48:S57-S71. [PMID: 27646462 PMCID: PMC5493504 DOI: 10.1080/15374416.2016.1197839] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This randomized controlled trial examined the longitudinal effects of two school-based indicated depression prevention programs on adolescents' internalizing and externalizing symptoms, as measured by adolescents, their parents, and their teachers. One hundred eighty-six adolescents participated in this study. The average age was 14.01 (SD = 1.22) years, and the sample was 66.7% female. One third of the sample belonged to a racial minority. Youth received either Interpersonal Psychotherapy-Adolescent Skills Training or group counseling. Symptoms were assessed using adolescent, parent, and teacher reports on the Achenbach System of Empirically Based Assessment at baseline, postintervention, and 6-month follow-up. Adolescents reported the most robust effects in favor of Interpersonal Psychotherapy-Adolescent Skills Training. Adolescents in Interpersonal Psychotherapy-Adolescent Skills Training reported significantly greater reductions in internalizing symptoms through the 6-month follow-up and significantly greater reductions in externalizing symptoms during the intervention as compared to group counseling. Less robust effects were found when examining parent and teacher reports, although there was evidence of significant within-group change in parent- and teacher-reported internalizing symptoms for both interventions and significant between-group differences in teacher-reported externalizing symptoms. This study provides additional evidence supporting the efficacy of Interpersonal Psychotherapy-Adolescent Skills Training as a depression prevention program for adolescents. Interpersonal Psychotherapy-Adolescent Skills Training appears to have fast-acting effects on broadband internalizing and externalizing symptoms as reported by adolescents. This suggests that Interpersonal Psychotherapy-Adolescent Skills Training may serve as a transdiagnostic preventive intervention. Moreover, given the disparate reports of adolescents, parents, and teachers, this study demonstrates the significance of collecting information from multiple sources when possible.
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Affiliation(s)
- Jessica S Benas
- a Graduate School of Applied and Professional Psychology, Rutgers University
| | - Alyssa E McCarthy
- a Graduate School of Applied and Professional Psychology, Rutgers University
| | - Caroline A Haimm
- a Graduate School of Applied and Professional Psychology, Rutgers University
| | - Meghan Huang
- a Graduate School of Applied and Professional Psychology, Rutgers University
| | - Robert Gallop
- b Department of Mathematics, West Chester University
| | - Jami F Young
- a Graduate School of Applied and Professional Psychology, Rutgers University
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Azlan HA, Overton PG, Simpson J, Powell PA. Differential disgust responding in people with cancer and implications for psychological wellbeing. Psychol Health 2016; 32:19-37. [PMID: 27615058 DOI: 10.1080/08870446.2016.1235165] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Evidence suggests that disgust responses, known to negatively affect psychological wellbeing, may differ in people with cancer. We performed the first quantitative investigation of three discrete types of disgust trait - disgust propensity, sensitivity and self-directed disgust - in people diagnosed with a broad range of cancers (versus cancer-free controls), and explored their associations with psychological wellbeing. DESIGN In a cross-sectional survey design, 107 participants with heterogeneous cancer diagnoses, recruited from cancer charities and support groups, were matched with cancer-free controls by age and gender. OUTCOME MEASURES Measures of the three disgust traits were taken alongside measures of anxiety and depression. RESULTS Disgust sensitivity and physical self-disgust were significantly higher in the cancer than control sample, while disgust propensity and behavioural self-disgust were lower. The disgust traits had a different pattern of associations to psychological wellbeing across the two groups, with disgust sensitivity predicting depressive symptoms to a significantly greater extent in the cancer than control group. CONCLUSIONS People with cancer differ from matched controls in their disgust responses and these responses have significant predictive relationships with aspects of their psychological wellbeing. The results suggest that emotion-based interventions may be useful for improving psychological wellbeing in people with cancer.
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Affiliation(s)
| | - Paul G Overton
- a Department of Psychology , University of Sheffield , Sheffield , UK
| | - Jane Simpson
- b Division of Health Research , Lancaster University , Lancaster , UK
| | - Philip A Powell
- c Department of Economics , University of Sheffield , Sheffield , UK
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Palmer CA, Alfano CA. Sleep Architecture Relates to Daytime Affect and Somatic Complaints in Clinically Anxious but Not Healthy Children. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:175-187. [PMID: 27610927 DOI: 10.1080/15374416.2016.1188704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
It is increasingly clear that seminal sleep-affective relationships begin to take root in childhood, yet studies exploring how nighttime sleep characteristics relate to daytime affective symptoms, both in clinical and healthy populations of children, are lacking. The current study sought to explore these relationships by investigating whether trait-like and/or daily reports of affective and somatic symptoms of children with generalized anxiety disorder and matched controls relate to sleep architecture. Sixty-six children (ages 7-11; 54.4% female; 56.1% Caucasian; 18.2% biracial; 6.1% African American; 3% Asian; 16.7% Hispanic) participated including 29 with primary generalized anxiety disorder (without comorbid depression) and 37 healthy controls matched on age and race/ethnicity. Participants underwent structured diagnostic assessments including child-report measures and subsequently reported on their negative affect and somatic symptoms over the course of 1 week. Children also completed 1 night of polysomnography. Among children with generalized anxiety disorder only, greater amounts of slow wave sleep corresponded with less negative affect, and greater amounts of rapid eye movement sleep was related to more somatic complaints across the week. Similarly, for trait-like measures, more rapid eye movement sleep and shorter latency to rapid eye movement sleep were related to greater depressive symptoms in the anxious group only. The current findings suggest that physiologic sleep characteristics may contribute in direct ways to the symptom profiles of clinically anxious children. The functional relevance of such findings (e.g., how specific sleep characteristics serve to either increase or reduce long-term risk) is a vital direction for future research.
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Affiliation(s)
- Cara A Palmer
- a Sleep and Anxiety Center of Houston , University of Houston
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16
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Waszczuk MA, Zavos HMS, Gregory AM, Eley TC. The stability and change of etiological influences on depression, anxiety symptoms and their co-occurrence across adolescence and young adulthood. Psychol Med 2016; 46:161-75. [PMID: 26310536 PMCID: PMC4673666 DOI: 10.1017/s0033291715001634] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/29/2015] [Accepted: 08/03/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Depression and anxiety persist within and across diagnostic boundaries. The manner in which common v. disorder-specific genetic and environmental influences operate across development to maintain internalizing disorders and their co-morbidity is unclear. This paper investigates the stability and change of etiological influences on depression, panic, generalized, separation and social anxiety symptoms, and their co-occurrence, across adolescence and young adulthood. METHOD A total of 2619 twins/siblings prospectively reported symptoms of depression and anxiety at mean ages 15, 17 and 20 years. RESULTS Each symptom scale showed a similar pattern of moderate continuity across development, largely underpinned by genetic stability. New genetic influences contributing to change in the developmental course of the symptoms emerged at each time point. All symptom scales correlated moderately with one another over time. Genetic influences, both stable and time-specific, overlapped considerably between the scales. Non-shared environmental influences were largely time- and symptom-specific, but some contributed moderately to the stability of depression and anxiety symptom scales. These stable, longitudinal environmental influences were highly correlated between the symptoms. CONCLUSIONS The results highlight both stable and dynamic etiology of depression and anxiety symptom scales. They provide preliminary evidence that stable as well as newly emerging genes contribute to the co-morbidity between depression and anxiety across adolescence and young adulthood. Conversely, environmental influences are largely time-specific and contribute to change in symptoms over time. The results inform molecular genetics research and transdiagnostic treatment and prevention approaches.
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Affiliation(s)
- M. A. Waszczuk
- King's College London, MRC
Social, Genetic and Developmental Psychiatry Centre, Institute of
Psychiatry, Psychology and Neuroscience, London,
UK
| | - H. M. S. Zavos
- King's College London, MRC
Social, Genetic and Developmental Psychiatry Centre, Institute of
Psychiatry, Psychology and Neuroscience, London,
UK
| | - A. M. Gregory
- Department of Psychology,
Goldsmiths, University of London,
London, UK
| | - T. C. Eley
- King's College London, MRC
Social, Genetic and Developmental Psychiatry Centre, Institute of
Psychiatry, Psychology and Neuroscience, London,
UK
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Waters AM, Kershaw R. Direction of attention bias to threat relates to differences in fear acquisition and extinction in anxious children. Behav Res Ther 2015; 64:56-65. [DOI: 10.1016/j.brat.2014.11.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 11/04/2014] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
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Salum GA, Desousa DA, do Rosário MC, Pine DS, Manfro GG. Pediatric anxiety disorders: from neuroscience to evidence-based clinical practice. BRAZILIAN JOURNAL OF PSYCHIATRY 2014; 35 Suppl 1:S03-21. [PMID: 24142122 DOI: 10.1590/1516-4446-2013-s108] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of this narrative review of the literature is to describe the epidemiology, etiology, pathophysiology, diagnosis, and treatment of pediatric anxiety disorders. We aim to guide clinicians in understanding the biology of anxiety disorders and to provide general guidelines for the proper diagnoses and treatment of these conditions early in life. Anxiety disorders are prevalent, associated with a number of negative life outcomes, and currently under-recognized and under-treated. The etiology involves both genes and environmental influences modifying the neural substrate in a complex interplay. Research on pathophysiology is still in its infancy, but some brain regions, such as the amygdala and the prefrontal cortex, have been implicated in fear and anxiety. Current practice is to establish diagnosis based purely on clinical features, derived from clinical interviews with the child, parents, and teachers. Treatment is effective using medication, cognitive behavioral therapy, or a combination of both. An introduction to the neuroscience behind anxiety disorders combined with an evidence-based approach may help clinicians to understand these disorders and treat them properly in childhood.
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Affiliation(s)
- Giovanni Abrahão Salum
- Universidade Federal do Rio Grande do Sul, Anxiety Disorders Outpatient Program for Child and Adolescent Psychiatry, Hospital de Clínicas de Porto Alegre, Porto AlegreRS, Brazil
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Alfano CA, Reynolds K, Scott N, Dahl RE, Mellman TA. Polysomnographic sleep patterns of non-depressed, non-medicated children with generalized anxiety disorder. J Affect Disord 2013; 147:379-84. [PMID: 23026127 PMCID: PMC3985749 DOI: 10.1016/j.jad.2012.08.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 08/16/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Polysomnographic (PSG) studies of children with psychiatric illness have primarily focused on depressed samples. Children with generalized anxiety disorder (GAD) report high rates of sleep problems yet investigation of objective sleep patterns in non-depressed children with GAD are unavailable. Identification of unique clinical features linking early GAD with sleep disturbance, including possible HPA activation during the pre-sleep period, is needed to inform effective treatments. METHOD Thirty non-medicated, pre-pubescent children (ages 7-11 years) were assessed including 15 children with GAD and 15 matched healthy controls. Anxious children had GAD as their primary diagnosis and did not meet criteria for secondary mood disorders. All participants underwent structured diagnostic assessment and laboratory-based polysomnography (PSG). State anxiety and salivary cortisol were assessed prior to light out on the PSG night. RESULTS Children with GAD showed significantly increased sleep onset latency and reduced latency to rapid eye movement (REM) sleep compared to controls. Marginal differences in the form of reduced sleep efficiency and increased total REM sleep also were found in the GAD group. Pre-sleep anxiety and cortisol levels did not differ between the two groups. LIMITATIONS A small sample size, time-limited assessment of cortisol, and possible first night effects should be considered. CONCLUSIONS Results of this study provide initial evidence of PSG-based differences in children with GAD compared to controls. Follow-up studies are needed to explore the course of sleep alterations and whether targeting sleep problems early in the course of GAD might improve clinical outcomes.
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Affiliation(s)
- Candice A Alfano
- Department of Psychology, University of Houston, Houston, TX 77204, USA.
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20
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Choi HW, Lee MS, Lim MH, Kwon HJ, Ha MN, Yoo SJ, Kim EJ, Paik KC. The Prevalence and Epidemiological Characteristics of Childhood Depressive Disorder in South Korea : Self Reported Study. Soa Chongsonyon Chongsin Uihak 2012. [DOI: 10.5765/jkacap.2012.23.3.134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Young JF, Makover HB, Cohen JR, Mufson L, Gallop R, Benas JS. Interpersonal psychotherapy-adolescent skills training: anxiety outcomes and impact of comorbidity. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2012; 41:640-53. [PMID: 22891881 PMCID: PMC3448978 DOI: 10.1080/15374416.2012.704843] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Given the frequent comorbidity of anxiety and depression, it is important to study the effects of depression interventions on anxiety and the impact of comorbid anxiety on depression outcomes. This article reports on pooled anxiety and depression data from two randomized trials of Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), a depression prevention program. Ninety-eight adolescents were randomized to receive IPT-AST or school counseling (SC). Outcome and predictor analyses were performed utilizing hierarchical linear models. IPT-AST adolescents had significantly greater reductions in anxiety and depressive symptoms than SC adolescents during the intervention. Baseline anxiety symptoms predicted change in depressive symptoms for adolescents in both intervention conditions, with adolescents low in baseline anxiety demonstrating more rapid change in depressive symptoms than adolescents high in baseline anxiety. These findings indicate that IPT-AST is effective at decreasing both depressive and anxiety symptoms. For adolescents with comorbid symptoms of anxiety, there may be slower rates of change in depressive symptoms following prevention programs.
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Affiliation(s)
- Jami F. Young
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University
| | - Heather B. Makover
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University
| | | | - Laura Mufson
- Department of Psychiatry, Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute
| | - Robert Gallop
- Department of Mathematics, Applied Statistics Program, West Chester University
| | - Jessica S. Benas
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University
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Abstract
This review focuses on developmental aspects in the epidemiology of anxiety disorders including prevalence, onset, natural course, longitudinal outcome, and correlates and risk factors, with focus on childhood through young adulthood. Anxiety disorders are frequent and early-emerging conditions. They may remit spontaneously; however, the same or other mental disorders often recur. Although risk factors have been identified, more work is needed to identify the most powerful predictors for onset and the progression to more complex forms of psychopathology and to understand the underlying mechanisms and interactions. This identification is crucial to facilitate research prevention, early interventions, and treatment programs.
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Affiliation(s)
- Katja Beesdo-Baum
- Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Chemnitzer Strasse 46, 01187 Dresden, Germany.
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Siegel RS, Dickstein DP. Anxiety in adolescents: Update on its diagnosis and treatment for primary care providers. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2011; 3:1-16. [PMID: 24600282 PMCID: PMC3916014 DOI: 10.2147/ahmt.s7597] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Anxiety disorders are the most prevalent mental health concern facing adolescents today, yet they are largely undertreated. This is especially concerning given that there are fairly good data to support an evidence-based approach to the diagnosis and treatment of anxiety, and also that untreated, these problems can continue into adulthood, growing in severity. Thus, knowing how to recognize and respond to anxiety in adolescents is of the utmost importance in primary care settings. To that end, this article provides an up-to-date review of the diagnosis and treatment of anxiety disorders geared towards professionals in primary care settings. Topics covered include subtypes, clinical presentation, the etiology and biology, effective screening instruments, evidence-based treatments (both medication and therapy), and the long-term prognosis for adolescents with anxiety. Importantly, we focus on the most common types of anxiety disorders, often known as phobias, which include generalized anxiety disorder, social anxiety/social phobia, separation anxiety disorder, panic disorder, and specific phobias. In summary, anxiety is a common psychiatric problem for adolescents, but armed with the right tools, primary care providers can make a major impact.
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Affiliation(s)
- Rebecca S Siegel
- Pediatric Mood, Imaging, and NeuroDevelopment Program, EP Bradley Hospital, East Providence, RI, USA
| | - Daniel P Dickstein
- Pediatric Mood, Imaging, and NeuroDevelopment Program, EP Bradley Hospital, East Providence, RI, USA
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Beesdo-Baum K, Wittchen HU. Depressive Störungen: Major Depression und Dysthymie. SPRINGER-LEHRBUCH 2011. [DOI: 10.1007/978-3-642-13018-2_40] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Kovacs M, Lopez-Duran N. Prodromal symptoms and atypical affectivity as predictors of major depression in juveniles: implications for prevention. J Child Psychol Psychiatry 2010; 51:472-96. [PMID: 20202041 PMCID: PMC2921595 DOI: 10.1111/j.1469-7610.2010.02230.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Given the long-term morbidity of juvenile-onset major depressive disorder (MDD), it is timely to consider whether more effort should be dedicated to its primary and secondary prevention. METHODS We reviewed studies of prodromal symptoms that may herald a first episode pediatric MDD and considered whether that literature has made an impact on secondary prevention (efforts to prevent progression from symptoms to full disorder). We also reviewed studies of children at familial risk for MDD that addressed atypical affectivity and the regulation of sad, dysphoric affect (mood repair) and related physiological systems, and considered whether research in those areas has made an impact on primary prevention of pediatric MDD (efforts to prevent the disorder). RESULTS A compelling body of literature indicates that depressive symptoms in youngsters predict subsequent MDD across the juvenile (and early adult) years and that any combination of several symptoms for at least one week is informative in that regard. These findings are echoed in the case selection criteria used by many secondary prevention programs. Convergent findings also indicate that (compared to typical peers) young offspring at familial risk for depression manifest low positive affectivity and compromised mood repair, along with signs of dysfunction in three intertwined physiological systems that contribute to affectivity and mood repair (the hypothalamic-pituitary-adrenal (HPA) axis, cerebral hemispheric asymmetry, and cardiac vagal control). While all these affect-related parameters are suitable for case selection and as intervention targets, they have not yet made an impact on primary prevention programs. CONCLUSIONS According to recent meta-analyses, attempts to prevent pediatric depression have not lived up to expectations. Based on our review, possible reasons for this include: (a) the use of case selection criteria that yield samples heterogeneous with regard to whether the symptoms are truly prodromal to an episode of MDD or are trait-like (which could affect response to the intervention), (b) failure to fully capitalize on the broad-ranging literature on vulnerability to pediatric MDD, as evidenced by the infrequent use of family history of depression (a robust index of vulnerability) or combined indices of vulnerability for case selection, and (c) lack of synchrony between dimensions of vulnerability and the content of the prevention program, as indicated by the overwhelming use of cognitive-behavioral interventions, irrespective of subjects' age, developmental readiness, and whether or not they evidenced the relevant cognitive vulnerability. Prevention trials of pediatric MDD could benefit from new approaches to case selection that combine various indices of vulnerability, more effective use of existing findings, and new or modified interventions that are developmentally sensitive.
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Affiliation(s)
- Maria Kovacs
- University of Pittsburgh of School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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Pine DS. Integrating research on development and fear learning: a vision for clinical neuroscience? Depress Anxiety 2009; 26:775-9. [PMID: 19731230 DOI: 10.1002/da.20595] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Daniel S Pine
- Section on Development and Affective Neuroscience, Mood and Anxiety Disorder Program, Intramural Research Program, National Institute of Mental Health, USA.
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Grant BF, Goldstein RB, Chou SP, Huang B, Stinson FS, Dawson DA, Saha TD, Smith SM, Pulay AJ, Pickering RP, Ruan WJ, Compton WM. Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. Mol Psychiatry 2009; 14:1051-66. [PMID: 18427559 PMCID: PMC2766434 DOI: 10.1038/mp.2008.41] [Citation(s) in RCA: 432] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The objective of this study was to present nationally representative findings on sociodemographic and psychopathologic predictors of first incidence of Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV) substance, mood and anxiety disorders using the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. One-year incidence rates of DSM-IV substance, mood and anxiety disorders were highest for alcohol abuse (1.02), alcohol dependence (1.70), major depressive disorder (MDD; 1.51) and generalized anxiety disorder (GAD; 1.12). Incidence rates were significantly greater (P<0.01) among men for substance use disorders and greater among women for mood and anxiety disorders except bipolar disorders and social phobia. Age was inversely related to all disorders. Black individuals were at decreased risk of incident alcohol abuse and Hispanic individuals were at decreased risk of GAD. Anxiety disorders at baseline more often predicted incidence of other anxiety disorders than mood disorders. Reciprocal temporal relationships were found between alcohol abuse and dependence, MDD and GAD, and GAD and panic disorder. Borderline and schizotypal personality disorders predicted most incident disorders. Incidence rates of substance, mood and anxiety disorders were comparable to or greater than rates of lung cancer, stroke and cardiovascular disease. The greater incidence of all disorders in the youngest cohort underscores the need for increased vigilance in identifying and treating these disorders among young adults. Strong common factors and unique factors appear to underlie associations between alcohol abuse and dependence, MDD and GAD, and GAD and panic disorder. The major results of this study are discussed with regard to prevention and treatment implications.
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Affiliation(s)
- Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Rise B. Goldstein
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - S. Patricia Chou
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Frederick S. Stinson
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Deborah A. Dawson
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Tulshi D. Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Sharon M. Smith
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Attila J. Pulay
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Roger P. Pickering
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - W. June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Ln., M.S. 9304, Bethesda, MD, USA 20892-9304
| | - Wilson M. Compton
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd., M.S. 9589, Bethesda, MD, USA 20892-9589
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Reef J, Diamantopoulou S, van Meurs I, Verhulst F, van der Ende J. Child to adult continuities of psychopathology: a 24-year follow-up. Acta Psychiatr Scand 2009; 120:230-8. [PMID: 19522882 DOI: 10.1111/j.1600-0447.2009.01422.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine continuities of mental health problems of children across a 24-year follow-up period. METHOD In 1983, parent ratings of emotional and behavioral problems were collected with the Child Behavior Checklist (CBCL) in a general population sample of 2076 children. Twenty-four years later, 1365 participants completed Adult Self-Reports (ASR) to assess emotional and behavioral problems. RESULTS Of the participants who were classified as deviant in childhood, 22.2% were also classified as deviant in adulthood. Both homotypic and heterotypic continuity was found. Childhood aggressive, delinquent, and anxious/depressed problems were associated with most adult psychopathology. Attention problems did not predict later problems independently. CONCLUSION Even though assessed with parent-reports in childhood and analogous self-reports in adulthood, and over a large period of 24 years, continuity of psychopathology was found from childhood into adulthood. Anxious/depressed problems, delinquent behavior and aggressive behavior in childhood are core predictors for adult psychopathology.
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Affiliation(s)
- J Reef
- Erasmus Medical Center-Sophia Children's Hospital - Child and Adolescent Psychiatry, Rotterdam 3000 CB, the Netherlands
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Keenan K, Feng X, Hipwell A, Klostermann S. Depression begets depression: comparing the predictive utility of depression and anxiety symptoms to later depression. J Child Psychol Psychiatry 2009; 50:1167-75. [PMID: 19344385 PMCID: PMC2733924 DOI: 10.1111/j.1469-7610.2009.02080.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The high comorbidity between depressive and anxiety disorders, especially among females, has called into question the independence of these two symptom groups. It is possible that childhood anxiety typically precedes depression in girls. Comparing of the predictive utility of symptoms of anxiety with the predictive utility of symptoms of depression from early childhood to early adolescence is needed to test this hypothesis. METHODS Data from a population-based sample of 2,451 girls were used to examine age-related changes and year-to-year stability within and across symptoms of major depression, separation anxiety, and generalized/social anxiety by maternal report from ages 6 to 12. In addition, the predictive utility of symptoms of major depression, separation anxiety, and generalized/social anxiety at ages 7-10 years of age to depressive disorders at ages 11-13 was tested. RESULTS Symptoms of separation anxiety demonstrated a linear decrease, depression symptoms a linear increase and symptoms of generalized/social anxiety an increase from 6-8, a plateau 8-10, followed by a decrease from 10-12 years. Year-to-year changes in symptoms of major depression were best predicted by depressive symptoms in the previous year, although a small amount of additional variance was accounted for by separation anxiety symptoms in early childhood and generalized/social anxiety symptoms in mid to later childhood. Age 8 was the earliest age from which depressive disorders in early adolescence could be predicted from symptoms of depression and generalized social anxiety. CONCLUSIONS Homotypic continuity of depression and anxiety symptoms from early childhood to early adolescence is more common in girls than heterotypic continuity. Some additional information about year-to-year changes in depression symptoms and later depressive disorder is gained by assessing anxiety symptoms. Depressive symptoms themselves, however, appear to be the strongest and most reliable predictor of later depression.
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Affiliation(s)
- Kate Keenan
- Department of Psychiatry, University of Chicago, IL, USA.
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Fichter MM, Kohlboeck G, Quadflieg N, Wyschkon A, Esser G. From childhood to adult age: 18-year longitudinal results and prediction of the course of mental disorders in the community. Soc Psychiatry Psychiatr Epidemiol 2009; 44:792-803. [PMID: 19212695 DOI: 10.1007/s00127-009-0501-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 01/20/2009] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This prospective longitudinal study of a representative community sample of children and adolescents (N = 269) examined the long-term course and predictive power of psychiatric symptoms in childhood/adolescence for diagnostic outcome (ICD-10) 18 years later at adult age. METHOD At both cross-sectional assessments, baseline (1980-1984) and the 18-year follow-up (2001-2004), psychiatric symptoms were assessed using the 'Standardized Psychiatric Interview' (Goldberg et al. in Br J Prev Soc Med 24:18-23, 1970). At follow-up, study participants were reassessed with the standardized M-CIDI (Wittchen and Pfister in Manual und Durchführungsbeschreibung des DIA-X-M-CIDI, Swets and Zeitlinger, Frankfurt, 1997) interview. RESULTS The participation rate at 18-year follow-up was 82% of those alive. The frequency of clinically relevant depressive symptoms and symptoms of anxiety or phobia was considerably higher when the participants were younger (baseline assessment at childhood, adolescent age) as compared to their scores in adult age. Increased levels of somatic symptoms, fatigue, irritability, sleep disturbances, depression, anxiety and worry as well as phobic symptoms in childhood/adolescence were related to a higher risk of suffering from a psychiatric disorder in adulthood. Depressive symptoms predicted both mood disorders and substance use disorders in adulthood. Phobias predicted later anxiety disorders. CONCLUSION These data spanning almost two decades add significant information to the existing literature on the course of mental disorders in the community during the transition from adolescence to adulthood.
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Beesdo K, Knappe S, Pine DS. Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatr Clin North Am 2009; 32:483-524. [PMID: 19716988 PMCID: PMC3018839 DOI: 10.1016/j.psc.2009.06.002] [Citation(s) in RCA: 881] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This review summarizes findings on the epidemiology and etiology of anxiety disorders among children and adolescents including separation anxiety disorder, specific phobia, social phobia, agoraphobia, panic disorder, and generalized anxiety disorder, also highlighting critical aspects of diagnosis, assessment, and treatment. Childhood and adolescence is the core risk phase for the development of anxiety symptoms and syndromes, ranging from transient mild symptoms to full-blown anxiety disorders. This article critically reviews epidemiological evidence covering prevalence, incidence, course, and risk factors. The core challenge in this age span is the derivation of developmentally more sensitive assessment methods. Identification of characteristics that could serve as solid predictors for onset, course, and outcome will require prospective designs that assess a wide range of putative vulnerability and risk factors. This type of information is important for improved early recognition and differential diagnosis as well as prevention and treatment in this age span.
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Affiliation(s)
- Katja Beesdo
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Faculty of Science, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.
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Luby JL, Si X, Belden AC, Tandon M, Spitznagel E. Preschool depression: homotypic continuity and course over 24 months. ARCHIVES OF GENERAL PSYCHIATRY 2009; 66:897-905. [PMID: 19652129 PMCID: PMC3184302 DOI: 10.1001/archgenpsychiatry.2009.97] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Childhood depression is a serious and relapsing psychiatric disorder. However, to date studies have focused mostly on children aged 6 years and older. Validation for depression in preschool children has been provided by 2 independent study samples. While several studies have demonstrated stability and poor outcomes of internalizing symptoms in preschoolers, there has not yet been longitudinal data available to inform the course of preschool depression and whether it shows homotypic continuity into early childhood. OBJECTIVE To examine the 24-month course of preschool depression and whether it showed homotypic vs heterotypic continuity or was a developmentally transient phenomenon. DESIGN Blindly rated, prospective, 24-month, longitudinal follow-up study. SETTING Community sites. Patients Three hundred six preschoolers aged 3 to 6 years recruited from community sites and oversampled for symptoms of depression. Main Outcome Measure Recurrence/stability of depression and predictors of course. RESULTS Preschoolers with depression at baseline had the highest likelihood of subsequent depression 12 and/or 24 months later compared with preschoolers with no baseline disorder and with those who had other psychiatric disorders. Preschoolers with depression at baseline were more likely to have later depression rather than other psychiatric disorders. Findings from a logistic regression analysis indicated that when controlling for demographic variables, risk factors, and comorbid disorders, depression during the preschool period and family history of affective disorders were the most robust and significant predictors of later depression. CONCLUSIONS Preschool depression, similar to childhood depression, is not a developmentally transient syndrome but rather shows chronicity and/or recurrence. Homotypic continuity of preschool MDD during a 24-month period was found. These results underscore the clinical and public health importance of identification of depression as early as preschool. Further follow-up of preschoolers with depression is warranted to inform the longitudinal course throughout childhood.
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Affiliation(s)
- Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63110, USA.
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Malkesman O, Pine DS, Tragon T, Austin DR, Henter ID, Chen G, Manji HK. Animal models of suicide-trait-related behaviors. Trends Pharmacol Sci 2009; 30:165-73. [PMID: 19269045 DOI: 10.1016/j.tips.2009.01.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 01/02/2009] [Accepted: 01/07/2009] [Indexed: 11/19/2022]
Abstract
Although antidepressants are moderately effective in treating major depressive disorder (MDD), concerns have arisen that selective serotonin-reuptake inhibitors (SSRIs) are associated with suicidal thinking and behavior, especially in children, adolescents and young adults. Almost no experimental research in model systems has considered the mechanisms by which SSRIs might be associated with this potential side effect in some susceptible individuals. Suicide is a complex behavior and impossible to fully reproduce in an animal model. However, by investigating traits that show strong cross-species parallels in addition to associations with suicide in humans, animal models might elucidate the mechanisms by which SSRIs are associated with suicidal thinking and behavior. Traits linked with suicide in humans that can be successfully modeled in rodents include aggression, impulsivity, irritability and hopelessness/helplessness. Modeling these relevant traits in animals can help to clarify the impact of SSRIs on these traits, suggesting avenues for reducing suicide risk in this vulnerable population.
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Affiliation(s)
- Oz Malkesman
- Laboratory of Molecular Pathophysiology, National Institute of Mental Health, Intramural Research Program, National Institutes of Health, Bethesda, MD 20892, USA
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Threat-related selective attention predicts treatment success in childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry 2009; 48:196-205. [PMID: 19127173 DOI: 10.1097/chi.0b013e31819176e4] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The present study examined whether threat-related selective attention was predictive of treatment success in children with anxiety disorders and whether age moderated this association. Specific components of selective attention were examined in treatment responders and nonresponders. METHOD Participants consisted of 131 children with anxiety disorders (aged 8-16 years), who received standardized cognitive-behavioral therapy. At pretreatment, a pictorial dot-probe task was administered to assess selective attention. Both at pretreatment and posttreatment, diagnostic status of the children was evaluated with a semistructured clinical interview (the Anxiety Disorders Interview Schedule for Children). RESULTS Selective attention for severely threatening pictures at pretreatment assessment was predictive of treatment success. Examination of the specific components of selective attention revealed that nonresponders showed difficulties to disengage their attention away from severe threat. Treatment responders showed a tendency not to engage their attention toward severe threat. Age was not associated with selective attention and treatment success. CONCLUSIONS Threat-related selective attention is a significant predictor of treatment success in children with anxiety disorders. Clinically anxious children with difficulties disengaging their attention away from severe threat profit less from cognitive-behavioral therapy. For these children, additional training focused on learning to disengage attention away from anxiety-arousing stimuli may be beneficial.
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Warner V, Wickramaratne P, Weissman MM. The role of fear and anxiety in the familial risk for major depression: a three-generation study. Psychol Med 2008; 38:1543-1556. [PMID: 18275630 PMCID: PMC2904071 DOI: 10.1017/s0033291708002894] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The overlap between anxiety and major depressive disorder (MDD), the increased risk for depression and anxiety in offspring of depressed parents, the sequence of onset with anxiety preceding MDD, and anxiety as a predictor of depression are well established. The specificity of anxiety disorders in these relationships is unclear. This study, using a longitudinal high-risk design, examined whether anxiety disorders associated with the emotions fear and anxiety mediate the association between parental and offspring depression. METHOD Two hundred and twenty-four second-generation and 155 third-generation descendants at high and low risk for depression because of MDD in the first generation were interviewed over 20 years. Probit and Cox proportional hazard models were fitted with generation 2 (G2) or G3 depression as the outcome and parental MDD as the predictor. In G2 and G3, fear- (phobia or panic) and anxiety-related [overanxious or generalized anxiety disorder (GAD)] disorders were examined as potential mediators of increased risk for offspring depression, due to parental MDD. RESULTS In G2, fear-related disorders met criteria for mediating the association between parental MDD and offspring MDD whereas anxiety-related disorders did not. These results were consistent, regardless of the analytic methods used. Further investigation of the mediating effect of fear-related disorders by age of onset of offspring MDD suggests that the mediating effect occurs primarily in adolescent onset MDD. The results for G3 appear to follow similar patterns. CONCLUSIONS These findings support the separation of anxiety disorders into at least two distinct forms, particularly when examining their role in the etiology of depression.
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Affiliation(s)
- V Warner
- Division of Epidemiology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
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Biel MG, Klein RG, Mannuzza S, Roizen ER, Truong NL, Roberson-Nay R, Pine DS. Does major depressive disorder in parents predict specific fears and phobias in offspring? Depress Anxiety 2008; 25:379-82. [PMID: 17935207 DOI: 10.1002/da.20383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Evidence suggests a relationship between parental depression and phobias in offspring as well as links between childhood fears and risk for major depression. This study examines the relationship between major depressive disorder (MDD) and anxiety disorders in parents and specific fears and phobias in offspring. Three hundred and eighteen children of parents with lifetime MDD, anxiety disorder, MDD+anxiety disorder, or neither were psychiatrically assessed via parent interview. Rates of specific phobias in offspring did not differ significantly across parental groups. Specific fears were significantly elevated in offspring of parents with MDD+anxiety disorder relative to the other groups (MDD, anxiety disorder, and controls, which did not differ). We failed to find increased phobias in offspring of parents with MDD without anxiety disorder. Elevated rates of specific fears in offspring of parents with MDD+anxiety disorder may be a function of more severe parental psychopathology, increased genetic loading, or unmeasured environmental influences.
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Affiliation(s)
- Matthew G Biel
- Department of Child and Adolescent Psychiatry, NYU Child Study Center, NYU School of Medicine, New York University, New York, USA.
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Abstract
OBJECTIVE To examine the evidence for and against the classification of attention-deficit hyperactivity disorder (ADHD) as a valid disease entity, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV ), criteria. DATA SOURCES Sources included but were not limited to published literature on ADHD accessed via PubMed (http://www.ncbi.nlm.nih.gov/PubMed/). STUDY SELECTION Peer-reviewed research, review articles, consensus statements, "white papers," and proceedings of professional meetings were used. DATA EXTRACTION Focused on evidence base and scientific validity of conclusions. DATA SYNTHESIS Evidence for a genetic or neuroanatomic cause of ADHD is insufficient. Experimental work shows that executive function deficits do not explain ADHD. The psychometric properties of widely used ADHD rating scales do not meet standards expected for disease identification. CONCLUSIONS ADHD is unlikely to exist as an identifiable disease. Inattention, hyperactivity, and impulsivity are symptoms of many underlying treatable medical, emotional, and psychosocial conditions affecting children.
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Affiliation(s)
- Lydia Mary Furman
- Division of General Academic Pediatrics, Rainbow Babies and Children's Hospital, Cleveland, Ohio 44106, USA.
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MacMaster FP, Mirza Y, Szeszko PR, Kmiecik LE, Easter PC, Taormina SP, Lynch M, Rose M, Moore GJ, Rosenberg DR. Amygdala and hippocampal volumes in familial early onset major depressive disorder. Biol Psychiatry 2008; 63:385-90. [PMID: 17640621 PMCID: PMC2268763 DOI: 10.1016/j.biopsych.2007.05.005] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Revised: 05/09/2007] [Accepted: 05/10/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Abnormalities in the amygdala and hippocampus have been implicated in the pathogenesis of major depressive disorder (MDD). To our knowledge, no prior study has examined amygdala-hippocampus anatomy in pediatric patients with familial MDD (at least one first degree relative with MDD). METHODS Thirty-two psychotropic-naive patients with familial MDD, aged 8-21 years (12 males and 20 females), and 35 group-matched healthy participants (13 males and 22 females) underwent volumetric magnetic resonance imaging in order to evaluate hippocampal and amygdala volumes. RESULTS Patients with familial MDD had significantly smaller left hippocampal (p = .007, effect size [d] = .44) and right hippocampal volumes (p = .025, d = .33) than controls. No differences were noted in amygdala volumes between groups (right: p > .05, left: p > .05). No correlations between hippocampal or amygdala volumes and demographic or clinical variables were noted. CONCLUSIONS Reduced hippocampal volume may be suggestive of a risk factor for developing MDD.
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Affiliation(s)
- Frank P. MacMaster
- The Department of Psychiatry & Behavioral Neurosciences, Wayne State University, and Children's Hospital of Michigan, Detroit, MI 48201
| | - Yousha Mirza
- The Department of Psychiatry & Behavioral Neurosciences, Wayne State University, and Children's Hospital of Michigan, Detroit, MI 48201
| | - Philip R. Szeszko
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY 11004
| | - Lauren E. Kmiecik
- The Department of Psychiatry & Behavioral Neurosciences, Wayne State University, and Children's Hospital of Michigan, Detroit, MI 48201
| | - Phillip C. Easter
- The Department of Psychiatry & Behavioral Neurosciences, Wayne State University, and Children's Hospital of Michigan, Detroit, MI 48201
| | - S. Preeya Taormina
- The Department of Psychiatry & Behavioral Neurosciences, Wayne State University, and Children's Hospital of Michigan, Detroit, MI 48201
| | - Michelle Lynch
- The Department of Psychiatry & Behavioral Neurosciences, Wayne State University, and Children's Hospital of Michigan, Detroit, MI 48201
| | - Michelle Rose
- The Department of Psychiatry & Behavioral Neurosciences, Wayne State University, and Children's Hospital of Michigan, Detroit, MI 48201
| | - Gregory J. Moore
- Departments of Psychiatry and Radiology, Pennsylvania State University College of Medicine, Hershey, PA 17033
| | - David R. Rosenberg
- The Department of Psychiatry & Behavioral Neurosciences, Wayne State University, and Children's Hospital of Michigan, Detroit, MI 48201
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Gordon J, King N, Gullone E, Muris P, Ollendick TH. Nighttime fears of children and adolescents: Frequency, content, severity, harm expectations, disclosure, and coping behaviours. Behav Res Ther 2007; 45:2464-72. [PMID: 17490610 DOI: 10.1016/j.brat.2007.03.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Revised: 03/19/2007] [Accepted: 03/21/2007] [Indexed: 10/23/2022]
Abstract
The present school-based study investigated the nighttime fears of 511 children and adolescents, aged 8-16 years. Participants were assessed using a structured interview about the frequency, content, severity, harm expectations, coping strategies, and disclosure of nighttime fears. Results indicated that nighttime fears are a common experience, with nearly two-thirds (64.2%) of children and adolescents reporting nighttime fears. Fear of intruders/home invasion was the most frequently reported nighttime fear. Females more frequently reported nighttime fears than males (72.9% and 54.6%, respectively) and a greater number of children reported nighttime fears compared to adolescents (79.4% and 48.8%, respectively). Nighttime fears were given moderate severity ratings, and harm expectations were most strongly associated with 'personal security' fears. Respondents reported a variety of coping strategies to manage their nighttime fears with self-control/distraction techniques being the most common. Most respondents reported disclosing their nighttime fear(s) to another person. The clinical implications of these findings and the methodological limitations are discussed.
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van Oort FVA, Joung IMA, Mackenbach JP, Verhulst FC, Bengi-Arslan L, Crijnen AAM, van der Ende J. Development of ethnic disparities in internalizing and externalizing problems from adolescence into young adulthood. J Child Psychol Psychiatry 2007; 48:176-84. [PMID: 17300556 DOI: 10.1111/j.1469-7610.2006.01706.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about changes in ethnic disparities in mental health during the development of adolescents into young adults. The aim of this study was to study the development of disparities in internalizing and externalizing problems between Dutch natives and Turkish migrant children from adolescence into adulthood. METHODS Turkish migrants (n = 217) and Dutch natives (n = 723) completed two comparable questionnaires about internalizing and externalizing problems: the Youth Self-Report at age 11-18 and the (Young) Adult Self-Report ten years later, at age 21-28. We used mixed linear regression models to model development of mental health problems and to test changes in disparities in mental health between Turkish migrants and Dutch natives. RESULTS Both in adolescence and in adulthood migrants reported more internalizing and externalizing problems than natives, most pronounced for internalizing problems. Disparities decreased from adolescence into adulthood for both internalizing problems (-52%, p < .0001) and externalizing problems (-67%, p = .01), independently of gender, age, country of birth of Turkish adolescents, and parental socio-economic position. The favorable changes in the disparities over time were due to more favorable development among Turkish migrants than among natives. CONCLUSIONS In this prospective study, ethnic disparities in internalizing and externalizing problems decreased as adolescents entered adulthood. Different explanations are discussed.
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Affiliation(s)
- Floor V A van Oort
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Ferdinand RF, Dieleman G, Ormel J, Verhulst FC. Homotypic versus heterotypic continuity of anxiety symptoms in young adolescents: evidence for distinctions between DSM-IV subtypes. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2007; 35:325-33. [PMID: 17226094 PMCID: PMC1915634 DOI: 10.1007/s10802-006-9093-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 12/22/2006] [Indexed: 11/12/2022]
Abstract
Objective: to investigate homotypic and heterotypic longitudinal patterns of symptoms of separation anxiety disorder (SAD), generalized anxiety disorder (GAD), social phobia (SoPh), panic disorder (PD), and obsessive compulsive disorder (OCD) in young adolescents from the Dutch general population. Method: 2,067 individuals (51.4% girls) from a Dutch community sample, who were assessed for the first time when they were aged 10 to 12 years, were followed up across a period of two years. At both assessments, anxiety symptoms were assessed with the RCADS, a self-report questionnaire. Results: Regression analyses indicated that homotypic continuity was relatively high for SAD, GAD, and SoPh symptoms, and for PD in girls. Conclusions: In many studies, anxiety disorders are treated as one group of disorders, and some widely used assessment instruments, such as the Child Behavior Checklist, do not even contain scales that tap different anxiety dimensions. In the present study, evidence for homotypic continuity was found, especially for symptoms of separation, social, and generalized anxiety, and for symptoms of panic disorder in girls, underscoring the usefulness of making distinctions between different anxiety constructs.
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Affiliation(s)
- Robert F Ferdinand
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center, Rotterdam/Sophia Children's Hospital, Dr. Molewaterplein 60, 3000 CB Rotterdam, The Netherlands.
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Flannery-Schroeder EC. Reducing anxiety to prevent depression. Am J Prev Med 2006; 31:S136-42. [PMID: 17175408 DOI: 10.1016/j.amepre.2006.07.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2005] [Revised: 06/29/2006] [Accepted: 07/18/2006] [Indexed: 12/14/2022]
Abstract
Depression is one of the most prevalent mental disorders. Accordingly, treatment research has flourished; however, prevention efforts have lagged behind. The extant literature is reviewed on the relationship between anxiety and depression and the potential for childhood anxiety interventions to reduce the risks of secondary depression. Additionally, methodologic issues and recommendations in the design of depression prevention programs are presented. Research appears to support the view that anxiety plays a role in the development of depression; yet, the nature of that role remains unclear.
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Leibenluft E, Cohen P, Gorrindo T, Brook JS, Pine DS. Chronic versus episodic irritability in youth: a community-based, longitudinal study of clinical and diagnostic associations. J Child Adolesc Psychopharmacol 2006; 16:456-66. [PMID: 16958570 DOI: 10.1089/cap.2006.16.456] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Irritability is both a normal developmental phenomenon and a common psychiatric symptom in children. In psychiatric nosology, a distinction is made between chronic and episodic irritability. This study examines the validity of this distinction. METHODS A sample of 776 youths received Diagnostic and Statistical Manual of Mental Disorders (DSM)-based structured interviews at three time points. Questions regarding episodic and chronic irritability were used to create scales measuring these constructs; associations with age, gender, and diagnosis were examined. RESULTS Episodic and chronic irritability differed in their associations with age. The longitudinal stability within irritability type was stronger than between types. In longitudinal analyses, chronic irritability at time 1 (mean age 13.8 +/- 2.6 years) predicted attention deficit/ hyperactivity disorder at time 2 (mean age 16.2 +/- 2.8 years) and major depression at time 3 (mean age 22.1 +/- 2.7 years). Episodic irritability at time 1 predicted simple phobia and mania at time 2. CONCLUSIONS Episodic and chronic irritability in adolescents appear to be stable, distinct constructs. Further research is needed to elucidate the longitudinal associations of each with specific psychiatric diagnoses.
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Affiliation(s)
- Ellen Leibenluft
- Mood and Anxiety Program, National Institute of Mental Health, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA.
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Abstract
Attention-deficit hyperactivity disorder (ADHD) is described as the most common neurobehavioral condition of childhood. We raise the concern that ADHD is not a disease per se but rather a group of symptoms representing a final common behavioral pathway for a gamut of emotional, psychological, and/or learning problems. Increasing numbers of children, especially boys, are diagnosed with ADHD and treated with stimulant medications according to a simplified approach. Methodical review of the literature, however, raised concerning issues. "Core" ADHD symptoms of inattentiveness, hyperactivity and impulsivity are not unique to ADHD. Rates of "comorbid" psychiatric and learning problems, including depression and anxiety, range from 12 to 60%, with significant symptom overlap with ADHD, difficulties in diagnosis, and evidence-based treatment methods that do not include stimulant medications. No neuropsychologic test result is pathognomic for ADHD, and structural and functional neuroimaging studies have not identified a unique etiology for ADHD. No genetic marker has been consistently identified, and heritability studies are confounded by familial environmental factors. The validity of the Conners' Rating Scale-Revised has been seriously questioned, and parent and teacher "ratings" of school children are frequently discrepant, suggesting that use of subjective informant data via scale or interview does not form an objective basis for diagnosis of ADHD. Empiric diagnostic trials of stimulant medication that produce a behavioral response have been shown not to distinguish between children with and without "ADHD." In summary, the working dogma that ADHD is a disease or neurobehavioral condition does not at this time hold up to scrutiny of evidence. Thorough evaluation of symptomatic children should be individualized, and include assessment of educational, psychologic, psychiatric, and family needs.
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Affiliation(s)
- Lydia Furman
- Department of Pediatrics, Case Western Reserve University School of Medicine, Rainbow Babies and Children's Hospital, Cleveland, OH 44106, USA.
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45
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Pine DS, Klein RG, Mannuzza S, Moulton JL, Lissek S, Guardino M, Woldehawariat G. Face-emotion processing in offspring at risk for panic disorder. J Am Acad Child Adolesc Psychiatry 2005; 44:664-72. [PMID: 15968235 DOI: 10.1097/01.chi.0000162580.92029.f4] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Panic disorder (PD) has been linked to perturbed processing of threats. This study tested the hypotheses that offspring of parents with PD and offspring with anxiety disorders display relatively greater sensitivity and attention allocation to fear provocation. METHOD Offspring of adults with PD, major depressive disorder (MDD), or no disorder (ages 9-19) viewed computer-presented face photographs depicting angry, fearful, and happy faces. Offspring rated (1) subjectively experienced fear level, (2) how hostile the face appeared, and (3) nose width. Attention allocation was indexed by latency to perform ratings. RESULTS Compared with offspring of parents without PD (n = 79), offspring of PD parents (n = 65) reported significantly more fear and had slower reaction times to rate fear, controlling for ongoing anxiety disorder in the offspring. Offspring with an anxiety disorder (n = 65) reported significantly more fear than offspring without an anxiety disorder but not when parental PD was controlled. Social phobia but no other anxiety disorder in offspring was associated with slower reaction times for fear ratings (but not greater fear ratings). Parental PD and offspring social phobia independently predicted slower reaction time. CONCLUSIONS Results support an association between parental PD and offspring responses to fear provocation. Social phobia in children may have a specific relationship to allocation of attention to subjective anxiety during face viewing.
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Affiliation(s)
- Daniel S Pine
- Section on Development and Affective Neuroscience, National Institute of Mental Health Intramural Research Program, Bethesda, MD 20817-2670, USA.
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Rice F, van den Bree MBM, Thapar A. A population-based study of anxiety as a precursor for depression in childhood and adolescence. BMC Psychiatry 2004; 4:43. [PMID: 15596007 PMCID: PMC545489 DOI: 10.1186/1471-244x-4-43] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2004] [Accepted: 12/13/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety and depression co-occur in children and adolescents with anxiety commonly preceding depression. Although there is some evidence to suggest that the association between early anxiety and later depression is explained by a shared genetic aetiology, the contribution of environmental factors is less well examined and it is unknown whether anxiety itself is a phenotypic risk factor for later depression. These explanations of the association between early anxiety and later depression were evaluated. METHODS Anxiety and depressive symptoms were assessed longitudinally in a U.K. population-based sample of 676 twins aged 5-17 at baseline. At baseline, anxiety and depression were assessed by parental questionnaire. Depression was assessed three years later by parental and adolescent questionnaire. RESULTS Shared genetic effects between early anxiety and later depression were found. A model of a phenotypic risk effect from early anxiety on later depression provided a poor fit to the data. However, there were significant genetic effects specific to later depression, showing that early anxiety and later depression do not index entirely the same genetic risk. CONCLUSIONS Anxiety and depression are associated over time because they share a partly common genetic aetiology rather than because the anxiety phenotype leads to later depression.
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Affiliation(s)
- Frances Rice
- Department of Psychological Medicine, School of Medicine, Cardiff University, Cardiff, UK
- School of Psychology, Cardiff University, Cardiff, UK
| | | | - Anita Thapar
- Department of Psychological Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Goodwin RD, Fergusson DM, Horwood LJ. Early anxious/withdrawn behaviours predict later internalising disorders. J Child Psychol Psychiatry 2004; 45:874-83. [PMID: 15056317 DOI: 10.1111/j.1469-7610.2004.00279.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of the study was to examine the association between anxious/withdrawn behaviours at age 8 and the development of internalising disorders in adolescence and young adulthood (ages 16-21). METHODS Data were gathered over the course of a 21-year longitudinal study of a birth cohort of over 1,000 New-Zealand-born young people. Over the course of the study, data were gathered on: (a) anxious/withdrawn behaviour at age 8; (b) anxiety disorders and major depression at ages 16-18 and 18-21; (c) a range of potential confounding factors, including measures of adversity and family factors during childhood. RESULTS Increasing anxious/withdrawn behaviour at age 8 was associated with increasing risks of social phobia; specific phobia; panic/agoraphobia; and major depression during adolescence and young adulthood. These associations persisted after adjustment for a series of confounding social, childhood, and family factors. CONCLUSIONS Anxious/withdrawn behaviour in childhood is associated with elevated rates of anxiety disorders and major depression during adolescence and young adulthood. These data are consistent with, and extend, previous clinical and epidemiologic findings, by showing consistent linkages between childhood anxious/withdrawn behaviours at age 8 and increased risk for anxiety disorders and depression at ages 16-18 and 18-21 among young persons in the community. These results may point to the need to provide support and possibly intervention to children showing early anxious or withdrawn behaviours.
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Affiliation(s)
- Renee D Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Srivastava S, Sharma HO, Mandal MK. Mood induction with facial expressions of emotion in patients with generalized anxiety disorder. Depress Anxiety 2004; 18:144-8. [PMID: 14625879 DOI: 10.1002/da.10128] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patients with general anxiety disorder (GAD), anxiety prone subjects, and normal controls (n=30, N=90) were subjected to happy and sad mood induction conditions using facial expressions of emotion of varied intensity. Following mood induction, subjects were required to judge their mood state on two scales: the Positive and Negative Affect Scale and the Emotional Self Rating Scale. In general, the anxiety groups showed more sensitivity to the sad mood induction condition. However, the anxiety groups had a higher subjective rating for positive than negative emotions during the happy mood induction condition. These findings suggest the efficacy of the mood induction procedures in anxiety disorders.
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Abstract
We examined the comorbidity of anxiety disorders and their clinical consequences in adolescents. The 1,035 adolescents, aged 12 to 17 years old, were randomly selected from 36 schools in the province of Bremen, Germany. Anxiety disorders and other psychiatric disorders were coded based on DSM-IV criteria using the computerized Munich version of the Composite International Diagnostic Interview. The comorbidity rate within the anxiety disorders was relatively low (14.1%). However, the comorbidity of anxiety disorders with other psychiatric disorders was high. Approximately half (51%) of the anxious adolescents had other psychiatric disorders. The most common comorbid pattern was that of anxiety and depressive disorders. Among those with both anxiety and depressive disorders, a majority of them (72%) had anxiety before that of depression. Anxious adolescents with comorbid disorders were significantly more psychologically distressed, as assessed using the SCL-90-R, and used more mental health services than adolescents with anxiety disorders only. The effect of comorbidity on mental health services utilization was stronger in males than females. The findings suggest the need to design intervention strategies to deal with cases with multiple disorders.
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Affiliation(s)
- Cecilia A Essau
- Westfälische Wilhelms-Universität Münster, Psychologisches Institut I, Münster, Germany.
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50
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Coyle JT, Pine DS, Charney DS, Lewis L, Nemeroff CB, Carlson GA, Joshi PT, Reiss D, Todd RD, Hellander M. Depression and bipolar support alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in children and adolescents. J Am Acad Child Adolesc Psychiatry 2003; 42:1494-503. [PMID: 14627885 DOI: 10.1097/00004583-200312000-00017] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To focus attention on the critical unmet needs of children and adolescents with mood disorders and to make recommendations for future research and allocation of healthcare resources. METHOD The 36-member Consensus Development Panel consisted of experts in child/adolescent or adult psychiatry and psychology, pediatrics, and mental health advocacy. Reviews of the literature concerning youth mood disorders were performed on the subjects of risk factors, prevention, diagnosis, treatment, and services delivery, and opinions and experiences of mental health advocates were obtained. RESULTS The Consensus Development Panel listened to presentations and participated in discussions. Independent workgroups of clinicians, scientists, and mental health advocates considered the evidence and prepared preliminary statements. Workgroup leaders presented drafts for discussion by the Consensus Development Panel. The final document was reviewed by the entire group and edited to incorporate input from all participants. CONCLUSIONS Evidence suggests high rates of unmet needs for children and adolescents with depression or bipolar disorder. Training is largely limited to child mental health specialists; general psychiatrists, pediatricians, and other primary care physicians receive little or no training. As a result, treatment patterns may reflect adult treatment plans that are not validated for youths. Effective treatments have been identified and some preliminary prevention models have been developed, but they are not yet widely applied. Patients experience limited exposure to clinicians adequately trained to address their problems and little information to guide care decisions, particularly concerning bipolar disorder. National efforts are required to restructure healthcare delivery and provider training and to immediately develop more advanced research on pathophysiology, prevention, and services delivery effectiveness.
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