Anxiety and depression in individuals with somatic health problems. The Nord-Trøndelag Health Study (HUNT)

There is a high occurrence of depressive symptoms in patients with somatic health problems. About one-third of individuals with somatic health problems have anxiety disorders and/or depression. Comorbid anxiety disorder and depression are found to be more strongly associated with somatic health problems than pure anxiety disorder and pure depression. Objective - To examine the relationship between anxiety disorders and depression and various somatic health problems in the general population. Design - Cross-sectional study with survey methods and clinical examinations. Setting - The Health Study of Nord-Trøndelag, Norway (the HUNT study). Participants - 60 &#116 869 individuals aged 20-89 years. Main outcome measures - Anxiety disorder, depression and their comorbidity are categorized based on scores on the Hospital Anxiety and Depression Scale. All somatic health variables are self-reported, while blood pressure, height and weight are measured. Multivariate nominal logistic regression analyses are used to investigate the relationship between somatic variables and the anxiety/depression categories. Results - Most somatic health variables show a stronger association with comorbid anxiety disorder/depression than with anxiety disorder or depression alone. About one-third of individuals reporting somatic health problems also have anxiety disorder and/or depression. Conclusion - Somatic health problems carry a high risk of both anxiety disorder and depression. Active identification and treatment of these co-occurring mental disorders are of practical importance.     

The Role of Comorbid Mood Disorders in Cognitive Behavioral Therapy for Childhood Social Anxiety

Background

Children with a social anxiety disorder have worse treatment outcomes after Cognitive Behavior Therapy (CBT) than children with other anxiety disorders. Anxiety disorders and mood disorders are strongly related and especially social anxiety is related to high comorbidity rates with mood disorders. The aim of the study was to investigate how comorbid mood disorders are related to treatment outcomes after CBT and whether this can explain the worse outcomes for childhood social anxiety.

Methods

Participants were 152 referred clinically children (7–18 years) with either a social anxiety disorder (n?=?52) or another anxiety disorder (n?=?100) of whom 24.3% (n?=?37) had a comorbid mood disorder. Child anxiety, internalizing symptoms, and quality of life were measured pre-treatment, post-treatment, 3 months and 1 year after treatment, using child and both parents’ report.

Results

Children with a primary social anxiety disorder more often had a comorbid mood disorder than children with another primary anxiety disorder. Children with a mood disorder had more severe anxiety problems before treatment. Comorbid mood disorders were related to greater anxiety reductions after treatment. The worse outcomes for children with a primary social anxiety disorder remained after controlling for comorbid mood disorders.

Conclusions

Findings stress the importance of future studies examining why the presence of a comorbid mood disorder is associated with greater anxiety reductions, and other factors that explain the worse treatment outcomes found for childhood social anxiety disorder.

     

Anxiety, Somatic Complaints, and Depressive Symptoms in Rural Adolescents

PROBLEM: Undiagnosed and untreated anxiety in adolescents is often associated with greater rates of mood and behavior problems, somatic complaints, and risk for future psychiatric disorders. METHODS. A self-report anxiety instrument was administered as part of a community survey of 466 rural adolescents. FINDINGS: Anxiety symptoms were strongly correlated with both physical complaints and depression. Females had higher scores for total anxiety and the anxiety subtypes of generalized anxiety disorder, separation anxiety disorder, panic disorder, social phobia, and school phobia. CONCLUSIONS: Implications for nursing practice are provided.     

Cognitive Bias in Adolescents with Social Anxiety Disorder

Judgmental biases for threat-relevant stimuli are thought to be important mechanisms underlying the etiology and maintenance of anxiety disorders. Previous research has shown that adults with social anxiety disorder rate negative social events as more likely (probability) to occur as well as more distressing (cost) than do nonanxious controls. However, no empirical research has examined whether this is also the case in adolescents with social anxiety disorder. Elucidation of the cognitive processes of social anxiety disorder in the adolescent population may aid in a better understanding of the etiology and maintenance of the disorder, and may suggest directions for treatment and prevention efforts. This study investigated probability and cost estimations of negative social and nonsocial events among adolescents with social anxiety disorder relative to nonanxious controls. Results indicated that socially anxious adolescents overestimated the cost and probability of negative social events compared to nonanxious adolescents, even after controlling for depressive symptoms. Implications and limitations of these findings are discussed.     

Recent advances in the understanding and treatment of anxiety disorders

Anxiety disorders usually are chronic or recurrent disorders characterized by stress sensitivity and a fluctuating course. Both psychopharmacologic and cognitive-behavioral treatments are well-established, evidence-based treatments for panic disorder, social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder. Exposure-based behavioral treatment is well established as evidence-based treatment for specific phobias. Primary care physicians can make a significant impact on patients' lives by identifying and educating about anxiety disorders, directing patients to appropriate self-help resources, choosing evidence-based drug treatment when indicated, and making referrals for specialist care.     

Panic disorder and antidepressants

Anxiety disorders, specifically, panic disorder, are the most common mental health disorders. Unless the clinician has a high index of suspicion, panic disorder or social anxiety disorder may remain undetected. Although quality of life(QOL) issues have long been recognized in severe psychiatric disorders, they have only recently come to be considered for the anxiety disorders. While the older tricyclic antidepressants(TCAs) are efficacious in the treatment of theses anxiety disorders, recent studies with paroxetine and other selective serotonin reuptake inhibitors(SSRIs) have emphasized the role of serotonin in the aetiology of these conditions. Both the TCA and SSRI antidepressants are effective in treating a wide variety of anxiety disorders. SSRIs, due to their greater safety and tolerability, should be the preferred choices in treating anxiety disorders in those instances.     

Work,social, and family disabilities of subjects with anxiety and depression

BACKGROUND: Functional impairment scales are increasingly used to evaluate subjects with a variety of mental disorders. METHODS: We evaluated the work, social, and family disabilities of 228 subjects with 6 common anxiety and depressive disorders, as assessed by the Sheehan Disability Scale (major depression, panic disorder, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, and mixed anxiety and depression). RESULTS: Subjects in the 6 diagnostic groups had significantly higher work, social, and family disability scores than control subjects, with the exception of the social phobia and panic disorder subjects' scores for family disability. Those with depressive disorders tended to have significantly higher family disability scores than the anxiety disorder subjects. CONCLUSION: Subjects with both anxiety and depressive disorders from primary care clinics and from chronic psychiatric and medical populations need further evaluation and treatment of the disabilities to decrease the personal, family, and economic burdens of these disorders.     

Emotion Dysregulation in Generalized Anxiety Disorder: A Comparison with Social Anxiety Disorder

From an emotion regulation framework, generalized anxiety disorder (GAD) can be conceptualized as a syndrome involving heightened intensity of subjective emotional experience, poor understanding of emotion, negative reactivity to emotional experience, and the use of maladaptive emotion management strategies (including over-reliance on cognitive control strategies such as worry). The current study sought to replicate previous findings of emotion dysregulation among individuals with GAD and delineate which aspects of emotion dysregulation are specific to GAD or common to GAD and another mental disorder (social anxiety disorder). Individuals with GAD reported greater emotion intensity and fear of the experience of depression than persons with social anxiety disorder and nonanxious control participants. Individuals with social anxiety disorder indicated being less expressive of positive emotions, paying less attention to their emotions, and having more difficulty describing their emotions than either persons with GAD or controls. Measures of emotion differentiated GAD, social anxiety disorder, and normal control groups with good accuracy in a discriminant function analysis. Findings are discussed in light of theoretical and treatment implications for both disorders.An earlier version of this paper was presented at the Association for Advancement of Behavior Therapy, Reno, NV, November, 2002     

Alcohol Expectancies and Drinking Behavior in Adults with Social Anxiety Disorder and Dysthymia

Previous research has found a positive relationship between social anxiety disorder and alcoholism, and that certain alcohol outcome expectancies are related to drinking behaviors. The purpose of this study was to examine the relationship among drinking behaviors and alcohol expectancies in treatment-seeking individuals diagnosed with social anxiety disorder or dysthymia, as well as normal controls. No significant differences were found across the 3 groups in alcohol consumption. As expected, socially anxious participants had higher social assertiveness expectancies than both participants with dysthymia and normal controls. Participants with social anxiety disorder had greater tension reduction and global positive change expectancies than the normal controls, but did not differ from participants with dysthymia. Additionally, the increased social assertiveness, tension reduction, and positive change expectancies were found to predict amount of drinking per month for socially anxious participants. Implications for understanding the relationship between social anxiety disorder and alcoholism are discussed.     

Generalized anxiety disorder

Patients with generalized anxiety disorder experience worry or anxiety and a number of physical and psychologic symptoms. The disorder is frequently difficult to diagnose because of the variety of presentations and the common occurrence of comorbid medical or psychiatric conditions. The lifetime prevalence is approximately 4 to 6 percent in the general population and is more common in women than in men. It is often chronic, and patients with this disorder are more likely to be seen by family physicians than by psychiatrists. Treatment consists of pharmacotherapy and various forms of psychotherapy. The benzodiazepines are used for short-term treatment, but because of the frequently chronic nature of generalized anxiety disorder, they may need to be continued for months to years. Buspirone and antidepressants are also used for the pharmacologic management of patients with generalized anxiety disorder. Patients must receive an appropriate pharmacologic trial with dosage titrated to optimal levels as judged by the control of symptoms and the tolerance of side effects. Psychiatric consultation should be considered for patients who do not respond to an appropriate trial of pharmacotherapy.     

Effects of Anxiety Disorder Severity on Social Functioning in Children with Autism Spectrum Disorders

Maladaptive social functioning is a core deficit in children with autism spectrum disorders (ASD). However, few studies have explicitly examined the linkage between anxiety and the degree of social functioning impairment in children with ASD. This study examines several types of anxiety and their covariation with social functioning deficits in children with ASD. Participants were 53 children with ASD who met criteria for at least one anxiety disorder. Within this sample of children, social anxiety disorder was the most common anxiety disorder. Results indicated that a greater severity of social anxiety disorder was associated with a higher level of social functioning deficits for elementary school aged children with ASD. Specifically, exploratory analyses revealed that higher levels of social anxiety disorder predicted lower assertive and responsible social skills. Social anxiety may increase the barriers to social engagement and thus serve as a risk factor for increased social deficits in youth with ASD.     

Perceptions of control in panic disorder and social phobia

Levenson's (1973) locus of control scale was used to assess perceptions of control in individuals with panic disorder and social phobia, compared to a nonclinical sample. Both anxiety disorder groups showed a lower sense of internal control compared to the normal sample. Furthermore, the two anxiety disorder groups showed contrasting externality orientations. Panic-disordered individuals viewed events as proceeding in a random and uncontrollable way, while social phobics viewed events as controlled by powerful others. Partial correlations confirmed the unique relationship between each disorder and a particular externality orientation and indicated that low internal perceptions of control were strongly influenced by the presence of beliefs in chance and powerful others. These data suggest that perceptions of diminished control may be an affective—cognitive theme of anxiety, and that specific types of control perceptions are uniquely associated with these particular anxiety disorders.     

‘I have anxiety,but I have values and preferences’ Experiences of users with generalized anxiety disorder: A qualitative study

To understand the experience and perceptions of people diagnosed with generalized anxiety disorder, along the whole process and their role through the decision‐making process for their treatment. A qualitative study through focus groups composed of people diagnosed with generalized anxiety disorder was carried out. Content analysis was carried out to explore the most representative issues. Five thematic categories were identified: onset of the disorder, symptoms and course; daily life with the disorder; coping with the disorder; demand of healthcare for anxiety, and treatment options and decision‐making. Most of the patients reported physical symptoms of anxiety. The majority of participants perceived little social support from their environment and occupational interferences. Coping seems to differ among participant that have recovered or not recovered. The involvement of users with generalized anxiety disorder was scarce, and pharmacological treatment was always the first option offered. There is scarce orientation to elicit preferences and values of patients across the process of care for people with generalized anxiety disorder. The consequence is a biased predisposition of the healthcare system to provide pharmacological treatment as the first option and ignore the perspective of patients on how to cope with their illness.     

Treatment for anxiety: Mindfulness meditation versus escitalopram (TAME): Design of a randomized,controlled non-inferiority trial

Anxiety disorders (generalized anxiety disorder, social anxiety disorder, panic disorder, and agoraphobia) are common, distressing, and impairing. While pharmacotherapy and psychotherapy are first-line treatment strategies for anxiety disorders, many patients are reluctant to take psychiatric medication, and many prefer to avoid any kind of mental health treatment due to stigma or distrust of traditional medical care. We present the trial protocol for the first study comparing first-line medication treatment with Mindfulness-Based Stress Reduction (MBSR), a popular mindfulness meditation training program, for the treatment of anxiety disorders. We will use a non-inferiority, comparative effectiveness trial design, in which individuals with diagnosed anxiety disorders will be randomized to either pharmacotherapy with escitalopram or MBSR for 8 weeks of treatment. Treatment outcome will be based on gold standard symptom severity measures assessed by trained independent evaluators blind to treatment allocation. Secondary outcomes will include key symptom and function measures, as well as tolerability and satisfaction with treatment. Findings will provide crucial information to inform decision making about the relative benefits of MBSR versus a first line medication for anxiety disorders by patients, medical care providers, healthcare insurers and other stakeholders.     

Anxiety disorders.

This article addresses the role of the primary care physician in the diagnosis and treatment of people with the principal anxiety disorders: panic disorder, generalized anxiety disorder, specific and social phobias, obsessive-compulsive disorder, and post-traumatic stress disorder. This article also discusses each disorder and current treatment options, emphasizing the various roles of psychotherapy, pharmacotherapy, and patient education in each. Most people with anxiety disorders do not seek help, therefore, the primary care physician has a significant opportunity to detect these life-constricting, but treatable, disorders.     

Occurrence of Headaches in Anxiety Disordered Patients

SYNOPSIS
Several previous investigations have suggested a positive relationship between anxiety symptoms and headaches. Twenty patients with anxiety symptoms severe enough to warrant a psychiatric diagnosis of anxiety disorder were questioned about headaches. The number of anxiety disorder patients afflicted with headaches was not different from that reported by 49 non-ill controls.     

Irritable bowel syndrome. Toward a biopsychosocial systems understanding

The symptoms of irritable bowel syndrome (IBS) are usually a subset of a broader problem that meets DSM-III criteria for depression, anxiety disorder, somatization disorder, or adjustment disorder. A biopsychosocial perspective that addresses multigenerational family patterns of anxiety, depression, and somatization of stress suggests guidelines for understanding and treating patients with IBS symptoms. Effective treatment focuses primarily on helping patients cope with emotional disorders and psychosocial stressors, and secondarily on direct symptom relief. Psychotherapy is a valuable adjunct to medical treatment. The medications most likely to yield lasting benefits are the antidepressants.     

Misinterpretation of ambiguous stimuli in panic disorder

This study investigated whether cognitive misinterpretation of ambiguous interoceptive stimuli is a process specific to panic disorder or whether it is found in other anxiety disorders. It also investigated the relationship of this cognitive bias to anxiety sensitivity. Results showed it to be stronger in panic disorder than in social phobia but only when the relevant cognitive schema were specifically activated. This cognitive bias therefore also existed in social phobia, albeit to a lesser degree. Evidence of a strong relationship between misinterpretation of ambiguous interoceptive stimuli and anxiety sensitivity was lacking. The results were interpretated as supporting the view that attentional bias toward ambiguous somatic cues is specifically related to activation of relevant cognitive schema, which are particularly extensive in panic disorder.     

Perinatal Mood and Anxiety Disorders

Perinatal mood and anxiety disorders (PMADs) are a public health issue that has a profound negative effect on women, families, and communities. It is estimated that 15% to 21% of pregnant and postpartum women experience PMAD, which includes depression, anxiety, obsessive-compulsive disorder, posttraumatic stress disorder, and postpartum psychosis. The purpose of this article is to provide an overview of perinatal mood and anxiety disorders in an effort to improve recognition, screening, diagnosis, treatment, and referral by nurse practitioners and midwives.