[The early maladaptive schemas: a study in adult patients with anxiety disorders]

[Article in French]

Delattre V, Servant D, Rusinek S, Lorette C, Parquet PJ, Goudemand M, Hautekeete M.

Unite Stress et Anxiete, Clinique de Psychiatrie, CHU de Lille, 57, boulevard de Metz, 59037 Lille cedex.

The theory of early maladaptive schemas was initiated by Young, who postulated that each pathology is supported by one or several schemas. Adults with anxiety disorders more activate schemas that controls. This hyper activate schemas would go back the childhood. In this study, we measure some cognitive schema's activation, with the Schmidt and al. Questionnaire: this schema's questionnaire measures the dysfunctional schemas in actual way. Our purpose was to compare early maladaptive schema's activation of adults with anxiety disorders and adults healthy. The results indicate that each dysfunctional schema is more significatively activate by the adults with anxiety disorders that adults healthy. He doesn't exist schema typical of anxiety, but just a more important activation of all schemas of adults with -anxiety disorders. All subjects (with anxiety disorder and healthy) activate the schemas in the same order. It would appear that schema who imply an action of subject was more activate. So, in our study, we doesn't observe schema typical of anxiety, as opposed to postulate of Young and Klosko. In fact, in comparison with healthy subjects, all early maladaptive schemas of subjects with anxiety disorders were hypervalent. The order of schema's activation was the same in the two groups, but the activation in the anxious is always more important that in the healthy. All early maladaptive schemas would so hyperactivate in the anxious and a important activation of this schemas in the infancy would predispose to adult's anxious pathology. We consider this research as a preliminary work about early maladaptive schemas. In order to specify the research about schemas in the anxious, il will be interesting to observe this schemas according to different anxious disorders and to study prospectively the evolution of child's schemas.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15235523&dopt=Abstract anxiety medicine




Anxiety measurements in university students undergoing third molar extraction.

Yusa H, Onizawa K, Hori M, Takeda S, Takeda H, Fukushima S, Yoshida H.

Department of Oral and Maxillofacial Surgery, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan. y-yusa md.tsukuba.ac.jp

OBJECTIVE: This investigation was conducted to quantitate the anxiety associated with third molar extraction in university students, and to compare the measured anxiety before and after extraction and between men and women, first and second extraction, and impacted versus nonimpacted tooth extraction. STUDY DESIGN: The Japanese version of The State-Trait Anxiety Inventory (STAI), a psychological test, was given to 108 students undergoing third molar extraction. The students completed the test on the first examination (day 1), immediately before the extraction (day 2), and the day after the extraction (day 3). RESULTS: The state anxiety (STAI-S) score showed no significant difference between days 1 and 2, but the score on day 3 was lower than that on day 1, with a decrease in cases with a stage IV or V. Women showed more anxiety state on day 2 than men. The anxiety score on days 2 and 3 for the second extraction were significantly lower than those for the first extraction in 43 students who underwent third molar extractions twice. The change in the trait anxiety (STAI-T) stage was unremarkable among days 1, 2, and 3. No statistical difference was found in the anxiety between students undergoing impacted and nonimpacted third molar extraction. CONCLUSIONS: The anxiety status of students undergoing third molar extraction could be quantitatively evaluated using the STAI. The results of this investigation may provide oral maxillofacial surgeons with useful information about patients' anxiety throughout the tooth removal process.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15243465&dopt=Abstract anxiety medicine




Variability in the benzodiazepine response of serotonin 5-HT1A receptor null mice displaying anxiety-like phenotype: evidence for genetic modifiers in the 5-HT-mediated regulation of GABA(A) receptors.

Bailey SJ, Toth M.

Department of Pharmacology, Weill Medical College of Cornell University, New York, New York 10021, USA. Sarah.J.Bailey bristol.ac.uk

Benzodiazepines (BZs) acting as modulators of GABA(A) receptors (GABA(A)Rs) are an important group of drugs for the treatment of anxiety disorders. However, a large inter-individual variation in BZ sensitivity occurs in the human population with some anxiety disorder patients exhibiting diminished sensitivity to BZ and reduced density of GABA(A)Rs. The mechanism underlying BZ treatment resistance is not known, and it is not possible to predict whether an anxiety patient will respond to BZ. 5-hydroxytryptamine1A receptor (5-HT1AR) null mice (R-/-) on the Swiss-Webster (SW) background reproduce several features of BZ-resistant anxiety; they exhibit anxiety-related behaviors, do not respond to BZ, have reduced BZ binding, and have decreased expression of the major GABA(A)R subunits alpha1 and alpha2. Here, we show that R-/- mice on the C57Bl6 (B6) background also have anxiety phenotype, but they respond to BZ and have normal GABA(A)R subunit expression. This indicates that the 5-HT1AR-mediated regulation of GABA(A)R alpha subunit expression is subject to genetic modification. Hybrid SW/B6-R-/- mice also exhibit BZ-resistant anxiety, suggesting that SW mice carry a genetic modifier, which mediates the effect of the 5-HT1AR on the expression of GABA(A)Ralpha subunits. In addition, we show that this genetic interaction in SW mice operates early in postnatal life to influence the expression of GABA(A)R alpha subunits at the transcriptional level. These data indicate that BZ-resistant anxiety results from a developmental arrest of GABA(A)R expression in SW-R-/- mice, and a similar mechanism may be responsible for the BZ insensitivity of some anxiety patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15254090&dopt=Abstract anxiety medicine




Assessment of anxiety in subclinical thyroid disorders.

Sait Gonen M, Kisakol G, Savas Cilli A, Dikbas O, Gungor K, Inal A, Kaya A.

Department of Internal Medicine, Division of Endocrinology, Meram Medical Faculty, Konya 42080, Turkey.

It is well known that manifest thyroid dysfunction causes mood disorders. In the literature there are few studies related with subclinical thyroid dysfunction and anxiety. We aimed to determine if there exists a relation between the anxiety and subclinical thyroid dysfunction. This study was carried out in the Meram Medical Faculty of Selcuk University, Department of Endocrinology and Metabolism. Eighty-five outpatients were enrolled into the study. In the presence of normal fT(3) and fT(4), patients were grouped as subclinical hyperthyroid with TSH lower than 0.1 mU/L (n = 24), subclinical hypothyroid with TSH higher than 4.5 mU/L (n = 32) and euthyroid subjects (n = 29). Beck's Anxiety Inventory (BAI) was administered to all patients. There was no any statistically significant difference between euthyroid and study groups in terms of age, gender, weight and height (p<0.05). One-way ANOVA showed that both of the subclinical hypothyroid and subclinical hyperthyroid groups had significantly higher anxiety scores than euthyroid group (F: 11.4, p<0.001). Manifest hypothyroidism and hyperthyroidism, as causes of mental and neurological dysfunction have been known for a long time, but the relation between subclinical thyroid dysfunction and anxiety is less well studied. We have found that subclinical thyroid dysfunction increases the anxiety of patients whether hyperthyroid or hypothyroid. Overlap of symptoms common to both thyroid dysfunction and anxiety is an important limitation in this study. Mood changes especially anxiety due to subclinical thyroid dysfunction may have an important impact on the patient's quality of life. Negative effect on quality of life may be an indication of treatment in these patients. It is the first study evaluating anxiety in subclinical hypothyroidism in the literature.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15256776&dopt=Abstract anxiety medicine




Is the female preponderance in major depression secondary to a gender difference in specific anxiety disorders?

Parker G, Hadzi-Pavlovic D.

School of Psychiatry, University of New South Wales, Mood Disorders Unit and Black Dog Institute, Prince of Wales Hospital, Randwick, NSW, Australia. g.parker unsw.ed.au

BACKGROUND: While a female preponderance in unipolar depression is a consistent finding in community-based studies, determinants remain speculative. This study aimed to examine whether a female preponderance in certain anxiety disorders drives a gender difference in depression. METHOD: The relevant data from the National Comorbidity Study (NCS) are analysed. RESULTS: We observed a biphasic pattern in the emergence of a female preponderance in the depressive and anxiety disorders, with an initial pre-pubertal or early adolescent onset, and after attenuation in early to middle adulthood, re-emergence in mid- to late-adulthood. Analyses focused on determinants of the initial female preponderance. Female gender, presence of an anxiety disorder and variable ages of onset in the anxiety disorder all contributed to the increased chance of an initial depressive episode. Some specificity in linking the onset of depressive temporally in early adolescence with two anxiety disorders was demonstrated, specifically generalized anxiety disorder and panic disorder. CONCLUSIONS: The separate anxiety disorders and their age of onset had variable links with depression, but female gender remained a significant predictor of depression after accounting for the effects of prior anxiety.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15259831&dopt=Abstract anxiety medicine




High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8- and 9-year-olds.

Van den Bergh BR, Marcoen A.

Department of Psychology, Catholic University of Leuven, Belgium. Bea.Vandenbergh psy.kuleuven.ac.be

Associations between antenatal maternal anxiety, measured with the State Trait Anxiety Inventory, and disorders in 8- and 9-year-olds were studied prospectively in 71 normal mothers and their 72 firstborns. Clinical scales were completed by the mother, the child, the teacher, and an external observer. Hierarchical multiple regression analyses showed that maternal state anxiety during pregnancy explained 22%, 15%, and 9% of the variance in cross-situational attention deficit hyperactivity disorder symptoms, externalizing problems, and self-report anxiety, respectively, even after controlling for child's gender, parents' educational level, smoking during pregnancy, birth weight, and postnatal maternal anxiety. Anxiety at 12 to 22 weeks postmenstrual age turned out to be a significant independent predictor whereas anxiety at 32 to 40 weeks was not. Results are consistent with a fetal programming hypothesis. Copyright 2004 Society for Research in Child Development, Inc.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15260866&dopt=Abstract anxiety medicine




Cognitive-behavioral therapy with childhood anxiety disorders: functioning in adolescence.

Manassis K, Avery D, Butalia S, Mendlowitz S.

Department of Psychiatry, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada. katharina.manassis sickkids.ca

We examined anxiety symptoms, anxiety-related impairment, and further treatment in adolescents who received cognitive behavioral therapy (CBT) for childhood anxiety disorders 6-7 years previously. Forty-three adolescents and their parents (14 boys, 29 girls; mean age 16.7 years) participated in structured telephone interviews. Participants (68% of initial sample of 63) did not differ in age, diagnostic profile, socioeconomic status, or initial severity from nonparticipants but more girls than boys participated. Indices based on child- and parent-reported symptoms and impairment were calculated, and within-sample comparisons by age, gender, diagnosis, and initial severity were done using t tests. Predictors of symptoms and impairment were also examined. On average, adolescents reported modest levels of anxiety-related impairment. Further treatment for anxiety had occurred in 30% (13 of 43) of patients. Stepwise regressions found female gender and diagnosis other than generalized anxiety disorder predictive of increased symptoms by parent report, and initial severity predicted adolescent-reported impairment. Adolescents showed limited internalizing symptomatology and impairment but almost one third had required further treatment. Studies comparing treated and untreated samples are needed to clarify whether CBT alters the natural history of childhood anxiety disorders and to replicate our findings regarding predictors of symptomatology and impairment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15274169&dopt=Abstract anxiety medicine




The relationship between trait vulnerability and anxiety and depressive diagnoses at long-term follow-up of Generalized Anxiety Disorder.

Chambers JA, Power KG, Durham RC.

Department of Psychiatry, Ninewells Hospital and Medical School, University of Dundee, Scotland, UK.

The current study examined the relationship between measures of trait vulnerability and long-term outcome in 83 patients diagnosed and treated for Generalized Anxiety Disorder (GAD) 8-14 years previously. Diagnostic status was assessed by structured interview, and trait affect, trait anxiety and trait depression were measured by the Positive and Negative Affect Scale (PANAS), the State-Trait Anxiety Inventory (STAI-T) and the Personal Style Inventory (PSI), respectively. Trait measures were all highly inter-correlated, and patients with diagnoses of GAD, social phobia and depressive disorders at long-term follow-up recorded very poor scores on all three scales. Trait anxiety recorded pre-treatment was also related to both anxiety and depression at long-term follow-up. However, trait depression showed no significant association with panic disorder. Increased numbers of comorbid diagnoses were strongly related to high levels of both trait anxiety and negative affect (NA). The findings suggest that patients reporting high trait anxiety or NA may suffer from a chronic course of disorder and higher levels of comorbidity over the longer term.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15275941&dopt=Abstract anxiety medicine




The Internet: home to a severe population of individuals with social anxiety disorder?

Erwin BA, Turk CL, Heimberg RG, Fresco DM, Hantula DA.

Adult Anxiety Clinic, Department of Psychology, Temple University, Philadelphia, PA, USA. berwin mail.med.upenn.edu

The current study sought to understand better the psychological characteristics of socially anxious individuals who seek information on the internet about social anxiety disorder and its treatment. Participants were 434 individuals who responded to an internet-based survey linked to the website of an anxiety specialty clinic. Using established cut-off scores, 92% of the sample met criteria for social anxiety disorder. Internet survey respondents who met these criteria reported greater severity of and impairment due to social anxiety than a treatment-seeking sample of persons with social anxiety disorder. Nevertheless, only about one-third of these internet respondents reported having received psychotherapy, and a similar percentage reported having received pharmacotherapy. Those with the most severe social interaction anxiety and who spent the most time interacting on the internet endorsed positive effects of internet use. However, a significant number of negative effects also were endorsed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15275943&dopt=Abstract anxiety medicine