Anxiety disorders and CRP in a population cohort study with 54,326 participants: The LifeLines study

Objectives: Growing evidence indicates that inflammatory processes may play a role in the pathogenesis of anxiety disorders. Nevertheless, much remains to be learned about the involvement of inflammation, including C-reactive protein (CRP), in specific anxiety disorders. This study examines the relation between anxiety disorders and CRP.

Methods: Associations of serum CRP with anxiety disorders were determined in a large population study (n?=?54,326 participants, mean age?=?47 years; 59% female), the LifeLines cohort. Depressive and anxiety disorders (generalized anxiety disorder, social anxiety phobia, panic disorder with or without agoraphobia and agoraphobia without panic disorder) were assessed using the Mini-International Neuropsychiatric Interview.

Results: Anxiety disorders, with the exception of social anxiety disorder, were significantly associated with increased CRP. After adjusting for demographics, life style factors, health factors, medication use, depression, and psychological stressors, CRP remained significantly associated with panic disorder with agoraphobia (β?=?0.01, P?=?.013). Moreover, CRP levels were significantly higher in people with panic disorder with agoraphobia compared to other anxiety disorders, independent of all covariates (F?=?3.00, df?=?4, P?=?.021).

Conclusions: Panic disorder with agoraphobia is associated with increased CRP, although the effect size of this association is small. This indicates that neuroinflammatory mechanisms may play a potential role in its pathophysiology.     

Panic attacks as a risk for later psychopathology: results from a nationally representative survey

Background: There is a growing body of literature suggesting that panic attacks without panic disorder are associated with increases in a wide range of psychopathology and impairment. However, the majority of the literature to date has been cross‐sectional. Some longitudinal research supports the view that panic attacks are a nonspecific risk factor for future psychopathology. Using a large nationally representative longitudinal survey of adults, we sought to determine whether panic attacks predict new onset Axis I disorders. Methods: The Alcohol Use Disorder and Associated Disabilities Interview Schedule—DSM‐IV Version was used to make diagnoses of psychiatric disorders in the National Epidemiologic Survey on Alcohol and Related Conditions Waves 1 and 2 (n = 34,653, aged 18 and older, response rate = 70.2%). Incident psychiatric disorders at Wave 2 were compared between people with and without panic attacks at Wave 1. Results: Panic attacks at Wave 1 were significantly associated with increased incidents of generalized anxiety disorder, panic disorder, social phobia, major depression, dysthymia, mania and hypomania, any anxiety disorder, and any mood disorder even after adjusting for sociodemographic variables, Wave 1 Axis I disorders, and Axis II disorders (OR's ranging from 1.62 to 2.77). Conclusions: The presence of panic attacks may be an important indicator of overall psychological distress and the risk of more severe psychopathology in the future. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Mirtazapine versus paroxetine in panic disorder: an open study

Introduction

Open studies suggest that mirtazapine has efficacy in panic disorder treatment. We designed an open study that evaluates changes induced by mirtazapine compared with paroxetine in panic disorder.

Methodology

Patients 18–65 years old consecutively referred to a psychiatry liaison service with panic disorder (DSM-IV criteria) were offered either mirtazapine or paroxetine treatment.

Results

There were statistically significant reductions from baseline to week 3 and from week 3 to 8 for mirtazapine and paroxetine groups for: number of panic attacks, Beck Anxiety or Depression Inventory (BAI, BDI) Clinical Global Impresion (CGI) of panic disorder severity and CGI of panic disorder response (these variables were evaluated by the patient, the clinician or a blind evaluator). Responders at week 3 (BAI decrease of 50%) were 83% for the mirtazapine group and 84% for the paroxetine group. Responders at week 8 (number of panic attacks equal to 0) were 77% for the mirtazapine group and 73% for the paroxetine group Statistically significant differences between mirtazapine and paroxetine were found for number of panic attacks at weeks 3 and 8 and BAI at week 3, suggesting a faster response for mirtazapine. Responders at week 8 maintained a no recurrence figure of 95% at follow-up 6 months later. Panic disorder either with or without comorbid depression improved in both groups of treatment.

Discussion

Our study supports the hypothesis that mirtazapine has efficacy in the treatment of panic disorder either with or without comorbid depression.     

Clinical and subthreshold panic disorder

Background: Panic disorder (PD) is a highly prevalent and disabling condition, and subthreshold cases may be even more prevalent. This study examined psychiatric comorbidities, work functioning, and health‐care utilization of individuals with subthreshold panic. The purpose of this study was to add to the accumulating evidence of significant comorbidity and disability associated with subthreshold PD. Methods: Data are drawn from the Health Care for Communities study, a national household survey of the United States' adult, civilian, noninstitutionalized population (N=9585). Data assessing psychiatric disorders, employment and work productivity, and health‐care utilization were collected. Seven categories of panic and subthreshold panic were created. Results: The prevalence of clinical and subthreshold panic in the general population was 40%. Subthreshold panic was associated with increased odds of several comorbid disorders, including depression, dysthymia, psychosis, generalized anxiety disorder, bipolar disorder, and alcohol and drug use disorders. Subthreshold panic was also associated with greater likelihood of health‐care service utilization but not with the intensity of mental health services. Conclusion: Psychiatric comorbidities and health‐care utilization are common among patients with subthreshold panic. The relationship between varying degrees of panic symptomology and other mental health problems and indices of functioning impairment warrants further investigation. These results inform further research focusing on the course of subthreshold PD and its impact on quality of life. Depression and Anxiety, 2010. © 2009 Wiley‐Liss, Inc.     

The relationship between anxiety disorders and suicide attempts: findings from the National Epidemiologic Survey on Alcohol and Related Conditions

Background: Previous work has suggested that anxiety disorders are associated with suicide attempts. However, many studies have been limited by lack of accounting for factors that could influence this relationship, notably personality disorders. This study aims to examine the relationship between anxiety disorders and suicide attempts, accounting for important comorbidities, in a large nationally representative sample. Methods: Data came from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2. Face‐to‐face interviews were conducted with 34,653 adults between 2004 and 2005 in the United States. The relationship between suicide attempts and anxiety disorders (panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder, posttraumatic stress disorder (PTSD)) was explored using multivariate regression models controlling for sociodemographics, Axis I and Axis II disorders. Results: Among individuals reporting a lifetime history of suicide attempt, over 70% had an anxiety disorder. Even after adjusting for sociodemographic factors, Axis I and Axis II disorders, the presence of an anxiety disorder was significantly associated with having made a suicide attempt (AOR=1.70, 95% confidence interval (CI): 1.40–2.08). Panic disorder (AOR=1.31, 95% CI: 1.06–1.61) and PTSD (AOR=1.81, 95% CI: 1.45–2.26) were independently associated with suicide attempts in multivariate models. Comorbidity of personality disorders with panic disorder (AOR=5.76, 95% CI: 4.58–7.25) and with PTSD (AOR=6.90, 95% CI: 5.41–8.79) demonstrated much stronger associations with suicide attempts over either disorder alone. Conclusion: Anxiety disorders, especially panic disorder and PTSD, are independently associated with suicide attempts. Clinicians need to assess suicidal behavior among patients presenting with anxiety problems. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Hypofrontality in panic disorder and major depressive disorder assessed by multi-channel near-infrared spectroscopy

Background: Panic disorder is a common and debilitating psychiatric disease; yet, the neurobiology of this disorder is not fully understood. Deficits in the prefrontal inhibitory control over hyperactivity of the anxiety‐related neural circuit are implicated in the pathophysiological core of panic disorder. The aims of this study were to investigate whether panic disorder reveals frontal lobe dysfunction while performing the word fluency test by using multi‐channel near‐infrared spectroscopy and to compare the findings in panic disorder with those in major depressive disorder. Methods: Twenty‐one patients with panic disorder, 17 patients with major depressive disorder, and 24 healthy control subjects participated in the study. Results: Both patients with panic disorder and with major depressive disorder showed similarly attenuated increases in oxy‐hemoglobin during the word fluency test in the bilateral frontal regions, when compared to healthy control participants. Hypofrontality in panic disorder and major depressive disorder was most prominent in the left medial inferior frontal lobe. Conclusions: This study clarified that hypofrontality in panic disorder is evident even with neutral stimuli of little emotional load. Depression and Anxiety 25, 2008. © 2008 Wiley‐Liss, Inc.     

Service utilisation for anxiety in an Australian community sample

Background Anxiety is common. Symptoms that meet criteria for an anxiety disorder are also common, disabling and treatable, yet the majority of people who experience symptoms do not seek treatment. This study aimed to examine the rates and correlates of treatment seeking, and the perceived barriers to care among individuals experiencing symptoms of anxiety in the community. Methods The study identified persons who reported anxiety as their principal complaint from the Australian National Survey of Mental Health and Wellbeing (N = 10641). Multivariate logistic regression was used to examine clinical and sociodemographic correlates of service utilisation, effective intervention and perceived need for care. Results Rates of consultation, specialist consultation and perceived need for care were low. Disability, neuroticism and presence of mental disorders were stronger determinants of consultation and perceived need than sociodemographics. Panic disorder was the only anxiety disorder associated with consultation, specialist consultation and effective treatment. Consultation with a mental health specialist as opposed to another health professional was associated with effective treatment for anxiety. The most common reason for not consulting was “I preferred to manage myself”. Conclusions Although the more severely symptomatic and comorbid individuals seek treatment for anxiety, a significant number of disabled individuals do not consult. While treatment coverage for panic disorder was better than for the other anxiety disorders, coverage could be improved across all the anxiety disorders. Given the relationship between specialist consultation and effective treatment, it is important that general practitioners are able to treat persons with mild to moderate anxiety competently and refer more disabled individuals to mental health specialists. The findings call for continued efforts to educate both health professionals and the public about the management of anxiety. Accepted: 20 December 2001     

Subtypes of panic attacks: a critical review of the empirical literature

Background: Panic disorder is a heterogeneous disorder, comprising a variety of somatic, physiological, and cognitive symptoms during repeated panic attacks. As a result, considerable data have examined whether panic attacks may be classified into distinct diagnostic or functional subtypes. The aim of this study is to evaluate the existing literature regarding the validity of panic attack subtypes. Methods: This review focuses on data published since 2000, with the publication of DSM‐IV‐TR, augmented by replicated data published since 1980, with the publication of DSM‐III and subsequently DSM‐IV. Published reports evaluating empirical evidence for the validity of panic attack subtypes are reviewed. Results: Five sets of panic symptoms (respiratory, nocturnal, nonfearful, cognitive, and vestibular) have been shown to cluster together at varying degrees of consistency. However, none of these potential subtypes have been associated with sufficient and reliable external validation criteria indicative of functional differences. This apparent lack of findings may be related to methodological inconsistencies or limitations across the reviewed studies. Conclusions: Although at present the data do not warrant the utility of subtyping, further research aimed at patent gaps in the literature, including clearer operationalization of symptom subtypes, greater use of biological challenge paradigms and physiological and other more objective measures of fear and anxiety, and exploration of subtyping based on biological factors such as genetics, may support the future designation of panic attack subtypes and their ultimate clinical utility. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Escitalopram in the treatment of panic disorder: a randomized, double-blind, placebo-controlled trial

BACKGROUND: Escitalopram, the therapeutically active isomer of the racemic selective serotonin reuptake inhibitor antidepressant citalopram, has shown significant anxiolytic effects in placebo-controlled clinical trials of social anxiety disorder, generalized anxiety disorder, and anxiety symptoms associated with major depression. This study evaluated the safety and efficacy of escitalopram in outpatients diagnosed with panic disorder. METHOD: Male and female outpatients between 18 and 80 years of age meeting DSM-IV criteria for panic disorder, with or without agoraphobia, were randomly assigned to 10 weeks of double-blind treatment with escitalopram, citalopram, or placebo in a study conducted from September 1999 to July 2001. The primary measure of efficacy was panic attack frequency at week 10 relative to baseline, as assessed by the Modified Sheehan Panic and Anticipatory Anxiety Scale. RESULTS: A total of 366 subjects (128 escitalopram patients, 119 citalopram patients, and 119 placebo patients) received at least 1 dose of double-blind treatment. The frequency of panic attacks was statistically significantly improved (p =.04), and the increase in percentage of patients with zero panic attacks reached borderline significance (p =.051), in the escitalopram-treated group relative to the placebo-treated group. Both escitalopram and citalopram statistically significantly reduced panic disorder symptoms and severity versus placebo at endpoint (p 相似文献   

The use of the Panic and Agoraphobia Scale (P & A) in a controlled clinical trial

BACKGROUND: A new 13-item scale has been developed for measuring severity of illness in patients with panic disorder and agoraphobia, the Panic and Agoraphobia Scale (P & A). The scale has five subscales covering the main factors that reduce quality of life in panic disorder patients (panic attacks, avoidance, anticipatory anxiety, disability and worries about health). The application of this scale in a double-blind placebo-controlled panic disorder trial is described. At the same time, the aim of the study was to compare the therapeutic effects of aerobic exercise with a treatment of well-documented efficacy. METHODS: Patients with Panic disorder (DSM-IV) were randomly assigned to three treatment modalities: running (n=45), clomipramine (n=15) or placebo (n=15). Treatment efficacy was measured with the Panic and Agoraphobia Scale (P & A) and other rating scales. RESULTS: According to the P & A and other scales, both exercise and clomipramine led to a significant decrease of symptoms in comparison to placebo treatment. Clomipramine was significantly more effective and improved anxiety symptoms significantly earlier than exercise. The evaluation of the P & A subscales revealed that exercise exerted its effect mainly reducing anticipatory anxiew and panic-related disability. CONCLUSIONS: The new Panic and Agoraphobia Scale was shown to be sensitive to differences between different panic treatments. Analysis of the scales five subscores may help to understand mechanisms of action of panic disorder treatments.     

Slow vs standard up-titration of paroxetine in the treatment of panic disorder: a prospective randomized trial

Aim: Patients with panic disorder (PD) might be sensitive to the stimulating effects of selective serotonin reuptake inhibitors (SSRI), thus requiring low dosages at treatment initiation. The aim of the present study was to assess eventual differences in terms of effectiveness and tolerability between a slow up‐titration with paroxetine and a standard one. Methods: In an open randomized, multicenter, primary‐care study, 60 patients (44 women and 16 men) with PD with or without agoraphobia were enrolled and randomized to receive a slow up‐titration with paroxetine (increments of 2.5 mg/day every 2 days) or a standard one (increments of 10 mg/day every week) up to a maximum daily dose of 20 mg. Repeated‐measures anova on sub‐items scores of the Panic Attack Anticipatory Anxiety Scale (PAAS) and Dosage Record and Treatment Emergent Symptom Scale (DOTES), respectively, used as outcome measures of effectiveness and tolerability, were performed. Significance level was set at 0.05 and it was not corrected. Results: anova showed no differences between the two treatments in terms of effectiveness and tolerability. Post hoc analysis found only one significant difference in the intensity of spontaneous panic attacks (Panic and Anticipatory Anxiety Scale) in the first 9 days of treatment between the two treatment groups, which was that this item was less intense in the slow‐titration group (treatment effect: F = 4.89, P = 0.03, effect size = 0.1). Conclusion: Present findings suggest only a small superiority for a slow up‐titration regimen of paroxetine compared to a standard one in the first 9 days of treatment but no differences at end‐point.     

Panic disorder: response to sodium lactate and treatment with antidepressants

Effective drugs for mental disorders have been found by serendipitous findings not supported by knowledge of psychopharmacology. Drug are assigned labels, such as "antidepressant" without knowledge that such a label delimits the utility of such agents. Many double-blind controlled studies have shown that imipramine effectively ameliorates panic attacks and agoraphobia. Epidemiological data show a relationship between Panic Disorder and Depression. Relatives of probands with Major Depression plus an Anxiety Disorder were at greater risk for both Major Depression and for an Anxiety Disorder. Panic Disorder, as a subcategory of Anxiety Disorder was associated with the greatest increased risk. Intravenous sodium lactate reliably produces anxiety attacks clinically indistinguishable from those occurring in Panic Disorder, in subjects with that disorder. Panic Disorder is characterized by response to imipramine, an epidemiological link to Affective Disorder, and is similar to panic induced by infusion of sodium lactate.     

The cardiac anxiety syndrome — a subtype of panic attacks

Summary Cardiac anxiety syndrome and the diagnosis of cardiac neurosis respectively are characterized by panic attacks. Panic attacks are the core syndrome of a validated anxiety disorder (panic disorder). The purpose of this study was to investigate if the cardiac anxiety syndrome represents a separate disorder or if it is only a subtype of panic attacks.In a sample of 122 patients with panic attacks, all patients with a cardiac anxiety syndrome were selected (n = 31). Furthermore, parallel to this group—matched in the variables age and sex—a second group of patients with no cardiac anxiety syndrome was selected. There were no significant differences in course; in clinical phenomenology, patients with a cardiac anxiety syndrome were only distinguished by a greater intensity of somatization and phobic avoidance from patients with no cardiac anxiety syndrome. These results confirm the hypothesis that the cardiac anxiety syndrome is a subtype of panic attacks and does not represent a separate disorder.     

Panik i Norden

Supplement No. 9 of this journal was devoted to the biology of anxiety and inter alia described the classification of anxiety disorders in DSM-IH and the effect of antidepressant drugs in «panic disorder» (PD). This has incited Professor Thorkil Vanggaard to discuss critically DSM-III in relation to the classical diagnose «anxiety neurosis» (AN) and the use of antidepressant drugs in anxiety that is not part of a depressive syndrome

In this reply the scientific support for separating anxiety states with and without panic attacks, as in DSM-III, is reviewed (mainly studies on outcome of drug therapy and genetic influence). The evidence showing that PD is discriminated from typical and atypical and hence that antidepressant drugs have true antipanic effects is also discussed (mainly that biological markers for depression are not found in PD and that depressive symptoms are by definition excluded in PD)

Finally it is underlined that a thorough discussion of facts, experiences and theories related to PD and AN is urgent. □ Panic disorder, anxiety neuroses, antidepressant treatment.     

Moderating effects of major depression on patterns of comorbidity in patients with panic disorder

Given the high rate of co-occurring major depression in patients with panic disorder, it is unclear whether patterns of comorbidity in individuals with panic disorder reported in the literature are associated with panic disorder or with the presence of major depression. Subjects were 231 adult subjects with panic disorder and major depression (n=102), panic disorder without comorbid major depression (n=29), major depression without comorbid panic disorder (n=39), and neither panic disorder nor major depression (n=61). Subjects were comprehensively assessed with structured diagnostic interviews that examined psychopathology across the life cycle. Panic disorder, independently of comorbidity with major depression, was significantly associated with comorbid separation anxiety disorder, simple phobia, obsessive-compulsive disorder, generalized anxiety disorder, and agoraphobia. Major depression, independently of comorbidity with panic disorder, was significantly associated with comorbidity with psychoactive substance use disorders and childhood disruptive behavior disorders. Overanxious disorder was associated with both panic disorder and major depression. Major depression has important moderating effects on patterns of comorbidity of panic disorder in referred adults.     

Depersonalization and personality in panic disorder

Background

Prevalence and clinical correlates of depersonalization symptoms have been associated with panic disorder. Personality traits might increase the likelihood of experiencing depersonalization symptoms or depersonalization disorder in panic patients.

Aims

The objectives of this study are to establish the prevalence of depersonalization symptoms during the panic attack and in depersonalization disorder and to examine the personality factors associated with the presence of depersonalization in patients with panic disorder.

Methods

The sample comprised 104 consecutive adult outpatients with panic disorder, diagnosed according to the Semistructured Clinical Interview for DSM-IV (Axis I/II disorders). Participants were assessed with the Cambridge Depersonalization Scales, the Temperament and Character Inventory, and the Panic and Agoraphobia Scale.

Results

Forty-eight percent of the sample had depersonalization symptoms during the panic attack, whereas 20% of patients had a depersonalization disorder. Women presented more depersonalization disorders than did men (P = .036). Patients with panic disorder with depersonalization disorder had a more severe panic disorder (P = .002). Logistic regression analysis showed that self-transcendence trait (odds ratio, 1.089; 95% confidence interval, 1.021-1.162; P = .010) and severity of panic (odds ratio, 1.056; 95% confidence interval, 1.005-1.110; P = .032) were independently associated with depersonalization disorder.

Conclusions

A high prevalence of depersonalization symptoms and depersonalization disorder was confirmed in patients with panic disorder, supporting a dosage effect model for understanding depersonalization pathology. Self-transcendence trait and severity of panic disorder were reported as risk factors for depersonalization disorder.     

Separation anxiety disorder in OCD

Background: A history of separation anxiety disorder (SAD) is frequently reported by patients with obsessive–compulsive disorder (OCD). The purpose of this study was to determine if there are clinical differences between OCD‐affected individuals with, versus without, a history of SAD. Methods: Using data collected during the OCD Collaborative Genetic Study, we studied 470 adult OCD participants; 80 had a history of SAD, whereas 390 did not. These two groups were compared as to onset and severity of OCD, lifetime prevalence of Axis I disorders, and number of personality disorder traits. Results: OCD participants with a history of SAD were significantly younger than the non‐SAD group (mean, 34.2 versus 42.2 years; P<.001). They had an earlier age of onset of OCD symptoms (mean, 8.0 versus 10.5 years; P<.003) and more severe OCD, as measured by the Yale–Brown Obsessive Compulsive Scale (mean, 27.5 versus 25.0; P<.005). In addition, those with a history of SAD had a significantly greater lifetime prevalence of agoraphobia (odds ratio (OR) = 2.52, 95% confidence interval (CI) = 1.4–4.6, P<.003), panic disorder (OR = 1.84, CI = 1.03–3.3 P<.04), social phobia (OR = 1.69, CI 1.01–2.8, P<.048), after adjusting for age at interview, age at onset of OCD, and OCD severity in logistic regression models. There was a strong relationship between the number of dependent personality disorder traits and SAD (adjusted OR = 1.42, CI = 1.2–1.6, P<.001). Conclusions: A history of SAD is associated with anxiety disorders and dependent personality disorder traits in individuals with OCD. Depression and Anxiety 28:256–262, 2011. © 2011 Wiley‐Liss, Inc.     

The Prevalence of Migraine Headaches in an Anxiety Disorders Clinic Sample

The association between migraine and psychiatric disorders has been reported in both clinical and epidemiological studies. The prevalence of psychiatric disorders has been found to be increased among individuals with migraine. Studies assessing migraine in psychiatric patients are limited and the majority of these studies have focused solely on examining patients with major depression. In the present study, we examined the prevalence and characteristics of migraine headache in an anxiety disorders clinic sample in order to better understand the relationship between these commonly associated conditions. We evaluated 206 consecutive outpatients to an Anxiety Disorders Clinic for the prevalence of migraine. The presence of migraine was established using International Headache Society Criteria. Subjects completed a modified self‐report version of the Headache Diagnostic Questionnaire. In order to assess the relationship between migraine and anxiety disorder symptom severity, subjects completed standardized measures of symptom severity. The prevalence of migraine in our anxiety disorder clinic sample was 67%. Anxiety disorder patients with migraine presented with a significantly greater number of comorbid psychiatric disorders than patients without migraine (P= 0.012). The prevalence of migraine was significantly higher in patients with a diagnosis of either panic disorder with agoraphobia (P= 0.048) or major depressive disorder/dysthymia (P= 0.008) compared to other psychiatric disorders. The severity of anxiety disorder symptoms was significantly higher in patients with migraine compared to patients without migraine. This study suggests that there is an increased prevalence of migraine headaches among anxiety disorder patients as compared to the general population. Migraine comorbidity may have important clinical implications, such that the treatment of one condition could potentially ameliorate the development or progression of the other. Further research is required to better understand the nature and implications of the association between migraine and psychiatric disorders.     

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.     

Avoidance behaviour: A predictor of the efficacy of pharmacotherapy in panic disorder?

Summary The impact of the avoidance behaviour on the psychopharmacological treatment of panic disorder was explored in the Cross National Collaborative Panic Study (n=1134 patients); in this double blind randomized trial alprazolam, imipramine and placebo were compared during an 8-week treatment period. Patients with extensive avoidance behaviour (agoraphobia) had the most profit from the active drugs. Counter expectancy these specific drug effects were most pronounced in avoidance behaviour. Active drugs (in particular imipramine) were especially more effective than placebo if the patients presented with associated avoidance behaviour. The results suggest that agoraphobia defines more a particular type of anxiety disorder overlapping with panic disorder than merely a severe state of panic disorder.