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Münker L, Rimvall MK, Frostholm L, Ørnbøl E, Wellnitz KB, Jeppesen P, Maria Rosmalen JG, Rask CU. Exploring the course of functional somatic symptoms (FSS) from pre- to late adolescence and associated internalizing psychopathology - an observational cohort-study. BMC Psychiatry 2024; 24:495. [PMID: 38977964 PMCID: PMC11232134 DOI: 10.1186/s12888-024-05937-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/26/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Functional somatic symptoms (FSS), which commonly cannot be attributed to well-defined organic pathology, often co-occur with internalizing psychopathology and fluctuate throughout different life stages. We examined FSS courses throughout adolescence, and the association between preadolescent FSS, FSS severity and internalizing psychopathology at late adolescence. METHODS Data from the Copenhagen Child Cohort (CCC2000) were utilized from assessments at ages 11-12 years (preadolescence; T0) and 16-17 years (late adolescence; T1). Self-report questionnaire and interview data on FSS, internalizing psychopathology, chronic medical conditions, and sociodemographic data from Danish national registers were available for 1285 youths. FSS courses were categorized into persistent (high FSS at T0 & T1), remission (high FSS only at T0), incident (high FSS only at T1) or no FSS (no FSS at T0 & T1). Multiple linear and multinomial logistic regressions were conducted to investigate the FSS/psychopathology association. RESULTS 1.8% of adolescents fell into the persistent FSS course group throughout adolescence. Higher preadolescent FSS predicted FSS (b = 0.07, p < .001), anxiety (b = 0.05, p < .001) and depression (b = 0.06, p < .001) at age 16/17, even after controlling for sex, parental education, a chronic medical condition and internalizing psychopathology in preadolescence. Persistent, incident, and remittent FSS courses were associated with significantly higher mean levels of anxiety and depression compared to the reference group (no FSS). CONCLUSIONS FSS during pre- and late adolescence might increase and co-occur with anxiety and depression throughout adolescence, potentially due to shared underlying risk factors and processes.
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Affiliation(s)
- Lina Münker
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Psychiatry, Aarhus, Denmark.
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Lisbeth Frostholm
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eva Ørnbøl
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kaare Bro Wellnitz
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pia Jeppesen
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Judith Gerarda Maria Rosmalen
- Departments of Psychiatry and Internal medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Peris-Baquero Ó, Moreno-Pérez JD, Navarro-Haro MV, Díaz-García A, Osma J. Emotion dysregulation and neuroticism as moderators of group Unified Protocol effectiveness outcomes for treating emotional disorders. J Affect Disord 2023; 331:313-321. [PMID: 36977435 DOI: 10.1016/j.jad.2023.03.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 02/27/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The personality dimension neuroticism and difficulties in emotional regulation (ER) are two variables closely related to the onset, course, and maintenance of emotional disorders (EDs). The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is a treatment specifically designed to address neuroticism by training in adaptive ER skills and has been shown to be effective in reducing difficulties in ER. However, the specific impact of these variables on treatment outcomes is not entirely clear. The aim of the present study was to explore the moderating role of neuroticism and difficulties in ER regarding the evolution of depressive and anxiety symptoms and quality of life. METHODS This secondary study included 140 participants diagnosed with EDs, who received the UP in group format as part of an RCT being conducted in different Spanish Public Mental Health Units. RESULTS The results of this study found that high scores in neuroticism and difficulties in ER were associated with greater severity of depression and anxiety symptomatology, and with poorer quality of life. In addition, difficulties in ER moderated the efficacy of UP regarding anxiety symptoms, and quality of life. No moderating effects were found for depression (p > 0.5). LIMITATIONS We only evaluated two moderators that may influence UP effectivenes; other key moderators should be analyzed in future. CONCLUSIONS The identification of specific moderators affecting transdiagnostic interventions outcomes will allow the development of personalized interventions and provide useful information to improve the psychopathology and well-being of people with EDs.
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Affiliation(s)
- Ó Peris-Baquero
- Universidad de Zaragoza, Teruel, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | | | - M V Navarro-Haro
- Universidad de Zaragoza, Teruel, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - A Díaz-García
- Universidad de Zaragoza, Teruel, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - J Osma
- Universidad de Zaragoza, Teruel, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain.
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3
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Ballester L, Alayo I, Vilagut G, Mortier P, Almenara J, Cebrià AI, Echeburúa E, Gabilondo A, Gili M, Lagares C, Piqueras JA, Roca M, Soto-Sanz V, Blasco MJ, Castellví P, Miranda-Mendizabal A, Bruffaerts R, Auerbach RP, Nock MK, Kessler RC, Alonso J. Predictive models for first-onset and persistence of depression and anxiety among university students. J Affect Disord 2022; 308:432-441. [PMID: 35398107 DOI: 10.1016/j.jad.2021.10.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Depression and anxiety are both prevalent among university students. They frequently co-occur and share risk factors. Yet few studies have focused on identifying students at highest risk of first-onset and persistence of either of these conditions. METHODS Multicenter cohort study among Spanish first-year university students. At baseline, students were assessed for lifetime and 12-month Major Depressive Episode and/or Generalized Anxiety Disorder (MDE-GAD), other mental disorders, childhood-adolescent adversities, stressful life events, social support, socio-demographics, and psychological factors using web-based surveys; 12-month MDE-GAD was again assessed at 12-month follow-up. RESULTS A total of 1253 students participated in both surveys (59.2% of baseline respondents; mean age = 18.7 (SD = 1.3); 56.0% female). First-onset of MDE-GAD at follow-up was 13.3%. Also 46.7% of those with baseline MDE-GAD showed persistence at follow-up. Childhood/Adolescence emotional abuse or neglect (OR= 4.33), prior bipolar spectrum disorder (OR= 4.34), prior suicidal ideation (OR=4.85) and prior lifetime symptoms of MDE (ORs=2.33-3.63) and GAD (ORs=2.15-3.75) were strongest predictors of first-onset MDE-GAD. Prior suicidal ideation (OR=3.17) and prior lifetime GAD symptoms (ORs=2.38-4.02) were strongest predictors of MDE-GAD persistence. Multivariable predictions from baseline showed AUCs of 0.76 for first-onset and 0.81 for persistence. 74.9% of first-onset MDE-GAD cases occurred among 30% students with highest predicted risk at baseline. LIMITATIONS Self-report data were used; external validation of the multivariable prediction models is needed. CONCLUSION MDE-GAD among university students is frequent, suggesting the need to implement web-based screening at university entrance that identify those students with highest risk.
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Affiliation(s)
- Laura Ballester
- Health Services Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain; Girona University (UdG), Girona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Itxaso Alayo
- Health Services Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Gemma Vilagut
- Health Services Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Philippe Mortier
- Health Services Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | | | - Ana Isabel Cebrià
- Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell, Spain; CIBER Salud Mental (CIBERSAM), Madrid, Spain
| | | | - Andrea Gabilondo
- BioDonostia Health Research Institute, Osakidetza, San Sebastián, Spain
| | - Margalida Gili
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISBA), Rediapp, University of Balearic Islands (UIB), Palma de Mallorca, Spain
| | | | | | - Miquel Roca
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISBA), Rediapp, University of Balearic Islands (UIB), Palma de Mallorca, Spain
| | | | - Maria Jesús Blasco
- Health Services Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Pere Castellví
- International University of Catalonia (UIC), Barcelona, Spain
| | | | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum (UPC-KUL), Center for Public Health Psychiatry, KULeuven, Leuven, Belgium
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, United States
| | - Matthew K Nock
- Department of Psychology, Harvard University, Boston, MA, United States
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Jordi Alonso
- Health Services Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Medicine and Life Scienes, Universitat Pompeu Fabra, Barcelona, Spain.
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Orouji F, Abdi R, Chalabianloo G. Mediating Role of Psychological Inflexibility as Transdiagnostic Factor in the Relationship Between Emotional Dysregulation and Sleep Problems With Symptoms of Emotional Disorders. Front Psychol 2022; 13:800041. [PMID: 35548493 PMCID: PMC9082666 DOI: 10.3389/fpsyg.2022.800041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/23/2022] [Indexed: 11/19/2022] Open
Abstract
This study aims to investigate the mediating role of psychological inflexibility as a transdiagnostic factor in the relationship between emotional dysregulation and sleep problems with symptoms of emotional disorders. A total of 500 subjects from three universities were selected by random multistage clustering, and they completed the Pittsburgh Sleep Quality Index, Difficulties in Emotional Regulation Scale, and Acceptance and Action Questionnaire–II, Inventory of Depression and Anxiety Symptoms. The results of correlation coefficients revealed that there is a positive and significant correlation among emotional dysregulation, sleep problems, and psychological inflexibility with emotional disorders. In addition, the results showed that psychological inflexibility acts as a transdiagnostic factor that mediates the relationship between emotional dysregulation and sleep problems with symptoms of emotional disorders. These findings illustrate how emotional dysregulation and sleep problems affect emotional disorders through psychological inflexibility.
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Affiliation(s)
- Farrin Orouji
- Department of Psychology, Azarbaijan Shahid Madani University, Tabriz, Iran
| | - Reza Abdi
- Department of Psychology, Faculty of Education and Psychology, Azarbaijan Shahid Madani University, Tabriz, Iran
| | - Gholamreza Chalabianloo
- Department of Psychology, Faculty of Education and Psychology, Azarbaijan Shahid Madani University, Tabriz, Iran
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Cao H, Wang J, Baranova A, Zhang F. Classifying major mental disorders genetically. Prog Neuropsychopharmacol Biol Psychiatry 2022; 112:110410. [PMID: 34339760 DOI: 10.1016/j.pnpbp.2021.110410] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/24/2021] [Accepted: 07/26/2021] [Indexed: 01/09/2023]
Abstract
Typically, mental disorders are defined and classified based on clinical symptoms and syndromes. Although clinically useful, current diagnostic systems for psychiatry cause concerns due to the lack of biological mechanisms. Deciphering the relationships among psychiatric traits according to their genetic basis may facilitate understanding the biological mechanisms of psychiatric disorders. Ten mental disorders were classified by genomic structural equation modeling (SEM), which leverages summary results of genome-wide association studies. Attention-deficit/hyperactivity disorder (ADHD), anorexia nervosa (AN), anxiety disorder (ANX), autism spectrum disorder (ASD), bipolar disorder (BD), major depressive disorder (MDD), obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), schizophrenia (SZ), and Tourette syndrome (TS) were included. The analysis indicates that they are genetically inter-correlated with one another and can be separated based on their general psychopathology. Most disorders have a close partner, forming pairs of traits; only TS is a relatively distinctive condition. At a higher level, MDD, ANX, ADHD, ASD, and PTSD cluster together, while OCD, AN, and TS cluster together. Together, the ten traits constitute a hierarchical classificatory system. This study allows inference of genetically determined classification of the ten mental disorders, which may biologically inform the current diagnostic framework and treatment regimens for mental disorders.
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Affiliation(s)
- Hongbao Cao
- School of Systems Biology, George Mason University (GMU), Fairfax, VA 22030, USA
| | - Jun Wang
- Department of Clinical Psychology, The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, Jiangsu Province 214151, China
| | - Ancha Baranova
- School of Systems Biology, George Mason University (GMU), Fairfax, VA 22030, USA; Research Centre for Medical Genetics, Moscow 115478, Russia
| | - Fuquan Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu Province 210029, China.
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6
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Yan Z, Meng F, He M, Li Z. The efficacy of a transdiagnostic group cognitive behavioral intervention for Chinese elderly with emotional disorders: A one-year follow-up randomized clinical trial. Front Psychiatry 2022; 13:1027994. [PMID: 36506431 PMCID: PMC9732091 DOI: 10.3389/fpsyt.2022.1027994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND With the global aging, geriatric emotional disorders have received more and more attention. Psychotherapy is an effective approach for alleviating the symptoms associated with emotional disorder, but the number of experienced therapists is low. Studies should be conducted to explore a low-cost and efficient treatment method. Previous findings indicate that transdiagnostic cognitive behavior therapy is an effective approach for treatment of emotional disorders. Group therapy is appropriate for the elderly as they are characterized by high levels of loneliness. In this study, we compared and explored the effects of a transdiagnostic group cognitive behavioral intervention (TD-GCBT), a transdiagnostic individual cognitive behavioral intervention (TD-CBT), and treatment as usual (TAU) on treatment of emotional disorders among the elderly. METHOD A total of 120 elderly patients diagnosed with emotional disorders were randomly assigned to the TD-GCBT group (40), TD-CBT group (40), and TAU group (40). Changes in symptoms were assessed using HAMD, PHQ-9, HAMA, and GAD-7 scales at baseline, post-treatment (three months), six-month and twelve-months follow-up. The efficacies of the three intervention strategies were compared using linear mixed-effects models. Post-hoc and simple effect analyses were conducted to determine the differences among the three groups. RESULTS The HAMD, PHQ-9, HAMA, and GAD-7 scores revealed a significant effect from baseline to 12 months for time (p < 0.001), group (p < 0.001) and time × group interaction (p < 0.001) in TD-GCBT group compared with the TD-CBT group and TAU group. The effect of TD-GCBT (HAMD: Cohen's d (3th month, 6th month, 12th month) = 2.69, 3.98, 4.51; HAMA: Cohen's d = 2.84, 4.13, 5.20) and TD-CBT (HAMD: Cohen's d = 2.55, 2.87, 2.63; HAMA: Cohen's d = 2.43, 2.83, 2.78) group was better relative to that of the TAU group (HAMD: Cohen's d = 0.41, 1.13, 1.46; HAMA: Cohen's d = 0.64, 1.22, 1.57) (p < 0.001). The scores of the TD-GCBT group showed the most significant decrease compared with the other two groups. CONCLUSION The findings indicate that TD-GCBT method is effective for treatment of emotional disorders among the elderly. TD-GCBT is effective for alleviating depression and anxiety symptoms up to at least nine months after treatment. The results indicate that TD-GCBT is a cost-effective and resource-effective strategy and can be used an alternative therapy for treatment of mental disorders. CLINICAL TRIAL REGISTRATION [https://www.chictr.org.cn], identifier [ChiCTR1900021806].
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Affiliation(s)
- Zijun Yan
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Fanqiang Meng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Meiling He
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhanjiang Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Langwerden RJ, Van der Heijden PT, Claassen T, Derksen JJL, Egger JIM. The structure of dimensions of psychopathology in normative and clinical samples: Applying causal discovery to MMPI-2-RF scales to investigate clustering of psychopathology spectra and p-factors. Front Psychiatry 2022; 13:1026900. [PMID: 36440421 PMCID: PMC9686405 DOI: 10.3389/fpsyt.2022.1026900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
We applied a Bayesian Constraint-based Causal Discovery method (BCCD) to examine the hierarchical structure of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) Restructured Clinical (RC) scales. Two different general psychopathology super spectra (p-factor) scales were extracted from (1) all RC scales and (2) all RC scales except the RCd (Demoralization) scale. These p-factor scales were included in separate models to investigate the structure of dimensions of psychopathology in a normative (n = 3,242) and clinical (n = 2,466) sample, as well as the combined normative/clinical sample (N = 5,708), by applying the BCCD algorithm to obtain a data-driven reconstruction of the internal hierarchical structure of the MMPI-2-RF. Research on the underlying structure of the MMPI-2-RF has clinical relevance as well as conceptual relevance in the context of the HiTOP model. Results demonstrated that the syndromes measured with the RC-scales-in presence of a p-factor-cluster into six spectra: internalizing, disinhibited-externalizing, antagonistic-externalizing, thought disorder, detachment, and somatoform. These results may support a super spectrum construct, as it was necessary for obtaining a bottom-up reconstruction of this six-spectrum structure. We found support for superiority of a broad super spectrum with additional variance over and above demoralization, as it resulted in the clearest structure (i.e., clustering of the RC scales). Furthermore, our results indicate independent support for the bifactor structure model of psychopathology.
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Affiliation(s)
- Robbert J Langwerden
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, Netherlands.,Community-Based Research Institute, Florida International University, Miami, FL, United States
| | - Paul T Van der Heijden
- Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands.,Centre for Adolescent Psychiatry, Reinier van Arkel Mental Health Institute, 's-Hertogenbosch, Netherlands
| | - Tom Claassen
- Institute for Computing and Information Sciences, Faculty of Science, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Jan J L Derksen
- Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands.,Faculty of Psychology and Educational Sciences, Department of Clinical and Life Span Psychology, Vrije Universiteit Brussels, Brussels, Belgium
| | - Jos I M Egger
- Centers of Excellence in Neuropsychiatry, Vincent van Gogh Mental Health Institute, Venray, Netherlands.,Stevig Specialized and Forensic Care for People With Intellectual Disabilities, Oostrom, Netherlands
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Alonso-Esteban Y, López-Ramón MF, Moreno-Campos V, Navarro-Pardo E, Alcantud-Marín F. A Systematic Review on the Impact of the Social Confinement on People with Autism Spectrum Disorder and Their Caregivers during the COVID-19 Pandemic. Brain Sci 2021; 11:1389. [PMID: 34827388 PMCID: PMC8615555 DOI: 10.3390/brainsci11111389] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 02/05/2023] Open
Abstract
The COVID-19 pandemic had imposed a variety of containment measures on the general population for prolonged periods. Confinement has had, and still has, social, economic, educational, health, and psychological consequences on the entire population. OBJECTIVE In this article, a systematic search has been performed based on studies carried out since the beginning of the pandemic, regarding the impact of these containment measures on the autism spectrum disorder (ASD) population and their caregivers. METHOD We consulted six databases (i.e., PubMed, Medline, Embase, Scopus, Web of Science, and Science Direct) and selected ten studies that met the inclusion criteria. The chosen studies have been classified according to their theoretical focus, methodology, and target population. RESULTS We found an increase in stress and a decrease in psychological well-being among individuals diagnosed with ASD (i.e., parents and caregivers). Additionally, in studies focused on children, youth, and adults with ASD diagnosis, the results are contradictory depending on variables such as age, ASD severity, or type of family structure. CONCLUSIONS The results show that the consequences of quarantine and social confinement are quite contradictory and depend on variables such as age, ASD severity, and family features.
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Affiliation(s)
| | | | | | | | - Francisco Alcantud-Marín
- PSiDEHESO Research Team, University of Valencia, 46010 Valencia, Spain; (Y.A.-E.); (M.F.L.-R.); (V.M.-C.); (E.N.-P.)
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9
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Bendau A, Kunas SL, Wyka S, Petzold MB, Plag J, Asselmann E, Ströhle A. Longitudinal changes of anxiety and depressive symptoms during the COVID-19 pandemic in Germany: The role of pre-existing anxiety, depressive, and other mental disorders. J Anxiety Disord 2021; 79:102377. [PMID: 33662702 PMCID: PMC9758512 DOI: 10.1016/j.janxdis.2021.102377] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/04/2021] [Accepted: 02/22/2021] [Indexed: 12/18/2022]
Abstract
Especially individuals with mental disorders might experience an escalation of psychopathological symptoms during the COVID-19 pandemic. Therefore, we investigated the role of anxiety, depressive, and other mental disorders for levels and longitudinal changes of COVID-19-related fear, anxiety and depressive symptoms during the first months of the COVID-19 pandemic in Germany. In a longitudinal observational design with four assessment waves from March, 27th until June, 15th 2020, a total of 6,551 adults from Germany was assessed. 4,175 individuals participated in one, 1,070 in two, 803 in three, and 503 in all four waves of data collection. Multilevel analyses revealed that across all assessment waves, COVID-19-related fear, anxiety, and depressive symptoms were significantly higher in individuals with vs. without anxiety, depressive, and other mental disorders. All symptoms decreased on average over time, and this decrease was significantly stronger in individuals with vs. without anxiety disorders, and particularly driven by individuals with generalized anxiety disorder. Our findings suggest that individuals with mental disorders, especially anxiety disorders - and in particular those with a generalized anxiety disorder - seem to be vulnerable to experience psychological strain in the context of the pandemic, might likely overestimate potential threat, and should be targeted by preventive and therapeutic interventions.
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Affiliation(s)
- Antonia Bendau
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Psychotherapy, Charitéplatz 1, Berlin, 10117, Germany.
| | - Stefanie Lydia Kunas
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Psychotherapy, Charitéplatz 1, Berlin, 10117, Germany
| | - Sarah Wyka
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Psychotherapy, Charitéplatz 1, Berlin, 10117, Germany
| | - Moritz Bruno Petzold
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Psychotherapy, Charitéplatz 1, Berlin, 10117, Germany
| | - Jens Plag
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Psychotherapy, Charitéplatz 1, Berlin, 10117, Germany
| | - Eva Asselmann
- Humboldt-Universität zu Berlin, Department of Psychology, Unter den Linden 6, Berlin, 10099, Germany
| | - Andreas Ströhle
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Psychiatry and Psychotherapy, Charitéplatz 1, Berlin, 10117, Germany
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10
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Lønfeldt NN, Strandberg-Larsen K, Verhulst FC, Plessen KJ, Lebowitz ER. Birth with Synthetic Oxytocin and Risk of Childhood Emotional Disorders: A Danish Population-based Study. J Affect Disord 2020; 274:112-117. [PMID: 32469793 DOI: 10.1016/j.jad.2020.04.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Concerns have been raised that synthetic oxytocin, a widely used obstetric tool for labor induction and augmentation, may have deleterious effects on the neuropsychological development of children. Few studies have examined the relationship between oxytocin-stimulated labor and emotional disorders. METHODS We conducted a nationwide register-based cohort study including 677,629 singletons born in Denmark in the years 2000 to 2012 and followed through 2016 (median age = 10.6 years). Data on oxytocin-stimulation were obtained from the Danish Medical Birth Register. Cases of emotional disorders - anxiety, obsessive-compulsive disorder, mood or traumatic stress disorders or a redeemed prescription for a selective serotonin reuptake inhibitor - were identified using Danish patient and prescription registries. RESULTS Oxytocin was used to stimulate 31% of births, and oxytocin-stimulated labor was not associated with childhood emotional disorders (HR = 1.05, 95% CI 0.99, 1.11) after adjustment for maternal history of psychopathology, antidepressants during pregnancy, cohabitation status, highest educational attainment, smoking status during pregnancy, birth year, and indications for labor stimulation. The crude cox model was also small and close to unity (HR = 1.09, 95% CI 1.03, 1.15). LIMITATIONS About 50% of our population had reached the age of 10 years, but the outcome included disorders with later average debut ages. Oxytocin dosage levels are not recorded in the registers. CONCLUSIONS Our small effect size estimates suggest that perinatal synthetic oxytocin does not contribute to the development of emotional disorders. Current evidence does not warrant revision of guidelines for the use of oxytocin in obstetrics.
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Affiliation(s)
- Nicole Nadine Lønfeldt
- Child and Adolescent Mental Health Center, Capital Region of Denmark, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | | | - Frank Cornelis Verhulst
- Child and Adolescent Mental Health Center, Capital Region of Denmark, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Center, Capital Region of Denmark, Copenhagen, Denmark; Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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11
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Asselmann E, Kunas SL, Wittchen HU, Martini J. Changes in psychopathological symptoms during pregnancy and after delivery: A prospective-longitudinal study in women with and without anxiety and depressive disorders prior to pregnancy. J Affect Disord 2020; 263:480-490. [PMID: 31969281 DOI: 10.1016/j.jad.2019.11.112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND The role of anxiety and depressive disorders prior to pregnancy for changes in peripartum psychopathological symptoms has not been resolved yet. METHODS A regional-epidemiological sample of 306 women was prospectively followed in seven waves from early pregnancy until 16 months postpartum. Lifetime DSM-IV anxiety and depressive disorders were assessed at baseline with the CIDI-V. Psychopathological symptoms (somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism) were measured with the BSI three times during pregnancy and three times after delivery. RESULTS Multilevel analyses revealed that women with versus without lifetime anxiety (β=0.22 to β=0.32) and depressive (β=0.24 to β=0.34) disorders prior to pregnancy experienced higher peripartum psychopathological symptoms. All symptoms linearly decreased during pregnancy (β=-0.02 to β=-0.07 per month). Somatization (β=-0.46) was lower, whereas paranoid ideation (β=0.26) and obsession-compulsion (β=0.21) were higher after delivery than during pregnancy. Though, obsession-compulsion linearly decreased after delivery (β=-0.02). Lifetime anxiety disorders prior to pregnancy interacted with linear changes in anxiety (β=-0.04) and phobic anxiety (β=-0.05) during pregnancy. That is, only women with, but not without anxiety disorders prior to pregnancy experienced a linear decline in anxiety and phobic anxiety during pregnancy. LIMITATIONS Lifetime anxiety and depressive disorders were assessed in early pregnancy and might be biased. CONCLUSIONS Peripartum psychopathological symptoms are higher in women with versus without lifetime anxiety and depressive disorders prior to pregnancy, but symptom changes only slightly vary by lifetime diagnostic status.
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Affiliation(s)
- E Asselmann
- Department of Psychology, Faculty of Life Sciences, Humboldt University of Berlin, Unter den Linden 6, 10099, Berlin, Germany.
| | - S L Kunas
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - H-U Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - J Martini
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry & Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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12
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Watson D, Clark LA. Personality traits as an organizing framework for personality pathology. Personal Ment Health 2020; 14:51-75. [PMID: 31309725 PMCID: PMC6960378 DOI: 10.1002/pmh.1458] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 12/12/2022]
Abstract
We review evidence establishing important parallels between the general structure of psychopathology, the more specific structure of personality pathology and the structure of normal-range personality. We then present data to explicate the nature of associations between the alternative model of personality disorder (AMPD)-as operationalized by the Personality Inventory for DSM-5-and the domains and facets subsumed within the five-factor model of personality. Our data demonstrate substantial links between four of the five domains within these models but also indicate that the AMPD could be realigned to enhance its convergence with the five-factor model of personality. Based on our data, we tentatively propose an expanded four-facet model of AMPD Negative Affectivity (Anxiousness, Depressivity, Hostility and Emotional Lability); an alternative bipolar scheme for Detachment that includes two positively keyed (Withdrawal and Anhedonia) and two negatively keyed (Risk Taking and Attention Seeking) facets; a broader five-facet model of Antagonism (Deceitfulness, Manipulativeness, Callousness, Grandiosity and Suspiciousness); and a reduced two-facet model of Disinhibition (Irresponsibility and Impulsivity). These alternative scores generally showed superior convergent and discriminant validity when compared with current measures of the AMPD domains but also raise other issues. Our findings highlight the strong overlap between normal and pathological personality and clarify the nature of the associations between them. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Lee Anna Clark
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
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13
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Guzick AG, Cooke DL, McNamara JPH, Reid AM, Graziano PA, Lewin AB, Murphy TK, Goodman WK, Storch EA, Geffken GR. Parents' Perceptions of Internalizing and Externalizing Features in Childhood OCD. Child Psychiatry Hum Dev 2019; 50:692-701. [PMID: 30778711 DOI: 10.1007/s10578-019-00873-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although obsessive-compulsive disorder (OCD) has often been characterized as an internalizing disorder, some children with OCD exhibit externalizing behaviors that are specific to their OCD. This study sought to demonstrate that parents perceive both internalizing and externalizing behaviors in childhood OCD by examining the factor structure of the Child Obsessive-Compulsive Externalizing/Internalizing Scale (COCEIS), a parent-report questionnaire intended to measure these constructs. This study also investigated clinical correlates of internalizing and externalizing factors in the COCEIS. A factor analysis of questionnaire responses from 122 parents of youth with OCD revealed both externalizing and internalizing factors in the COCEIS. Externalizing behaviors in childhood OCD were associated with other, co-occurring externalizing behavior problems, while both factors were positively correlated with OCD severity and co-occurring internalizing symptoms. They were positively associated with each other at a trend level, and neither showed a significant relationship with insight. Sixty-two percent of parents endorsed "often" or "always" to at least one externalizing item, though modal responses to items suggested that each individual feature captured by the COCEIS may be relatively uncommon. Mean responses were significantly greater for internalizing items. This study provides evidence for distinct but related externalizing and internalizing behaviors specific to childhood OCD. Treatment for children with OCD presenting with more externalizing behaviors may require a greater emphasis on behavioral parent training and motivational enhancement.
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Affiliation(s)
- Andrew G Guzick
- College of Medicine, University of Florida (UF), 8491 NW 39th Ave, Gainesville, FL, 32606, USA. .,UF College of Public Health and Health Professions, 1225 Center Drive, Gainesville, FL, 32611, USA.
| | - Danielle L Cooke
- College of Medicine, University of Florida (UF), 8491 NW 39th Ave, Gainesville, FL, 32606, USA.,UF College of Public Health and Health Professions, 1225 Center Drive, Gainesville, FL, 32611, USA
| | - Joseph P H McNamara
- College of Medicine, University of Florida (UF), 8491 NW 39th Ave, Gainesville, FL, 32606, USA.,UF College of Public Health and Health Professions, 1225 Center Drive, Gainesville, FL, 32611, USA.,UF College of Liberal Arts and Sciences, 945 Center Drive, Gainesville, FL, 32611, USA
| | - Adam M Reid
- McLean Hospital, Harvard Medical School, 115 Mill Street, Boston, MA, 02478, USA
| | - Paulo A Graziano
- Florida International University, AHC4, Room 459, 121200 SW 8th Street, Miami, FL, 33199, USA
| | - Adam B Lewin
- Rothman Center for Neuropsychiatry, Department of Pediatrics, University of South Florida, St. Petersburg, FL, 33701, USA
| | - Tanya K Murphy
- Rothman Center for Neuropsychiatry, Department of Pediatrics, University of South Florida, St. Petersburg, FL, 33701, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Eric A Storch
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, 77030, USA.,Department of Pediatrics, Texas Children's Hospital, Houston, TX, 77030, USA
| | - Gary R Geffken
- The Geffken Group, 2833 NW 41 St #140, Gainesville, FL, 32606, USA
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14
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Hovenkamp-Hermelink JHM, Jeronimus BF, van der Veen DC, Spinhoven P, Penninx BWJH, Schoevers RA, Riese H. Differential associations of locus of control with anxiety, depression and life-events: A five-wave, nine-year study to test stability and change. J Affect Disord 2019; 253:26-34. [PMID: 31009845 DOI: 10.1016/j.jad.2019.04.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/10/2019] [Accepted: 04/06/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND The locus of control (LOC) construct has been associated with onset, course, and severity of anxiety and depression. We investigated the stability of LOC, the bidirectional relationships between LOC and symptom severity of anxiety and depression over nine years, and the influence of intermediate positive and negative life-events on these associations. METHODS Data came from five assessment waves over nine years of 2052 subjects with an anxiety or depressive disorder or healthy controls. First, the stability of LOC (assessed with 5-item Mastery Scale) was tested. Next, associations between LOC, anxiety severity (Beck Anxiety Inventory), depression severity (Inventory of Depressive Symptomatology), and intermediate positive and negative life-events (20-item List of Threatening Experience Questionnaire) were determined with structural equation modeling. RESULTS LOC was rather stable over nine years (r = 0.62), and scores increased slightly with age (i.e. became more internal). LOC yielded equal stability estimates as symptom levels of anxiety and depression did over nine years. A more external LOC predicted higher anxiety and depression severity, but did not influence the incidence of positive and negative life-events. Higher depression severity and more negative life-events predicted the development of a more external LOC, whereas more positive life-events predicted a more internal LOC. Anxiety severity had no effect on LOC. LIMITATIONS Life-events were assessed with self-report measures. CONCLUSIONS The prospective associations between LOC and meaningful changes in anxiety and depressive symptom severity and experienced life-events may yield important new insights for clinical interventions.
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Affiliation(s)
- Johanna H M Hovenkamp-Hermelink
- University of Groningen, University Medical Center Groningen (UMCG), Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotional regulation (ICPE), Groningen, the Netherlands.
| | - Bertus F Jeronimus
- University of Groningen, University Medical Center Groningen (UMCG), Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotional regulation (ICPE), Groningen, the Netherlands; University of Groningen, Department of Developmental Psychology, Groningen, the Netherlands
| | - Date C van der Veen
- University of Groningen, University Medical Center Groningen (UMCG), Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotional regulation (ICPE), Groningen, the Netherlands
| | - Philip Spinhoven
- Leiden University, Institute of Psychology, Leiden, the Netherlands; Leiden University Medical Center, Department of Psychiatry, Leiden, the Netherlands
| | - Brenda W J H Penninx
- VU University Medical Center, Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; GGZ inGeest Amsterdam, the Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen (UMCG), Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotional regulation (ICPE), Groningen, the Netherlands
| | - Harriëtte Riese
- University of Groningen, University Medical Center Groningen (UMCG), Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotional regulation (ICPE), Groningen, the Netherlands
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15
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The mediating role of emotion dysregulation as a transdiagnostic factor in the relationship between pathological personality dimensions and emotional disorders symptoms severity. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.paid.2018.09.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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16
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Bullis JR, Boettcher H, Sauer‐Zavala S, Farchione TJ, Barlow DH. What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2019. [DOI: 10.1111/cpsp.12278] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Jacqueline R. Bullis
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
- Division of Depression and Anxiety Disorders Harvard Medical School McLean Hospital Belmont Massachusetts
| | - Hannah Boettcher
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
| | | | - Todd J. Farchione
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
| | - David H. Barlow
- Center for Anxiety and Related Disorders Boston University Boston Massachusetts
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17
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Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder. Aust N Z J Psychiatry 2018. [DOI: 10.1177/0004867418799453] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective: To provide practical clinical guidance for the treatment of adults with panic disorder, social anxiety disorder and generalised anxiety disorder in Australia and New Zealand. Method: Relevant systematic reviews and meta-analyses of clinical trials were identified by searching PsycINFO, Medline, Embase and Cochrane databases. Additional relevant studies were identified from reference lists of identified articles, grey literature and literature known to the working group. Evidence-based and consensus-based recommendations were formulated by synthesising the evidence from efficacy studies, considering effectiveness in routine practice, accessibility and availability of treatment options in Australia and New Zealand, fidelity, acceptability to patients, safety and costs. The draft guidelines were reviewed by expert and clinical advisors, key stakeholders, professional bodies, and specialist groups with interest and expertise in anxiety disorders. Results: The guidelines recommend a pragmatic approach beginning with psychoeducation and advice on lifestyle factors, followed by initial treatment selected in collaboration with the patient from evidence-based options, taking into account symptom severity, patient preference, accessibility and cost. Recommended initial treatment options for all three anxiety disorders are cognitive–behavioural therapy (face-to-face or delivered by computer, tablet or smartphone application), pharmacotherapy (a selective serotonin reuptake inhibitor or serotonin and noradrenaline reuptake inhibitor together with advice about graded exposure to anxiety triggers), or the combination of cognitive–behavioural therapy and pharmacotherapy. Conclusion: The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder provide up-to-date guidance and advice on the management of these disorders for use by health professionals in Australia and New Zealand.
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18
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Asselmann E, Hertel J, Schmidt CO, Homuth G, Nauck M, Beesdo-Baum K, Grabe HJ, Pané-Farré CA. Interplay between RGS2 and childhood adversities in predicting anxiety and depressive disorders: Findings from a general population sample. Depress Anxiety 2018; 35:1104-1113. [PMID: 30107643 DOI: 10.1002/da.22812] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/24/2018] [Accepted: 06/13/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND It remains unresolved whether childhood adversities interact with genetic variation in regulator of G-protein signaling 2 (RGS2) rs4606 in predicting various anxiety and depressive disorders and whether diagnostic specificity exists in these interactions. METHODS The genotype of RGS2 rs4606 was determined for N = 2,263 adults with European ancestry from the Study of Health in Pomerania. Lifetime anxiety and depressive disorders according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, were assessed with the Munich Composite International Diagnostic Interview (DIA-X/M-CIDI). Childhood adversities were assessed with the Childhood Trauma Questionnaire (CTQ, when participants were aged 29-89). RESULTS Logistic regressions adjusted for sex and age revealed that rs4606 interacted with total childhood adversity in predicting each diagnostic outcome except for panic disorder and generalized anxiety disorder, uncorrected and corrected for multiple testing (odds ratio [OR] = 1.06-1.16). That is, carriers of the GG (vs. CC/CG) genotype were at decreased risk for anxiety and/or depression in the presence of low, but at increased risk in the presence of high total childhood adversity. Respective gene-environment (G × E) interactions were found for (a) comorbid anxiety and depressive disorders (OR = 1.13), but neither pure anxiety nor pure depressive disorders and (b) pure/temporally primary anxiety disorders (OR = 1.07), but not pure/temporally primary depressive disorders. The G × E interaction remained associated with depressive disorders after introducing pure/temporally primary anxiety disorders as additional predictor (OR = 1.09). CONCLUSIONS rs4606 alters the risk of developing a range of anxiety but also depressive disorders after childhood adversities. A complex risk pattern of genotype, environmental factors, and preexisting anxiety contributes to subsequent depression development.
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Affiliation(s)
- Eva Asselmann
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychology, Faculty of Life Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johannes Hertel
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | | | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research, Partner Site Greifswald, University Medicine, Greifswald, Germany
| | - Katja Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Hans-Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Christiane A Pané-Farré
- Department of Physiological and Clinical Psychology, University of Greifswald, Greifswald, Germany
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19
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Vollbehr NK, Bartels-Velthuis AA, Nauta MH, Castelein S, Steenhuis LA, Hoenders HJR, Ostafin BD. Hatha yoga for acute, chronic and/or treatment-resistant mood and anxiety disorders: A systematic review and meta-analysis. PLoS One 2018; 13:e0204925. [PMID: 30273409 PMCID: PMC6166972 DOI: 10.1371/journal.pone.0204925] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/17/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The aim of this study was to systematically investigate the effectiveness of hatha yoga in treating acute, chronic and/or treatment-resistant mood and anxiety disorders. METHODS Medline, Cochrane Library, Current Controlled Trials, Clinical Trials.gov, NHR Centre for Reviews and Dissemination, PsycINFO and CINAHL were searched through June 2018. Randomized controlled trials with patients with mood and anxiety disorders were included. Main outcomes were continuous measures of severity of mood and anxiety symptoms. Cohen's d was calculated as a measure of effect size. Meta-analyses using a random effects model was applied to estimate direct comparisons between yoga and control conditions for depression and anxiety outcomes. Publication bias was visually inspected using funnel plots. RESULTS Eighteen studies were found, fourteen in acute patients and four in chronic patients. Most studies were of low quality. For depression outcomes, hatha yoga did not show a significant effect when compared to treatment as usual, an overall effect size of Cohen's d -0.64 (95% CI = -1.41, 0.13) or to all active control groups, Cohen's d -0.13 (95% CI = -0.49, 0.22). A sub-analysis showed that yoga had a significant effect on the reduction of depression compared to psychoeducation control groups, Cohen's d -0.52 (95% CI = -0.96, -0.08) but not to other active control groups, Cohen's d 0.28 (95% CI = -0.07, 0.63) For studies using a follow-up of six months or more, hatha yoga had no effect on the reduction of depression compared to active control groups, Cohen's d -0.14 (95% CI = -0.60, 0.33). Regarding anxiety, hatha yoga had no significant effect when compared to active control groups, Cohen's d -0.09 (95% CI = -0.47, 0.30). The I2 and Q-statistic revealed heterogeneity amongst comparisons. Qualitative analyses suggest some promise of hatha yoga for chronic populations. CONCLUSIONS The ability to draw firm conclusions is limited by the notable heterogeneity and low quality of most of the included studies. With this caveat in mind, the results of the current meta-analysis suggest that hatha yoga does not have effects on acute, chronic and/or treatment-resistant mood and anxiety disorders compared to treatment as usual or active control groups. However, when compared to psychoeducation, hatha yoga showed more reductions in depression. It is clear that more high-quality studies are needed to advance the field.
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Affiliation(s)
- Nina K. Vollbehr
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Groningen, the Netherlands
- University of Groningen, Faculty of Behavioral and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - Agna A. Bartels-Velthuis
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Groningen, the Netherlands
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands
| | - Maaike H. Nauta
- University of Groningen, Faculty of Behavioral and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - Stynke Castelein
- University of Groningen, Faculty of Behavioral and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
- Lentis Psychiatric Institute, Lentis Research, Groningen, the Netherlands
| | - Laura A. Steenhuis
- University of Groningen, Faculty of Behavioral and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - H. J. Rogier Hoenders
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Groningen, the Netherlands
| | - Brian D. Ostafin
- University of Groningen, Faculty of Behavioral and Social Sciences, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
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Weitz E, Kleiboer A, van Straten A, Cuijpers P. The effects of psychotherapy for depression on anxiety symptoms: a meta-analysis. Psychol Med 2018; 48:2140-2152. [PMID: 29361995 DOI: 10.1017/s0033291717003622] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND More than half of patients who present with depressive disorders also have elevated comorbid anxiety symptoms. Given the high comorbidity between these disorders, it is important to understand the extent that psychotherapies for depression additionally ameliorate symptoms of anxiety. METHODS Systematic searches were conducted in PubMed, PSYCinfo, EMBASE, and the Cochrane Registry of Controlled Trials. Included studies were randomized controlled trials that compared psychotherapy compared with a control condition for the treatment of adults with a primary diagnosis or elevated symptoms of depression and that examined the effects of treatment on anxiety outcomes. Acute phase depression and anxiety (continuous measure) outcomes were extracted. Effect sizes were calculated by subtracting the average post-treatment scores of the psychotherapy group from the average post-treatment scores of the comparison group divided by the pooled standard deviation. RESULTS Fifty-two studies of varying quality met the inclusion criteria. Pooled effect sizes showed that anxiety outcomes were significantly lower in the psychotherapy conditions than in control conditions at post-treatment [g = 0.52; 95% confidence interval (CI) 0.44-0.60; NNT (numbers-needed-to-treat) = 3.50]. Moderate heterogeneity was observed (I2 = 55%, 95% CI 40-66). Bivariate metaregression analysis revealed a significant association between depression and anxiety effect sizes at post-treatment Longer-term follow-ups of up to 14 months post-baseline showed indications for a small lasting effect of psychotherapy on anxiety outcomes (g = 0.27). CONCLUSIONS This meta-analysis provides evidence that psychotherapy aimed at depression can also reduce anxiety symptoms in relation to control conditions.
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Affiliation(s)
- Erica Weitz
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology,EMGO Institute for Health and Care Research,Vrije Universiteit Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
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New insights into the correlation structure of DSM-IV depression symptoms in the general population v. subsamples of depressed individuals. Epidemiol Psychiatr Sci 2018; 27:288-300. [PMID: 28067191 PMCID: PMC6998857 DOI: 10.1017/s2045796016001086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS Previous research failed to uncover a replicable dimensional structure underlying the symptoms of depression. We aimed to examine two neglected methodological issues in this research: (a) adjusting symptom correlations for overall depression severity; and (b) analysing general population samples v. subsamples of currently depressed individuals. METHODS Using population-based cross-sectional and longitudinal data from two nations (Switzerland, 5883 young men; USA, 2174 young men and 2244 young women) we assessed the dimensions of the nine DSM-IV depression symptoms in young adults. In each general-population sample and each subsample of currently depressed participants, we conducted a standardised process of three analytical steps, based on exploratory and confirmatory factor and bifactor analysis, to reveal any replicable dimensional structure underlying symptom correlations while controlling for overall depression severity. RESULTS We found no evidence of a replicable dimensional structure across samples when adjusting symptom correlations for overall depression severity. In the general-population samples, symptoms correlated strongly and a single dimension of depression severity was revealed. Among depressed participants, symptom correlations were surprisingly weak and no replicable dimensions were identified, regardless of severity-adjustment. CONCLUSIONS First, caution is warranted when considering studies assessing dimensions of depression because general population-based studies and studies of depressed individuals generate different data that can lead to different conclusions. This problem likely generalises to other models based on the symptoms' inter-relationships such as network models. Second, whereas the overall severity aligns individuals on a continuum of disorder intensity that allows non-affected individuals to be distinguished from affected individuals, the clinical evaluation and treatment of depressed individuals should focus directly on each individual's symptom profile.
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Pearson CM, Lavender JM, Cao L, Wonderlich SA, Crosby RD, Engel SG, Mitchell JE, Peterson CB, Crow SJ. Associations of borderline personality disorder traits with stressful events and emotional reactivity in women with bulimia nervosa. JOURNAL OF ABNORMAL PSYCHOLOGY 2018; 126:531-539. [PMID: 28691843 DOI: 10.1037/abn0000225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Borderline personality disorder (BPD) traits are common among those with bulimia nervosa (BN). However, how these traits impact the state experience of precipitants of BN behavior, such as stressful events and emotional reactivity, has not been determined. Thus, the purpose of this naturalistic study was to examine this trait-state association in BN. Women with DSM-IV BN (N = 133) completed a baseline measure of personality pathology traits, and subsequently recorded their affective state and the frequency and perception of 3 types of stressful events (interpersonal, work/environment, and daily hassles) several times per day for 2 weeks using ecological momentary assessment (EMA). Pearson correlations assessed the associations between BPD traits (affective lability, identity problems, insecure attachment, and cognitive dysregulation) and (a) frequency of stressful events and (b) perception of stressful events. Generalized linear models (GLM) were used to evaluate the relationship between BPD traits and changes in negative affect following stressful events. Results revealed that while all traits were significantly associated with perceived stressfulness, certain BPD traits were significantly associated with the frequency of stressful events. Individuals with higher trait insecure attachment experienced larger increases in negative affect following interpersonal stressful events. These findings suggest that interventions focused on addressing stressful events and enhancing adaptive emotional responses to interpersonal events may be particularly useful for a subset of individuals with BN with BPD-related personality characteristics, including insecure attachment, affective lability, and identity problems. (PsycINFO Database Record
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Affiliation(s)
| | - Jason M Lavender
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine
| | - Li Cao
- Neuropsychiatric Research Institute
| | - Stephen A Wonderlich
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine
| | - Ross D Crosby
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine
| | - Scott G Engel
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine
| | - James E Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota Medical School and The Emily Program
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota Medical School and The Emily Program
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Goldberg D. The classification of mental disorder: a simpler system for DSM–V and ICD–11. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.109.007120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
SummaryThis article proposes a simplification to the chapter structure of current classifications of mental disorder, which cause unnecessary estimates of ‘comorbidity’ and pay major attention to symptom similarity as a criterion for deciding on groupings. A simpler system, taking account of recent developments in aetiology, is proposed. There is at present no simple solution to the problems posed by the structure of our classification, but the advantages as well as the shortcomings of changing our approach to diagnosis are discussed.
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Klumpp H, Hosseini B, Phan KL. Self-Reported Sleep Quality Modulates Amygdala Resting-State Functional Connectivity in Anxiety and Depression. Front Psychiatry 2018; 9:220. [PMID: 29896128 PMCID: PMC5987592 DOI: 10.3389/fpsyt.2018.00220] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 05/07/2018] [Indexed: 01/22/2023] Open
Abstract
Sufficient sleep plays an important role in neurocognitive function, yet, problematic sleep is ubiquitous in the general population. It is also frequently predictive of, and concurrent with, internalizing psychopathologies (IPs) such as anxiety and depression suggesting sleep quality is dimensional and transdiagnostic. Along with problematic sleep, IPs are characterized by negative affectivity, therefore, prominent neurobiological models of internalizing conditions involve the amygdala, a region central to emotion. In resting-state studies (independent of sleep considerations), abnormalities in amygdala-frontal functional connectivity are commonly observed suggesting emotion dysregulation may contribute to clinically-relevant phenotypes. In a separate line of research, studies of sleep deprivation, and insomnia disorder suggest sleep loss may alter amygdala-frontal connectivity. Taken together, findings point to shared neurobiology between sleep and emotion systems, however, the impact of sleep quality on the amygdala circuit in anxiety or depression is unclear. Therefore, we evaluated variance in naturalistic sleep quality on amygdala-based circuity in individuals with and without psychiatric illness. Resting-state fMRI data was collected in 87 un-medicated, treatment-seeking adults diagnosed with a primary anxiety disorder (n = 68) or primary depressive disorder (n = 19) in addition to healthy individuals (n = 40). Regression analysis was conducted with bilateral anatomical amygdala as seed regions and self-reported sleep quality was indexed with a validated self-report measure, the Pittsburgh Sleep Quality Index (PSQI). Post-hoc analysis was performed to evaluate whether diagnostic status (primary anxiety, primary depression, healthy) significantly explained functional connectivity results. Whole-brain regression analysis, controlling for anxiety and depression symptoms, revealed worse sleep quality (i.e., higher PSQI total scores) predicted increased left amygdala-subgenual anterior cingulate functional connectivity and reduced connectivity with posterior cerebellar lobe and superior temporal gyrus. For right amygdala, increased coupling with postcentral gyrus corresponded with worse sleep. Post-hoc analysis did not detect a significant relationship between diagnostic status and whole-brain findings. Results expand on previous studies and indicate variance in sleep quality tracks brain pathways involved in cognitive-emotion functions implicated in the neurobiology of IPs that may extend to individuals at risk for clinical anxiety or depression. Altogether, the clinical relevance of identifying phenotypes to improve our understanding of psychopathology may be improved by incorporating sleep quality.
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Affiliation(s)
- Heide Klumpp
- Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States.,Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States
| | - Bobak Hosseini
- Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - K Luan Phan
- Mood and Anxiety Disorders Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States.,Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States.,Mental Health Service, Jesse Brown VA Medical Center, Chicago, IL, United States
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Snir A, Apter A, Barzilay S, Feldman D, Rafaeli E, Carli V, Wasserman C, Hadlaczky G, Hoven CW, Sarchiapone M, Wasserman D. Explicit Motives, Antecedents, and Consequences of Direct Self-Injurious Behaviors. CRISIS 2017; 39:255-266. [PMID: 29216755 DOI: 10.1027/0227-5910/a000493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Self-injurious behaviors in adolescence are a serious public health concern. AIMS The current study aims to expand our understanding of motives for direct self-injurious behaviors (D-SIB). We examined the explicit motives but also the actual antecedents and consequences of D-SIB over time. METHOD As part of the Saving and Empowering Young Lives in Europe (SEYLE) study, adolescents between the ages of 14 and 18 years from Israel completed self-report questionnaires at baseline, 3-month, and 12-month follow-ups. RESULTS Decreases in social support predicted later increases in D-SIB, an effect mediated by negative affect. Both peer and parental support also exerted quadratic effects on D-SIB. Thus, low as well as high support predicted subsequent D-SIB. In turn, D-SIB was followed by increased peer and parental support. LIMITATIONS Our methodology relies on self-reports, affected by social desirability and recall biases. CONCLUSION The findings support a causal path for the development of D-SIB: from interpersonal distress to emotional distress and then to D-SIB. They also point to interesting avenues regarding subgroupings of adolescents who self-injure depending on their motives. Finally, our results reveal that D-SIB, although of negative import, might paradoxically be effective in serving certain functions such as gaining support from parents and peers.
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Affiliation(s)
- Avigal Snir
- 1 1Feinberg Child Study Centre, Schneider Children's Medical Centre, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel.,2 Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Alan Apter
- 1 1Feinberg Child Study Centre, Schneider Children's Medical Centre, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel
| | - Shira Barzilay
- 1 1Feinberg Child Study Centre, Schneider Children's Medical Centre, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel.,2 Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Dana Feldman
- 1 1Feinberg Child Study Centre, Schneider Children's Medical Centre, Sackler School of Medicine Tel Aviv University, Tel Aviv, Israel.,2 Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Eshkol Rafaeli
- 2 Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Vladimir Carli
- 3 National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Camilla Wasserman
- 4 Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.,6 Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Gergö Hadlaczky
- 3 National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Christina W Hoven
- 4 Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA.,5 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Marco Sarchiapone
- 6 Department of Health Sciences, University of Molise, Campobasso, Italy
| | - Danuta Wasserman
- 3 National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute, Stockholm, Sweden
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Waszczuk MA, Zimmerman M, Ruggero C, Li K, MacNamara A, Weinberg A, Hajcak G, Watson D, Kotov R. What do clinicians treat: Diagnoses or symptoms? The incremental validity of a symptom-based, dimensional characterization of emotional disorders in predicting medication prescription patterns. Compr Psychiatry 2017; 79:80-88. [PMID: 28495012 PMCID: PMC5643213 DOI: 10.1016/j.comppsych.2017.04.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/14/2017] [Accepted: 04/14/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although practice guidelines are based on disorders specified in diagnostic manuals, such as the DSM, practitioners appear to follow symptoms when making treatment decisions. Psychiatric medication is generally prescribed in a transdiagnostic manner, further highlighting how symptoms, not diagnoses, often guide clinical practice. A quantitative approach to nosology promises to provide better guidance as it describes psychopathology dimensionally and its organization reflects patterns of covariation among symptoms. AIM To investigate whether a quantitative classification of emotional disorders can account for naturalistic medication prescription patterns better than traditional diagnoses. METHODS Symptom dimensions and DSM diagnoses of emotional disorders, as well as prescribed medications, were assessed using interviews in a psychiatric outpatient sample (N=318, mean age 42.5years old, 59% female, 81% Caucasian). RESULTS Each diagnosis was associated with prescription of multiple medication classes, and most medications were associated with multiple disorders. This was largely due to heterogeneity of clinical diagnoses, with narrow, homogenous dimensions underpinning diagnoses showing different medication profiles. Symptom dimensions predicted medication prescription better than DSM diagnoses, irrespective of whether this was examined broadly across all conditions, or focused on a specific disorder and medication indicated for it. CONCLUSIONS Psychiatric medication was prescribed in line with symptoms rather than DSM diagnoses. A quantitative approach to nosology may better reflect treatment planning and be a more effective guide to pharmacotherapy than traditional diagnoses. This adds to a diverse body of evidence about superiority of the quantitative system in practical applications and highlights its potential to improve psychiatric care.
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Affiliation(s)
- Monika A Waszczuk
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA; Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Camilo Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Kaiqiao Li
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Annmarie MacNamara
- Department of Psychology, Texas A&M University, College Station, TX, USA
| | - Anna Weinberg
- Department of Psychology, McGill University, Montreal, Canada
| | - Greg Hajcak
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
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van de Pavert I, Sunderland M, Luijten M, Slade T, Teesson M. The general relationship between internalizing psychopathology and chronic physical health conditions: a population-based study. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1257-1265. [PMID: 28744565 DOI: 10.1007/s00127-017-1422-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/14/2017] [Indexed: 11/25/2022]
Abstract
Studies have consistently demonstrated a reciprocal relationship between internalizing disorders and several chronic physical health conditions. Yet, much of the extant literature fails to take into account the role of comorbidity among internalizing disorders when examining the relationship with poor physical health. The current study applied latent variable modelling to investigate the shared and specific relationships between internalizing (fear and distress factors) and a range of physical health conditions. Data comprised 8841 respondents aged 16-85 years who took part in the 2007 Australian National Survey of Mental Health and Wellbeing. Multiple indicator, multiple causes models were used to parse the shared and specific relationships between internalizing disorders and variables associated with poor physical health. The study found that several physical conditions were significantly related to mean levels of fear and distress. The results were broadly similar but minor differences emerged depending on whether lifetime or past 12 months indicators of mental disorders and physical conditions were utilized in the model. Finally, the results demonstrated that the association between individual mental disorders and physical health conditions are better accounted for by indirect relationships with broad transdiagnostic dimensions rather than including additional disorder-specific relationships. The results indicate that researchers should focus on common mechanisms across multiple internalizing disorders and poor physical health when developing prevention and treatment initiatives.
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Affiliation(s)
- Iris van de Pavert
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Matthew Sunderland
- Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, 2052, Australia.
| | - Maartje Luijten
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Tim Slade
- Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, 2052, Australia
| | - Maree Teesson
- Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, 2052, Australia
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Psychometric Properties of the Kessler 10 Scale in Chinese Parents of Children With Cancer. Cancer Nurs 2017; 40:297-304. [PMID: 27257800 DOI: 10.1097/ncc.0000000000000392] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Kessler Psychological Distress Scale (K10) has been widely used in rating psychological distress in general and clinical populations. However, whether it can be used in parents of children with cancer is unknown. Still lacking is the evidence on its reliability and validity in culturally diverse groups. OBJECTIVE The aim of this study was to translate the K10 into Mandarin Chinese and test its psychometric properties (especially the factor structure) of the Chinese version (C-K10) in parents of children with cancer. METHODS By convenience sampling, 2 samples of parents of children with cancer (sample I, n = 206, and sample II, n = 103) were surveyed in Guangzhou, China. Sample I completed the C-K10, and the internal consistency reliability and exploratory factor analysis of the C-K10 were estimated. Sample II completed the C-K10, the State Subscale of State-Trait Anxiety Inventory, and the Zung Self-rating Depression Scale; confirmatory factor analysis and concurrent validity estimates were completed. RESULTS The C-K10 demonstrated strong internal consistency reliability (Cronbach's α = .93). Both exploratory and confirmatory factor analyses supported a 2-factor structure (ie, anxiety and depression). The concurrent validity was moderate with Pearson correlations greater than 0.50 (P < .001). CONCLUSION The C-K10 demonstrated very acceptable reliability and validity in screening psychological distress in Chinese parents of children with cancer. IMPLICATIONS FOR PRACTICE This study provides evidence that the C-K10 is a valid tool that can be used in clinical settings to screen for psychological distress in Chinese parents of children with cancer.
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Psychometric Properties of the Worry Behaviors Inventory: Replication and Extension in a Large Clinical and Community Sample. Behav Cogn Psychother 2017; 46:84-100. [PMID: 28756794 DOI: 10.1017/s1352465817000455] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The use of maladaptive behaviors by individuals with generalized anxiety disorder (GAD) is theoretically important and clinically meaningful. However, little is known about the specificity of avoidant behaviors to GAD and how these behaviors can be reliably assessed. AIMS This study replicated and extended the psychometric evaluation of the Worry Behaviors Inventory (WBI), a brief self-report measure of avoidant behaviors associated with GAD. METHOD The WBI was administered to a hospital-based sample of adults seeking treatment for symptoms of anxiety and/or depression (n = 639) and to a community sample (n = 55). Participants completed measures of symptom severity (GAD, depression, panic disorder, health anxiety, and personality disorder), and measures of checking, reassurance-seeking and behavioral inhibition. Analyses evaluated the factor structure, convergent, divergent, incremental, and discriminant validity, as well the temporal stability and treatment sensitivity of the WBI. RESULTS The two-factor structure found in the preliminary psychometric evaluation of the WBI was replicated. The WBI was sensitive to changes across treatment and correlated well with measures of GAD symptom severity and maladaptive behaviors. The WBI was more strongly related to GAD symptom severity than other disorders. The WBI discriminated between clinical and community samples. CONCLUSIONS The WBI provides clinicians and researchers with a brief, clinically meaningful index of problematic behaviors that may guide treatment decisions and contribute to our understanding of maintaining factors in GAD.
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Beyond comorbidity: Toward a dimensional and hierarchical approach to understanding psychopathology across the life span. Dev Psychopathol 2017; 28:971-986. [PMID: 27739384 DOI: 10.1017/s0954579416000651] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We propose a novel developmentally informed framework to push research beyond a focus on comorbidity between discrete diagnostic categories and to move toward research based on the well-validated dimensional and hierarchical structure of psychopathology. For example, a large body of research speaks to the validity and utility of the internalizing and externalizing spectra as organizing constructs for research on common forms of psychopathology. The internalizing and externalizing spectra act as powerful explanatory variables that channel the psychopathological effects of genetic and environmental risk factors, predict adaptive functioning, and account for the likelihood of disorder-level manifestations of psychopathology. As such, our proposed theoretical framework uses the internalizing and externalizing spectra as central constructs to guide future psychopathology research across the life span. The framework is particularly flexible, because any of the facets or factors from the dimensional and hierarchical structure of psychopathology can form the focus of research. We describe the utility and strengths of this framework for developmental psychopathology in particular and explore avenues for future research.
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Forbes MK, Baillie AJ, Eaton NR, Krueger RF. A Place for Sexual Dysfunctions in an Empirical Taxonomy of Psychopathology. JOURNAL OF SEX RESEARCH 2017; 54:465-485. [PMID: 28121167 PMCID: PMC5433908 DOI: 10.1080/00224499.2016.1269306] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sexual dysfunctions commonly co-occur with various depressive and anxiety disorders. An emerging framework for understanding the classification of mental disorders suggests that such comorbidity is a manifestation of underlying dimensions of psychopathology (or "spectra"). In this review, we synthesize the evidence that sexual dysfunctions should be included in the empirical taxonomy of psychopathology as part of the internalizing spectrum, which accounts for comorbidity among the depressive and anxiety disorders. The review has four parts. Part 1 summarizes the empirical basis and utility of the empirical taxonomy of psychopathology. Part 2 reviews the prima facie evidence for the hypothesis that sexual dysfunctions are part of the internalizing spectrum (i.e., high rates of comorbidity; shared cognitive, affective, and temperament characteristics; common neural substrates and biomarkers; shared course and treatment response; and the lack of causal relationships between them). Part 3 critically analyzes and integrates the results of the eight studies that have addressed this hypothesis. Finally, Part 4 examines the implications of reconceptualizing sexual dysfunctions as part of the internalizing spectrum, and explores avenues for future research.
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Affiliation(s)
- Miriam K Forbes
- a Departments of Psychiatry and Psychology , University of Minnesota
| | - Andrew J Baillie
- b Centre for Emotional Health and Centre of Research Excellence in Mental Health and Substance Use , Macquarie University
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White RL, Babic MJ, Parker PD, Lubans DR, Astell-Burt T, Lonsdale C. Domain-Specific Physical Activity and Mental Health: A Meta-analysis. Am J Prev Med 2017; 52:653-666. [PMID: 28153647 DOI: 10.1016/j.amepre.2016.12.008] [Citation(s) in RCA: 277] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 10/27/2016] [Accepted: 12/06/2016] [Indexed: 12/19/2022]
Abstract
CONTEXT The mental health benefits of physical activity are well established. However, less is known about whether the relationship between physical activity and mental health is consistent across different life domains. It is important to understand how context may influence the relationship between physical activity and mental health so that interventions and policy guidelines can be tailored to maximize positive effects. EVIDENCE ACQUISITION In 2015, systematic searches of four databases identified 13,435 records, of which 98 studies met the inclusion criteria. EVIDENCE SYNTHESIS Included studies were published between 1988 and 2015 and had a combined sample size of 648,726. Of the 98 included studies, 93 examined leisure-time physical activity, 14 examined work-related physical activity, 15 examined transport physical activity, 16 examined household physical activity, three examined school sport, and three examined physical education. Multi-level meta-analyses showed that leisure-time physical activity (r =0.13) and transport physical activity (r =0.13) both had a positive association with mental health. Leisure-time physical activity (r = -0.11) and school sport (r = -0.09) both had an inverse association with mental ill-health. However, physical activity was not consistently associated with lower mental ill-health across domains, as work-related physical activity was positively associated with mental ill-health (r =0.09). Household physical activity and participation in physical education had no relationship with mental health or mental ill-health. CONCLUSIONS The domain in which physical activity occurs influences the relationship between physical activity and mental health and should, therefore, be considered when developing interventions, treatment programs, and policy guidelines.
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Affiliation(s)
- Rhiannon Lee White
- Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, New South Wales, Australia
| | - Mark J Babic
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia
| | - Philip D Parker
- Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, New South Wales, Australia
| | - David R Lubans
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia; Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Chris Lonsdale
- Institute for Positive Psychology and Education, Australian Catholic University, Strathfield, New South Wales, Australia.
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Arnfred SM, Aharoni R, Hvenegaard M, Poulsen S, Bach B, Arendt M, Rosenberg NK, Reinholt N. Transdiagnostic group CBT vs. standard group CBT for depression, social anxiety disorder and agoraphobia/panic disorder: Study protocol for a pragmatic, multicenter non-inferiority randomized controlled trial. BMC Psychiatry 2017; 17:37. [PMID: 28114915 PMCID: PMC5260024 DOI: 10.1186/s12888-016-1175-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/23/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Transdiagnostic Cognitive Behavior Therapy (TCBT) manuals delivered in individual format have been reported to be just as effective as traditional diagnosis specific CBT manuals. We have translated and modified the "The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders" (UP-CBT) for group delivery in Mental Health Service (MHS), and shown effects comparable to traditional CBT in a naturalistic study. As the use of one manual instead of several diagnosis-specific manuals could simplify logistics, reduce waiting time, and increase therapist expertise compared to diagnosis specific CBT, we aim to test the relative efficacy of group UP-CBT and diagnosis specific group CBT. METHODS/DESIGN The study is a partially blinded, pragmatic, non-inferiority, parallel, multi-center randomized controlled trial (RCT) of UP-CBT vs diagnosis specific CBT for Unipolar Depression, Social Anxiety Disorder and Agoraphobia/Panic Disorder. In total, 248 patients are recruited from three regional MHS centers across Denmark and included in two intervention arms. The primary outcome is patient-ratings of well-being (WHO Well-being Index, WHO-5), secondary outcomes include level of depressive and anxious symptoms, personality variables, emotion regulation, reflective functioning, and social adjustment. Assessments are conducted before and after therapy and at 6 months follow-up. Weekly patient-rated outcomes and group evaluations are collected for every session. Outcome assessors, blind to treatment allocation, will perform the observer-based symptom ratings, and fidelity assessors will monitor manual adherence. DISCUSSION The current study will be the first RCT investigating the dissemination of the UP in a MHS setting, the UP delivered in groups, and with depressive patients included. Hence the results are expected to add substantially to the evidence base for rational group psychotherapy in MHS. The planned moderator and mediator analyses could spur new hypotheses about mechanisms of change in psychotherapy and the association between patient characteristics and treatment effect. TRIAL REGISTRATION Clinicaltrials.gov NCT02954731 . Registered 25 October 2016.
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Affiliation(s)
- Sidse M. Arnfred
- Psychiatric Hospital Slagelse & Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, Building 3, Level 4., DK-4200 Slagelse, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Aharoni
- Psychotherapeutic Clinic Nannasgade, Mental Health Centre Copenhagen, Capital Region Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Hvenegaard
- Psychiatric Hospital Slagelse & Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, Building 3, Level 4., DK-4200 Slagelse, Denmark
| | - Stig Poulsen
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bo Bach
- Psychiatric Hospital Slagelse & Psychiatric Research Unit, Region Zealand Psychiatry, Faelledvej 6, Building 3, Level 4., DK-4200 Slagelse, Denmark
| | - Mikkel Arendt
- Unit for Anxiety and Compulsive Disorders, Psychiatric Hospital Risskov, Aarhus University Hospital, Aarhus, Denmark
| | - Nicole K. Rosenberg
- Psychotherapeutic Clinic Nannasgade, Mental Health Centre Copenhagen, Capital Region Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nina Reinholt
- Psychotherapeutic Clinic Nannasgade, Mental Health Centre Copenhagen, Capital Region Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Snyder HR, Young JF, Hankin BL. Strong Homotypic Continuity in Common Psychopathology-, Internalizing-, and Externalizing-Specific Factors Over Time in Adolescents. Clin Psychol Sci 2017; 5:98-110. [PMID: 28239532 PMCID: PMC5320894 DOI: 10.1177/2167702616651076] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dimensional models of psychopathology have recently gained prominence that posit a general psychopathology factor (i.e., p factor), in addition to specific internalizing and externalizing factors. However, the stability of these factors, and the specificity with which they are related to one another over time (e.g., homotypic or heterotypic continuity), have not been investigated. The current study addressed these questions. We estimated bifactor models, with p, internalizing-specific and externalizing-specific factors, with youth and caretaker report of symptoms at two time points (18 months apart), in a large community sample of adolescents. Results showed strong stability over time with highly specific links (i.e., p factor at Time 1 to Time 2; internalizing-specific at Time 1 to Time 2, externalizing-specific at Time 1 to Time 2), suggesting strong homotypic continuity between higher-order latent psychopathology factors.
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Affiliation(s)
| | - Jami F. Young
- Graduate School of Applied and Professional Psychology, Rutgers
University, Piscataway, NJ, USA
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36
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Kogan CS, Stein DJ, Maj M, First MB, Emmelkamp PMG, Reed GM. The Classification of Anxiety and Fear-Related Disorders in the ICD-11. Depress Anxiety 2016; 33:1141-1154. [PMID: 27411108 DOI: 10.1002/da.22530] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 01/21/2023] Open
Abstract
Anxiety disorders are highly prevalent worldwide and engender substantial economic costs and disability. The World Health Organization is currently developing the Eleventh Revision of the International Classification of Diseases and Related Health Problems (ICD-11), which represents the first opportunity to improve the validity, clinical utility, and global applicability of the classification in more than 25 years. This article describes changes in the organization and diagnostic guidelines for anxiety and fear-related disorders proposed by the ICD-11 Working Group on the Classification of Mood and Anxiety Disorders and the rationale and evidence base for the proposals. In ICD-11, anxiety and fear-related disorders that manifest across the lifespan are brought together under a new grouping, and are partly distinguished by their focus of apprehension. The focus of apprehension is the stimulus or situation that triggers the fear or anxiety and may be highly specific as in specific phobia or relate to a broader class of situations as in social anxiety disorder. The guidelines also clarify the relationship between panic disorder and agoraphobia and a qualifier is provided for panic attacks in the context of other disorders. A standardized format emphasizing essential features of anxiety disorders is intended to improve clinical utility. Guidelines will be further refined based on findings from two types of field studies: those using a case-controlled vignette methodology disseminated via the Internet to practitioners worldwide (http://gcp.network) and clinic-based field trials implemented globally at participating field study centers.
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Affiliation(s)
- Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town Groote Schuur Hospital, Cape Town, South Africa
| | - Mario Maj
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - Michael B First
- Department of Psychiatry, Columbia University New York State Psychiatric Institute, New York, New York
| | - Paul M G Emmelkamp
- Department of Clinical Psychology, University of Amsterdam and The Netherlands Institute for Advanced Study, Amsterdam, The Netherlands
| | - Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.,Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
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Cuijpers P, Cristea IA, Weitz E, Gentili C, Berking M. The effects of cognitive and behavioural therapies for anxiety disorders on depression: a meta-analysis. Psychol Med 2016; 46:3451-3462. [PMID: 27659840 DOI: 10.1017/s0033291716002348] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The effects of cognitive behavioural therapy of anxiety disorders on depression has been examined in previous meta-analyses, suggesting that these treatments have considerable effects on depression. In the current meta-analysis we examined whether the effects of treatments of anxiety disorders on depression differ across generalized anxiety disorder (GAD), social anxiety disorder (SAD) and panic disorder (PD). We also compared the effects of these treatments with the effects of cognitive and behavioural therapies of major depression (MDD). METHOD We searched PubMed, PsycINFO, EMBASE and the Cochrane database, and included 47 trials on anxiety disorders and 34 trials on MDD. RESULTS Baseline depression severity was somewhat lower in anxiety disorders than in MDD, but still mild to moderate in most studies. Baseline severity differed across the three anxiety disorders. The effect sizes found for treatment of the anxiety disorders ranged from g = 0.47 for PD, g = 0.68 for GAD and g = 0.69 for SAD. Differences between these effect sizes and those found in the treatment of MDD (g = 0.81) were not significant in most analyses and we found few indications that the effects differed across anxiety disorders. We did find that within-group effect sizes resulted in significantly (p < 0.001) larger effect sizes for depression (g = 1.50) than anxiety disorders (g = 0.73-0.91). Risk of bias was considerable in the majority of studies. CONCLUSIONS Patients participating in trials of cognitive behavioural therapy for anxiety disorders have high levels of depression. These treatments have considerable effects on depression, and these effects are comparable to those of treatment of primary MDD.
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Affiliation(s)
- P Cuijpers
- Department of Clinical, Neuro and Developmental Psychology,Vrije Universiteit Amsterdam,The Netherlands
| | - I A Cristea
- Department of Clinical Psychology and Psychotherapy,Babes-Bolyai University,Cluj-Napoca,Romania
| | - E Weitz
- Department of Clinical, Neuro and Developmental Psychology,Vrije Universiteit Amsterdam,The Netherlands
| | - C Gentili
- Department of General Psychology,University of Padova,Padova,Italy
| | - M Berking
- Department of Clinical Psychology and Psychotherapy,Friedrich-Alexander-University Erlangen-Nürnberg,Germany
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Marusak HA, Thomason ME, Peters C, Zundel C, Elrahal F, Rabinak CA. You say 'prefrontal cortex' and I say 'anterior cingulate': meta-analysis of spatial overlap in amygdala-to-prefrontal connectivity and internalizing symptomology. Transl Psychiatry 2016; 6:e944. [PMID: 27824358 PMCID: PMC5314129 DOI: 10.1038/tp.2016.218] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/31/2016] [Accepted: 09/27/2016] [Indexed: 12/12/2022] Open
Abstract
Connections between the amygdala and medial prefrontal cortex (mPFC) are considered critical for the expression and regulation of emotional behavior. Abnormalities in frontoamygdala circuitry are reported across several internalizing conditions and associated risk factors (for example, childhood trauma), which may underlie the strong phenotypic overlap and co-occurrence of internalizing conditions. However, it is unclear if these findings converge on the same localized areas of mPFC or adjacent anterior cingulate cortex (ACC). Examining 46 resting-state functional connectivity magnetic resonance imaging studies of internalizing conditions or risk factors (for example, early adversity and family history), we conducted an activation likelihood estimation meta-analysis of frontoamygdala circuitry. We included all reported amygdala to frontal coordinate locations that fell within a liberal anatomically defined frontal mask. Peak effects across studies were centered in two focal subareas of the ACC: pregenual (pgACC) and subgenual (sgACC). Using publicly available maps and databases of healthy individuals, we found that observed subareas have unique connectivity profiles, patterns of neural co-activation across a range of neuropsychological tasks, and distribution of tasks spanning various behavioral domains within peak regions, also known as 'functional fingerprints'. These results suggest disruptions in unique amygdala-ACC subcircuits across internalizing, genetic and environmental risk studies. Based on functional characterizations and the studies contributing to each peak, observed amygdala-ACC subcircuits may reflect separate transdiagnostic neural signatures. In particular, they may reflect common neurobiological substrates involved in developmental risk (sgACC), or the broad expression of emotional psychopathology (pgACC) across disease boundaries.
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Affiliation(s)
- H A Marusak
- Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA,Department of Pharmacy Practice, Wayne State University, 259 Mack Avenue, Suite 2190, Detroit, MI 48202, USA. E-mail:
| | - M E Thomason
- Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, MI, USA,Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA,Unit on Perinatal Neural Connectivity, Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, USA
| | - C Peters
- Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA
| | - C Zundel
- Behavioral Neuroscience, Boston University, Boston, MA, USA
| | - F Elrahal
- Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA
| | - C A Rabinak
- Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA
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Porcu M, Balestrieri A, Siotto P, Lucatelli P, Anzidei M, Suri JS, Zaccagna F, Argiolas GM, Saba L. Clinical neuroimaging markers of response to treatment in mood disorders. Neurosci Lett 2016; 669:43-54. [PMID: 27737806 DOI: 10.1016/j.neulet.2016.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 09/01/2016] [Accepted: 10/06/2016] [Indexed: 12/22/2022]
Abstract
Mood disorders (MD) are important and frequent psychiatric illness. The management of patients affected by these conditions represents an important factor of disability as well as a significant social and economic burden. The "in-vivo" studies can help researchers to understand the first developmental events of the pathology and to identify the molecular and non-molecular targets of therapies. However, they have strong limitations due to the fact that human brain circuitry can not be reproduced in animal models. In addition, these neural pathways are difficult to be selectively studied with the modern imaging (such as Magnetic Resonance and Positron Emitted Tomography/Computed Tomography) and non-imaging (such as electroencephalography, magnetoencephalography, transcranial magnetic stimulation and evoked potentials) methods. In comparison with other methods, the "in-vivo" imaging investigations have higher temporal and spatial resolution compared to the "in-vivo" non-imaging techniques. All these factors make difficult to fully understand the aetiology and pathophysiology of these disorders, and consequently hinder the analysis of the effects of pharmacological and non-pharmacological therapies, which have been demonstrated effective in clinical settings. In this review, we will focus our attention on the current state of the art of imaging in the assessment of treatment efficacy in MD. We will analyse briefly the actual classification of MD; then we will focus on the "in vivo" imaging methods used in research and clinical activity, the current knowledge about the neural models at the base of MD. Finally the last part of the review will focus on the analysis of the main markers of response to treatment.
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Affiliation(s)
- Michele Porcu
- Department of Radiology, AOU of Cagliari, SS 554 Monserrato, CA, Italy
| | | | - Paolo Siotto
- Department of Radiology, AOB Azienda Ospedaliera Brotzu, CA, Italy
| | - Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Michele Anzidei
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Jasjit S Suri
- Diagnostic and Monitoring Division, AtheroPoint™, Roseville, CA, USA; Electrical Engineering Department, Idaho State University (Aff.), Pocatello, ID, USA
| | - Fulvio Zaccagna
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | | | - Luca Saba
- Department of Radiology, AOU of Cagliari, SS 554 Monserrato, CA, Italy.
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Reinholt N, Aharoni R, Winding C, Rosenberg N, Rosenbaum B, Arnfred S. Transdiagnostic group CBT for anxiety disorders: the unified protocol in mental health services. Cogn Behav Ther 2016; 46:29-43. [PMID: 27705086 DOI: 10.1080/16506073.2016.1227360] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Comorbidity among the anxiety disorders is common and may negatively impact treatment outcome. Potentially, transdiagnostic cognitive-behavioral treatments (CBT) deal more effectively with comorbidity than standard CBT. The present study tested the effectiveness of The Unified Protocol (UP) applied to Mental Health Services. Pre-post-treatment effects were examined for psychiatric outpatients with anxiety disorders receiving UP treatment in groups. Forty-seven patients (mean-age = 34.1 (SD = 9.92), 77% females) with a principal diagnosis of anxiety were included. We found significant and clinically meaningful changes in the primary outcomes Clinical Global Impression Severity Scale (CGI-S; d = 1.36), Hamilton Anxiety Scale (HARS; d = .71), and WHO-5 Well-being Index (WHO-5; d = .54). Also, comorbid depressive symptoms and levels of positive and negative affect changed significantly after treatment. Patients with high levels of comorbidity profited as much as patients with less comorbidity; however, these patients had higher scores after treatment due to higher symptom burden at onset. Patients with comorbid depression profited more from treatment than patients without comorbid depression. The treatment effects found in the present study correspond to treatment effects of other TCBT studies, other UP group studies, and effectiveness studies on standard CBT for outpatients. The results indicate that the UP can be successfully applied to a MHS group setting, demonstrating positive effects on anxiety and depressive symptoms for even highly comorbid cases.
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Affiliation(s)
- Nina Reinholt
- a Faculty of Health Sciences, Mental Health Centre Copenhagen , University of Copenhagen , Copenhagen , Denmark
| | - Ruth Aharoni
- b Mental Health Centre of Copenhagen , Mental Health Services Capital Region of Denmark , Copenhagen , Denmark
| | - Clas Winding
- b Mental Health Centre of Copenhagen , Mental Health Services Capital Region of Denmark , Copenhagen , Denmark
| | - Nicole Rosenberg
- b Mental Health Centre of Copenhagen , Mental Health Services Capital Region of Denmark , Copenhagen , Denmark
| | - Bent Rosenbaum
- c Department of Psychology , University of Copenhagen , Copenhagen , Denmark
| | - Sidse Arnfred
- d Faculty of Health and Medical Science , University of Copenhagen , Copenhagen , Denmark
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41
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Forbes MK, Baillie AJ, Schniering CA. A Structural Equation Modeling Analysis of the Relationships between Depression, Anxiety, and Sexual Problems over Time. JOURNAL OF SEX RESEARCH 2016; 53:942-954. [PMID: 26488460 DOI: 10.1080/00224499.2015.1063576] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Sexual dysfunctions are related to depressive and anxiety disorders, but the nature of these relationships remains unclear. This study examined the relationship among symptoms of these disorders over time by comparing (a) a model that included causal relationships, (b) a model that accounted for change over time with a shared underlying factor (or latent liability) among all the disorders, and (c) a model that conceptualized sexual dysfunctions as unrelated to depressive and anxiety disorders over time. Participants (n = 1,012) completed online self-report measures of sexual dysfunctions and depressive and anxiety disorders across six time points at either weekly or monthly intervals. Models 1 and 2 provided equal best fit for men and women based on data collected four weeks apart, but there were no evident causal relationships in Model 1. Subsequent analyses using data collected one week and six months apart found Model 2 provided robust fit for women, but these data were not examined for men due to inadequate sample sizes. The results are consistent with a shared latent liability of internalizing psychopathology driving the change in these disorders over time, which provides a clear direction for an empirically driven nosology and for future research into transdiagnostic treatments.
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Affiliation(s)
- Miriam K Forbes
- a Centre for Emotional Health and NHMRC Centre of Research Excellence in Mental Health and Substance Use, Department of Psychology , Macquarie University
| | - Andrew J Baillie
- a Centre for Emotional Health and NHMRC Centre of Research Excellence in Mental Health and Substance Use, Department of Psychology , Macquarie University
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42
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Andrews G, Hobbs MJ. Pragmatic treatment options for depression and anxiety disorders are needed. World Psychiatry 2016; 15:241-242. [PMID: 27717253 PMCID: PMC5032497 DOI: 10.1002/wps.20364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Gavin Andrews
- Clinical Research Unit for Anxiety and Depression, School of PsychiatryUniversity of New South WalesSydneyAustralia
| | - Megan J. Hobbs
- Clinical Research Unit for Anxiety and Depression, School of PsychiatryUniversity of New South WalesSydneyAustralia
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43
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The Worry Behaviors Inventory: Assessing the behavioral avoidance associated with generalized anxiety disorder. J Affect Disord 2016; 203:256-264. [PMID: 27314812 DOI: 10.1016/j.jad.2016.06.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/16/2016] [Accepted: 06/05/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Understanding behavioral avoidance associated with generalized anxiety disorder (GAD) has implications for the classification, theoretical conceptualization, and clinical management of the disorder. This study describes the development and preliminary psychometric evaluation of a self-report measure of avoidant behaviors associated with GAD: the Worry Behaviors Inventory (WBI). METHODS The WBI was administered to treatment-seeking patients (N=1201). Convergent validity was assessed by correlating the WBI with measures of GAD symptom severity. Divergent validity was assessed by correlating the WBI with measures of general disability and measures of depression, social anxiety and panic disorder symptom severity. RESULTS Exploratory and confirmatory factor analyses supported a two-factor structure (Safety Behaviors and Avoidance). Internal reliability was acceptable for the 10-item WBI scale (α=.86), Safety Behaviors (α=.85) and Avoidance subscales (α=.75). Evidence of convergent, divergent, and discriminant validity is reported. WBI subscales demonstrated differential associations with measures of symptom severity. The Safety Behaviors subscale was more strongly associated with GAD symptoms than symptoms of other disorders, whereas the Avoidance subscale was as strongly correlated with GAD severity as it was with depression, social anxiety and panic disorder severity. LIMITATIONS Structured diagnostic interviews were not conducted therefor validity analyses are limited to probable diagnoses based on self-report. The cross-sectional design precluded examination of the WBI's temporal stability and treatment sensitivity. CONCLUSIONS Preliminary evidence supports the use of the WBI in research and clinical settings and may assist clinicians to identify behaviors that are theorized to maintain GAD and that can be targeted during psychological treatment.
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Kujawa A, MacNamara A, Fitzgerald KD, Monk CS, Phan KL. Enhanced Neural Reactivity to Threatening Faces in Anxious Youth: Evidence from Event-Related Potentials. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 43:1493-1501. [PMID: 25943264 DOI: 10.1007/s10802-015-0029-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Anxiety disorders are characterized by enhanced reactivity to threat, and event-related potentials (ERPs) are useful neural measures of the dynamics of threat processing. In particular, the late positive potential (LPP) is an ERP component that reflects sustained attention towards motivationally salient information. Previous studies in adults suggest that the LPP is enhanced to threatening stimuli in anxiety but blunted in depression; however, very little work has evaluated the LPP to threat in anxious youth. We measured the LPP during an emotional face-matching task in youth (age 7-19) with current anxiety disorders (n = 53) and healthy controls with no history of psychopathology (n = 37). We evaluated group differences, as well as the effect of depressive symptoms on the LPP. Youth with anxiety disorders exhibited enhanced LPPs to angry and fearful faces 1000-2000 ms after stimulus onset. Higher depressive symptoms were associated with reduced LPPs to angry faces across both groups. Enhanced LPPs to threatening faces were most apparent for social anxiety disorder, as opposed to generalized anxiety disorder or separation anxiety disorder. Results suggest the LPP may be a useful neural measure of threat reactivity in youth with anxiety disorders and highlight the importance of accounting for symptoms of both depression and anxiety when examining emotional processing.
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Affiliation(s)
- Autumn Kujawa
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA. .,Department of Psychology, Stony Brook University, Stony Brook, NY, USA.
| | - Annmarie MacNamara
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | - K Luan Phan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.,Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA.,Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, USA
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45
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Newby JM, Twomey C, Yuan Li SS, Andrews G. Transdiagnostic computerised cognitive behavioural therapy for depression and anxiety: A systematic review and meta-analysis. J Affect Disord 2016; 199:30-41. [PMID: 27060430 DOI: 10.1016/j.jad.2016.03.018] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/17/2016] [Accepted: 03/07/2016] [Indexed: 11/16/2022]
Abstract
An increasing number of computerised transdiagnostic cognitive behavioural therapy programs (TD-cCBT) have been developed in the past decade, but there are no meta-analyses to explore the efficacy of these programs, nor moderators of the effects. The current meta-analysis focused on studies evaluating TD-cCBT interventions to examine their effects on anxiety, depression and quality of life (QOL). Results from 17 RCTs showed computerised TD-cCBT outperformed control conditions on all outcome measures at post-treatment, with large effect sizes for depression (g's=.84), and medium effect sizes for anxiety (g=.78) and QOL (g=.48). RCT quality was generally good, although heterogeneity was moderate to high. Further analyses revealed that studies comparing TD-cCBT to waitlist controls had the largest differences (g=.93) compared to active (g=.59) and usual care control groups (g=.37) on anxiety outcomes, but there was no influence of control group subtype on depression outcomes. Treatment length, symptom target (mixed versus anxiety only), treatment design (standardised versus tailored), and therapist experience (students versus qualified therapists) did not influence the results. Preliminary evidence from 4 comparisons with disorder-specific treatments suggests transdiagnostic treatments are as effective for reducing anxiety, and there may be small but superior outcomes for TD-cCBT programs for reducing depression (g=.21) and improving QOL (g=.21) compared to disorder-specific cCBT. These findings show that TD-cCBT programs are efficacious, and have comparable effects to disorder-specific cCBT programs.
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Affiliation(s)
- Jill M Newby
- Clinical Research Unit for Anxiety and Depression (CRUfAD), School of Psychiatry, Faculty of Medicine, UNSW Australia at St Vincent's Hospital, Sydney, Australia.
| | - Conal Twomey
- Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Susan Shi Yuan Li
- Clinical Research Unit for Anxiety and Depression (CRUfAD), School of Psychiatry, Faculty of Medicine, UNSW Australia at St Vincent's Hospital, Sydney, Australia
| | - Gavin Andrews
- Clinical Research Unit for Anxiety and Depression (CRUfAD), School of Psychiatry, Faculty of Medicine, UNSW Australia at St Vincent's Hospital, Sydney, Australia
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46
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Longitudinal Course of Risk for Parental Postadoption Depression. J Obstet Gynecol Neonatal Nurs 2016; 45:210-26. [PMID: 26874267 DOI: 10.1016/j.jogn.2015.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine whether the Postpartum Depression Predictors Inventory-Revised (PDPI-R) could be used to reveal distinct classes of adoptive parents across time. DESIGN Longitudinal data were collected via online surveys at 4 to 6 weeks preplacement, 4 to 6 weeks postplacement, and 5 to 6 months postplacement. SETTING Participants were primarily clients of the largest adoption agency in the United States. PARTICIPANTS Participants included 127 adoptive parents (68 mothers and 59 fathers). METHODS We applied a latent class growth analysis to the PDPI-R and conducted mixed effects modeling of class, time, and class × time interaction for the following categories of explanatory variables: parental expectations, interpersonal variables, psychological symptoms, and life orientation. RESULTS Four latent trajectory classes were found. Class 1 (55% of sample) showed a stably low level of PDPI-R scores over time. Class 2 (32%) reported mean scores below the cut-off points at all three time points. Class 3 (8%) started with scores at an intermediate level that increased after postplacement but decreased at 5 to 6 months postplacement. Class 4 (5%) had high mean scores at all three time points. Significant main effects were found for almost all explanatory variables for class and for several variables for time. Significant interactions between class and time were found for expectations about the child and amounts of love and ambivalence in parent's intimate relationship. CONCLUSION Findings may help nurses be alert to trajectories of risk for postadoption depression. Additional factors not included in the PDPI-R may be needed to determine risk for postadoption depression in adoptive parents.
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47
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Tully PJ, Turnbull DA, Beltrame J, Horowitz J, Cosh S, Baumeister H, Wittert GA. Panic disorder and incident coronary heart disease: a systematic review and meta-regression in 1131612 persons and 58111 cardiac events. Psychol Med 2015; 45:2909-2920. [PMID: 26027689 DOI: 10.1017/s0033291715000963] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Substantial healthcare resources are devoted to panic disorder (PD) and coronary heart disease (CHD); however, the association between these conditions remains controversial. Our objective was to conduct a systematic review of studies assessing the association between PD, related syndromes, and incident CHD. METHOD Relevant studies were retrieved from Medline, EMBASE, SCOPUS and PsycINFO without restrictions from inception to January 2015 supplemented with hand-searching. We included studies that reported hazard ratios (HR) or sufficient data to calculate the risk ratio and 95% confidence interval (CI) which were pooled using a random-effects model. Studies utilizing self-reported CHD were ineligible. Twelve studies were included comprising 1 131 612 persons and 58 111 incident CHD cases. RESULTS PD was associated with the primary incident CHD endpoint [adjusted HR (aHR) 1.47, 95% CI 1.24-1.74, p < 0.00001] even after excluding angina (aHR 1.49, 95% CI 1.22-1.81, p < 0.00001). High to moderate quality evidence suggested an association with incident major adverse cardiac events (MACE; aHR 1.40, 95% CI 1.16-1.69, p = 0.0004) and myocardial infarction (aHR 1.36, 95% CI 1.12-1.66, p = 0.002). The risk for CHD was significant after excluding depression (aHR 1.64, 95% CI 1.45-1.85) and after depression adjustment (aHR 1.38, 95% CI 1.03-1.87). Age, sex, length of follow-up, socioeconomic status and diabetes were sources of heterogeneity in the primary endpoint. CONCLUSIONS Meta-analysis showed that PD was independently associated with incident CHD, myocardial infarction and MACE; however, reverse causality cannot be ruled out and there was evidence of heterogeneity.
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Affiliation(s)
- P J Tully
- Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia
| | - D A Turnbull
- Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia
| | - J Beltrame
- School of Medicine,Discipline of Medicine,The University of Adelaide,Australia
| | - J Horowitz
- School of Medicine,Discipline of Medicine,The University of Adelaide,Australia
| | - S Cosh
- Clinic of Psychiatry and Psychotherapy II,University of Ulm,Gunzburg,Germany
| | - H Baumeister
- Department of Rehabilitation Psychology and Psychotherapy,Institute of Psychology,University of Freiburg,Germany
| | - G A Wittert
- Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia
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Proudfit GH, Bress JN, Foti D, Kujawa A, Klein DN. Depression and Event-related Potentials: Emotional disengagement and reward insensitivity. Curr Opin Psychol 2015; 4:110-113. [PMID: 26462292 PMCID: PMC4598954 DOI: 10.1016/j.copsyc.2014.12.018] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Pearson CM, Wonderlich SA, Smith GT. A risk and maintenance model for bulimia nervosa: From impulsive action to compulsive behavior. Psychol Rev 2015; 122:516-35. [PMID: 25961467 PMCID: PMC4486518 DOI: 10.1037/a0039268] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article offers a new model for bulimia nervosa (BN) that explains both the initial impulsive nature of binge eating and purging, as well as the compulsive quality of the fully developed disorder. The model is based on a review of advances in research on BN and advances in relevant basic psychological science. It integrates transdiagnostic personality risk, eating-disorder-specific risk, reinforcement theory, cognitive neuroscience, and theory drawn from the drug addiction literature. We identify both a state-based and a trait-based risk pathway, and we then propose possible state-by-trait interaction risk processes. The state-based pathway emphasizes depletion of self-control. The trait-based pathway emphasizes transactions between the trait of negative urgency (the tendency to act rashly when distressed) and high-risk psychosocial learning. We then describe a process by which initially impulsive BN behaviors become compulsive over time, and we consider the clinical implications of our model. (PsycINFO Database Record
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Affiliation(s)
| | - Stephen A Wonderlich
- Department of Clinical Neuroscience, Neuropsychiatric Research Institute, University of North Dakota School of Medicine and Health Sciences
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Kotov R, Perlman G, Gámez W, Watson D. The structure and short-term stability of the emotional disorders: a dimensional approach. Psychol Med 2015; 45:1687-1698. [PMID: 25499142 DOI: 10.1017/s0033291714002815] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Factor-analytic studies have found that depressive, bipolar, post-traumatic, obsessive-compulsive, and anxiety disorders - jointly referred to as the emotional disorders - form an internalizing spectrum that includes distress and fear subfactors. However, placement of some disorders is uncertain. Also, prior research analysed dichotomous interview-based diagnoses or dimensional self-report measures. We investigated this structure using a third-generation measure - the Interview for Mood and Anxiety Symptoms (IMAS) - that combines strengths of a clinical interview with dimensional assessment. METHOD The interview was administered to 385 students and 288 psychiatric out-patients. Participants were reinterviewed 2 months later. RESULTS Exploratory and confirmatory factor analyses identified three factors: distress (depression, generalized anxiety, post-traumatic stress, irritability, and panic syndrome); fear (social anxiety, agoraphobia, specific phobia, and obsessive-compulsive); and bipolar (mania and obsessive-compulsive). The structure was consistent over time and across samples, except that panic and agoraphobia had higher factor loadings in patients. Longitudinal analyses revealed high temporal stability of the factors (test-retest r = 0.72 to 0.87), but also substantial disorder-specific stability. CONCLUSIONS This investigation - which bridges diagnostic and self-report studies - found three subfactors of internalizing psychopathology. It provided support for a new subfactor, clarified the placement of obsessive-compulsive and bipolar disorders, and demonstrated that this model generalizes across populations. The accumulating research suggests the need to recognize formally the close links among the emotional disorders, as well as empirical clusters within this spectrum. The IMAS demonstrated strong psychometric properties and can be useful for various research and clinical applications by providing dimensional, interview-based assessment of the emotional disorders.
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Affiliation(s)
- R Kotov
- Department of Psychiatry,Stony Brook University,Stony Brook,New York,USA
| | - G Perlman
- Department of Psychiatry,Stony Brook University,Stony Brook,New York,USA
| | - W Gámez
- Department of Psychology,University of Iowa,Iowa City,IA,USA
| | - D Watson
- Department of Psychology,University of Notre Dame,Notre Dame,IN,USA
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