Cigarette smoking and mood disorders in U.S. adolescents: sex-specific associations with symptoms, diagnoses, impairment and health services use

ObjectiveTo report sex-specific associations between cigarette smoking and DSM-IV disorders, symptoms, and mental health services use related to depression and anxiety in a nationally representative sample of U.S. adolescents.MethodsData on two samples were drawn from the 1999–2004 National Health and Nutrition Examination Surveys to examine the association of ever smoking (versus never smoking) with depression (n = 1884 12–15 year-olds) and anxiety (n = 6336 12–19 year-olds). Sex-specific associations between smoking and DSM-IV diagnoses, subthreshold and severe disorder, symptoms, impairment and mental health services use were assessed using logistic regression modeling.ResultsRates of DSM-IV depression and anxiety were increased in adolescent female ever smokers as compared to never smokers (OR = 3.9, 95% CI: 1.3–11.3 and OR = 10.6, 95% CI: 3.1–37.0, respectively). Females also showed statistically significant increases in severe disorder, subthreshold disorder, all symptoms of major depressive disorder, most symptoms of panic disorder, and increases in severe impairment, especially those related to schoolwork and teachers. Male adolescents showed smaller variations in depression and anxiety by smoking status, but were more likely to seek mental health services.ConclusionsSmoking prevention efforts may benefit from specifically targeting female youth who show signs of depression or anxiety diagnoses through a school-based program, while greater benefits with males may be evident through programs integrated into mental health services.     

A discussion of various aspects of panic disorder depending on presence or absence of agoraphobia

ObjectiveThe quality of life of individuals with panic disorder and agoraphobia can be improved by the alleviation of agoraphobia. In other words, examining panic disorder in terms of whether agoraphobia is present is crucial. The current study examined panic disorder from this perspective.MethodsSubjects were 253 patients who met the diagnostic criteria for panic disorder (lifetime) according to the Mini International Neuropsychiatric Interview (MINI). Of those patients, 179 had agoraphobia and 74 did not. Statistical analysis was used to examine gender differences in the presence (or absence) of agoraphobia, comorbidities, and the effects of the presence of agoraphobia (severity, assessment of depression, assessment of anxiety, and personality) in these patients.ResultsResults indicated gender differences in the presence (or absence) of agoraphobia. Compared to patients without agoraphobia, significantly more patients with agoraphobia were female (p < .001), and had a higher prevalence of comorbidities. Patients with agoraphobia had a higher suicide risk (p < .05), more hypomanic episodes (current) (p < .05), and more frequent episodes of social phobia (p < .05). In addition, patients with agoraphobia had more severe panic disorder and a higher level of neuroticism, sensitivity to anxiety, and trait anxiety [PDSS-J, P&A, NEO-N: p < .01, ASI, STAI (Trait Anxiety): p < .05].ConclusionsThe current findings suggest that when treating a panic disorder, diagnosing the presence of agoraphobia is extremely important.     

Prevalence of anxiety disorders in patients with refractory focal epilepsy—a prospective clinic based survey

Comorbid anxiety disorders severely affect daily living and quality of life in patients with epilepsy. We evaluated 97 consecutive outpatients (41.2% male, mean age = 42.3 ± 13.2 years, mean epilepsy duration = 26.9 ± 14.2 years) with refractory focal epilepsy using the German version of the anxiety section of the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Nineteen patients (19.6%) were diagnosed with an anxiety disorder (social phobia, 7.2%; specific phobia, 6.2%; panic disorder, 5.1%; generalized anxiety disorder, 3.1%; anxiety disorder not further specified, 2.1%; obsessive–compulsive disorder, 1.0%; posttraumatic stress disorder, 1.0%). Four-week prevalence rates reported elsewhere for the general population in Germany are 1.24% for social phobia, 4.8% for specific phobia, 1.1% for panic disorder, 1.2% for generalized anxiety disorder, 1.3% for anxiety disorder not further specified, and 0.4% for obsessive–compulsive disorder. A trend for people with shorter epilepsy duration (P = 0.084) and younger age (P = 0.078) being more likely to have a diagnosis of anxiety disorder was revealed. No gender differences were found; however, this may be due to the small sample size. In conclusion, anxiety disorders are frequent in patients with refractory focal epilepsy, and clinicians should carefully examine their patients with this important comorbidity in mind.     

Decreased IFN-γ and IL-12 levels in panic disorder

ObjectiveThe aim of this study is to assess the measures of proinflammatory cytokines in patients with panic disorder in comparison with the healthy subjects.MethodsTwenty three patients with panic disorder with or without agoraphobia and twenty three controls were recruited for the study. Plasma samples of all subjects were analyzed for TNF-α, IFN-γ, IL-1β, IL-2, IL-6, and IL-12 concentrations and NK-cell activity is measured in the peripheral blood samples of the subjects.ResultsWe found significant differences on the mean values of IL-12 (p = 0.01) and IFN-γ (p = 0.02) between the panic disorder and control groups. In a logistic regression analysis, IFN-γ values were significant statistical predictors of the presence of panic disorder (B = ? 0.07, SE = 0.03, p = 0.04).ConclusionThe most important implication of our results is to suggest a relation between panic disorder and low levels of IFN-γ, compatible with the results of the animal studies showing that IFN-γ plays a role by acting to regulate the development of anxiety-like behaviors.     

Changes in intolerance of uncertainty during cognitive behavior group therapy for social phobia

Background and objectivesRecent research suggests that intolerance of uncertainty (IU), most commonly associated with generalized anxiety disorder, also contributes to symptoms of social phobia. This study examines the relationship between IU and social anxiety symptoms across treatment.MethodChanges in IU, social anxiety symptoms, and depression symptoms were examined following cognitive behavior group therapy (CBGT) for social phobia (N = 32).ResultsCBGT led to significant improvements in symptoms of social anxiety and depression, as well as reductions in IU. Reductions in IU were associated with reductions in social anxiety but were unrelated to improvements in depression symptoms. Reductions in IU were predictive of post-treatment social phobia symptoms after controlling for pre-treatment social phobia symptoms and changes in depression symptoms following treatment.LimitationsThe relationship between IU and social anxiety requires further examination within experimental and longitudinal designs, and needs to take into account additional constructs that are thought to maintain social phobia.ConclusionsCurrent findings suggest that the enhancing tolerance of uncertainty may play a role in the optimal management of social phobia. Theoretical and clinical implications are discussed.     

Comorbidity,age of onset and suicidality in obsessive–compulsive disorder (OCD): An international collaboration

ObjectivesTo collate data from multiple obsessive–compulsive disorder (OCD) treatment centers across seven countries and five continents, and to report findings in relation to OCD comorbidity, age of onset of OCD and comorbid disorders, and suicidality, in a large clinical and ethnically diverse sample, with the aim of investigating cultural variation and the utility of the psychiatric diagnostic classification of obsessive–compulsive and related disorders.MethodsResearchers in the field of OCD were invited to contribute summary statistics on current and lifetime psychiatric comorbidity, age of onset of OCD and comorbid disorders and suicidality in their patients with OCD.ResultsData from 3711 adult patients with primary OCD came from Brazil (n = 955), India (n = 802), Italy (n = 750), South Africa (n = 565), Japan (n = 322), Australia (n = 219), and Spain (n = 98). The most common current comorbid disorders were major depressive disorder (28.4%; n = 1055), obsessive–compulsive personality disorder (24.5%, n = 478), generalized anxiety disorder (19.3%, n = 716), specific phobia (19.2%, n = 714) and social phobia (18.5%, n = 686). Major depression was also the most commonly co-occurring lifetime diagnosis, with a rate of 50.5% (n = 1874). OCD generally had an age of onset in late adolescence (mean = 17.9 years, SD = 1.9). Social phobia, specific phobia and body dysmorphic disorder also had an early age of onset. Co-occurring major depressive disorder, generalized anxiety disorder and psychotic disorders tended to have a later age of onset than OCD. Suicidal ideation within the last month was reported by 6.4% (n = 200) of patients with OCD and 9.0% (n = 314) reported a lifetime history of suicide attempt.ConclusionsIn this large cross-continental study, comorbidity in OCD was common. The high rates of comorbid major depression and anxiety disorders emphasize the need for clinicians to assess and monitor for these disorders. Earlier ages of onset of OCD, specific phobia and social phobia may indicate some relatedness between these disorders, but this requires further study. Although there do not appear to be significant cultural variations in rates or patterns of comorbidity and suicidality, further research using similar recruitment strategies and controlling for demographic and clinical variables may help to determine whether any sociocultural factors protect against suicidal ideation or psychiatric comorbidity in patients with OCD.     

Catecholamines and heart rate in female fibromyalgia patients

BackgroundFibromyalgia syndrome is a disease of unknown pathogenesis characterised by widespread chronic musculoskeletal pain. Fibromyalgia has been associated with dysregulation of the stress systems, but results are inconsistent.PurposeTo investigate autonomic nervous system activity (urinary noradrenaline, adrenaline, dopamine, and heart rate) of fibromyalgia patients and healthy controls.MethodsUrinary catecholamines and heart rate were assessed for a 24-hour period in a controlled hospital setting (including relaxation, a test with prolonged mental stress, and sleep), and during daily activity in 29 female fibromyalgia patients and 29 age-matched female healthy controls.ResultsWith repeated measures ANOVAs, catecholamine levels were lower in patients than controls (P = .035 for noradrenaline; P = .005 for adrenaline; P = .001 for dopamine). One-way ANOVAs for the single periods showed that patients compared to controls had significantly lower adrenaline levels during the night (P = .010) and the second day (P = .010), significantly lower dopamine levels during the first day (P = .008), the night (P = .001), and the second day (P = .004). However, single time point noradrenaline levels were not significantly different between the groups. Overall, heart rate was significantly higher in patients than controls (P = .014). Specifically, significant differences emerged during relaxation (P = .016) and sleep (P = .011), but not during stress provocation or daily activities.ConclusionsThe results indicate an altered regulation of the autonomic nervous system in fibromyalgia patients, with attenuated activity of both the sympathetic (adrenal medulla component) and the parasympathetic branch.     

Efficacy of oral iron in patients with restless legs syndrome and a low-normal ferritin: A randomized, double-blind, placebo-controlled study

Background and PurposeRestless Legs Syndrome (RLS) is a primary disorder of sensation that affects sleep and has been associated with iron deficiency. The purpose of this study was to determine if symptomatic RLS patients with low-normal serum ferritin levels benefit from oral iron replacement.Patients and MethodsThis was a randomized, placebo-controlled, double-blinded study. Eligible patients were randomized to oral iron therapy vs. appearance-matched placebo and followed over a 12 week period.ResultsBaseline International Restless Leg Scale (IRLS) scores for the treatment (24.8 ± 5.72) and placebo (23.0 ± 5.03) groups were similar. Baseline ferritin levels for the treatment (40.6 ± 15.3 ng/ml) and placebo (36.7 ± 20.8 ng/ml) groups were also similar. After 12 weeks, IRLS scores decreased more in the treatment arm (10.3 ± 7.40) than in the placebo arm (1.14 ± 5.64), (p = 0.01). Ferritin levels increased more in the treatment arm (25.1 ± 20.3 ng/ml) than in the placebo arm (7.5 ± 13.7 ng/ml), (p = 0.04). We observed a nonsignificant trend toward improved quality of life in the treated patients, (p = 0.07).ConclusionsThis is the first double-blinded, placebo-controlled study to demonstrate statistically significant improvement in RLS symptoms using oral iron therapy in patients with low-normal ferritin. The findings from this study suggest that additional larger randomized placebo-controlled trials of iron as treatment for patients with low-normal ferritin are warranted.     

Predictors of response to group cognitive-behavioral therapy in the treatment of obsessive-compulsive disorder

PurposeTo identify the presence of factors associated with treatment outcome in patients under group cognitive-behavioral therapy (GCBT) for obsessive-compulsive disorder (OCD).Subjects and methodsThis study evaluated 181 patients with OCD that attended a 12-session weekly GCBT program. Response criteria were: ≥35% reduction in Y-BOCS scores and global improvement score of the Clinical Global Impression (CGI) ≤ 2 at post-treatment evaluation. Sociodemographic data, OCD characteristics, and treatment data were studied.ResultsIn the bivariate analysis, the following variables showed statistical significance (p < 0.20) to enter the regression model: being woman (p = 0.074), greater insight (p = 0.017) and better quality of life (QOL) in all domains before treatment (p = 0.053), overall severity of disease according to the CGI (p = 0.007), number of associated comorbidities (p = 0.063), social phobia (p = 0.044), and dysthymia (p = 0.072). In the final regression model, these variables were associated with response to GCBT: female gender (p = 0.021); WHOQOL-BREF psychological domain (p = 0.011); insight (p = 0.042); and global improvement score of the CGI severity-scale before therapy (p = 0.045).ConclusionSpecial attention should be paid to patients with poor insight, increasing the cognitive aspects of the therapy in an attempt to modify the rigidity and fixity of their beliefs. In addition, male patients should be more observed, since they showed lower chance of response to GCBT when compared to women. Patients with more severe global symptoms (CGI) are poorer responders to GCBT, which indicates that not only obsessive-compulsive symptoms (OCS) should be evaluated, since other symptoms, such as depression and anxiety, may affect the treatment; therefore, an attempt to reduce these symptoms, prior to the treatment of OCD, should be considered as an option in some cases.     

A cross-sectional study to investigate the correlation between depression comorbid with anxiety and serum lipid levels

BackgroundDepression is a common psychological disorder that severely threatens human health. Its pathology remains unclear, but it has been suggested to be associated with abnormal blood lipid metabolism.ObjectivesThis study aimed to explore the changes in blood lipid levels in patients with depression accompanied or not by anxiety, and assess whether adjusting the clinical therapeutic strategy could be based on blood lipid test results, providing a novel insight into depression treatment.MethodsThis was a cross-sectional study. We assessed 60 outpatients and inpatients diagnosed with depression from January 2013 to January 2014 who met the Chinese Classification of Mental Disorders version 3 (CCMD-3) criteria, with Hamilton Rating Scale for Depression (HAMD-24) ≥ 20. They were grouped into depression with anxiety (n = 29) and depression without anxiety (n = 31) groups by the Hamilton Anxiety Scale (HAMA).ResultsTG levels were higher in the depression with anxiety group compared with patients without anxiety (P = 0.045), which was confirmed by multifactorial analysis [P = 0.017, OR = 4.394, 95% CI (1.303–14.824)]. A negative correlation between anxiety score and HDL levels was observed in patients with depression (r = − 0.340, P = 0.046). Meanwhile, positive associations were obtained between retardation and LDL levels (r = 0.307, P = 0.017) as well as age at disease onset and total cholesterol levels (r = 0.410, P = 0.002).ConclusionTG levels differ in patients with depression accompanied by anxiety compared with those without anxiety.     

Anxiety disorders and obsessive compulsive disorder 9 months after perinatal loss

ObjectivePerinatal loss (stillbirth after 20 weeks of gestational age or infant death in the first month) impacts one to two infants per hundred live births in the United States and can be a devastating experience for parents. We assessed prevalence of anxiety disorders and obsessive compulsive disorder (OCD) among bereaved and live-birth mothers.MethodsWe collaborated with the Michigan Department of Community Health to survey Michigan mothers with perinatal death or live birth. We measured symptoms of generalized anxiety disorder, social phobia, panic disorder and OCD using validated written self-report screens and collected data on maternal demographics, psychiatric history, social support and intimate partner violence.ResultsA total 609/1400 mothers (44%) participated, returning surveys 9 months postdelivery. Two hundred thirty-two mothers had live birth, and 377 had perinatal loss. In unadjusted analyses, bereaved mothers had higher odds of all four disorders. In logistic regression adjusted for covariates, bereaved mothers still had higher odds of moderate–severe generalized anxiety disorder [odds ratio (OR): 2.39, confidence interval (CI): 1.10–5.18, P= .028] and social phobia (OR: 2.32, CI: 1.52–3.54, P< .0005) but not panic disorder or OCD.ConclusionBereaved mothers struggle with clinically significant anxiety disorders in the first year after perinatal loss; improved identification and treatment are essential to improve mental health for this vulnerable population.     

Social anxiety and self-concept in children with epilepsy: A pilot intervention study

PurposeThe purpose of this study was to assess the impact of a cognitive behavioral therapy (CBT) anxiety intervention on social phobia, social skill development, and self-concept.MethodFifteen children with epilepsy and a primary anxiety disorder participated in a CBT intervention for 12 weeks plus a 3-month follow-up visit. Children were assessed at baseline, week 7, week 12, and 3 months post treatment to measure changes in social phobia using the Screen for Child Anxiety Related Emotional Disorders (SCARED). Self-concept was also assessed by using the Piers-Harris Children's Self-Concept Scale II (Piers-Harris 2).ResultsThere was a significant reduction in symptoms of social phobia and improved self-concept at the end of the 12-week intervention and at the 3 month follow-up. Repeated measures ANOVA's of child ratings revealed significant change over time on the SCARED-Social Phobia/Social Anxiety subscale score (p = 0.024). In terms of self-concept, significant change over time was detected on the Piers-Harris 2-Total score (p = 0.015) and several subscale scores of Piers-Harris 2, including: Physical Appearance and Attributes (p = 0.016), Freedom from Anxiety (p = 0.005), and Popularity (p = 0.003).ConclusionThis pilot investigation utilized an evidenced based CBT intervention to reduce symptoms of social phobia, which in turn provided a vehicle to address specific social skills improving self-concept in children with epilepsy.     

Psychiatric disorders in burning mouth syndrome

BackgroundPrevalence of psychiatric disorders in burning mouth syndrome (BMS) is high, but their role in the pathogenesis of BMS remains unclear.ObjectiveThe authors aimed to assess the frequency of psychiatric disorders and the severity of psychopathology in BMS.MethodsThirty BMS patients and thirty-one controls underwent a psychiatric evaluation which included a structured interview (MINI-Plus) and five psychometric scales. A Visual Analogue Scale (VAS) was used to measure the intensity of burning sensation.ResultsPatients with BMS showed a higher frequency of current major depressive disorder, past major depressive disorder, generalized anxiety disorder, hypochondria and cancerophobia (p < 0.05). In BMS patients, generalized anxiety disorder was significantly associated with current major depression and social phobia (p < 0.05). As expected, cancerophobia was significantly associated with hypochondria (p < 0.05). Patients with BMS had higher scores in Hamilton Rating Scale for Depression (HRSD), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Dutch Fatigue Scale (DUFS) (p < 0.05).ConclusionBMS patients may have a particular psychological and/or psychiatric profile. Psychometric scales might be useful in screening psychiatric disorders, as well as for assessment of treatment outcomes. In the presence of clinical relevant psychiatric symptoms, patients must be treated appropriately.     

Serum S100B levels in children with simple febrile seizures

PurposeRecent studies have found that S100B is a useful marker for astroglial activation seen in various neurologic disorders. The purpose of this study was to evaluate whether simple febrile seizures (SFS) was associated with an elevation in serum S100B levels.MethodsIn this study the samples consisted of 39 patients with SFS ranging from 6 to 36 months of age, and age-matched and sex-matched controls including 30 patients with fever and 30 healthy subjects. Two serum samples were obtained for S100B from the study group at 0–1 h and 6–24 h following seizure. Serum samples were drawn once in the control group. The serum samples were then analyzed using ELISA.ResultsIn the study group, the mean values of the serum S100B concentrations at 0–1 h and 6–24 h were 32.6 ± 7.8 pg/ml and 32.1 ± 5.8 pg/ml, respectively, while the concentrations were 32.1 ± 8.8 pg/ml and 29.5 ± 7.8 pg/ml in the control groups. No significant differences were detected in serum S100B levels at 0–1 h or 6–24 h in the study when compared to the control groups.ConclusionsThese results suggest that SFS do not raise serum S100B concentration above the normal range.     

Anxiety disorders in adolescence are associated with impaired facial expression recognition to negative valence

ObjectiveThe aim of the present study was to test the ability of adolescents with a current anxiety diagnosis to recognize facial affective expressions, compared to those without an anxiety disorder.MethodsForty cases and 27 controls were selected from a larger cross sectional community sample of adolescents, aged from 10 to 17 years old. Adolescent’s facial recognition of six human emotions (sadness, anger, disgust, happy, surprise and fear) and neutral faces was assessed through a facial labeling test using Ekman’s Pictures of Facial Affect (POFA).ResultsAdolescents with anxiety disorders had a higher mean number of errors in angry faces as compared to controls: 3.1 (SD = 1.13) vs. 2.5 (SD = 2.5), OR = 1.72 (CI95% 1.02 to 2.89; p = 0.040). However, they named neutral faces more accurately than adolescents without anxiety diagnosis: 15% of cases vs. 37.1% of controls presented at least one error in neutral faces, OR = 3.46 (CI95% 1.02 to 11.7; p = 0.047). No differences were found considering other human emotions or on the distribution of errors in each emotional face between the groups.ConclusionOur findings support an anxiety-mediated influence on the recognition of facial expressions in adolescence. These difficulty in recognizing angry faces and more accuracy in naming neutral faces may lead to misinterpretation of social clues and can explain some aspects of the impairment in social interactions in adolescents with anxiety disorders.     

Subjective anger and overt aggression in psychiatric outpatients

BackgroundThe attention given to anger and aggression in psychiatric patients pales in comparison to the attention given to depression and anxiety. Most studies have focused on a limited number of psychiatric disorders, and results have been inconsistent. The present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project sought to replicate and extend prior findings examining which psychiatric disorders and demographic characteristics were independently associated with elevated levels of anger and aggression.Method3800 individuals presenting to the Rhode Island Hospital Department of Psychiatry outpatient practice underwent a semi-structured interview to determine current Axis I (N = 3800) and Axis II (N = 2151) pathology. Severity of subjective anger and overt aggression within the past week were also assessed for each patient, and odds ratios were determined for each disorder. Multiple regression analyses were conducted to determine which diagnoses independently contributed to increased levels of anger and aggression.ResultsAlmost half of the sample reported moderate-to-severe levels of current subjective anger, and more than 20% endorsed moderate-to-severe levels of current overt aggression. The frequency of anger was similar to the frequencies of depressed mood and psychic anxiety. Anger and aggression were elevated across all diagnoses except adjustment disorder. Anger and aggression were most elevated in patients with major depressive disorder, panic disorder with agoraphobia, post-traumatic stress disorder, intermittent explosive disorder, and cluster B personality disorders.ConclusionsAnger is as common as depressed mood and psychic anxiety amongst psychiatric outpatients, and problems with anger cut across diagnostic categories. Given the high prevalence of problems with anger in psychiatric patients, more research should be directed towards its effective treatment.     

Increased pulse wave velocity in patients with panic disorder: independent vascular influence of panic disorder on arterial stiffness

ObjectiveAcute and chronic mental stress and many psychiatric disorders have been accepted as a cause of cardiovascular disease. Panic disorder, a subtype of anxiety disorder, has been associated with increased risk of fatal myocardial infarction and sudden cardiac death in epidemiological studies. Carotid–femoral pulse wave velocity (CF-PWV) is currently the gold standard measurement of arterial stiffness. CF-PWV is a well-recognized predictor of an adverse cardiovascular outcome with higher predictive value than classical cardiovascular risk factors. The aim of our study is to measure PWV as the surrogate of arterial stiffness and vascular involvement in patients with panic disorder.MethodsForty-two patients with PD, and 30 control participants were included in the study. Patients with hypertension, diabetes mellitus, or the history of any cardiovascular disease were excluded from study.ResultsBaseline characteristics were not significantly different between the two groups, except carotid–femoral pulse wave velocity (PD vs. control; 7.51 ± 2.02 vs. 6.24 ± 1.09 m/s, p = 0.001), heart rate, and smoking status. Additionally, CF-PWV positively correlated with age (r = 0.250, p = 0.034), heart rate (r = 0.284, p = 0.017), systolic and diastolic blood pressure (r = 0.393, p = 0.001 and r = 0.286, p = 0.015, respectively) significantly. However, only the presence of panic disorder was independently related to PWV (βeta: 0.317, p = 0.011) in the multivariate analysis including age, heart rate, smoking status and blood pressure measurements.ConclusionIncreased pulse wave velocity in patients with panic disorder may justify the associated risk as documented in previous studies, and may be useful in identifying the patients with higher risk of future cardiovascular complications.     

The anxious heart in whose mind? A systematic review and meta-regression of factors associated with anxiety disorder diagnosis,treatment and morbidity risk in coronary heart disease

ObjectiveTo (1) report the prognostic association between anxiety disorder subtypes and major adverse cardiac events (MACE), (2) report anxiety disorder prevalence in coronary heart disease (CHD), and (3) report the efficacy of anxiety disorder treatments in CHD.MethodsA comprehensive electronic database search was performed in November 2013 for studies reporting anxiety disorder prevalence according to structured interview in CHD samples or MACE, and randomized controlled trials (RCTs) comparing anxiety disorder treatment with placebo or usual care. From 4041 articles 42 samples were selected for extraction (8 for MACE prognosis, 39 for prevalence, no RCTs were eligible).ResultsFive generalized anxiety disorder (GAD) studies reported 883 MACE events (combined n = 2851). There was a non-significant association between GAD and MACE (risk ratio = 1.20, 95% CI .86–1.68, P = .28) however the effect size was highly significant in outpatient samples (adjusted hazard ratio = 1.94, 95% CI 1.45–2.60, P < .001). No other anxiety disorder subtype was associated with MACE. Prevalence data showed high comorbidity with depression (49.06%; 95% CI 34.28–64.01) and substantial heterogeneity between studies. Panic disorder prevalence was higher in psychiatrist/psychologist raters (9.92% vs. 4.74%) as was GAD (18.45% vs. 13.01%). Panic and GAD estimates were also heterogeneous according to DSM-III-R versus DSM-IV taxonomies.ConclusionsThe paucity of extant anxiety disorder RCTs, alongside MACE risk for GAD outpatients, should stimulate further anxiety disorder intervention in CHD populations. Research should focus on depression and anxiety, thereby unraveling disorder specific and more generic pathways.     

Dimensional anxiety scales for DSM-5: Sensitivity to clinical severity

PurposePsychometric properties and clinical sensitivity of brief self-rated dimensional scales to supplement categorical diagnoses of anxiety disorders in the DSM-5 were recently demonstrated in a German treatment seeking sample of adults. The present study aims to demonstrate sensitivity of these scales to clinical severity levels.MethodsThe dimensional scales were administered to 102 adults at a university outpatient clinic for psychotherapy. Diagnostic status was assessed using the Munich-Composite International Diagnostic Interview. To establish a wide range of clinical severity, we considered subthreshold (n = 83) and threshold anxiety disorders (n = 49, including Social Phobia, Specific Phobia, Agoraphobia, Panic Disorder, and Generalized Anxiety Disorder).ResultsIndividuals with either subthreshold or threshold anxiety disorder scored higher on all dimensional scales relative to individuals without anxiety. In addition, individuals with a threshold anxiety disorder scored higher on the dimensional scales than individuals with a subthreshold anxiety disorder (except for specific phobia). Disorder-related impairment ratings, global functioning assessments and number of panic attacks were associated with higher scores on dimensional scales. Findings were largely unaffected by the number of anxiety disorders and comorbid depressive disorders.ConclusionThe self-rated dimensional anxiety scales demonstrated sensitivity to clinical severity, and a cut-off based on additional assessment of impairment and distress may assist in the discrimination between subthreshold and threshold anxiety disorders. Findings suggest further research in various populations to test the utility of the scales for use in DSM-5.     

Pain and the relationship with mood and anxiety disorders and psychological symptoms

ObjectiveThe objective of this study was to investigate the association between pain and mood and anxiety disorders, as well as psychological symptoms, in a population-based sample of women.MethodsThis study examined the data collected from 1067 women aged 20–93 years (median 51 years) participating in the Geelong Osteoporosis Study. Mood and anxiety disorders were diagnosed using a clinical interview (SCID-I/NP) and psychological symptomatology was assessed using the General Health Questionnaire. Pain was determined using a Visual Analogue Scale (0–100 mm) and deemed present if score ≥ 40 mm.ResultsCurrent mood disorders were associated with an increased likelihood of overall (OR = 3.2, 95% CI 2.0–5.1), headache (OR = 2.8, 95% CI 1.6–4.8), back (OR = 4.0, 95% CI 2.5–6.5) and shoulder pain (OR = 2.2, 95% CI 1.2–4.2). In those with current mood disorders, the pain interfered with daily activities (OR = 3.2, 95% CI 1.9–5.5) and was present most of their time awake (OR = 2.5, 95% CI 1.5–4.1). This pattern was similarly observed for those with past mood disorders. Current anxiety disorders were associated with an increased likelihood for overall (OR = 2.2, 95% CI 1.4–3.6), headache (OR = 2.2, 95% CI 1.3–4.0), back (OR = 1.8, 95% CI 1.1–3.0) and shoulder pain (OR = 1.9, 95% CI 1.0–3.5, p = .05). In those with current anxiety disorders, the pain interfered with daily activities (OR = 2.4, 95% CI 1.4–4.1) and was present most of their time awake (OR = 1.9, 95% CI 1.2–3.2). There was no association between pain and past anxiety. Psychological symptomatology was associated with pain at each site (all p < .001).ConclusionsThis study is consistent with studies utilising clinical samples in reporting that mood and anxiety disorders, as well as psychological symptoms, are associated with higher levels of perceived pain.