Is the attentional dysfunction in schizotypy related to anxiety?

Two factors, 'anxiety-loaded' (AL) and 'perceptual-disorganization' (PD), emerged in a factor analysis of the Schizotypal Personality Questionnaire (SPQ). Sixty of the 219 participants performed a latent inhibition (LI) task. During the pre-exposure phase, one group was exposed to repeated non-reinforced presentations of an irrelevant stimulus and the other was not pre-exposed. In the subsequent test phase, learning was slower in the pre-exposed group than in the non-pre-exposed group. The LI effect was assessed, separately, as a function of SPQ, trait-anxiety sub-scale (TASS) of the State and Trait Anxiety Inventory (STAI), and AL and PD factors scores. LI was disrupted in participants with either high scores on SPQ, STAI, or the AL factor. A regression analysis indicated that both TASS and SPQ independently accounted for LI disruption in high schizotypals, but that the contribution of TASS was stronger. It was suggested that the anxiety component of schizotypy, more than the perceptual-disorganization (schizophrenia-like) component, accounts for the attentional dysfunction in high schizotypals, and for their greater than normal distraction by irrelevant stimuli.     

Is major depressive episode related to anxiety disorders in anorexics and bulimics?

OBJECTIVE: To determine whether the presence of anxiety disorders is related to depressive comorbidity in subjects with eating disorders (ED), while taking into account certain variables that may be related to depression (subjects' age, ED duration, prior incidents of anorexia nervosa in bulimic subjects, inpatient or outpatient status, nutritional state [as measured by body mass index]). METHOD: We evaluated the frequency of depressive disorders in 271 subjects presenting with a diagnosis of either anorexia nervosa or bulimia, using the Mini International Neuropsychiatric Interview, DSM-IV version. RESULTS: A multivariate analysis reveals that anxiety disorders do not all have the same influence in terms of risk of onset of major depressive episode in anorexics and bulimics when adjusted on variables related to depression. CONCLUSION: Depression in subjects with ED can be explained in part by comorbidity with obsessive-compulsive disorder, generalized anxiety, social phobia, and panic disorder.     

What is the internal structure of intolerance of uncertainty? A network analysis approach

Intolerance of uncertainty (IU) is a transdiagnostic vulnerability factor spanning psychological disorders. Although IU has been extensively studied, its internal structure is still not fully understood. In the current study, we applied network analysis to investigate IU – as measured by the Intolerance of Uncertainty Scale-Revised (IUS-R) - in two large non-clinical samples, consisting of undergraduates (N = 1172) and community individuals (N = 1759). Network analysis revealed that feeling a general internal uncertainty aversion and the belief that things have to be planned in advance are the most central nodes in both samples. Moreover, the community analysis revealed that, in both samples, the network of IU consists of three communities referring to negative beliefs about uncertainty, behavioral reactions to uncertainty, and emotional reactions to uncertainty. Lastly, the network was highly similar in undergraduates and community individuals in terms of network similarity, global connectivity, and structure and items mean levels; only minimal-to-negligible differences were found. The way current findings expand our knowledge of the internal structure of IU, along with theoretical and clinical implications, are discussed.     

How close is evidence to truth in evidence-based treatment of mental disorders?

Given the importance of the term 'evidence' in evidence-based medicine (EBM), the meaning of this term is evaluated, going back to the philosophical tradition and current meaning of the terms 'evidence' and 'truth'. Based on this, current problems in the definition of evidence and in the grading of evidence in EBM are described, taking examples from the field of psychiatry and especially pharmacopsychiatry. These problems underline that the use of the term evidence in EBM is inconsistent and inconclusive. This should be fairly stated in all EBM-related publications, especially in EBM-based guidelines, to avoid severe misunderstandings in and outside the field of psychiatry. Although EBM might have increased empirically driven rational decision-making in psychiatry/medicine, the current limitations should be carefully considered.     

Does ADHD moderate the manifestation of anxiety disorders in children?

The main aim of this study was to examine the moderating effects of attention deficit hyperactivity disorder (ADHD) on anxiety disorders in children. Data were analyzed from a large referred sample of children with anxiety disorder without comorbid ADHD (anxiety disorder, N = 253), anxiety disorder plus comorbid ADHD (anxiety disorder + ADHD, N = 704), and ADHD without comorbid anxiety disorder (ADHD, N = 511). Children were comprehensively assessed, including by structured diagnostic interview (K-SADS-E). Overall rates of individual anxiety disorders, as well as age of onset and severity of illness were not significantly different in the presence of comorbid ADHD. School functioning in children with anxiety disorders was negatively impacted by the presence of comorbid ADHD. Frequency of mental health treatment in children with anxiety disorders was significantly increased in the presence of comorbid ADHD. ADHD had a limited impact on the manifestation of anxiety disorder in children suggesting that ADHD and anxiety disorders are independently expressed.     

What are the odds of anxiety disorders running in families? A family study of anxiety disorders in mothers,fathers, and siblings of children with anxiety disorders

This family study investigated (1) the prevalence of anxiety disorders (ADs) in parents and siblings of children (n = 144) aged 8–18 years with ADs compared to control children (n = 49), and (2) the specificity of relationships between child–mother, child–father, and child–sibling ADs. Clinical interviews were used to assess current DSM-IV-TR ADs in children and siblings, and lifetime and current ADs in parents. Results showed that children with ADs were two to three times more likely to have at least one parent with current and lifetime ADs than the control children (odds ratio (OR) = 2.04 and 3.14). Children with ADs were more likely to have mothers with current ADs (OR = 2.51), fathers with lifetime ADs (OR = 2.84), but not siblings with ADs (OR = 0.75). Specific relationships between mother–child ADs were found for Social Anxiety Disorder (SAD, OR = 3.69) and Generalized Anxiety Disorder (OR = 3.47). Interestingly, all fathers and siblings with SAD came from families of children with SAD. Fathers of children with SAD were more likely to have lifetime ADs themselves (OR = 2.86). Findings indicate that children with ADs more often have parents with ADs, and specifically SAD is more prevalent in families of children with SAD. Influence of parent’s (social) ADs should be considered when treating children with ADs.     

How does premenstrual dysphoric disorder relate to depression and anxiety disorders?

Premenstrual dysphoric disorder (PMDD) is a severe variant of premenstrual syndrome that afflicts approximately 5% of all women of fertile age. The hallmark of this condition is the surfacing of symptoms during the luteal phase of the menstrual cycle, and the disappearance of symptoms shortly after the onset of menstruation. Whereas many researchers have emphasized the similarities between PMDD and anxiety disorders, and in particular panic disorder, others have suggested that PMDD should be regarded as a variant of depression. Supporting both these notions, the treatment of choice for PMDD, the serotonin reuptake inhibitors (SRIs), is also first line of treatment for depression and for most anxiety disorders. In this review, the relationship between PMDD on the one hand, and anxiety and depression on the other, is being discussed. Our conclusion is that PMDD is neither a variant of depression nor an anxiety disorder, but a distinct diagnostic entity, with irritability and affect lability rather than depressed mood or anxiety as most characteristic features. The clinical profile of SRIs when used for PMDD, including a short onset of action, suggests that this effect is mediated by other serotonergic synapses than the antidepressant and anti-anxiety effects of these drugs. Although we hence suggest that PMDD should be regarded as a distinct entity, it should be emphasized that this disorder does display intriguing similarities with other conditions, and in particular with panic disorder, which should be the subject of further studies. Also, the possibility that there are subtypes of PMDD more closely related to depression, or anxiety disorders, than the most common form of the syndrome, should not be excluded.     

Psychotherapy for anxiety disorders in childhood and adolescence--what is evidence-based?

Anxiety disorders are the most frequent mental disorders in children and adolescents. They are also an important risk factor for psychological disturbances in adulthood and require adequate treatment. The effectiveness of psychotherapy in the treatment of anxiety disorders today can no longer be questioned. However, a meta-analysis of treatment studies shows that so far, only cognitive-behavior therapy has proved, on the basis of randomized, controlled trials (RCT), to be successful in the treatment of anxiety disorders in children and adolescents. Regardless of whether the cognitive behavior therapy took place individually or in a group, or whether it was carried out with the child alone or with the inclusion of the family, no differences in the effectiveness were found. The follow-up data show that the therapy success persisted for several years and that it was not limited only to the symptoms of anxiety. Although for many psychotherapeutic interventions there is still no empirical basis, initial RCT prove the short-term effectiveness of psychopharmacological treatment (SSRI). The central, empirically validated psychotherapeutic interventions include psychoeducation, cognitive treatment of dysfunctional thoughts, and systematic exposure to the situation triggering anxiety. These interventions will be presented briefly and open questions in psychotherapy research will be discussed in the conclusion.     

How specific is the association of two disorders with respect to the association with a third disorder?

A common problem in psychiatric epidemiology is that of finding appropriate statistical methods to determine the specificity of an association of two disorders (A and B), when disorder A is also associated with a third disorder C. This paper discusses this problem, which is particularly frequent in mental disorders due to substantial comorbidity between disorders. It is suggested that a measure of specificity of association (MSA) can be applied to address this problem. By building on mutually exclusive categories, classes, this measure indicates a high specificity of association A–B whenever two conditions are fulfilled: (a) there is a considerable difference in strength of association of A with pure B (not C) on the one hand and A with pure C (not B) on the other hand, and (b) the association of A with comorbid cases (cases that have both disorders B and C) is at least not stronger than the association of A with pure B cases. The measure is based on a logistic regression model with the probability of having disorder A as the outcome and mutually exclusive categories of B and C as explanatories as well as possibly other confounding variables. Statistical inference in MSA is based on a bias-corrected bootstrap confidence interval. This paper exemplifies the use of this measure with an example from a longitudinal prospective study on the relationship of nicotine dependence with ‘affective’ and ‘anxiety’ disorders. Copyright © 1999 Whurr Publishers Ltd.     

How is impulsivity related to depression in adolescence? Evidence from a French validation of the cognitive emotion regulation questionnaire

The aim of this study was to validate a French version of the Cognitive Emotion Regulation Questionnaire (CERQ; Garnefski, N., Kraaij, V., & Spinhoven, P., 2001. Negative life events, cognitive emotion regulation and emotional problems. Personality and Individual Differences, 30, 1311-1327) and to explore its relationships with impulsivity and depression. Teenagers from a junior secondary (n=107, 13-16 years) and a secondary school (n=110, 15-19 years) completed the CERQ, which assesses regulation strategies in response to negative events. The secondary school adolescents also completed the UPPS Impulsive Behavior Scale (Whiteside, S. P., & Lynam, D. R., 2001. The five factor model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and Individual Differences, 30, 669-689) and the Reynolds Adolescent Depression Scale (Reynolds, W. M., 1987. Reynolds Adolescent Depression Scale: Professional manual. Odessa, FL: Psychological Assessment Resources). Factor analysis for the CERQ confirmed the presence of the nine original regulation strategies. In the secondary school students, impulsivity was related to depression. A path analysis revealed that regulation strategies mediated this relationship. The role of emotion regulation in the development of adolescent psychopathology is discussed.     

Would the use of dimensions instead of categories remove problems related to subthreshold disorders?

Scientific progress fostered in DSM and ICD over the past quarter of century has significantly increased awareness of the limitation of categorical definitions of mental illness. Disorders highly merge into another with no natural boundary in between. The addition of continuous, “dimensional” measures into the various diagnostic domains might help resolve some of the critical taxonomic issues currently facing the field of mental health. It was overtly recognized that both categorical and dimensional approaches to diagnosis are important both for clinical work and for research, and that the ideal taxonomy would offer both. Within each diagnostic entity, there are multiple options for creating a dimensional scale based on a categorical definition. The ICD 10 and DSM IV have no place for subthreshold disorders except in atypical, not otherwise specified or to marginalize its existence with subsequent suffering and impairment of the patients. The chapter will discuss how the subthreshold affective, psychotic, anxiety, cognitive and substance abuse and other psychiatric disorders contribute to psychiatric morbidity and impairment. The chapter discusses the impairment and suffering of patients with subthreshold various psychiatric disorders and how its inclusion in a dimensional approach may result in ameliorating the suffering of that group as their current status may initiate some ethical considerations for their management.

     

How much warfarin is enough in APS related thrombosis?

Warfarin is the best available, most effective treatment for the secondary prevention of recurrent thrombosis in antiphospholipid syndrome (APS) patients. However, warfarin is cumbersome for both patients and physicians because of risk for bleeding and the need for frequent monitoring. Much detail regarding optimal management of APS patients still lacks an evidence-based approach. Asymptomatic patients should not receive warfarin. An optimal treatment for patients with livedo, cardiac valve disease, leg ulcers or microangiopathic nephropathy is unknown; it is likely that warfarin is ineffective for these manifestations of the APS. In low risk patients who have not previously failed warfarin, moderate intensity anticoagulation (target international normalized ratio [INR] 2.5) is as effective as, and safer than, high intensity anticoagulation (INR 3.5), at least for patients with venous thrombosis.

Current recommendations, based on the opinion rather than on documentation, state that warfarin should be prescribed for the APS patient's life; studies that challenge this conclusion for carefully defined low risk patients whose thromboses occurred with trigger events will be welcome, as will be studies examining alternatives to warfarin, including antiplatelet drugs.     

Should OCD leave the anxiety disorders in DSM‐V? The case for obsessive compulsive‐related disorders

Recently in 2006, a group of experts in obsessive compulsive disorder (OCD) and obsessive compulsive-related disorders (OCRDs) convened in Washington, DC, to review existing data on the relationships between these various disorders, and to suggest approaches to address the gaps in our knowledge, in preparation for the upcoming Diagnostic and Statistical Manual (Fifth Edition) (DSM-V). As a result of this meeting, the Research Planning Agenda for DSM-V: OCRD Work Group suggested removing OCD from the anxiety disorders, where it is currently found. This proposal is in accordance with the current International Classification of Mental Disorders (ICD-10) classification of OCD as a separate category from the anxiety disorders. Although the ICD-10 places both OCD and the anxiety disorders under the umbrella category of "neurotic, stress-related, and somatoform disorders," they are two separate categories, distinct from one another. As OCD and other putative OCRDs share aspects of phenomenology, comorbidity, neurotransmitter/peptide systems, neurocircuitry, familial and genetic factors, and treatment response, it was proposed to create a new category in DSM-V entitled OCRDs. Alternatively, the OCRDs might be conceptualized as a new category within the broader category of anxiety disorders. Future studies are needed to better define the relationships among these disorders, and to study boundary issues for this proposed category. There are both advantages and disadvantages in creating a new diagnostic category in DSM-V, and these are discussed in this article.     

What is the place of emotion in cognitive-behavioral approaches of obsessive-compulsive disorders?

The efficacy of behavioral techniques based on exposure and response prevention has been well validated in the treatment of obsessive-compulsive disorder. Nevertheless in a large proportion of patients the disease persists, among others due to refusal of the treatment or due to non-response. About one of two patient entering treatment seems therefore to possibly benefit from behavioral therapy (Ladouceur et al., 1999). Cognitive techniques may extend the behavioral approach, and may represent a more indirect and progressive method, and may improve patients' commitment in the therapy. However, the proportion of treatment resistant patients remains important. New techniques are therefore warranted in order to progress in the understanding and treatment of these patients. Emotion focused therapy could possibly represent an interesting approach based on the improvement of emotional awareness, the exploration and the cognitive restructuring of emotions. The different techniques are described throughout clinical case reports.     

Intolerance of uncertainty in emotional disorders: What uncertainties remain?

The current paper presents a future research agenda for intolerance of uncertainty (IU), which is a transdiagnostic risk and maintaining factor for emotional disorders. In light of the accumulating interest and promising research on IU, it is timely to emphasize the theoretical and therapeutic significance of IU, as well as to highlight what remains unknown about IU across areas such as development, assessment, behavior, threat and risk, and relationships to cognitive vulnerability factors and emotional disorders. The present paper was designed to provide a synthesis of what is known and unknown about IU, and, in doing so, proposes broad and novel directions for future research to address the remaining uncertainties in the literature.