Anxiety in depressive disorders

In this psychopathological study, the subjective experience of anxiety was investigated in depressive patients by means of a semistructured interview. Both International Classification of Diseases-9 (ICD-9) diagnostic criteria (melancholia or neurotic depression; N = 160 or 93, respectively) and the DSM-III classification system (major depressive episode with or without "melancholia"; N = 63 or 153, respectively) were applied. Anxiety can be identified in virtually all patients examined. In contrast, the themes of anxiety are subject to substantial differences. There is a statistically significant correlation between the extent of anxiety and the severity of depression by the Hamilton Depression Scale (Ham-D). However, a distinction between anxiety and depression is possible in the majority of cases if the contents of anxiety are taken into account.     

Unintended pregnancy and depressive symptoms among first-time mothers and fathers

The consequences of unintended first pregnancy on the mental health of cohabitating couples (N = 124) were examined in the third trimester of pregnancy and at four months postpartum. Results indicated that the influence of unintended pregnancy on parental depressive symptoms is complex and via different mechanisms for men and women. Pregnancy viewed as unintended by males and intended by their partners appeared to pose the greatest risk for postpartum depressive symptoms, particularly in women.     

Anxiety disorders in mothers and their children: prospective longitudinal community study

The relationship between DSM-IV anxiety disorders and their clinical characteristics in mothers and anxiety in offspring was examined in 933 mother-child pairs from a longitudinal community study. Offspring of mothers with an anxiety disorder had an elevated risk of developing any anxiety disorder, compared with offspring of mothers with no anxiety disorder. Increased risk of anxiety in the offspring was especially associated with maternal social phobia and generalised anxiety disorder, and with maternal diagnoses of early onset, greater number and more severe impairment. These results suggest that the type of maternal anxiety disorder and its severity of manifestation contribute to mother-offspring aggregation of anxiety.     

Psychiatric illness in the mothers of anxious children

The authors compared maternal lifetime psychiatric illness for children with separation anxiety disorder and/or overanxious disorder (N = 58) and for children who were psychiatrically disturbed but did not manifest an anxiety or affective disorder (N = 15). The vast majority (83%) of mothers of children with separation anxiety disorder and/or overanxious disorder had a lifetime history of an anxiety disorder. Moreover, over one-half (57%) of the mothers presented with an anxiety disorder at the same time at which their children were seen for similar problems. Both of these rates significantly differed from those obtained for control subjects.     

Anxiety and depressive disorders in tobacco dependence

The association between tobacco dependence and various forms of anxiety and depressive disorders is well established. The presence of these disorders constitutes a key cause of failure in subjects seeking to stop smoking. In addition to the clinically manifest forms of such anomalies, systematic screening for minor forms of these disorders was performed at the Centre for Tobacco Studies of Créteil, France; as well as the standard questionnaire concerning personal and familial history and current psychological well-being, subjects were asked to complete two self-questionnaires, the HAD (Hospital Anxiety Depression score) and the BDI (Beck Depression Inventory, abridged version) together with the MINI (structured mini-interview). In a series of 400 heavy smokers, sub-syndromes of such anxiety and depressive disorders were noted in 34% of subjects, and a combination of anxiety and depressive disorders was seen in 2/3 of these subjects, mainly general anxiety and social phobia, which were frequently preceded by depressive episodes. In these forms of tobacco dependence with anxiety and depressive disorder, relapse was very common in spite of nicotine substitution therapy (NST), usually as a result of a depressive episode that tended to subside very rapidly on resumption of cigarette smoking. Psychotropic therapy involving selective serotonin reuptake inhibitors (SSRIs) coupled with NST resulted in lasting success accompanied by an often unexpected and spectacular improvement in psychological status. These findings confirm the role of mood disorders in tobacco addiction in keeping with other types of addiction.     

Imipramine and chlordiazepoxide in depressive and anxiety disorders. II. Efficacy in anxious outpatients

A double-blind, placebo-controlled comparison at three collaborating university sites included 242 patients diagnosed as having anxiety disorders. A two-week placebo washout period preceded random assignment to eight weeks of imipramine hydrochloride, chlordiazepoxide hydrochloride, or placebo treatment. Antianxiety effects of imipramine were superior to those of the other two agents by the second treatment week; these effects became more clearly significant thereafter and were independent of degree of both baseline depression and anxiety. Excluding patients with possible panic-phobic syndromes from the analyses removed most significant antiphobic and antidepressant effects of imipramine but left intact imipramine's significantly superior antianxiety effects.     

Depression in mothers and fathers of children with intellectual disability

Parental depression was assessed using the Beck Depression Inventory (BDI) in 216 families with children with autism and/or intellectual disability (ID), and in 214 control families. Mothers with children with autism had higher depression scores (mean = 11.8) than mothers of children with ID without autism (mean = 9.2), who in turn, had higher depression scores than fathers of children with autism (mean = 6.2), fathers of children with ID without autism (mean = 5.0), and control mothers (mean = 5.0) and fathers (mean = 4.1). Forty‐five per cent of mothers with children with ID without autism and 50% of mothers with children with autism had elevated depression scores (BDI > 9), compared to 15–21% in the other groups. Single mothers of children with disabilities were found to be more vulnerable to severe depression than mothers living with a partner.     

Anxiety disorders in children

The nature, development and treatment of anxiety disorders in children remains one of the most neglected areas of research in psychopathology. This paper reviews current approaches to diagnosis, conceptualization, assessment and treatment of the major childhood anxiety disorders: separation anxiety, overanxious and avoidant disorders, and simple phobias. While considerable knowledge of the learning mechanisms involved in phobias is available and has been translated into effective interventions, much else remains in the realm of speculation. High priorities for attention include the biological bases of anxiety and evaluation of medication for severe cases, the role of family variables, the long term outcome of childhood anxiety, and the validity of current diagnostic systems     

Behavioural and emotional problems in children of alcoholic mothers and fathers

 The Child Behavior Check List (CBCL) was used to compare a sample of 103 Danish children of alcoholics (CoA) to a Danish population-based sample (N = 780). The CoA had a significantly greater incidence of symptoms on 17 of the 118 CBCL items. Compared to the reference population, daughters of alcoholics were more impaired than sons of alcoholics on most CBCL measures. In families with maternal alcoholism daughters had higher internalising and depression scores than sons, and in families with paternal alcoholism, sons had higher internalising and depression scores than daughters. The CoA also had a significantly greater risk of scoring above the 95th percentile on internalising behaviour, depression symptoms and socially deviant behaviour. On all CBCL dimensions, almost half of the CoA samples functioned as well as the average of the reference population. The results from this study suggest that CoA should be regarded as a risk group but with very heterogeneous consequences in response to parental alcoholism. Accepted: 29 November 1999     

Anxiety disorders and depressive disorders preceding Parkinson's disease: a case-control study.

We studied the association between preceding psychiatric disorders and Parkinson's disease (PD) using a case-control design. We used the medical records-linkage system of the Rochester Epidemiology Project to identify 196 subjects who developed PD in Olmsted County, Minnesota, during the years 1976-1995. Each case was matched by age (+/-1 yr) and sex to a general population control. We reviewed the complete medical records of cases and control subjects to detect preceding psychiatric disorders. The frequency of psychiatric disorders was higher in cases than in control subjects; the odds ratio was 2.2 for anxiety disorders (95% confidence interval [95% CI] = 1.4-3.4; p = 0.0003), 1.9 for depressive disorders (95% CI = 1.1-3.2; p = 0.02), and 2.4 for both anxiety disorders and depressive disorders occurring in the same individual (95% CI = 1.2-4.8; p = 0.02). When we restricted analyses to disorders present 5 years or more before the onset of motor symptoms of PD, the association with depressive disorders lost statistical significance. However, the association with anxiety disorders remained significant for disorders present 5, 10, or 20 years before onset of motor symptoms. Our results suggest that anxiety disorders and depressive disorders are associated with PD and that the causative process or the risk factors underlying PD are present many years before the appearance of motor symptoms.     

Neuropsychological functioning in adolescent children of mothers with a history of bipolar or major depressive disorders.

BACKGROUND: Growing evidence demonstrates an association of neuropsychological deficits with mood disorders, but it is not yet clear whether these deficits are risk factors or are concomitant with the symptoms. This study examines the neuropsychological functioning of a group of adolescent offspring who are at risk for a mood disorder by virtue of being raised by mothers who have been diagnosed with major depressive disorder (MDD) or bipolar disorder (BPD). METHODS: Adolescent offspring of mothers with BPD (n = 43) or MDD (n = 72) and of psychiatrically well parents (n = 50) completed a battery of neuropsychological tests to assess executive functioning, memory, and attention. RESULTS: Children of mothers with BPD showed deficits in executive functioning and selective deficits in spatial memory and attention, in comparison with children of well mothers. Deficits were not found for children of MDD mothers. CONCLUSIONS: Knowledge of these neurocognitive processes could aid ultimately in determining whether neurocognitive deficits precede BPD, whether unique profiles are associated with various types of mood disorders, and who may benefit from interventions.     

Deliberate emotional expressions of socially anxious children and their mothers

The aim of the present study was to investigate whether socially anxious children show deficits in their deliberate facial expression of emotions. To test for potential mother-child transmission effects, the mothers' facial expressions were also assessed. Fifty socially anxious and 25 socially nonanxious children (8-12 years) and their mothers participated in a facial expression posing task. The expressions produced were coded using Ekman and Friesen's (1978) Facial Action Coding System (FACS). In addition, naive raters rated their quality of emotion. FACS analyses indicated that socially anxious children show a reduced general facial activity, have a more restricted facial repertoire and differ qualitatively from controls in their facial expression of emotions. Similarly, the global ratings indicated that the socially anxious children's posed facial expressions are less accurate. For the mothers no differences between groups were found when global ratings were used. However, the FACS data demonstrate that the facial expressions of mothers of socially anxious children are less intense compared to controls. It is possible that the decreased intensity of the mothers' facial expressiveness makes it more difficult for the socially anxious children to learn adequate facial expressions.     

Anxiety disorders in children and adolescents

Summary

Bioactive lipids, in particular arachidonic acid (AA), are vital for monoaminergic neurotransmission, brain development and synaptic plasticity. Phospholipases A2 (PLA2) are key-enzymes in AA metabolism and are activated during monoaminergic neurotransmission. Reduced membrane AA levels, and an altered activity of PLA2 have been found in peripheral membranes of drug-naïve patients with schizophrenia with some conflicting results in more chronic patient populations. Furthermore, in vivo brain phosphorus-31 magnetic resonance spectroscopy suggests reduced lipid membrane precursors (phosphomonoesters) and increased membrane breakdown products (phosphodiesters) in drug-naïve or early treated first-episode schizophrenia patients compared to age-matched controls or chronic populations and these changes were correlated with peripheral red blood cell membrane AA levels. We postulate that processes modulating membrane lipid metabolism are associated with psychotic illnesses and might partially explain the mechanism of action of antipsychotic agents, as well as experimental agents such as purified ethyl-eicosapentaenoic acid (E-EPA). Recent supplementation trials suggest that E-EPA is a modestly effective augmentation treatment resulting in reduced doses of antipsychotic medication in acutely ill patients with schizophrenia (but not in residual-type schizophrenia). This review investigates the role of bioactive lipids in schizophrenia and its treatment, as well as its potential use in prevention.     

Parenting dimensions in mothers and fathers of children with Autism Spectrum Disorders

Rearing a child with Autism Spectrum Disorder (ASD) is a unique challenge for both parents. Previous studies addressed how mothers are affected by the challenges of raising a child with ASD, mostly in terms of stress pattern. In this study, we focused on comparisons between mothers and fathers of children with ASD in parental stress, attitude and mental health. We examined 99 parents of children with ASD using the Parenting Stress Index-Short Form, the Parental Style Questionnaire, the Self-Perceptions of the Parental Role and the Symptom Checklist-90-Revised. The results revealed the gender differences in the parental attitude and mental health. Mothers reported that they engaged in more social behaviors with their children than fathers. In addition mothers reported higher level of depression than fathers. No difference among parents emerged in the Parenting Stress Index-Short Form. The results of a multiple regression analysis revealed that parenting distress is associated with depression, balance of parents’ diverse roles in their life and dysfunctional interaction between parents and children. These findings highlight both similarities and differences between mothers and fathers of children with ASD and the existence of a relationship between parental stress, mental health and attitude. Results suggest the importance of developing specific intervention programs which incorporate these fundamental parenting domains.     

Predictors of stress in mothers and fathers of children with fragile X syndrome

This study examined parental and family stress and functioning where there is a child with fragile X syndrome. Mothers and fathers in 40 families were asked about their child with fragile X syndrome, family supports, their psychological stress, the marital relationship, and their family stress. Results indicate parents were well adjusted in terms of their levels of psychological stress and in their marital relationships, however, parents reported high levels of family stress. Mothers and fathers were found to experience similar levels of stress and to report similar levels of satisfaction with supports. Stress was predicted by different variables in mothers and fathers, suggesting that different processes underlie their experiences. The strongest predictor of maternal stress was the level of marital satisfaction while the strongest predictor of paternal stress was the level of the child's adaptive skills.     

Anxiety and depression in children with epilepsy and their mothers

OBJECTIVE: Children with epilepsy have high rates of depression and anxiety. The majority of studies concentrate on the children with epilepsy, but the emotional impact of epilepsy on family members is of clinical concern. In this cross-sectional study we aimed to examine the association between epilepsy in childhood and adolescence, and anxiety and depression in these patients and their mothers. METHODS: We studied 35 children and adolescents with seizures (age range, 7-19 years), 35 gender-matched healthy controls (age range, 8-17) who did not have any chronic medical illness, and mothers of these individuals (n=70) in a cross-sectional analysis. We administered the Kovac Child Depression Inventory (CDI) and State-Trait Anxiety Inventory for Children (STAIc) to the children. We administered the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) to the mothers of these children. Pearson correlations were used to analyze dependence between variables, and Student's t test was used to compare mean values between test scores. RESULTS: Patients with epilepsy had higher CDI scores (mean+/-SD, 12.48+/-6.35) than controls (9.31+/-5.11) (P<0.05), whereas the STAIc scores did not differ between cases (34.03+/-8.29) and controls (35.20+/-6.23) (P<0.05). Mothers of children with epilepsy did not have more depression or anxiety symptoms than mothers of children without epilepsy as measured by BDI and STAI scores (P>0.05). There was no correlation between mothers' scores and patients' or controls' scores. CONCLUSIONS: These results support findings from previous studies that children and adolescents with epilepsy have a higher frequency of depressive but not anxiety symptoms than the general population of healthy children and that this is independent of their mothers' symptoms.     

儿童青少年焦虑与抑郁障碍共病的临床研究

目的了解焦虑和抑郁障碍患儿中焦虑与抑郁共病的发生率和行为特点。方法在门诊收集符合中国精神障碍分类与诊断标准第3版中焦虑障碍和抑郁障碍诊断标准的5～17岁儿童青少年,其中单纯焦虑障碍41例(焦虑组),单纯抑郁障碍31例(抑郁组),焦虑与抑郁共病31例(共病组)。由父母、儿童、医师分别采用自编一般资料表、Achenbach儿童行为量表(CBCL)、儿童焦虑性情绪障碍筛查表(SCARED)、儿童抑郁障碍自评量表和儿童大体评定量表,评定三组儿童。结果(1)焦虑障碍患儿有16%(8例)合并抑郁;抑郁障碍患儿有42%(23例)合并焦虑。(2)CBCL焦虑组的活动情况及社会能力总分[(15.74±3.65)分]优于共病组[(12.98±4.00)分]和抑郁组[(14.02±3.67)分],均P<0.01和<0.05;共病组行为问题总分[(61.74±28.96)分]高于焦虑组[(43.44±22.54)分]和抑郁组[(47.74±25.99)分;F=4.62,P<0.05]。(3)SCARED共病组的总分高于焦虑组和抑郁组(P<0.05)。(4)儿童抑郁障碍自评量表抑郁组和共病组总分高于焦虑组(P<0.01)。(5)儿童大体评定量表焦虑组[(67.71±9.54)分]优于抑郁组[(58.55±8.08)分]和共病组[(61.16±7.60)分;F=11.10,P<0.001]。结论儿童焦虑、抑郁共病现象常见,共病患儿比单纯焦虑或抑郁患儿的内化性问题、外化性问题更严重,社会功能损害更明显。     

In-home observations of young Down syndrome children with their mothers and fathers

Sixteen mothers, fathers, and their 4- to 7-year-old children were observed interacting in their homes during three family groupings: (a) mother and child, (b) father and child, and (c) mother, father, and child. Half the children had Down syndrome and half were nonhandicapped. Parents of children with Down syndrome structured their interactions with their offspring by assuming manager and teacher roles more often than did parents of nonhandicapped children. Children with Down syndrome were less contingently responsive to both parents than were nonhandicapped children. Mothers of Down syndrome children assumed the teacher role more often than fathers did. Fathers of both groups of children interacted less with their offspring in the triadic family grouping, whereas mothers were more consistent, assuming a parenting role across family contexts.