Panic attack as a risk factor for severe psychopathology

OBJECTIVE: The purpose of the study was to examine the relationship between panic attack and the onset of specific mental disorders and severe psychopathology across the diagnostic spectrum among adolescents and young adults. METHOD: Data were drawn from the Early Developmental Stages of Psychopathology Study (N=3,021), a 5-year prospective longitudinal study of psychopathology among youths ages 14-24 years at baseline in the community. Multiple logistic regression analyses were used to examine the associations between panic attacks at baseline, comorbid mental disorders in adolescence, and the risk of mental disorders across the diagnostic spectrum at follow-up. RESULTS: The large majority of subjects with panic attacks at baseline developed at least one DSM-IV mental disorder at baseline (89.4% versus 52.8% of subjects without panic attacks). Subjects with panic attacks at baseline had significantly higher baseline levels of any anxiety disorder (54.6% versus 25.0%), any mood disorder (42.7% versus 15.5%), and any substance use disorder (60.4% versus 27.5%), compared to subjects without panic attacks at baseline. Preexisting panic attacks significantly increased the risk of onset of any anxiety disorder, social phobia, specific phobia, generalized anxiety disorder, any substance use disorder, and any alcohol use disorder at follow-up in young adulthood, and these associations persisted after adjustment for all comorbid mental disorders assessed at baseline. More than one-third (37.6% versus 9.8%) of the subjects with panic attack at baseline met the criteria for at least three mental disorders at follow-up during young adulthood. CONCLUSIONS: Panic attacks are associated with significantly increased odds of mental disorders across the diagnostic spectrum among young persons and appear to be a risk factor for the onset of specific anxiety and substance use disorders. Investigation of key family, environmental, and individual factors associated with the onset of panic attacks, especially in youth, may be an important direction for future research.     

Association between anxiety disorders and substance use disorders among young persons: results of a 21-year longitudinal study

OBJECTIVE: To examine the linkages between anxiety disorders and the development of substance use disorders in a birth cohort of young people studied to young adulthood. METHOD: Data were gathered over the course of a longitudinal study of a birth cohort of over 1000 New Zealand born young people. Over the course of the study, data were gathered on: (a) anxiety disorders and substance use disorders at ages 16-18 and 18-21; (b) a range of potential confounding factors including measures of childhood, social, and family factors. RESULTS: Young people with anxiety disorders had odds of substance dependence that were between 1.3 and 3.9 times higher than young people without anxiety disorders. These associations were largely explained by a series of covariate factors relating to: (a) childhood and family factors; (b) prior substance dependence; (c) comorbid depression; (d) peer affiliations. After adjustment for these factors, anxiety disorder was unrelated to all measures of substance use. CONCLUSIONS: Young people with anxiety disorders are at increased risk of substance dependence. However, this association appears to be largely or wholly non causal and reflects the associations between childhood factors, prior substance dependence, comorbid depression, peer affiliations and the development of anxiety disorders.     

What characteristics of primary anxiety disorders predict subsequent major depressive disorder?

OBJECTIVE: The goal of this study was to examine the associations between specific anxiety disorders and the risk of major depressive disorder and to explore the role of various clinical characteristics of anxiety disorders in these relationships using a prospective, longitudinal design. METHOD: The data are from a 4-year prospective, longitudinal community study, which included both baseline and follow-up survey data on 2548 adolescents and young adults aged 14 to 24 years at baseline. DSM-IV diagnoses were made using the Munich-Composite International Diagnostic Interview. RESULTS: The presence at baseline of any anxiety disorder (odds ratio [OR] = 2.2 [95% CI = 1.6 to 3.2]) and each of the anxiety disorders (specific phobia, OR = 1.9 [95% CI = 1.3 to 2.8]; social phobia, OR = 2.9 [95% CI = 1.7 to 4.8]; agoraphobia, OR = 3.1 [95% CI = 1.4 to 6.7]; panic disorder, OR = 3.4 [95% CI = 1.2 to 9.0]; generalized anxiety disorder, OR = 4.5 [95% CI = 1.9 to 10.3]) was associated with a significantly (p <.05) increased risk of first onset of major depressive disorder. These associations remained significant after we adjusted for mental disorders occurring prior to the onset of the anxiety disorder, with the exception of the panic disorder association. The following clinical characteristics of anxiety disorders were associated with a significantly (p <.05) increased risk of developing major depressive disorder: more than 1 anxiety disorder, severe impairment due to the anxiety disorder, and comorbid panic attacks. In the final model, which included all clinical characteristics, severe impairment remained the only clinical characteristic that was an independent predictor of the development of major depressive disorder (OR = 2.2 [95% CI = 1.0 to 4.4]). CONCLUSION: Our findings suggest that anxiety disorders are risk factors for the first onset of major depressive disorder. Although a number of clinical characteristics of anxiety disorders appear to play a role in the association between anxiety disorders and depression, severe impairment is the strongest predictor of major depressive disorder.     

Mental disorders and asthma in the community

OBJECTIVE: To determine the association between asthma and mental disorders among adults in the community. SETTING: Germany. PARTICIPANTS: Representative sample of the general population aged 18 to 65 years. MAIN OUTCOME MEASURES: Diagnoses of current (the past 4 weeks) and lifetime asthma were based on physician diagnosis; current and lifetime DSM-IV mental disorders were assessed using the Composite International Diagnostic Interview. RESULTS: Current severe asthma (the past 4 weeks) was associated with a significantly increased likelihood of any anxiety disorder (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.35-5.18), specific phobia (OR, 4.78; 95% CI, 2.35-4.05), panic disorder (OR, 4.61; 95% CI, 1.09-9.4), and panic attacks (OR, 4.12; 95% CI, 1.32-12.8). Lifetime severe asthma was associated with the increased likelihood of any anxiety disorder (OR, 2.09; 1.3-3.36), panic disorder (OR, 2.61; 95% CI, 1.29-5.25), panic attacks (OR, 2.84; 95% CI, 1.66, 4.89), social phobia (OR, 3.28; 95% CI, 1.42, 7.59), specific phobia (OR, 2.93; 95% CI, 1.71-5.0), generalized anxiety disorder (OR, 5.51; 95% CI, 2.29-13.22), and bipolar disorder (OR, 5.64; 95% CI, 1.95-16.35). Current nonsevere asthma was associated with the increased likelihood of any affective disorder (OR, 2.42; 95% CI, 1.03-5.72); and lifetime nonsevere asthma was associated with increased odds of any anxiety disorder (OR, 1.51; 95% CI, 1.0-2.32), anxiety disorder not otherwise specified (OR, 2.08; 95% CI, 1.03-4.23), and any somatoform disorder (OR, 1.7; 95% CI, 1.14-2.53). CONCLUSIONS: To our knowledge, these findings are consistent with and extend the findings of previous reports by providing the first available information on the association between physician-diagnosed asthma and DSM-IV mental disorders in a representative population sample of adults. Our results suggest an association between asthma and a range of mental disorders. Longitudinal studies that can examine the sequence of onset and the role of genetic and environmental factors in the association between asthma and affective and anxiety disorders are needed next to further elucidate possible shared causative mechanisms.     

The College Health Related Information Survey (C.H.R.I.S.-73): A Screen for College Student Athletes

Objective: To assess the reliability and discriminate validity of a new screening instrument for college student athletes. Method: 518 Stanford University students completed the proposed instrument (College Health Related Information Survey—CHRIS-73), which was based on the Juvenile Wellness and Health Survey (JWHS-76) but re-designed to assess mental health domains relevant to college athletes. Results: Factor analysis yielded four factors: mental health problems, eating problems, risk behaviors, and performance pressure. Factors were internally consistent, reasonably independent, and clearly discriminated between athletes and non-athletes, and males and females. Conclusions: This study supports the CHRIS-73 as a useful screen for assessing mental health problems among college student athletes.     

Lung disease and internalizing disorders. Is childhood abuse a shared etiologic factor?

OBJECTIVE: To investigate the role of childhood abuse in the relationship between panic attack, depression and lung disease among adults in the population. METHODS: Data were drawn from the National Comorbidity Survey (n=5877), a representative sample of adults age 15-54 in the United States. Multiple logistic regression analyses were used to determine the association between childhood abuse and lung disease, and to determine whether childhood abuse is an independent predictor of the co-occurrence of lung disease, panic attack and depression. RESULTS: Childhood abuse was associated with significantly increased odds of panic attacks (OR=2.2 (1.5, 3.1)) and depression (OR=1.6 (1.1, 2.3)). Childhood abuse increased likelihood of lung disease (OR=1.5 (1.1, 2.2)). Childhood abuse independently predicted the co-occurrence of lung disease, panic attack and depression (OR=10.7 (2.2, 51.5)). CONCLUSION: These data are preliminary, but if replicated, suggest that childhood abuse may be associated with increased risk of lung disease during adulthood, and further may reflect a shared vulnerability for the co-occurrence of lung disease, panic attack and depression in the community. Future studies are needed to further explore the mechanism of this association.     

Chronic fatigue syndrome versus neuroendocrineimmune dysfunction syndrome:differential attributions

Since 1988, when the term chronic fatigue syndrome (CFS) was coined, considerable discussion has occurred about stigma associated with this diagnostic term. In particular, patients with CFS have felt that this term trivializes the serious nature of this disorder. A Name Change Work group, appointed by the CFS Coordinating Committee, developed an umbrella term: chronic neuroendocrineimmune dysfunction syndrome (CNDS), and proposed that there would be sub-types under this term, one being CFS. The present study examined attributions of this new umbrella term when compared with CFS. Nurses and physician assistants (PAs) were presented a case study of a patient with symptoms of CFS. They were told that the patient had either "chronic fatigue syndrome," "chronic neuroendocrineimmune dysfunction syndrome," or "chronic neuroendocrineimmune dysfunction syndrome, which had formerly been called chronic fatigue syndrome." The different terms led to different attributions, with PA respondents rating the "CNDS" label as more severe. Results suggest that a more medical sounding term (CNDS) may lead to attributions that this syndrome is a more serious, disabling illness. The policy implications of these findings are discussed.     

Detection of lung cancer with volatile markers in the breath

STUDY OBJECTIVES: To evaluate volatile organic compounds (VOCs) in the breath as tumor markers in lung cancer. Alkanes and monomethylated alkanes are oxidative stress products that are excreted in the breath, the catabolism of which may be accelerated by polymorphic cytochrome p450-mixed oxidase enzymes that are induced in patients with lung cancer. DESIGN: Combined case-control and cross-sectional study. SETTING: Five academic pulmonary medicine services in the United States and the United Kingdom. Patients and participants: One hundred seventy-eight bronchoscopy patients and 41 healthy volunteers. INTERVENTION: Breath samples were analyzed by gas chromatography and mass spectroscopy to determine alveolar gradients (ie, the abundance in breath minus the abundance in room air) of C4-C20 alkanes and monomethylated alkanes. MEASUREMENTS: Patients with primary lung cancer (PLC) were compared to healthy volunteers, and a predictive model was constructed using forward stepwise discriminant analysis of the alveolar gradients. This model was cross-validated with a leave-one-out jackknife technique and was tested in two additional groups of patients who had not been used to develop the model (ie, bronchoscopy patients in whom cancer was not detected, and patients with metastatic lung cancer [MLC]). RESULTS: Eighty-seven of 178 patients had lung cancer (PLC, 67 patients; MLC, 15 patients; undetermined, 5 patients). A predictive model employing nine VOCs identified PLC with a sensitivity of 89.6% (60 of 67 patients) and a specificity of 82.9% (34 of 41 patients). On cross-validation, the sensitivity was 85.1% (57 of 67 patients) and the specificity was 80.5% (33 of 41 patients). The stratification of patients by tobacco smoking status, histologic type of cancer, and TNM stage of cancer revealed no marked effects. In the two additional tests, the model predicted MLC with a sensitivity of 66.7% (10 of 15 patients), and it classified the cancer-negative bronchoscopy patients with a specificity of 37.4% (34 of 91 patients). CONCLUSIONS: Compared to healthy volunteers, patients with PLC had abnormal breath test findings that were consistent with the accelerated catabolism of alkanes and monomethylated alkanes. A predictive model employing nine of these VOCs exhibited sufficient sensitivity and specificity to be considered as a screen for lung cancer in a high-risk population such as adult smokers.     

Social support moderates caregiver life satisfaction following traumatic brain injury

Social support is an important determinant of adjustment following traumatic brain injury (TBI) sustained by a family member. The present study examined the extent to which social support moderates the influence of characteristics of the person with injury on caregiver subjective well-being. Sixty pairs of individuals who had sustained a moderate to severe TBI and their caregivers (N=120) participated. Years postinjury ranged from 0.3 to 9.9 ( M=4.8, SD=2.6). Cognitive, functional, and neurobehavioral functioning of participants with TBI were assessed using neuropsychological tests and rating scales. Caregiver life satisfaction and perceived social support were assessed using self-report questionnaires. Results indicated that time since injury was unrelated to life satisfaction. Neurobehavioral disturbances showed an inverse relation with life satisfaction. Social support emerged as an important moderator of life satisfaction. Only among caregivers with low social support was cognitive dysfunction adversely related to life satisfaction. Similarly, a trend suggested that patient unawareness of deficit was associated with caregiver life dissatisfaction only among caregivers with low social support. In contrast, these characteristics were unrelated to life satisfaction among caregivers with adequate social support.