Evidence for the existence of major depression with and without anxiety features.

Maes M, Meltzer HY, Cosyns P, Schotte C.

Department of Psychiatry of Case Western Reserve University, Cleveland, Ohio.

Several studies have reported on comorbidity between depression and anxiety. The present study investigates the occurrence of anxiety symptoms during an episode of unipolar depression. The authors administered the 15-item Rating Scale for Anxiety States of Hamilton (HAM-A) to 73 depressed inpatients categorized according to DSM-III criteria into minor (300.40, 309.00), major depression without (296.X2) and with (296.X3) melancholia. Principal-component (PC) analysis revealed three interpretable PCs: a somatic anxiety, a depression-anxiety overlap, and an anxious mood-behavior factor. Subjects with major depression showed significantly higher ratings on total HAM-A score, the three above PCs, and on all HAM-A items (except general somatic muscular and genitourinary symptoms) than subjects with minor depression. A cluster analysis generated two stable, qualitatively distinct clusters: i.e. one with severe anxiety and one with no or minimal anxiety; the six most discriminating symptoms were: tension, behavior at interview (general or physiological), respiratory, genitourinary and autonomic symptoms. Up to 95.4% of patients allocated to the severe anxiety cluster were major depressives. The results suggest that major depression may be divided into two qualitatively distinct classes, i.e. major depression with and without anxiety features.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7972633&dopt=Abstract anxiety medicine




Prospective study of phobic anxiety and risk of Parkinson's disease.

Weisskopf MG, Chen H, Schwarzschild MA, Kawachi I, Ascherio A.

Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA. mweissko hsph.harvard.edu

Anxiety disorders are common in Parkinson's disease (PD). However, the risk of PD among people with anxiety has not been examined in a prospective cohort study. We examined this relation prospectively within the Health Professionals Follow-Up Study, a cohort of US male health professionals. In 1988, anxiety was assessed using the Crown-Crisp phobic anxiety index in 35,815 men without PD, stroke, or cancer at baseline. There were 189 incident cases of PD during 12 years of follow-up. After adjusting for age, smoking, and caffeine intake, the relative risk of PD among men with the highest level of anxiety (Crown-Crisp index scores of 4 and above) was 1.5 (95% CI = 1.0-2.1; P-trend = 0.01) compared to men with the lowest level of anxiety. This positive association persisted after excluding cases of PD with onset in the first 2 years of follow-up. Use of anxiolytic medication was also associated with an elevated risk of PD (RR= 1.6; 95% CI = 0.9-3.1), but adjusting for this potential confounder did not materially affect the association between anxiety and risk of PD. Our results suggest that anxiety is a risk factor for PD. Whether this association is causal or the result of shared underlying biology remains a question. Copyright 2003 Movement Disorder Society

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12784267&dopt=Abstract anxiety medicine




Struggling and flumazenil effects in the swimming test are related to the level of anxiety in mice.

Ferre P, Fernandez Teruel A, Escorihuela RM, Garcia E, Zapata A, Tobena A.

Department of Pharmacology and Psychiatry, School of Medicine, Autonomous University of Barcelona, Bellaterra, Spain.

The possible involvement of anxiety and learning/memory processes in escape-directed (struggling) behavior in a two-trial swimming test was investigated in mice, as well as the differential effects that low doses of flumazenil (a benzodiazepine receptor antagonist) could display depending on the animals' anxiety levels. Mice showing less anxiety in the plus-maze test exhibited less struggling behavior in the first swimming trial than the more anxious animals, suggesting a relationship between anxiety and struggling behavior in the swimming test. Flumazenil (5 mg/kg) given before the first swimming trial displayed differential effects depending upon the animals' anxiety levels. Thus, it increased struggling behavior in the first swimming trial in 'low-anxiety' mice whereas the opposite tendency was observed in 'high-anxiety' animals. Struggling decreased in the second swimming trial in all the animals, giving support to the involvement of learning/memory processes in the two-trial swimming test. That reduction in escape-directed behavior was greater in animals treated with flumazenil before the first swimming session, thus indicating a slight enhancement of retention.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8127420&dopt=Abstract anxiety medicine




Social desirability and self-reports of alcohol abuse in anxiety disorder patients.

Cox BJ, Swinson RP, Direnfeld DM, Bourdeau D.

Anxiety Disorders Clinic, Clarke Institute of Psychiatry, Toronto, Ontario, Canada.

Previous research has shown there is significant comorbidity between alcohol abuse and anxiety disorders. However, the prevalence of anxiety disorders in alcoholic samples has been found to be higher than the occurrence of alcohol abuse in anxiety disorder samples. One possibility for this apparent discrepancy involves a social desirability response bias where it may be less socially acceptable to report alcoholism than to report an anxiety disorder. Thus, a high need for social approval may be associated with minimizing alcohol abuse. The relationship between standardized self-reports of alcohol abuse and social desirability was assessed in 51 panic disorder (PD) and 33 social phobia (SP) patients. In male PD patients there was a negative correlation (-0.46) between social desirability and self-reports of alcohol abuse that approached statistical significance, and the prevalence of alcohol abuse was 18%. In male SP patients there was no such inverse relation and the prevalence of alcohol abuse was much higher (47%). In female anxiety disorder patients these patterns were not evident. These results suggest that when there is a strong (negative) relationship between self-reports of alcoholism and social desirability, the alcohol use may be minimized. In general, however, this relationship was not pronounced in most anxiety disorder patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8135718&dopt=Abstract anxiety medicine




The effect of kindling of different nuclei in the left and right amygdala on anxiety in the rat.

Adamec RE, Morgan HD.

Department of Psychology and Basic Medical Science, Memorial University, St. John's, Newfoundland, Canada.

The effects on rodent anxiety of kindling in the medial or basolateral amygdaloid nuclei in each hemisphere were examined. Anxiety was measured using the hole board and elevated plus maze tests. The animals were kindled in medial or basolateral amygdalas, of either the left or right hemisphere. Controls had electrodes implanted in comparable areas, but were not kindled. Analysis of electrode location showed that some animals were kindled in amygdaloid nuclei other than medial or basolateral amygdala. These animals were labelled outliers. Kindling of the medial/basolateral amygdala in the left hemisphere decreased anxiety for at least 1 week after the last kindled seizure. Right hemisphere medial/basolateral kindling tended to increase anxiety. Outlier-kindled rats were less anxious than their controls regardless of hemisphere 1 week after their last kindled seizure. Clear anxiogenic effects were not likely seen in the right hemisphere in this study because of the electrode locations. The degree of anxiety following kindling was correlated with electrode location in the anterior-posterior plane. More anterior foci in the amygdala were associated with more anxiety. More posterior amygdala foci were associated with less anxiety. These findings point to the importance of kindled focus in the amygdala for behavioral effect. Future research should carefully control the location of kindled foci when investigating effects of amygdala kindling on anxiety and other behaviors.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8140150&dopt=Abstract anxiety medicine




Impact of the Gulf War on the anxiety, cortisol, and growth hormone levels of Israeli civilians.

Weizman R, Laor N, Barber Y, Selman A, Schujovizky A, Wolmer L, Laron Z, Gil-Ad I.

Tel Aviv-Brull Community Mental Health Center, Israel.

OBJECTIVE: The authors investigated the impact of continuous and repeated stress on Israeli civilians exposed to missile attacks during the Gulf War. METHOD: Study 1 included 26 healthy volunteers aged 28-59 years. Their scores on the Hamilton Anxiety Rating Scale and levels of plasma cortisol and growth hormone (GH) were evaluated before, during, and after the war. Study 2 included 13 healthy volunteers aged 25-59 years. Their scores on the state portion of the State-Trait Anxiety Inventory and levels of cortisol and GH were measured three times daily (8:00 a.m., noon, and 6:00 p.m.) at two time points (during and after the war). RESULTS: Anxiety levels of civilians exposed to the threat of war and later to actual missile attacks were significantly higher before and during the war than afterward. Anxiety during the war reached a peak in the evening. The increase in anxiety was not accompanied by any change from basal morning cortisol and GH levels or by diurnal variations in these hormones. CONCLUSIONS: Anxiety levels during the war were similar to those 1 day before its onset, which can be explained by the nature of coping processes. During the war, anxiety levels were highest in the evening, reflecting the war routine (missile attacks occurred mostly at night). The unaltered hormone levels and their normal diurnal variations despite the subjects' persistent anxiety were probably due to adaptation of the hypothalamic-pituitary-adrenal and hypothalamic-somatotropin axes to continuous stress.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8267138&dopt=Abstract anxiety medicine




Adults who feared school: is early separation anxiety specific to the pathogenesis of panic disorder?

Silove D, Manicavasagar V.

University of New South Wales, Academic Mental Health Unit, Liverpool Hospital, Australia.

Although juvenile separation anxiety disorder is maintained to be a predisposing factor to adult panic disorder in DSM-III-R, past research has failed to clarify (a) whether it is separation anxiety per se or school refusal that is the pathogenic risk factor and (b) whether affected youngsters are specifically at risk of developing panic disorder rather than symptoms of general anxiety or phobias in later life. The present study of 74 adults who responded to media publicity found that a measure of early separation anxiety but not a history of school refusal was associated with risk of adult panic disorder according to DSM-III-R criteria. In contrast, separation anxiety scores were not associated with the presence or absence of general anxiety symptoms or phobic-avoidance in adulthood. Subjects with higher separation anxiety scores were more likely to have either a sibling or child with school refusal. Although the present study is limited in its method to mailed survey responses and, in part, to retrospective data, the results do provide additional support for Klein's influential separation anxiety theory of panic disorder.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8310844&dopt=Abstract anxiety medicine




The effects of competitive anxiety on memory span and rebound shooting tasks in basketball players.

Parfitt G, Hardy L.

University of Wales, Bangor, Gwynedd, UK.

Two theoretical models were used to investigate aspects of basketball performance: Eysenck's (1979, 1984) compensatory arousal model and Humphreys and Revelle's (1984) twin resources model. Cognitive and somatic anxiety were manipulated using a 'time to event' paradigm. The aspects of performance were a short-term memory task (letter span) and a low memory demand, motoric-sustained information transfer task (rebound shooting). Hypotheses based on the different models were formulated and subsequently tested using analysis of variance and polynomial regression analysis. The results indicated significant (P < 0.01) linear relationships with negative slopes between cognitive anxiety and letter span, and between somatic anxiety and letter span; while significant (P < 0.01) linear relationships with positive slopes were recorded between cognitive anxiety and rebound shooting, and between somatic anxiety and rebound shooting. The analysis of variance results were in agreement with a positive effect (P < 0.05) for cognitive anxiety upon rebound shooting, and a negative effect which approached significance (P < 0.07) for somatic anxiety upon letter span. The results were interpreted as offering partial support for Eysenck's (1979) theoretical model, although further examination of multidimensional anxiety effects via the two models is warranted.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8114177&dopt=Abstract anxiety medicine




Baccalaureate nursing students' experiences of anxiety producing situations in the clinical setting.

Kim KH.

California State University, Hayward, CA, USA.

The purpose of this study was to identify the clinical experiences of nursing students that were anxiety provoking and examine the relationship between the level of trait anxiety and the clinical experience that produced anxiety in nursing students. A descriptive correlational design collected data from 61 nursing students in their last semester of the baccalaureate nursing program using survey questionnaires that captured demographic data and included the Trait Anxiety Scale and the Clinical Experience Assessment form. Analyses of data indicate that 36% of the students experienced a moderate level of anxiety. Clinical experiences related to arriving late, being observed by instructors, responding to initial experiences, having a fear of making mistakes, and talking to physicians were the most anxiety producing for these students. A significantly positive relationship (r = .40, p < .05) was found between the trait anxiety and clinical experience that was anxiety producing. A higher level of perceived anxiety accompanied the following clinical experiences; being observed by instructors (F = 3.44, p = .04), doing beforehand in-hospital preparation (F = 4.46, p < .02), asking questions of faculty (F = 4.38, p < .02), being evaluated by faculty (F = 3.37, p < .04), and reporting to team leader (F = 3.60, p < .05). The most anxiety producing clinical experiences in nursing students before graduation are evaluated with descriptive data. Results would provide useful insights for faculty and senior nursing students involved in clinical practice, and have implications for education, further research, and clinical support.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12785605&dopt=Abstract anxiety medicine