Anxiety sensitivity, controllability, and experiential avoidance and their relation to drug of choice and addiction severity in a residential sample of substance-abusing veterans.

Forsyth JP, Parker JD, Finlay CG.

Department of Psychology, University at Albany, State University of New York, SS112, 1400 Washington Avenue, Albany, NY 12222, USA. forsyth csc.albany.edu

The aim of the present study was to evaluate anxiety-related psychological risk factors (e.g., anxiety sensitivity, perceived uncontrollability, emotional avoidance) and their relation to drug of choice and addiction severity in an inpatient residential substance abuse population. Fully detoxified veterans (N=94) meeting criteria for Axis I substance abuse disorders were enrolled in a 28-day residential substance abuse treatment program and completed the following measures at intake and discharge: Anxiety Sensitivity Index, Body Sensations Questionnaire (BSQ), Acceptance and Action Questionnaire (AAQ), Beck Depression Inventory (BDI; intake only), and the Anxiety Control Questionnaire (ACQ). Consistent with the expectation, veterans who reported more distress over bodily sensations (anxiety sensitivity, BSQ) and depressive symptoms (BDI) were more likely to avoid experiencing negative affect (AAQ) and perceived themselves as lacking in control (ACQ). Further, extent of avoidance, and to a lesser extent, controllability, discriminated between participants as a function of primary and comorbid diagnostic status, whereas anxiety sensitivity did not. No relation was found between anxiety sensitivity and drug of choice, and relations between assessed psychological factors and domains of addiction severity were mixed. Findings suggest that heightened bodily sensitivity, emotional avoidance, and perceived uncontrollability are common sequelae of patients seeking residential substance abuse treatment, but they do not contribute uniquely to drug of choice and measures of addiction severity. Theoretical and treatment implications are discussed with particular emphasis on approaches that may increase coping with untoward bodily cues, decrease avoidance of negative affect, and improve patient's sense of personal control over their responses and the environment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12788261&dopt=Abstract anxiety medicine




Amygdala kindling, anxiety, and corticotrophin releasing factor (CRF).

Adamec RE, McKay D.

Department of Psychology, Memorial University, St. John's, Newfoundland, Canada.

Wistar rats were kindled electrically in the anterior or posterior medial amygdala of the right hemisphere. One week after the fourth stage 5 seizure, anxiety was assessed in the elevated plus maze test. Anxiety levels of rats kindled in posterior medial amygdala were reduced relative to implanted controls, but not relative to unoperated controls. Kindling of the anterior medial amygdala increased anxiety relative to implanted and unoperated controls. The different effects of kindling on behavior were unrelated to any parameter of kindling. The stress of an ICV injection of saline increased anxiety in unkindled controls but reduced anxiety in anterior medial amygdala-kindled rats. Injection stress effects on behavior were blocked by 50 micrograms of alpha-helical CRF (the CRF receptor blocker). These findings suggest that CRF released by the stress of the injection procedure mediates the behavioral effects in both kindled and control rats. In contrast, injection of CRF (2 micrograms, ICV) has no greater effect than ICV saline in anterior medial amygdala kindled rats, whereas it was anxiogenic in unkindled rats. ICV vehicle and CRF reduce kindling-induced anxiety equally. These findings suggest that CRF released during the injection procedure saturates available CRF receptors. Finally, kindling did not alter basal plasma corticosterone levels. These and other findings suggest that the anxiety-modulating actions of CRF are at central CRF receptors.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8415932&dopt=Abstract anxiety medicine




A twin study of DSM-III-R anxiety disorders.

Skre I, Onstad S, Torgersen S, Lygren S, Kringlen E.

Department of Psychology, University of Oslo, Norway.

The prevalence of anxiety disorders was studied in a sample of 20 monozygotic (MZ) and 29 dizygotic (DZ) co-twins of anxiety disorder probands. A comparison group of co-twins of 12 MZ and 20 DZ twin probands with other non-psychotic mental disorders was also studied. All subjects were personally interviewed with the Structured Clinical Interview for DSM-III-R Axis I (SCID-I). Panic disorder was significantly more prevalent in co-twins of panic probands. Generalized anxiety disorder (GAD) was more prevalent in co-twins of GAD probands with a history of mood disorder (NS). Post-traumatic stress disorder was significantly more prevalent in co-twins of anxiety probands and was more prevalent in MZ than in DZ co-twins. The prevalences of social and simple phobia were equal in co-twins of anxiety and comparison probands. For both panic disorder and generalized anxiety disorder the MZ:DZ concordance ratio was more than 2:1. The results support the hypothesis of a genetic contribution in the etiology of panic disorder, generalized anxiety disorder and post-traumatic stress disorder. The hypothesis that simple and social phobia are mainly caused by environmental experiences was also supported.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8213211&dopt=Abstract anxiety medicine




Anxiety, pain and discomfort associated with dental treatment.

Vassend O.

Institute of Community Dentistry, University of Oslo, Norway.

The aims of the study were to describe the level of anxiety and pain/discomfort associated with dental treatment in two samples (N = 1288 and N = 2382) representative of an adult population, and to assess the statistical effects of these variables on utilization of dental services (dental attendance measures, expenditure, and items of dental treatment received during the last year). The prevalence of high dental anxiety in the samples as measured by Corah's Dental Anxiety Scale, the Dental Fear Scale, and the Dental Anxiety Question was 4.2%, 7.1% and 5.4%, respectively. Rather large proportions of the respondents judged dental treatment to be painful or uncomfortable: between 20 and 30% rated their last dental visit as moderately painful or worse; about 60% reported having had at least one very painful experience, and 5-6% experienced dental treatment in general to be very painful. Dental anxiety was significantly related to pain reports (correlations in the 0.32-0.48 range). There were no differences between the youngest age group (15-19 yr) and the rest of the respondents in Study II with regard to dental pain ratings. Possible explanations for these findings are discussed. The effects of dental pain and anxiety on utilization measures, although attaining significance in several of the analyses, were generally weak. Both studies demonstrated few significant differences between individuals with high dental anxiety and the rest of the study samples with respect to type and extent of dental treatment received during the last year. Thus, these data seem to show that many dentally anxious patients seek out and undergo dental treatment despite high fear levels.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8216168&dopt=Abstract anxiety medicine




Lasting effects on rodent anxiety of a single exposure to a cat.

Adamec RE, Shallow T.

Department of Psychology, Memorial University, St. John's, Newfoundland, Canada.

The effects on anxiety and risk assessment of exposure to a cat were tested in hooded rats. Anxiety and risk assessment were measured in an elevated plus maze and hole board in a room different from the cat-exposure room. Behavior was tested either 1, 2, 7, 14, or 21 days after cat exposure in different groups of rats. A single exposure to a cat increased anxiety over controls in the plus maze from 1 to 21 days after exposure to a cat. The effects on anxiety were independent of activity or exploratory tendency. Severity of anxiety produced was predicted by the approach, but not the attack, behavior of the cat. Analogous correlations between traumatic stimuli and anxiety are seen in humans suffering from posttraumatic stress disorder (PTSD). Risk assessment in the plus maze was reduced over the same period in rats exposed to cats. Risk assessment was weakly correlated with anxiety. The findings are discussed with respect to the potential of this phenomenon as a model of generalized anxiety disorder found in PTSD.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8327588&dopt=Abstract anxiety medicine




Psychiatric comorbidity in patients with generalized anxiety disorder.

Brawman-Mintzer O, Lydiard RB, Emmanuel N, Payeur R, Johnson M, Roberts J, Jarrell MP, Ballenger JC.

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston 29425.

OBJECTIVE: The goal of this study was to test the validity of generalized anxiety disorder as an independent diagnostic entity and to evaluate the prevalence and type of other psychiatric disorders coexisting with generalized anxiety disorder. Although a few published studies have addressed the subject, this study presents data from a larger group of subjects and excludes concurrent major depression as a potential confound. METHOD: The authors studied patients with a primary diagnosis of generalized anxiety disorder assigned after evaluation with the Structured Clinical Interview for DSM-III-R. Patients with a concurrent major depressive episode were excluded. All diagnoses for which the patient met criteria were determined, including lifetime occurrence of major depressive episode and substance use. RESULTS: One hundred nine patients with generalized anxiety disorder were included in the analysis. Twenty-eight (26%) of these patients were not given any other lifetime psychiatric diagnosis. The most prevalent comorbid diagnoses were social phobia (25 [23%] of the patients) and simple phobia (23 [21%] of the patients). Forty-six (42%) of the patients with generalized anxiety disorder had experienced at least one major depressive episode during their lifetime. CONCLUSIONS: These results support previous findings of high rates of psychiatric comorbidity in generalized anxiety disorder and validate the usefulness of generalized anxiety disorder as a separate diagnostic entity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8328567&dopt=Abstract anxiety medicine




A 3-year follow-up of children with and without behavioral inhibition.

Biederman J, Rosenbaum JF, Bolduc-Murphy EA, Faraone SV, Chaloff J, Hirshfeld DR, Kagan J.

Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114-3139.

OBJECTIVE: Previous work suggested that children of parents with panic disorder and agoraphobia were likely to be classified as behaviorally inhibited and that behaviorally inhibited children were likely to develop anxiety disorders. Although these findings suggested that "behavioral inhibition to the unfamiliar" may be associated with risk for anxiety disorders in children, longitudinal data were needed to confirm the initial impressions. METHOD: Using DSM-III structured interviews, the authors examined psychiatric disorders at 3-year follow-up in children of two independently ascertained, previously described, and preexisting samples of children. One sample was cross sectional and clinically derived (Massachusetts General Hospital at-risk sample), and the other was epidemiologically derived and longitudinal (Kagan et al. Longitudinal Cohort). RESULTS: Analyses of follow-up findings revealed significant differences between inhibited and not inhibited children in the rates of multiple > or = 4 psychiatric disorders, multiple > or = 2 anxiety disorders, avoidant disorder, separation anxiety disorder, and agoraphobia. Among inhibited children, the rates of anxiety disorders increased markedly from baseline to follow-up assessments, attaining statistical significance for multiple > or = 2 anxiety disorders and avoidant disorder. Our findings also show there were significant differences between inhibited and not inhibited children in the emergence of multiple > or = 2 anxiety disorders, avoidant disorder, and separation anxiety disorder in children who did not have these diagnoses at baseline. CONCLUSIONS: These findings indicate that inhibited children are at high risk for developing childhood-onset anxiety disorders and provide additional support for the hypothesis that behavioral inhibition is a predictor of later anxiety disorder.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8340303&dopt=Abstract anxiety medicine




Role of anxiety and personality in non-ulcer dyspepsia: a comparative study with duodenal ulcer.

Alexander PJ, Tantry BV.

Department of Psychiatry, Kasturba Medical College, Karnataka.

BACKGROUND: Though emotional factors are known to influence gut functions, studies evaluating the role of anxiety and personality in non-ulcer dyspepsia (NUD) are few and have not yielded consistent results. AIMS: To find out whether anxiety and abnormal personality pattern are specifically associated with NUD. METHODS: 33 patients with NUD and 30 patients with duodenal ulcer, who were randomly selected from among those attending a gastroenterology out-patient clinic, were administered a) the Eyesenck Personality Inventory, to measure neuroticism and extroversion; and b) a short self-rating scale for anxiety, to measure state and trait anxiety. RESULTS: There were no significant differences between the two groups in state anxiety, neuroticism and extroversion. Trait anxiety, however, was significantly higher in the NUD group (p = 0.05). CONCLUSIONS: Though the difference in trait anxiety score between the two groups attained significance, this finding needs further support to indicate a causal role for anxiety in NUD. There is need for further studies about the role of anxiety in various subgroups of NUD.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8354535&dopt=Abstract anxiety medicine




Dental students' perception of patient anxiety.

Lodge J, Tripp G.

Department of Psychology, University of Otago, Dunedin.

This study examined the ability of dental students to assess patients' anxiety during dental treatment, and the relationship between patients' general, waiting room and clinic levels of anxiety. Sixty-six restorative dental patients and 35 Final-year dental students participated in the study. Prior to a routine dental appointment, patients completed visual analogue scales indicating their general and waiting room levels of anxiety. During treatment, patients and dental students completed similar scales to indicate patients' levels of anxiety up to and at that time. Patients' general and waiting room levels of anxiety were found to correlate significantly with their reports of anxiety during treatment. Female patients reported higher levels of anxiety than male patients. The correlations between patient and student ratings of patients' anxiety were small and non-significant, suggesting the students were not accurate in their estimates of patients' anxiety during treatment. It is suggested, therefore, that dental students be encouraged to ask patients directly how they are feeling about the dental situation. Such discussion could take place prior to, or at the beginning of, the dental appointment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7898798&dopt=Abstract anxiety medicine