Understanding social anxiety as a risk for alcohol use disorders: fear of scrutiny, not social interaction fears, prospectively predicts alcohol use disorders

Increasing evidence indicates that social anxiety may be a premorbid risk factor for alcohol use disorders (AUD). The aim of this study was to replicate and extend previous work examining whether social anxiety is a risk factor for AUD by evaluating both the temporal antecedence and non-spuriousness of this relationship. We also examined whether social anxiety first-order factors (social interaction anxiety, observation anxieties) served as specific predictors of AUD. A non-referred sample of 404 psychologically healthy young adults (i.e. free from current or past Axis I psychopathology) was prospectively followed over approximately two years. Social anxiety (but not depression or trait anxiety) at baseline significantly predicted subsequent AUD onset. The relationship between social anxiety and AUD remained even after controlling for relevant variables (gender, depression, trait anxiety). Further, social anxiety first-order factors differentially predicted AUD onset, such that observation anxieties (but not social interaction anxiety) were prospectively linked to AUD onset. This study provides further support that social anxiety (and fear of scrutiny specifically) appears to serve as an important and potentially specific AUD-related variable that deserves serious attention as a potential vulnerability factor.     

The AUDIT-C: screening for alcohol use disorders and risk drinking in the presence of other psychiatric disorders

This article examines the performance of the AUDIT-C, as embedded in a large national survey, as a screener for alcohol use disorders (AUDs) and risk drinking among individuals with past-year psychopathology. The analysis is based on data collected in personal interviews from a representative population sample of US adults. The study population consisted of past-year drinkers with any past-year mood disorder (n = 2818), any past-year anxiety disorder (n = 3173), or any personality disorder (n = 4389). Screening performance was evaluated by means of sensitivity, specificity, and areas under receiver operating characteristic curves (AUCs). The AUCs for the AUDIT-C were from 0.888 to 0.893 for alcohol dependence, from 0.864 to 0.876 for any AUD, and from 0.941 to 0.951 for any AUD or risk drinking-all on a par with those observed in the general population. Among men, cut points of either > or =5 or > or =6 points (the former favoring sensitivity and the latter favoring specificity) were optimal for detecting dependence, and cut points of > or =5 points were optimal for any AUD and for any AUD or risk drinking. Among women, a cut point of > or =4 points was optimal for the outcomes of both alcohol dependence and any AUD, whereas a cut point of > or =3 points was preferable for detecting any AUD or risk drinking.     

Shared genetic factors influence risk for bipolar disorder and alcohol use disorders

Bipolar disorder and alcohol use disorder (AUD) have a high rate of comorbidity, more than 50% of individuals with bipolar disorder also receive a diagnosis of AUD in their lifetimes. Although both disorders are heritable, it is unclear if the same genetic factors mediate risk for bipolar disorder and AUD. We examined 733 Costa Rican individuals from 61 bipolar pedigrees. Based on a best estimate process, 32% of the sample met criteria for bipolar disorder, 17% had a lifetime AUD diagnosis, 32% met criteria for lifetime nicotine dependence, and 21% had an anxiety disorder. AUD, nicotine dependence and anxiety disorders were relatively more common among individuals with bipolar disorder than in their non-bipolar relatives. All illnesses were shown to be heritable and bipolar disorder was genetically correlated with AUD, nicotine dependence and anxiety disorders. The genetic correlation between bipolar and AUD remained when controlling for anxiety, suggesting that unique genetic factors influence the risk for comorbid bipolar and AUD independent of anxiety. Our findings provide evidence for shared genetic effects on bipolar disorder and AUD risk. Demonstrating that common genetic factors influence these independent diagnostic constructs could help to refine our diagnostic nosology.     

Iron status: a possible risk factor for the first febrile seizure

PURPOSE: We conducted a controlled study to investigate the relation of iron status and first febrile seizure (FFS). METHODS: Measures of iron sufficiency including hemoglobin concentration (HB), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and plasma ferritin (PF) were prospectively measured in 75 children with FFS and compared with 75 controls matched for age and sex with febrile illnesses without convulsions. RESULTS: Mean ferritin level was significantly lower in cases with FFS (29.5 +/- 21.3 microg/L) than in controls (53.3 +/- 37.6 microg/L) with p = 0.0001. The proportion of subjects with a PF level 相似文献   

酒精使用障碍家族史对男性不良饮酒行为及酒精使用障碍患病的影响

目的 探 讨 酒 精 使 用 障 碍（AUD）家 族 史 对 男 性 不 良 饮 酒 行 为 及 AUD 患 病 的 影 响。 方法 采用分层随机抽样法,于 2016 年 1— 12 月调查河北省石家庄市藁城区 10 个单位的 1 379 名在 职男职工,根据是否有 AUD 家族史分为有酒依赖家族史（PFH）组（n=452）和无酒依赖家族史（NFH）组 （n=927）。采用自制问卷、自我报告方式调查一般人口学特征和酒精使用情况;采用 AUD 筛查量表、酒精 依赖量表分别评估受试者饮酒风险水平和酒精依赖程度;采用《精神障碍诊断与统计手册第 4 版》诊断 AUD;采用流调中心抑郁自评量表、焦虑自评量表、匹兹堡睡眠质量指数评估受试者抑郁情绪、焦虑情 绪和睡眠情况。采用多因素 Logistic 回归分析发生 AUD 的危险因素。结果 PFH 组首次饮酒年龄低于 NFH组,差异有统计学意义（t=2.519,P＜0.05）。PFH组经常饮酒、独自饮酒、空腹饮酒、快速饮酒、喝闷酒、 近 1 年每周饮酒 6 d、饮中度白酒、重度饮酒、饮酒后醉酒、狂饮的发生率均高于 NFH 组,差异均有统计 学意义（χ2 =50.930、11.856、19.165、26.808、11.809、49.897、39.483、19.534、63.310、21.643;均P＜ 0.01）。 PFH 组高风险饮酒、酒依赖、AUD 发生率高于 NFH 组［56.9%（257/452）比 34.1%（316/927）、14.4%（65/452） 比 6.8%（63/927）、52.0%（235/452）比 30.5%（283/927）］,差异有统计学意义（χ2 =64.866、20.757、59.678;P＜ 0.01）。多因素 Logistic 回归分析显示,在控制了年龄、文化程度、职业等因素后,有 AUD 家族史是在职 男职工发生 AUD 的危险因素（OR=1.838,95%CI=1.430～2.364,P＜ 0.01）。结论 具有 AUD 家族史的男 性更容易发展不良饮酒行为,AUD 家族史是发生 AUD 的独立危险因素。     

Adoption as a risk factor for mental disorders

Although adoption has been viewed as a risk factor for mental disorders in children and adolescents, few studies have investigated this association in adults. To address this question, we analyzed data from a random community sample of adults where the presence of adoption in the first year of life was systematically noted and where the presence of lifetime mental disorders was determined by structured interview. In comparison to individuals raised by both biological parents, adoption was strongly associated with a history of childhood conduct disorder, antisocial personality and drug abuse or dependence. Adoption may thus be a risk factor for these mental disorders.     

High impulsivity as a risk factor for the development of internalizing disorders in detained juvenile offenders

Background

Whilst impulsivity is most commonly linked to the development of internalizing disorders, high levels of impulsivity, anxiety, and depression have been found in detained juvenile offenders. We therefore sought to determine whether impulsivity is associated with the development of self-reported anxiety or depression in a sample of detained juvenile offenders.

Methods

323 male juvenile offenders and 86 typically developing controls, aged 15–17 were assessed. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (SADS-PL) was used to assess psychiatric diagnoses, the Barratt Impulsivity Scale (BIS-11) was used to measure impulsivity, and the Screen for Child Anxiety Related Emotional Disorders (SCARED) and the Birleson Depression Self-Rating Scale (DSRS) were used to assess self-reported anxiety and depression respectively.

Results

Compared to controls, juvenile offenders had significantly higher scores on the BIS-11 total, as well as on the motor and nonplanning subscales (all p values <0.001), as well as higher DSRS (p < 0.001) and SCARED (p < 0.05) scores. Within the juvenile offender group, scores on the SCARED correlated positively with BIS-11 total, attention subscale, motor subscale, and total DSRS (all p values <0.01). DSRS scores correlated positively with BIS-11 total, attention subscale, nonplanning subscale, and total SCARED scores (all p values <0.01). Participants were then categorized low, middle or high impulsivity according to scores on the BIS-11. One-way ANOVAs demonstrated a significant difference between these tertiles on DSRS [F(2,320) = 4.862, p < 0.05] and SCARED total scores [F(2,320) = 3.581, p < 0.05]. Specifically, post-hoc analyses found that the high impulsivity tertile scored significant higher than the remaining tertiles on both DSRS (16.1 ± 0.3 vs. 14.0 ± 0.6, p < 0.05) and SCARED (23.3 ± 0.9 vs. 18.4 ± 1.4, p < 0.05) scores. Using multiple linear regression, BIS-11 attention scores, number of months served in custody, age, and BIS-11 nonplanning scores predicted higher levels of anxiety, whilst only BIS-11 attention and nonplanning scores predicted higher levels of depression.

Conclusions

In detained juvenile offenders, high impulsivity may be an important risk factor not only for the externalizing disorders, but also for anxiety and depression. Results of this study, therefore, suggest that specific facets of impulsivity may represent one mechanism underlying the emergence of anxiety and depression in this population.     

Anxiety disorders and first alcohol use in the general population. Findings from a nationally representative sample

ObjectiveTo examine how early onset anxiety disorders are related to age of first alcohol use in a general population sample.MethodDiscrete time survival analysis was used to model the odds of first alcohol use among those with, vs without, early onset anxiety disorders. Data came from the 2007 Australian National Survey of Mental Health and Wellbeing.ResultsAfter adjusting for the effects of family history of alcohol/drug use, sex, age cohort and education, people who experienced an early onset anxiety disorder had a 27% increased odds of first alcohol use in any given year, when compared to those with no anxiety disorder. This effect was particularly strong for transitions to first alcohol use that occurred after the age of 13 years.ConclusionsEarly onset anxiety disorders significantly predict first alcohol use in the general population and this relationship appears to be related to change over time. These results point to the need for developmentally appropriate and integrated prevention programs that target anxiety and alcohol use together.     

Glucocerebrosidase gene mutations: a risk factor for Lewy body disorders

BACKGROUND: Mutations in the glucocerebrosidase (GBA) gene have been reported to modify risk for Parkinson disease (PD) and dementia with Lewy bodies (DLB). However, these findings have not been consistently replicated, and most studies have had substantial methodological shortcomings. OBJECTIVE: To better assess the role of GBA variants in altering risk for Lewy body disorders. DESIGN: Case-control study. SETTING: Four movement disorder clinics in the Seattle, Washington, area. PARTICIPANTS: Seven hundred twenty-one patients with PD, 554 healthy control subjects, and 57 patients with DLB. MAIN OUTCOME MEASURES: Disease status and presence or absence of the 2 most common GBA mutations (N370S and L444P). RESULTS: We observed a significantly higher heterozygote frequency for the 2 mutations in patients with PD (2.9%; P <.001) and those with DLB (3.5%; P = .045) compared with control subjects (0.4%). CONCLUSION: Our findings suggest that GBA mutations exert a large effect on susceptibility for Lewy body disorders at the individual level but are associated with a modest (approximately 3%) population-attributable risk in individuals of European ancestry.     

The natural history of alcohol abuse: implications for definitions of alcohol use disorders

Is the DSM-III-R category of alcohol abuse validly differentiated from the DSM-III-R category of alcohol dependence, or is abuse primarily a mild, prodromal condition that typically deteriorates into dependence? A 4-year longitudinal epidemiologic study of male drinkers provided data to answer this question. The study used identical questions at baseline and follow-up. At follow-up, 70% of the subjects who were initially classified as alcohol abusers were still abusers or were classified as remitted. This contrasted significantly with outcome in the subjects who initially reported alcohol dependence. Although additional research is needed, these results indicate that alcohol abuse often has a course distinct from that of alcohol dependence.     

Developmental traumatology: a contributory mechanism for alcohol and substance use disorders.

Early childhood traumatic experiences, such as childhood maltreatment, are associated with an enhanced risk of adolescent and adult alcohol and substance use disorders (defined as DSM-IV alcohol or substance abuse or dependence). Maltreated children and adolescents manifest dysregulation of major biological stress response systems including adverse influences on brain development. Dysregulation of biological stress response systems may lead to an enhanced vulnerability for psychopathology, particularly posttraumatic stress disorder (PTSD) and depression. These negative affect disorders may put a child at increased risk for adolescent or young adult onset alcohol or substance use disorders. Thus, studies in developmental traumatology may prove to be critical in the effort to attempt to link the neurobiology of maltreatment-related PTSD with the neurobiology of alcohol and substance use disorders and in developing early strategies for the prevention of adolescent and adult alcohol and substance use disorders.     

Drug use and the risk of major depressive disorder,alcohol dependence,and substance use disorders

BACKGROUND: The Children in the Community Study is a prospective longitudinal study investigating the association between early drug use (childhood, adolescence, and early 20s) and later psychiatric disorders (in the late 20s). METHODS: Using data from a community-based sample of 736 adults (50% female) from upstate New York, the subjects were interviewed at the mean ages of 14, 16, 22, and 27 years. Psychiatric disorders, measured by age-appropriate versions of the University of Michigan Composite International Diagnostic Interview, and participant's drug use were assessed. RESULTS: Adolescent and young adult tobacco use was significantly associated with an increased risk of alcohol dependence and substance use disorders at a mean age of 27 years, but not with new episodes of major depressive disorder. Earlier alcohol use significantly predicted later major depressive disorder, alcohol dependence, and substance use disorders in the late 20s, as did early marijuana use and other illicit drug use. Except for the effect of tobacco use on major depressive disorder, early drug use was significantly related to later psychiatric disorders, even after statistically controlling for age, sex, parental educational level, family income, and prior episodes of major depressive disorder and substance use disorders. CONCLUSIONS: Our results suggest that early drug use is associated with and predicts later psychiatric disorders. Preventive implications stem from the importance of studying a range of psychiatric disorders in the context of substance use assessed over a wide age range.     

Comorbidity: alcohol use and other psychiatric disorders

Alcohol related disorders often coexist with other psychiatric disorders and its incidence is increasing in last decades. Studies show that patients with comorbidity, specially those with severe psychiatric disorders, have higher rates of suicide, relapse, money spent in treatment, homeless and they use more medical service. Their evaluation must be meticulous because the differential diagnosis become complicated without a long period of alcohol withdrawal. These patients have a worse prognostic and their treatment is more difficult. Most of studies in this area have indicated that the integration of psychosocial and pharmacological techniques is more effective. The long term treatment must focus in the reduction of symptoms, improvement of social and familiar functioning, coping skills and relapse prevention.     

Age at onset in bipolar affective disorders: a review

Bipolar affective disorder (BPAD) is a multifactorial disorder with various clinical presentations. Etiologic heterogeneity may partly underlie the phenotypic heterogeneity. Efforts to dissect BPAD have been based on the course of the disorders (BP I versus BP II or rapid cycling), comorbidity pattern (panic attacks, suicide attempts, addiction or hyperactivity), differences between the sexes, and clinical pattern (cycloid and puerperal psychosis). The present article provides a comprehensive review of the existing data, showing that age at onset (AAO) identifies homogeneous sub-groups of patients with BPAD. Recent work has demonstrated the existence of three--early, intermediate and late--onset bipolar sub-groups based on AAO, following Kendell's criteria for validity (The American Journal of Psychiatry 2003; 160: 999). We will also show how these distinctions may be of use in the search for genetic vulnerability factors and other pathogenic influences. Following Kendell's criteria, we show that AAO of bipolar disorders has been tested with most of the available strategies for establishing the validity of clinical syndromes. We also present data from genetic epidemiologic studies in bipolar disorder, showing that AAO sub-groups may reduce the underlying genetic heterogeneity. No accurate AAO thresholds to define valid sub-groups have been identified precisely. Until recently, studies defined early- and late-onset as corresponding to early or mid-adulthood, not taking into account juvenile-onset bipolar disorder. A recently proposed theoretical model with three AAO sub-groups (onset age 17, 27 and 46) is discussed.     

Sweet taste preference as a risk factor for alcohol dependence

OBJECTIVE: Previous research has found that alcoholics have a greater preference for sweet solutions than comparison subjects. This study tested the hypothesis that preference for sweet solutions is a marker for alcoholism risk. METHOD: A total of 122 nonalcoholic subjects (59 men) participated. Fifty-eight subjects had a paternal history of alcoholism, and 64 did not. Each subject rated a series of sucrose solutions for intensity of sweetness and degree of preference. RESULTS: Subjects were able to rate accurately the relative intensity of sweetness in the sucrose solutions. Both subjects with and those without a paternal history of alcoholism preferred a 0.42-M sucrose solution, irrespective of gender. CONCLUSIONS: This study failed to support the hypothesis that sweet preference is a marker of alcoholism risk. The sweet preference observed previously among alcoholics may be a consequence of chronic alcohol consumption or other factors associated with heavy drinking.