A three-generational presentation of separation anxiety in childhood with agoraphobia in adulthood.

Deltito JA, Hahn R.

Anxiety and Mood Disorder Program, Cornell University Medical Center, New York Hospital, Westchester Division, White Plains 10605.

School phobia belongs to a family of childhood anxiety states that appear to be related to adult forms of anxiety disorders, particularly to panic disorder with agoraphobia. School phobia appears to affect at least 5 percent of elementary school children and 2 percent of middle school children. Many of these children would be classified under the current DSM-III-R system of nomenclature as suffering from separation anxiety disorder. The present study is related to the elaboration of a three-generation family presentation of separation anxiety disorder manifesting itself as school phobia in childhood, which evolves toward panic disorder with agoraphobia in young adulthood and diffuse anxiety with hypochondriacal features in later life. All 13 genetically related members of the family investigated have been afflicted. The children with separation anxiety disorder and school phobia in this family who have been treated with imipramine have shown a resolution of anxiety symptoms that has allowed their successful return to school. The information from this family would fit into a model that describes a spectrum of anxiety disorders that present with different manifestations of overt psychopathology throughout the life cycle. We hope to follow this family prospectively over the next 30 years.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8290664&dopt=Abstract anxiety medicine




Divergent, criterion-related, and discriminant validities for the Kuwait University Anxiety Scale.

Abdel-Khalek AM.

Department of Psychology, College of Social Sciences, University of Kuwait, P.O. Box 68168, Kaifan, Code No. 71962, Kuwait.

Three analyses were carried out. Analysis I estimated the correlation between the total score of the Kuwait University Anxiety Scale and a self-rating scale of happiness with large sample of male (n = 1,312) and female (n = 1,272) Kuwaiti adolescents. Pearson product-moment correlations were -.43 and -.44 (p < .001) for boys and girls, respectively, suggesting divergent validity of the anxiety scale. Analysis II examined the correlations between scores on the Kuwait University Anxiety Scale and the Somatic Symptoms Inventory for a nonclinical sample of women (n = 30), and female outpatients with anxiety disorder (n = 30). Pearson product-moment correlations were, respectively, .85 and .53, (p < .001), which support the criterion-related validity of the Kuwait University Anxiety Scale with respect to the Somatic Symptoms Inventory. In Analysis III a sample of 60 male and female outpatients with anxiety disorder and 60 nonclinical participants were matched on age, education, and occupation. All responded individually to the Kuwait University Anxiety Scale. Significant differences among groups, especially noticeable for men, support the discriminant validity of the scale. So, the clinical as well as research use of the scale can be recommended. By and large, the divergent, discriminant, and criterion-related validities of the scale have been adequately supported so subsequent replication is expected.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15154187&dopt=Abstract anxiety medicine




Anxiety and motor behavior: a review.

Martens R.

Children's Research Center, University of Illinois, IL, USA.

Anxiety and related terms were defined by conceptually distinguishing between "state" and "trait" anxiety and between anxiety, stress and fear. The literature concerned with the anxiety-motor behavior relationship was reviewed using the state-trait anxiety distinction. After outlining the general notions of drive theory as related between the Taylor Manifest Anxiety Scale (MAS) and motor behavior in the absence or in the presence of a stressor, and on those studies using anxiety scales other than MAS. The accumulated evidence failed to reveal any consistent trends in these three areas. The use of drive theory and the MAS to predict motor behavior ws shown not to be a viable approach. Two alternative approaches were briefly outlined.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15155170&dopt=Abstract anxiety medicine




Anxiety and depressive symptoms measured by the Hospital Anxiety and Depression Scale as predictors of time to recurrence in localized cutaneous melanoma.

Bergenmar M, Nilsson B, Hansson J, Brandberg Y.

Department of Oncology-Pathology, Karolinska Hospital and Institutet, Stockholm, Sweden. mia.bergenmar ks.se

The purpose of this study was to investigate anxiety and depression as predictors for recurrence-free survival in cutaneous melanoma, when corrected for known prognostic factors. The association between known prognostic factors and anxiety and depression were also studied. Consecutive patients (n = 437) completed the Hospital Anxiety and Depression Scale (HAD) approximately three months after diagnosis of melanoma. Neither anxiety, nor depression turned out to be prognostic factors for time to recurrence. A higher proportion of young patients, women, patients without ulcerated tumours, patients with tumours with low mitotic index and Clark's level II tumours scored > or = 8 (possible clinical levels of anxiety) on the anxiety scale. Furthermore, on the depression scale, a higher proportion of young patients scored > or = 8 (possible clinical level of depression). Using the HAD scale, a well-validated instrument for assessing anxiety and depression in patients with somatic diseases, our data did not show any associations between anxiety or depression and outcome in terms of recurrence in patients with localized disease.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15163164&dopt=Abstract anxiety medicine




[Some background data about the high dental anxiety of the Hungarian population]

[Article in Hungarian]

Gaspar J, Toth Z, Fejerdy L, Kaan B, Fabian TK.

Semmelweis Egyetem, Fogpotlastani Klinika, Budapest.

100 dental patients waiting for hypnotic dental treatment (n = 100, 58 female, 42 male, mean age: 36.4 +/- 10.6 yr.) was investigated about their perceived origins of dental anxiety. Dental anxiety levels (DAS, DFS) and general anxiety were measured as well. Mean dental anxiety scores were high (DAS: 12.5 +/- 3.3; DFS: 47.9 +/- 17.3). The most frequent reason of high dental anxiety was previous painful dental treatment (20.0%), dislike of dentist's behaviour (15.0%), treatment error (5.0%), and "other reasons" (4.0%). A large amount of the patients (48.0%) did not know what to expect, and 8.0% indicate no fear related to dentistry. Previous painful dental treatment induced the highest dental anxiety (DAS: 15.1 +/- 3.1; DFS: 58.1 +/- 20.3), followed by the "other reasons" (DAS: 14.0 +/- 0.8; DFS: 50.5 +/- 13.5), treatment error (DAS: 13.0 +/- 3.7; DFS: 49.0 +/- 16.1), and dislike of dentist's behaviour (DAS: 11.4 +/- 2.8; DFS: 45.0 +/- 12.5). Increased general anxiety was found in the groups indicated previous painful dental treatment, "other reasons", and no expectation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15164677&dopt=Abstract anxiety medicine




[A study on the factors influencing the anxiety of family members in the emergency department]

[Article in Japanese]

Kawakami C, Matsuoka M, Taki K.

Department of Health Sciences, School of Medicine, Kyushu University, Fukuoka, Japan.

The purpose of this study was to determine the factors which affect anxiety of family members in the emergency department (ED). 174 family members of patients participated in this study. The age of family members was a mean of 43.1 (range: 20 to 84) years and 59.8% of them were women. The informations were obtained from a questionnaire filled out by the family members when they were waiting during examination and treatment of the patients. In this study, we divided the factors that influence the anxiety of family members into 4 categories; demographic factors, the family's individual factors, factors associated illness, and environmental factors in the ED. Multiple regression analysis with SPSS was used to identify the variables contributing to the variance in anxiety. We used the State Anxiety Inventory (S-STAI) to measure anxiety. As a result, 8 variables involving in severity of illness, situation in the emergency room, disagreement between perceived severity of illness and actual severity of illness, having symptoms of trauma, neurological, heart, and respiratory problems, waiting time, family needs, naturally anxious personality and a first visit patient were identified as significant predictors of anxiety. These variables accounted for 46.9% of total variance. These results suggest that nurses need more interaction with family members to reduce their anxiety.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15164934&dopt=Abstract anxiety medicine




Generalized anxiety disorder in referred children and adolescents.

Masi G, Millepiedi S, Mucci M, Poli P, Bertini N, Milantoni L.

IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy. gabrielle.masi inpe.unipi.it

OBJECTIVE: There are insufficient data on generalized anxiety disorder in children and adolescents. Symptoms and comorbidity of generalized anxiety disorder are described as a function of age, gender, and comorbidity in a consecutive series of referred children and adolescents. METHOD: One hundred fifty-seven outpatients (97 males and 60 females, 50 children and 107 adolescents, age range 7-18 years, mean age 13.4 +/- 2.7 years) were diagnosed as having generalized anxiety disorder, using historical information and a structured clinical interview (Diagnostic Interview for Children and Adolescents-Revised) according to the DSM-IV. RESULTS: Feelings of tension, apprehensive expectations, negative self-image, need for reassurance, irritability, and physical complaints were reported in more than 75% of the participants. Differences in symptomatology according to age and gender were nonsignificant. Depressive disorder was the most frequent comorbidity, being present in 56% of the patients. Comorbid anxiety disorders were present in about 75% of the patients, and 21% showed externalizing disorders. Subjects with comorbid depression had less anxiety comorbidity, subjects with comorbid separation anxiety disorder had higher rates of panic disorder, and subjects with comorbid externalizing disorders had higher rates of bipolar disorder. CONCLUSIONS: Referred children and adolescents with generalized anxiety disorder are heavily symptomatic and have frequent comorbidity. A more precise definition of the clinical picture may help early diagnosis and prevention of superimposed mental disorders.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15167092&dopt=Abstract anxiety medicine




The gynecologic oncology consult: symptom presentation and concurrent symptoms of depression and anxiety.

Fowler JM, Carpenter KM, Gupta P, Golden-Kreutz DM, Andersen BL.

Department of Obstetrics-Gynecology, Division of Gynecologic Oncology, The Ohio State University, Columbus, OH 43210, USA.

OBJECTIVE: To detail the relationship of gynecologic symptoms and sociodemographic variables to depression and anxiety reports among women who were referred to gynecologic oncologists for evaluation. METHODS: Consecutive patients (N = 151) from an National Cancer Institute-designated comprehensive cancer center were accrued and participated on the day of consultation. Patients completed measures assessing depression (Center for Epidemiological Studies Depression Scale) and anxiety (Beck Anxiety Inventory) symptoms, common gynecologic signs/symptoms, and sociodemographic characteristics. Patients were followed up and subsequent diagnoses yielded 73 (48%) cancer and 78 (52%) benign cases. RESULTS: Descriptive analyses revealed that the cancer group was significantly older (52 versus 45 years) than the benign group, and variables correlated with age also differed significantly, with the cancer sample more likely to be postmenopausal, unemployed, and if employed, working fewer hours per week. Importantly, the groups did not differ on reports of depressive, anxiety, or gynecologic symptoms. Hierarchical multiple regression analyses, collapsing across groups, yielded significant correlates of emotional distress. Women who were older, without a spouse/partner, and who had more gynecologic symptoms had higher levels of both depressive and anxiety symptoms. Among the women who did have a partner, those with relationships of longer duration reported lower levels of depression/anxiety CONCLUSION: Reports of clinically significant depressive (42%) and anxiety symptoms (30%) were high. The number of gynecologic symptoms was reliably correlated with emotional distress. Age and absence of partner may have conferred added vulnerability. For those women with partners, lengthier relationships appeared to offer protection from both depressive and anxiety symptoms. LEVEL OF EVIDENCE: III

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15172854&dopt=Abstract anxiety medicine




Plasma concentrations of anxiolytic neurosteroids in men with normal anxiety scores: a correlation analysis.

Brambilla F, Biggio G, Pisu MG, Purdy RH, Gerra G, Zaimovich A, Serra M.

Addiction Research Center, Azienda Unita Sanitaria, Parma, Italy. francesca.brambilla4 tin.it

Neurosteroids are physiological regulators of anxiety in experimental animals, but there are no data for humans about the modulatory effects of the hormones on normal aspects of this emotional parameter. Plasma concentrations of four neurosteroids, pregnenolone, progesterone (PROG), allopregnanolone and tetrahydrodeoxycorticosterone, suggested to be major anxiety regulators in experimental animals, were measured in a group of 58 physically and psychologically normal adult male subjects. In parallel, trait (genotypical) and state (phenotypical) anxiety scores were measured by the State-Trait Anxiety Inventory. The possible correlations between the hormonal secretions and the psychological parameters were statistically analyzed. The neurosteroid concentrations and the anxiety scores of the probands were within the ranges of normality according to data of the literature and our own. PROG concentrations correlated significantly with state anxiety scores. These data suggest that neurosteroids may physiologically modulate anxiety not only in experimental animals but also in humans. Copyright 2004 S. Karger AG, Basel

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15179013&dopt=Abstract anxiety medicine