Cognitive biases in childhood anxiety disorders: Do interpretive and judgment biases distinguish anxious youth from their non-anxious peers?

The purpose of this study was to compare interpretive biases (i.e., the tendency to interpret neutral stimuli in a negative way) and judgment biases (i.e., a lowered estimate of one's ability to cope with a threatening situation) in clinically anxious youth (n = 24) with a demographically matched group of non-referred youth (n = 48). Interpretive biases were assessed with the Children's Negative Cognitive Error Questionnaire (CNCEQ) and judgment biases were assessed with the Anxiety Control Questionnaire-child form (ACQ-C). Results indicated that (1) children in the clinic sample exhibited significantly more negative interpretive biases and less positive judgment biases relative to the control sample, (2) the ACQ-C demonstrated incremental validity over the CNCEQ in predicting diagnostic status, (3) the ACQ-C predicted diagnostic status while controlling for Generalized Anxiety Disorder symptoms and parent-reported internalizing and externalizing symptoms, (4) the relationship between the CNCEQ and diagnostic status was moderated by age and gender. Implications of the findings for theory and practice are discussed to highlight suggestions for future research and clinical practice.     

Mood,anxiety, and physical illness: body and mind,or mind and body?

This research review examines the recent articles that have investigated the relationship between mood, anxiety, and physical illness (e.g., asthma, autoimmune disorders, cancer, cardiovascular disease, obesity, and sexual dysfunction). There is growing evidence of an overall negative impact of depression and other mood states, and anxiety on numerous physical illnesses and conditions, and their outcome.     

Attentional biases in social anxiety and dysphoria: Does comorbidity make a difference?

This study examined whether comorbid symptoms influence the attentional biases associated with social anxiety and dysphoria using the Emotional Stroop Task (EST). Participants were recruited into three groups: a Social Anxiety group, a Dysphoric group, and a Social Anxiety/Dysphoric group. Four types of stimulus words were used: social anxiety threat, depressive threat, neutral words, and positive words. It was hypothesized that the Social Anxiety group would display an attentional bias to emotionally threatening stimuli whereas neither the dysphoric nor the Social Anxiety/Dysphoric group would display an attentional bias. Results found that the Social Anxiety group took longer to color name social threat and depressive words, whereas neither the Dysphoric nor the Comorbid group displayed an attentional bias. These results are discussed in light of their implications for cognitive theories of social anxiety and depression.     

Depression, anxiety, and somatoform disorders: Vague or distinct categories in primary care? Results from a large cross-sectional study

Objective

Depression, anxiety, and somatization are the most frequently observed mental disorders in primary health care. Our main objective was to draw on the often neglected general practitioners' (GPs) perspective to investigate what characterizes these three common mental diagnoses with regard to creating more suitable categories in the DSM-V and ICD-11.

Methods

We collected independent data from 1751 primary care patients (participation rate=77%) and their 32 treating GPs in Germany. Patients filled out validated patient self-report measures for depression (PHQ-9), somatic symptom severity (PHQ-15), and illness anxiety (Whiteley-7), and questions regarding coping and attribution of illness. GPs' clinical diagnoses and associated features were assessed.

Results

Patients diagnosed by their GPs with depression, anxiety, and/or somatoform disorders were significantly older, less educated, and more often female than the reference group not diagnosed with a mental disorder. They had visited the GP more often, had a longer duration of symptoms, and were more often under social or financial stress. Among the mental disorders diagnosed by the GPs, depression (OR=4.4; 95% CI=2.6 to 7.5) and comorbidity of somatoform, depressive, and anxiety disorders (OR=9.5; 95% CI=4.6 to 19.4) were associated with the largest degrees of impairment compared to the reference group. Patients diagnosed as having a somatoform/functional disorder only had mildly elevated impairment on all dimensions (OR=2.0; 95% CI=1.4 to 2.7). Similar results were found for the physicians' attribution of psychosocial factors for cause and maintenance of the disease, difficult patient-doctor relationship, and self-assessed mental disorder.

Conclusion

In order to make the DSM-V and ICD-11 more suitable for primary care, we propose providing appropriate diagnostic categories for (1) the many mild forms of mental syndromes typically seen in primary care; and (2) the severe forms of comorbidity between somatoform, depressive, and/or anxiety disorder, e.g., with a dimensional approach.     

Visual letter matching: hemispheric functioning or scanning biases?

Finding two mixed-case letters that share the same name is easier to do when the letters are presented in opposite visual fields than when they are both in the same field. By contrast, finding a match between two same-case letters is easier when they are in the same field. These visual field effects have been attributed to the ability of the corpus callosum to coordinate the work of the cerebral hemispheres [Banich, M. T. (1998). The missing link: The role of interhemispheric interaction in attentional processing. Brain and Cognition, 36, 128-157; Weissman, D. H., & Banich, M. T. (2000). The cerebral hemispheres cooperate to perform complex but not simple tasks. Neuropsychology, 14, 41-59]. The present study considers the alternative hypothesis that attentional scanning biases may be at work. Experiment 1 examined the effects of explicit instructions to scan items in a specific order; Experiment 2 examined influences of implicit location biasing; Experiment 3 considered the possibility that same-case letter matching is different because a perceptual grouping mechanism can be used in that task. In each experiment, we first interpreted the results within the hemispheric framework before considering the alternative accounts. We concluded that two scanning biases may be in effect: (1) an automatic bias favoring items in locations relatively distant from the current focus of attention and (2) a learned bias to scan letters in a left-to-right direction.     

Separation anxiety in adulthood: dimensional or categorical?

Recent evidence suggests that a clinical form of separation anxiety can be observed in adults. An important question of relevance to defining the construct of adult separation anxiety is whether there is discontinuity between that constellation and other forms of anxiety. In the present study, 2 taxometric procedures - Mean Above Minus Below a Cut and Maximum Eigenvalue - were used to assess whether adult separation anxiety conformed primarily to a categorical or a dimensional pattern. The data were derived from a separation anxiety symptom questionnaire completed by 840 consecutive adult patients attending an anxiety disorders clinic. Although some results of the analysis were ambiguous, the overall findings suggested a dimensional pattern. The relevance of the finding to the status of adult separation anxiety is discussed.     

Music and anxiety in Williams syndrome: a harmonious or discordant relationship?

In this two-part study, we assessed musical involvements in two samples of persons with Williams syndrome compared to others with mental retardation and also related musicality to anxiety and fears in Study 2. Relative to others with mental retardation, those with Williams syndrome were more likely to take music lessons, play an instrument, and have higher ratings of musical skills. In the Williams syndrome groups only, fewer externalizing symptoms were associated with listening to music, whereas less anxiety and fewer fears were associated with the frequency, duration, and skill in producing music as well as emotional responses to negatively toned music. Implications are discussed for future research on musical processing, musical interventions, and well-being in Williams syndrome and other groups.     

Comorbid anxiety and depression: bête noire or quick fix?

The common territory shared by anxiety and depression has always been a contentious subject. Research in favour of anxious depression as a potentially treatment-relevant subtype has been limited by diagnostic dilemmas and crude measurement. The most recent evidence from genetics, neuropeptide systems and functional neuroimaging suggests a valid diagnostic construct.     

Suicidal ideation and anxiety disorders: elevated risk or artifact of comorbid depression?

Research into the possible relationship between anxiety disorders and suicidal ideation has yielded mixed results, leading some to suggest that the positive findings between anxiety and suicidal ideation might simply be a by-product of comorbid depression. Recent work has suggested that having an anxiety disorder without history of mood disorder does convey increased risk for suicidal ideation, although the study could not assess for the possible impact of subsyndromal depressiveness. This current study, therefore, examined the relationship between anxiety disorder symptoms and suicidality using continuous scales and controlling for depressiveness. Data regarding the severity of panic, social anxiety, generalized anxiety, and obsessive-compulsive symptoms were obtained from a sample of 166 college students. Results generally supported the conclusions that anxiety disorders convey risk for suicidal ideation above and beyond any co-occurring depressiveness, and anxiety and depression together conveyed an additional interactive risk.     

High altitudes,anxiety, and panic attacks: is there a relationship?

People exposed to high altitudes often experience somatic symptoms triggered by hypoxia, such as breathlessness, palpitations, dizziness, headache, and insomnia. Most of the symptoms are identical to those reported in panic attacks or severe anxiety. Potential causal links between adaptation to altitude and anxiety are apparent in all three leading models of panic, namely, hyperventilation (hypoxia leads to hypocapnia), suffocation false alarms (hypoxia counteracted to some extent by hypocapnia), and cognitive misinterpretations (symptoms from hypoxia and hypocapnia interpreted as dangerous). Furthermore, exposure to high altitudes produces respiratory disturbances during sleep in normals similar to those in panic disorder at low altitudes. In spite of these connections and their clinical importance, evidence for precipitation of panic attacks or more gradual increases in anxiety during altitude exposure is meager. We suggest some improvements that could be made in the design of future studies, possible tests of some of the theoretical causal links, and possible treatment applications, such as systematic exposure of panic patients to high altitude.     

Mitochondrial amyloid-beta peptide: pathogenesis or late-phase development?

Mitochondrial and metabolic dysfunction have been linked to Alzheimer's disease for some time. Key questions regarding this association concern the nature and mechanisms of mitochondrial dysfunction, and whether such changes in metabolic properties are pathogenic or secondary, with respect to neuronal degeneration. In terms of mitochondria and Alzheimer's, altered function could reflect intrinsic properties of this organelle, potentially due to mutations in mitochondrial DNA, or extrinsic changes secondary to signal transduction mechanisms activated in the cytosol. This review presents data relevant to these questions, and considers the implication of recent findings demonstrating the presence of amyloid-beta peptide in mitochondria, as well as intra-mitochondrial molecular targets with which it can interact. Regardless of the underlying mechanism(s), it is likely that mitochondrial dysfunction contributes to oxidant stress which is commonly observed in brains of patients with Alzheimer's and transgenic models of Alzheimer's-like pathology.     

Childhood rituals: normal development or obsessive-compulsive symptoms?

The symptoms of obsessive compulsive disorder (OCD) have been viewed as extreme variants of normal developmental rituals and superstitiousness; however, difference in timing, content, and severity argue against this continuum. In a systematic comparison of 38 children with severe primary OCD and 22 matched normal controls, parents were interviewed about their child's early developmental rituals and current superstitions. Children were asked about superstitious beliefs. Children with OCD did not differ significantly from controls in number or type of superstitions. However, parents of the OCD children reported significantly more "marked" patterns of early ritualistic behavior than did parents of normal controls. When behaviors resembling primary OCD symptoms were excluded, other rituals did not differ leaving open the possibility that such behaviors were early manifestations of the disorder. Only a prospective study can determine whether these results reflect preclinical OCD or are an artifact of biased recall.     

Depersonalization disorder and anxiety: a special relationship?

A significant association between anxiety and depersonalization has been found in healthy controls and psychiatric patients irrespective of underlying conditions. Although patients with depersonalization disorder (DPD) often have a history of severe anxiety symptoms, clinical observations suggest that the relation between anxiety and depersonalization is complex and poorly understood. Using relevant rating scales, levels of anxiety and depersonalization were assessed in 291 consecutive DPD cases. 'High' and 'low' depersonalization groups, were compared according to anxiety severity. Correlation and multivariate regression analyses were also used to assessed the contribution of anxiety to the phenomenology and natural course of depersonalization. A low but significant association between depersonalization and anxiety (as measured by Beck's Anxiety Inventory) was only apparent in those patients with low intensity depersonalization, but not in those with severe depersonalization. Levels of anxiety did not seem to make specific contributions to the clinical features of depersonalization itself, although DPD patients with high anxiety seem characterised by additional non-specific perceptual symptoms. The presence of a 'statistical dissociation' between depersonalization and anxiety adds further evidence in favour of depersonalization disorder being an independent condition and suggests that its association with anxiety has been overemphasized.     

Do depression and anxiety converge or diverge in their association with suicidality?

Depressive disorders have been strongly linked to suicidality, but the association with anxiety disorders is less well established. This exploratory study aims to examine whether anxiety and depressive disorders are both independent risk factors for suicidal ideation and attempted suicide, and additionally examined the role of specific clinical characteristics (disorder type, severity, duration, onset age) in suicidality. Data are from 1693 persons with a current (6-month) CIDI based depressive or anxiety disorder and 644 healthy controls participating in the baseline measurement of the Netherlands Study of Depression and Anxiety, which is an existing dataset. Suicidal ideation in the week prior to baseline and attempted suicide ever in life were assessed. Results showed that compared to persons with only an anxiety disorder, persons with a depressive disorder were at significantly higher risk to have current suicidal ideation or a history of attempted suicide. When examining the association between type of disorder and suicidality the odds ratio for MDD was significantly higher than those for the separate anxiety disorders. Although depression and anxiety severity were univariate risk indicators for suicidal ideation and attempted suicide, only depression severity remained a risk indicator for suicidal ideation and attempted suicide in multivariate analyses. Additional risk indicators were an early age at disorder onset for both suicidal ideation and attempted suicide, male gender for suicidal ideation and lower education for attempted suicide. These findings suggest that although anxiety and depression tend to converge in many important areas, they appear to diverge with respect to suicidality.