社交焦虑障碍的脑网络特征与症状的联系(综述)

社交焦虑障碍是一种常见的精神疾病,发病机制尚不明,影像学研究提示该病存在脑网络功能连接异常。社交焦虑障碍患者的脑网络特征与症状之间存在一定的联系,情感网络异常对应患者的情绪失调、默认模式网络异常提示患者过强的自我参照思维、认知控制网络异常影响患者的认知策略以及动机网络异常影响患者对社交活动的快感体验,本文主要探讨社交焦虑障碍患者主要症状的神经机制,为临床实践和科学研究提供参考。     

儿童情绪障碍相关因素的LOGISTIC回归分析

情绪障碍是儿童期常见的心理障碍之一 ,对儿童的生活和社会功能有着明显影响。本文就综合性儿科医院心理门诊中儿童情绪障碍患者的有关资料进行对照研究 ;采用Ｌｏｇｉｓｔｉｃ回归多因素分析方法 ,对引起儿童情绪障碍的相关因素作一初步分析。1　对象和方法1.1　对象病例组来源于上海医科大学儿科医院心理咨询门诊来访者 ,共 88例 ,男 :4 0例 ;女 4 8例。采用ＩＣＤ- 10精神与行为障碍分类诊断标准进行诊断。其中广泛性焦虑障碍 14例 ,惊恐障碍 6例 ,混合性焦虑抑郁障碍 9例 ,恐怖性焦虑障碍 5例 ,社交恐怖症5例 ,学校恐怖症 8例 ,分离性焦…     

儿童焦虑研究评述

焦虑作为人类心理失调的最主要和最经常出现的问题，一直是心理学比较活跃的研究领域。儿童作为不成熟的个体，在发展过程中面临着大量的矛盾与困难，因此，儿童焦虑具有普遍性。如果这些焦虑情绪不加干预，有可能影响儿童的日常生活，进一步转化成焦虑障碍，甚至持续至成年期，影响其一生的发展。     

大学生羞耻感对社交焦虑影响的纵向研究

目的：在大学生中尝试验证羞耻感对社交焦虑的影响作用。方法：对213名大学生进行了问隔六周的前后测．用结构方程模型的纵向研究方法，检验羞耻感对社交焦虑的影响是否存在及影响的程度。结果：所建构的自回归模型拟合指标理想．作为自变量的羞耻感和因变量社交焦虑呈正相关的关系．羞耻感的降低有利于减轻个体的社交焦虑水平。个性羞耻维度对社交焦虑水平的影响较其他羞耻感因素更加显著。此外，在行为羞耻和人际敏感因素间有一定程度的直接相关。结论：验证了羞耻感对社交焦虑的重要影响作用．为进一步探索羞耻感和社交焦虑问的因果关系提供了支持证据。对探索羞耻感和社交焦虑的关系提供了更有效的研究方法。     

焦虑和抑郁障碍共病的研究现状

目的 了解焦虑和抑郁障碍共病的发病率及治疗。方法 查阅相关文献，就焦虑和抑郁共瘸的研究现状进行综鎏。结果 焦虑和抑郁共病的易患因素有遗传、心理社会因素、生化因素、免疫学、内分泌和神经电生理变化，临床上常采用誓焦虑和抗抑郁药联合应用的药物治疗，并辅以认知心理疗法的综合方案。结论 当前，对焦虑和抑郁障碍共病的研究，尚存在诊断一致性欠统一；对发病机制内在联系的复杂性认识不足；治疗和诊断脱节等问题。     

儿童焦虑研究评述

<正>焦虑作为人类心理失调的最主要和最经常出现的问题,一直是心理学比较活跃的研究领域。儿童作为不成熟的个体,在发展过程中面临着大量的矛盾与困难,因此,儿童焦虑具有普遍性。如果这些焦虑情绪不加干预,有可能影响儿童的日常生活,进一步转化成焦虑障碍,甚至持续至成年期,影     

神经症患者述情障碍及其特征的探讨

目的：了解神经症患者的述情障碍状况；了解不同类型的神经症患者述情障碍的差异及其主要的特点，为神经症的病因学研究及治疗和预防提供一些信息和证据。方法：神经症组：符合CCMD—Ⅲ神经症诊断标准的病人258人；符合DSM—Ⅳ分类与诊断标准中抑郁障碍的患者73人，焦虑障碍54人，抑郁与焦虑同时存在的(共病)65人，其它类型的神经症患者66人。对照组：无神经症及其它精神疾病健康人，共150人。使用本课题组修订的20个条目的多仑多述情量表(TAS-20)中文版作为评定工具，对所有样本进行述情障碍评定。结果：两组在总分及各因子分上的差异显著，神经症患者的述情障碍明显高于正常对照组；抑郁性障碍、焦虑性障碍、抑郁与焦虑共存(共病)三组在外向性思维因子分和量表总分上有明显的组间差异，抑郁性障碍组和共病组在外向思维因子分及量表总分上均显著高于焦虑性障碍组；不同性别的述情障碍比较结果表明正常对照组内没有明显的性别差异，而在神经症组内男性患者的述情量表总分和外向思维因子分明显低于女性病人。结论：神经症患者存在明显的述情障碍，且女性更严重；不同类型的神经症患者述情障碍的严重程度存在差异，抑郁性障碍和共病患者的述情障碍比焦虑性障碍严重，主要表现在外向思维方面。     

抑郁症共病其他精神障碍的特点及相关因素

目的:了解一般人群中抑郁症患者共病其他精神障碍的情况和特点及相关因素。方法:以河北省精神疾病流行病学抽样调查中诊断的现患抑郁症399例为研究对象,以美国精神障碍诊断与统计手册第四版轴Ⅰ障碍定式临床检查患者版(Structured Clinical Interview for DSM-Ⅳ AxisI Disorders-Patient Edition SCID-I/P)为诊断工具。采用大体功能量表(Global Assessment of Function,GAF)、匹茨堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)中国修订版评估患者的严重程度和睡眠质量。结果:399例抑郁症患者与其他精神障碍的共病率为48.4%,其中37.1%共病1种精神障碍,11.3%共病2种精神障碍。共病焦虑障碍占35.6%,共病未特定的焦虑障碍20.05%,共病心境恶劣障碍14.04%,共病创伤后应激障碍5.26%,共病广泛焦虑症4.26%,共病惊恐障碍3.01%。共病组患者精神运动性激越、自杀观念和行为等症状出现的频率明显高于非共病组(62.69%vs.48.06%,45.08%vs.35.44%,7.77%vs.1.94%,Ps0.05)。Lo-gistic回归分析显示信仰宗教是共病心境恶劣障碍的保护性因素,60～69岁是共病未特定焦虑障碍的危险因素,20～29岁、60～69岁、低收入、独居是共病惊恐障碍的危险因素,40～59岁是共病创伤后应激障碍高风险年龄,已婚是保护性因素。结论:抑郁症共病其他精神障碍的现象比较常见,其中共病心境恶劣障碍和未特定焦虑障碍较多见,共病不同精神障碍的危险因素和保护性因素不同。     

服刑人员述情障碍与自杀风险的关系：抑郁焦虑的中介作用

目的:探讨监狱服刑人员中的自杀风险与述情障碍、抑郁焦虑的关系。方法:采用自杀行为问卷(SBQ-R)、多伦多述情障碍量表(TAS-20)、贝克抑郁量表第2版(BDI-Ⅱ)、贝克焦虑量表(BAI)对广东省广州市某监狱的456名成年男性服刑人员进行集体施测。结果:述情障碍、重度抑郁症状、重度焦虑症状、高自杀风险检出率分别为28.2%、22.2%、10.4%、12.6%。服刑人员的述情障碍得分在入狱前是否有职业和教育程度在统计学上有差异(t=-2.10,P0.05;F=6.28,P0.01);服刑人员的抑郁、焦虑和自杀风险得分在刑期上的差异有统计学意义(F=7.34,P0.001;F=3.51,P0.01;F=4.52,P0.01);Pearson相关分析结果显示述情障碍、抑郁、焦虑和自杀风险两两之间均成正相关(r=0.37～0.67,P0.01);述情障碍通过抑郁焦虑情绪障碍的中介作用对自杀风险产生影响。结论:服刑人员存在严重的心理健康问题,抑郁、焦虑发生率和严重程度均较高,高述情障碍和高自杀风险检出率均较高。述情障碍、抑郁、焦虑和自杀风险两两之间均成正相关;抑郁焦虑的情绪障碍在述情障碍和自杀风险中存在完全中介效应。     

焦虑障碍、抑郁障碍与焦虑抑郁障碍共病患者的功能失调性认知的比较

目的 :探讨焦虑症、抑郁症和焦虑抑郁障碍共病与功能失调性认知的关系。方法 :使用功能失调性态度量表 (DAS)、汉密尔顿抑郁量表 (HAMD)及汉密尔顿焦虑量表 (HAMA)对 3 5例抑郁症、 3 0例焦虑症及 3 0例焦虑抑郁障碍共病患者于治疗前后 ( 6～ 8周 )进行评定 ,并与 3 0名正常人进行对照。结果 :( 1)治疗前后三组DAS总分及各因子分均高于对照组 ;( 2 )焦虑抑郁障碍共病组治疗前后的DAS总分值及大多数因子分明显高于焦虑症组及抑郁症组 (P <0 0 5 ) ,而后两组间差异无显著性 (P >0 0 5 ) ;( 3 )三组DAS分值与各自相应的HAMD和 /或HAMA均无相关性。结论 :焦虑症、抑郁症及焦虑抑郁共病患者均存在明显的功能失调性认知 ,而非抑郁症所独具 ,且共病患者较前两者严重 (P <0 0 5 )。     

Adult separation anxiety disorder in DSM-5

Unlike other DSM-IV anxiety disorders, separation anxiety disorder (SAD) has been considered a disorder that typically begins in childhood, and could be diagnosed only in adults “if onset is before 18.” Moreover, SAD is the only DSM-IV anxiety disorder placed under “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence” whereas most anxiety disorders typically start – and are diagnosed – in childhood. Therefore, adult SAD may have been under-recognized and under-diagnosed. A literature review was carried out on behalf of the Anxiety, Obsessive–Compulsive Spectrum, Posttraumatic, and Dissociative Disorders DSM-5 workgroup to explore the evidence for SAD in adulthood, focusing on potentially relevant clinical characteristics and risk factors. The review revealed that SAD in adulthood is prevalent, often comorbid and debilitating. The DSM-IV age-of-onset criterion was not supported as a substantial portion of adults report first onset in adulthood. Research on putative risk factors is limited to childhood SAD: SAD runs in families, albeit patterns of familial aggregation and heritability estimates indicate low specificity. Tentative evidence for biomarkers and biased cognitive processes exists, again pointing to moderate SAD-specificity only. Further research on the epidemiology, etiology, and treatment of ASAD, using DSM-5 criteria, is needed, and particularly prospective-longitudinal studies to understand the developmental trajectories of separation anxiety disorder from childhood to adulthood.     

Separation Anxiety Disorder in Young Children: A Longitudinal and Family Analysis

We conducted a longitudinal study of young children with clinical, subclinical, or nonclinical levels of separation anxiety to evaluate the diagnostic stability and concomitant parent and family variables of separation anxiety disorder (SAD). Youngsters were assessed at age 3 years (n = 60) and 3.5 years later (n = 44). Data were collected from children, parents, teachers, and clinicians. Results revealed that most diagnoses of SAD were not stable during this developmental period, as many children drifted toward subclinical or nonclinical status. In addition, children with clinical SAD, compared to those with subclinical SAD or no symptoms of SAD, had a disproportionately higher number of comorbid diagnoses and experienced significantly greater somatic concerns, anxiety, and general internalizing behavior. In addition, their parents experienced greater depression, obsessive-compulsive behavior, phobic anxiety, and general distress. The results preliminarily support prior findings that most children experience a dissipation of SAD symptoms in young childhood but that some children continue to experience stable, significant distress. The results are consistent with prior research on older children that SAD remits for many but not all youth and suggest that parent and family variables may have much to do with cases of poor remission in this population.     

Recognizing increased risk of depressive comorbidity after myocardial infarction: looking for 4 symptoms of anxiety-depression

BACKGROUND: Screening for depression in myocardial infarction (MI) patients must be improved: (1) depression often goes unrecognized and (2) anxiety has been largely overlooked as an essential feature of depression in these patients. We therefore examined the co-occurrence of anxiety and depression after MI, and the validity of a brief mixed anxiety-depression index as a simple way to identify post-MI patients at increased risk of comorbid depression. METHODS: One month after MI, 176 patients underwent a psychiatric interview and completed the Beck Depression Inventory (BDI) and the Symptoms of Anxiety-Depression index (SAD(4)) containing four symptoms of anxiety (tension, restlessness) and depression (feeling blue, hopelessness). RESULTS: Thirty-one MI patients (18%) had comorbid depression and 37 (21%) depressive or anxiety disorder. High factor loadings and item-total correlations (SAD(4), alpha = 0.86) confirmed that symptoms of anxiety and depression co-occurred after MI. Mixed anxiety-depression (SAD(4)>or=3) was present in 90% of depressed MI patients and in 100% of severely depressed patients. After adjustment for standard depression symptoms (BDI; OR = 4.4, 95% CI 1.6-12.1, p = 0.004), left ventricular ejection fraction, age and sex, mixed anxiety-depression symptomatology was associated with an increased risk of depressive comorbidity (OR = 11.2, 95% CI 3.0-42.5, p < 0.0001). Mixed anxiety-depression was also independently associated with depressive or anxiety disorder (OR = 9.2, 95% CI 3.0-27.6, p < 0.0001). CONCLUSIONS: Anxiety is underrecognized in post-MI patients; however, the present findings suggest that anxiety symptomatology should not be overlooked in these patients. Depressive comorbidity after MI is characterized by symptoms of mixed anxiety-depression, after controlling for standard depression symptoms. The SAD(4) represents an easy way to recognize the increased risk of post-MI depression.     

The relationship between social anxiety disorder and alcohol use disorders: a critical review

Epidemiological studies have demonstrated a significant co-morbidity between social anxiety disorder (SAD) and alcohol use disorders (AUDs). Despite the fact that many studies have demonstrated strong relationships between SAD and AUD diagnoses, there has been much inconsistency in demonstrating causality or even directionality of the relationship between social anxiety and alcohol-related variables. For example, some studies have showed a positive relationship between social anxiety and alcohol-related variables, while others have shown a negative relationship or no relationship whatsoever. In an attempt to better understand the relationship between social anxiety and alcohol, some researchers have explored potential moderating variables such as gender or alcohol expectancies. The present review reports on what has been found with regard to explaining the high co-morbidity between social anxiety and alcohol problems, in both clinical and non-clinical socially anxious individuals. With a better understanding of this complex relationship, treatment programs will be able to better target specific individuals for treatment and potentially improve the efficacy of the treatments currently available for individuals with co-morbid SAD and AUD.     

Relationship between social anxiety disorder and body dysmorphic disorder

Social anxiety disorder (SAD) and body dysmorphic disorder (BDD) are two separate, but conceptually overlapping nosological entities. In this review, we examine similarities between SAD and BDD in comorbidity, phenomenology, cognitive biases, treatment outcome, and cross-cultural aspects. Our review suggests that SAD and BDD are highly comorbid, show a similar age of onset, share a chronic trajectory, and show similar cognitive biases for interpreting ambiguous social information in a negative manner. Furthermore, research from treatment outcome studies have demonstrated that improvements in SAD were significantly correlated with improvements in BDD. Findings from cross-cultural research suggest that BDD may be conceived as a subtype of SAD in some Eastern cultures. Directions for future research and clinical implications of these findings are discussed.     

Clarifying the Temporal Relationship between Dependent Personality Disorder and Anxiety Disorders

The relationship between dependent personality disorder (DPD) and several of the anxiety disorders is explored. Recent meta-analytic findings (this issue) suggest that DPD is comorbid with social phobia, obsessivecompulsive disorder, and panic disorder but not with the other anxiety disorders. Examination of comorbidity rates clarifies the relationship between DPD and specific anxiety disorders, but this method does not address many of the important questions concerning this relationship. It remains unclear whether DPD is associated with an increased risk for developing an anxiety disorder or whether anxiety disorders increase the risk of developing DPD. Additionally, if DPD does serve as a risk factor for the development of anxiety disorders, it is unclear whether this risk is clinically meaningful. Finally, causal mechanisms leading from DPD to anxiety disorder have not been examined and warrant future investigation. Examination of comorbidity rates between DPD and the anxiety disorders does not address many clinically relevant issues surrounding the DPD-anxiety relationship, but it does highlight important directions for future research.     

Differential Occurrence of Comorbidity Within Childhood Anxiety Disorders

Investigated differences in comorbidity in children ages 8 to 13 (N = 199) with primary diagnoses of generalized anxiety disorder (GAD), separation anxiety disorder (SAD), or social phobia (SP). Children with primary SAD were found to have the highest number of comorbid diagnoses. Specific phobias were more common in children with primary SAD than in those with primary SP, whereas neither group differed from children with primary GAD. Mood disorders were more common in children with GAD or SP than in children with primary SAD. Comorbid externalizing disorders, although present in 17% of the sample, were not found to vary across diagnostic groups. Functional enuresis was most common in children with primary SAD. Results are discussed with respect to diagnostic and treatment issues.     

High risk studies and developmental antecedents of anxiety disorders

The past two decades have witnessed significant growth in our understanding of the developmental antecedents of anxiety disorders. In this article, we review studies of offspring at risk for anxiety disorders, longitudinal studies of the course of anxiety disorders in clinical, epidemiologic, and at-risk samples, studies of hypothesized temperamental risk factors for anxiety, and give a brief overview of the literature on environmental risk factors. Clear developmental antecedents to anxiety disorders identified include (1) childhood anxiety disorders [in particular, separation anxiety and overanxious disorder/general anxiety disorder (GAD)], (2) behavioral inhibition which predicts later social phobia, (3) anxiety sensitivity which predicts later panic disorder, and (4) negative affectivity, which predicts a spectrum of psychopathology including anxiety disorders. Further prospective studies are needed to examine the roles of environmental factors such as parenting practices, peer influences, stressful life events, and perinatal stressors. Future studies could benefit from (1) beginning earlier in development and following individuals into adulthood, (2) assessing the overlap between multiple temperamental constructs, (3) greater use of observational measures of temperament and of parent-child and peer interactions, (4) greater attention to parental psychopathology which may confound associations noted, (5) exploration of other features of anxiety disorders (neurofunctional correlates, cognitive features, other aspects of emotional regulation) as potential precursors, and (6) intervention studies exploring whether modifying developmental antecedents can alter the course of anxiety disorders.     

Examining the Role of Anxiety Sensitivity in Sleep Dysfunction Across Anxiety Disorders

Anxiety Sensitivity (AS) has been associated with sleep difficulties in certain anxiety disorder populations, but no studies have examined cross-diagnostically the role of anxiety sensitivity in sleep dysfunction. Three hundred one participants with generalized anxiety disorder (GAD), social anxiety disorder (SAD), and panic disorder (PD) completed an ancillary questionnaire-based study. Linear regression was used to examine AS and sleep dysfunction, and mediation analyses were used to examine whether AS was a mediator of the effect of primary diagnosis on sleep. AS was associated with increased sleep dysfunction across anxiety disorders, and primary anxiety disorder diagnosis was significantly associated with sleep dysfunction. However, after controlling for AS, primary diagnosis was no longer significant. AS significantly mediated the effects of PD versus SAD and of PD versus GAD on sleep dysfunction, but did not significantly mediate the effect of GAD versus SAD on sleep dysfunction. Taken together, AS appears to be a more important predictor of sleep dysfunction overall, emphasizing the cross-diagnostic nature of AS and bolstering the RDoC initiative approach for treating psychological dysfunction.     

Pathways to comorbidity: the transition of pure mood, anxiety and substance use disorders into comorbid conditions in a longitudinal population-based study

BACKGROUND: To describe transitions to comorbidity within a 3-year period in three cohorts of subjects with at baseline a 12-month pure mood, anxiety or substance use disorder but no lifetime history of any other disorder category. To assess the role of personal and social vulnerability factors, life events, clinical factors and functional disability in the pathway to comorbidity. METHODS: Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective epidemiologic study of a representative sample of 7076 adults aged 18-65, interviewed in three waves (baseline, 1 and 3 years after baseline) with the Composite International Diagnostic Interview. RESULTS: 15.2% of 99 pure mood, 10.5% of 220 anxiety and 6.8% of 192 substance use disorder cases became comorbid. Comorbid transition from pure mood disorder was multivariately associated with higher age, external mastery and severity of the disorder. Comorbidity developing from pure anxiety disorder was associated with past and recent stressful life circumstances (childhood trauma, negative life events) and physical functional disability. Predictors of comorbid transition from pure substance use disorder were personal and social vulnerability variables only (high neuroticism, low social support). LIMITATIONS: Although NEMESIS was performed among a substantial number of cases, the number of cases with a pure disorder at baseline subsequently developing comorbidity was low. This limited analysing determinants of different comorbid conditions. CONCLUSIONS: Risk factors for comorbid transitions vary depending on whether subjects have a primary mood, anxiety or substance use disorder. Interventions aimed at primary prevention of comorbidity to reduce psychiatric burden in populations with a history of pure disorders are indicated in response to clearly identified risk factors.