Interrelationships among anxiety, aggression, impulsivity, and mood: a serotonergically linked cluster?

Serotonin abnormalities appear to be related to a variety of psychopathological dimensions such as anxiety, depressed mood, impulsivity, and aggression dysregulation. We hypothesized that the psychopathological dimensions related to serotonin would be significantly intercorrelated since they seem to have a common biological basis. Sixty psychiatric inpatients were examined on a series of psychometric tests measuring suicidality, violence potential, impulsivity, depressive mood, and anxiety. The scores on all of these measures tended to be significantly correlated with one another. These findings support the additional hypothesis that biological markers may be more closely related to basic psychological dimensions than to nosological categories.     

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.     

Suicidality in panic disorder: a comparison with schizophrenic, depressed, and other anxiety disorder outpatients

Recent findings by Weissman, Klerman, Markowitz, and Ouellette (1989) that subjects with panic disorder, with and without comorbid conditions, may be at increased risk for suicide attempts have been controversial. In an attempt to further investigate this finding, we utilized the original National Institute of Mental Health Epidemiological Catchment Area (ECA) suicide questions in an outpatient psychiatric clinic. We examined patients with panic disorder (n = 101). other anxiety disorders (n = 47), schizophrenia (n = 22). and major depression (n = 19). No significant differences were found among all four groups on any of the ECA suicide ideation questions. Only two (2%) of the panic disorder patients and none of the other groups made a suicide attempt in the past year. While 17% of patients with panic disorder and 9% of patients with other anxiety disorders reported having made a suicide attempt at some other time in their life, the schizophrenic (33%) and depressed groups (40%) reported significantly greater histories of suicide attempts. In a forward stepwise regression analysis for panic disorder patients, a history of substance abuse and comorbid depression predicted suicidality. The actual clinical risk for suicide attempts in panic disorder patients appears to occur when they suffer with comorbid diagnoses. These results highlight the need to aggressively treat panic disorder patients so they do not suffer the all-too-common sequelae of depression and substance abuse.     

Substance use disorders: Relationship with intermittent explosive disorder and with aggression,anger, and impulsivity

BackgroundA relationship between substance use and aggression has been noted for decades. While substance use appears to be associated with an increased risk of aggressive behavior, no study has yet reported on the pattern of comorbidity and temporal relationship between impulsive aggression (i.e., intermittent explosive disorder) and substance use disorders (SUD), specifically.MethodsTo specify these relationships, we examined DSM-5 diagnosis data from diagnostic interviews of 1355 adults who met one of five non-overlapping diagnostic subgroups: those with intermittent explosive disorder (IED; n = 339), those with SUD (n = 136), IED+SUD (n = 280), adults with psychiatric disorders but no SUD or IED (n = 320), and healthy Controls: HC, n = 282).ResultsOccurrence of lifetime SUD was elevated in IED vs. all Non-IED subjects (Odds Ratio: 3.61 [95% CI: 2.82–4.63]) and onset of IED preceded SUD in 80% of comorbid IED+SUD cases. Examination of the severity of impulsive aggression and SUD revealed that IED increased SUD severity but the presence of SUD did not increase severity of IED core features, including aggression, anger, or impulsivity.ConclusionsSubjects with IED are at increased risk of developing substance use disorder, compared to those without IED. This suggests that history of recurrent, problematic, impulsive aggression is a risk factor for the later development of SUD rather than the reverse. Thus, effective treatment of impulsive aggression, before the onset of substance misuse, may prevent or delay the development of SUD in young individuals.     

Anxiety,impulsivity and depressed mood in relation to suicidal and violent behavior

Many different variables have been associated with suicidal behavior as well as with violent behavior. This study was designed to test a model that attempts to relate such variables to violence and suicide risk. Sixty psychiatric patients were evaluated and divided into suicidal and nonsuicidal groups and then into violent and nonviolent groups. Scores on suicide risk, violence risk, anxiety, anger, impulsivity and mood were then compared between these groups. In a second analysis, scores on suicide risk and violence risk were correlated with all the other variables. Anxiety and impulsivity were found to strongly correlate with suicide risk. Angry and resentful mood correlated with violence risk; trait anxiety correlated negatively with violence risk. The results contribute further insight into the authors' two-stage model of countervailing forces.     

CSF testosterone: relationship to aggression, impulsivity, and venturesomeness in adult males with personality disorder

OBJECTIVE: Studies of various species suggest that testosterone, assayed in various compartments, is correlated with aggression and possibly related behaviors. The objective of this study was to assess the relationship between cerebrospinal fluid testosterone (CSF TEST) and measures of aggression, impulsivity, and venturesomeness in male personality disordered subjects and test the hypothesis that CSF TEST would correlate directly with each measure in this group. METHODS: Lumbar CSF for morning basal levels of testosterone were obtained from 31 male subjects with personality disorder. Aggression was assessed dimensionally through the use of the life history of aggression (LHA) assessment, and categorically by the research diagnosis of intermittent explosive disorder. Impulsiveness and venturesomeness were assessed using the Eysenck personality questionnaire - II (EPQ-II). RESULTS: CSF TEST did not correlate with measures of aggression or impulsivity but did correlate directly with venturesomeness (r = .42, p = .021). Adjusting for age and height modestly reduced the magnitude and statistical significance of this correlation. CONCLUSIONS: In contrast to some published studies, CSF TEST was not found to have a significant relationship with aggression. The presence of a modest correlation between CSF TEST and venturesomeness, but not impulsivity, in male personality-disordered subjects suggests a possible relationship between CSF TEST and a type of sensation-seeking that involves consideration of the consequences of action taken.     

Anger and parent-to-child aggression in mood and anxiety disorders

The relationship between anger and parent-to-child aggression (PTCA) was examined in mothers presenting for treatment of mood and anxiety disorders, because parental anger may have adverse effects on children and anger may decrease with treatment. Anger's role as mediator and moderator of the effects of the following predictors on PTCA was assessed: depression, anxiety, and ecologic variables that can induce or buffer against stress (partner verbal aggression, satisfaction with and perceived availability of social support, socioeconomic status, and number of children). Anger was found to mediate the effects of depression, partner verbal aggression, satisfaction with social support, and number of children on PTCA. Anger also had significant effects on PTCA after controlling for these variables. The other predictors did not have effects on PTCA, and anger did not moderate their effects. If replicated, these findings suggest the importance of examining whether treatment to reduce parental anger will reduce PTCA.     

Laboratory measures of aggression and impulsivity in women with borderline personality disorder.

To characterize how severe negative affect in women is reflected in objective measures of aggression and impulsivity, the aggressive and impulsive behavior of 14 hospitalized women with borderline personality disorder (BPD) was compared with that of 17 controls. In an impulsivity task, subjects experienced two sets of 50 trials during which they could choose a smaller, immediate monetary reward or a larger but progressively delayed reward. In a separate task (PSAP), subjects earned monetary reinforcers with repeated button presses, and were provoked by the subtraction of money which was blamed on a fictitious other participant. Subjects could respond by ostensibly subtracting money from the fictitious subject (the aggressive response). While selection frequency of the short-delay responses was similar in patients and controls, BPD patients responded to avoid longer delay of reward across trials, and had higher Barratt Impulsiveness Scale total scores and attentional subscale scores. BPD patients responded to the money losses with roughly three times as many aggressive responses as controls and had higher Buss-Durkee Hostility Inventory (BDHI), Brown History of Violence, and Retrospective Overt Aggression Scale scores than controls. Aggressive responding rates correlated positively with BDHI scores. These results extend previous findings that negative affect in women is reflected in laboratory behavioral measures.     

Correlation between anxiety and oppositionality in a children's mood and anxiety disorder clinic.

OBJECTIVE: While parents and clinicians have described oppositional features as interfering with the management of children with anxiety, research on this relation is lacking. We designed this study to investigate the presence of oppositional symptoms in children presenting with mood and anxiety symptoms. METHOD: In a mood and anxiety disorders clinic, we used the DSM-IV Child Symptom Inventory to document the presence and correlates of oppositional defiant symptoms in 145 preadolescents assessed during a 2-year period. RESULTS: Oppositional defiant symptoms were found to correlate (P < 0.01) with generalized anxiety symptoms in both parent and teacher ratings. Correlations remained significant after controlling for the presence of symptoms of attention-deficit hyperactivity disorder (ADHD). Parents found both boys and girls to be equally oppositional, while teachers found boys to be significantly more oppositional. CONCLUSION: Oppositional features are found in clinically referred children with anxiety and are potentially significant for treatment and prognosis of anxiety disorders in children.     

Incompleteness,harm avoidance,and disgust: A comparison of youth with OCD,anxiety disorders,and no psychiatric disorder

Psychological models of pediatric obsessive-compulsive disorder (OCD) place a heavy emphasis on harm avoidance as a maintaining factor and target for treatment. Incompleteness and disgust may also play a role in pediatric OCD but remain understudied. Youth with OCD (n = 100), anxiety disorders (n = 96), and no impairing psychiatric symptoms (n = 25) completed self-report measures of trait-level incompleteness, harm avoidance, and disgust and current symptoms of OCD, anxiety, and depression. Group differences and associations between emotions, symptoms, and pre- to post-treatment change in overall OCD severity were examined. Youth with OCD and anxiety disorders scored higher on harm avoidance and disgust than youth with no psychiatric disorder. Youth with OCD scored higher on incompleteness than youth with anxiety disorders and youth with no psychiatric disorder. Harm avoidance showed unique associations to self-reported symptoms of OCD, anxiety, and depression while incompleteness was uniquely related to OCD and disgust to anxiety. Within the OCD sample, incompleteness and harm avoidance were differentially related to the major OCD symptom dimensions, and change in incompleteness was uniquely related to pre- to post-treatment change in OCD severity. Trait-level incompleteness appears to play a central role in pediatric OCD and studies investigating its direct involvement in symptoms and associations with treatment outcome are needed. The role of disgust in relation to pediatric OCD remains unclear.     

Ginkgo biloba special extract EGb 761 in generalized anxiety disorder and adjustment disorder with anxious mood: a randomized, double-blind, placebo-controlled trial

Ginkgo biloba special extract EGb 761, an anti-dementia drug, enhances cognitive functioning and stabilizes mood in cognitively impaired elderly subjects. Moreover, EGb 761 had been found to alleviate symptoms of anxiety in people with mental decline, therefore it was now tested for clinical efficacy in younger patients suffering from anxiety. One hundred and seven patients with generalized anxiety disorder (GAD, n=82) or adjustment disorder with anxious mood (ADWAM, n=25) according to the diagnostic and statistical manual of mental disorders, third edition - revised (DSM-III-R) were randomized to daily doses of 480 mg EGb 761, 240 mg EGb 761 or placebo for 4 weeks. Intention-to-treat (ITT) analyses were performed on the primary outcome measure, the Hamilton rating scale for anxiety (HAMA), and the secondary variables, the clinical global impression of change (CGI-C), the Erlangen anxiety tension and aggression scale (EAAS), the list of complaints (B-L'), and the patient's global rating of change. The HAMA total scores decreased by -14.3 (+/-8.1), -12.1 (+/-9.0) and -7.8 (+/-9.2) in the high-dose EGb 761, the low-dose EGb 761 and the placebo group, respectively. Changes were significantly different from placebo for both treatment groups with p=0.0003 (high-dose group) and p=0.01 (low-dose). Regression analyses revealed a dose-response trend (p=0.003). EGb 761 was significantly superior to placebo on all secondary outcome measures. It was safe and well tolerated and may thus be of particular value in elderly patients with anxiety related to cognitive decline.     

Evaluation of behavioral impulsivity and aggression tasks as endophenotypes for borderline personality disorder

Borderline personality disorder (BPD) is marked by aggression and impulsive, often self-destructive behavior. Despite the severe risks associated with BPD, relatively little is known about the disorder’s etiology. Identification of genetic correlates (endophenotypes) of BPD would improve the prospects of targeted interventions for more homogeneous subsets of borderline patients characterized by specific genetic vulnerabilities. The current study evaluated behavioral measures of aggression and impulsivity as potential endophenotypes for BPD. Subjects with BPD (N = 127), a non cluster B personality disorder (OPD N = 122), or healthy volunteers (HV N = 112) completed self report and behavioral measures of aggression, motor impulsivity and cognitive impulsivity. Results showed that BPD subjects demonstrated more aggression and motor impulsivity than HV (but not OPD) subjects on behavioral tasks. In contrast, BPD subjects self-reported more impulsivity and aggression than either comparison group. Subsequent analyses showed that among BPD subjects behavioral aggression was associated with self-reported aggression, while behavioral and self-report impulsivity measures were more modestly associated. Overall, the results provide partial support for the use of behavioral measures of aggression and motor impulsivity as endophenotypes for BPD, with stronger support for behavioral aggression measures as an endophenotype for aggression within BPD samples.     

Frontal white matter microstructure, aggression, and impulsivity in men with schizophrenia: a preliminary study.

BACKGROUND: Aggression and impulsivity may involve altered frontal white matter. METHODS: Axial diffusion tensor images were acquired in 14 men with schizophrenia using a pulsed gradient, double spin echo, echo planar imaging method. White matter microstructural measures (fractional anisotropy and trace) were calculated from these data. Regions of interest were placed in frontal white matter on four slices. Impulsivity was measured using the Motor Impulsiveness factor of the Barratt Impulsiveness Scale. Aggressiveness was measured using the Assaultiveness scale of the Buss Durkee Hostility Inventory and the Aggression scale of the Life History of Aggression. RESULTS: Lower fractional anisotropy in right inferior frontal white matter was associated with higher motor impulsiveness. Higher trace in these regions was associated with aggressiveness. CONCLUSIONS: Inferior frontal white matter microstructure was associated with impulsivity and aggression in men with schizophrenia. These results implicate frontal lobe dysfunction in aggression and certain aspects of impulsivity.     

The clinical impact of mood disorder comorbidity on social anxiety disorder

Background

High comorbidity rates of mood disorders have been reported in patients with social anxiety disorder (SAD). Our study aims to identify the frequency of comorbid Axis I disorders in patients with SAD and to investigate the impact of psychiatric comorbidity on SAD.

Methods

The study included 247 patients with SAD. Thirty eight patients with bipolar depression (SAD-BD), 150 patients with major depressive disorder (SAD-MDD) and 25 patients who do not have any mood disorder comorbidity (SAD-NOMD) were compared.

Results

Around 90% of SAD patients had at least one comorbid disorder. Comorbidity rates of lifetime MDD and BD were 74.5% and 15.4%, respectively. There was no comorbidity in the SAD-NOMD group. Atypical depression, total number of depressive episodes and rate of PTSD comorbidity were higher in SAD-BD than in SAD-MDD. Additionally, OCD comorbidity was higher in SAD-BD than in SAD-NOMD. SAD-MDD group had higher social anxiety severity than SAD-NOMD.

Conclusions

Mood disorder comorbidity might be associated with increased severity and decreased functionality in patients with SAD.     

Retrospective reports of parenting in depressed adults with and without comorbid panic disorder and social anxiety disorder

Previous research has examined the role of parenting in the development of depression and anxiety disorders using retrospective reports of parenting behaviors. However, most studies have not considered comorbidity; the few that have did not differentially examine individual anxiety disorders and yielded inconsistent results. The present study compared retrospective parenting reports given by depressed individuals with no comorbid anxiety disorder, comorbid panic disorder, and comorbid social anxiety disorder. Results indicated that depressed men with panic disorder reported significantly greater maternal and nonsignificantly greater paternal protectiveness than depressed men without panic disorder but not than depressed women with and without panic disorder. No differences were found for the retrospective parenting reports given by depressed participants with or without social anxiety disorder. This work highlights the importance of examining specific anxiety disorders rather than grouping all depressed patients with any anxiety disorder together, as well as examining males and females separately when investigating the influence of parental behavior.