Lifetime comorbidity of antisocial personality disorder and anxiety disorders among adults in the community.

Goodwin RD, Hamilton SP.

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. rdg66 columbia.edu

The association between lifetime anxiety disorders, conduct disorder (CD), and antisocial personality disorder (ASPD) among adults in the community was explored. Data were drawn from the National Comorbidity Survey (n = 5,877), a representative community sample of adults aged 15-54 in the 48 contiguous US states. Multiple logistic regression analyses were used to determine the association between anxiety disorders, CD and ASPD, and between the co-occurrence of anxiety disorders and ASPD in the likelihood of comorbid substance use and affective disorders, suicidal ideation (SI) and suicide attempt (SA). Out of the 3.3% of adults with ASPD, over half (54.33%) had a comorbid anxiety disorder (lifetime). Similarly, 42.31% of adults with a history of CD (9.4%) who did not meet criteria for ASPD had a lifetime anxiety disorder. Social phobia [OR = 1.65 (1.01, 2.7)] and post-traumatic stress disorder [OR = 2.28 (1.3, 4.0)] were associated with significantly increased odds of ASPD, after adjusting for differences in sociodemographic characteristics and other psychiatric comorbidity. Major depression was no longer significantly associated with ASPD after adjusting for anxiety disorders. The comorbidity of anxiety disorders and ASPD was associated with significantly higher odds of major depression, substance use disorders, and SI and SA compared with odds among those without both disorders. These data provide initial evidence of an association between PTSD and social phobia and an increased likelihood of ASPD among adults in the community, after adjustment for comorbid affective and substance use disorders. Adults with ASPD and comorbid anxiety had significantly higher levels of comorbid major depression, alcohol dependence, and substance dependence and substantially higher rates of lifetime suicidal ideation and suicide attempts compared to adults with ASPD or anxiety disorders alone or with neither disorder. Future studies are needed to replicate this finding using longitudinal data and to investigate the possible mechanisms of the observed links between anxiety disorders and ASPD. Copyright 2003 Elsevier Science Ireland Ltd.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12606017&dopt=Abstract anxiety medicine




Stressful situations for toddlers: indications for dental anxiety?

Klaassen MA, Veerkamp JS, Aartman IH, Hoogstraten J.

Pedodontology Section, Cariology Department, Academish Centre Tandheelkunde Amsterdam (ACTA), Amsterdam.

The present study was undertaken to examine if daily anxiety-provoking situations can predict dental anxiety in a toddler. Parents of 73 toddlers were sent 2 questionnaires: 1) the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS), and 2) the Inventory of Stressful Situations (ISS), a list of 16 questions developed to assess anxiety in daily stressful situations. This investigation was repeated one year later. Forty-eight parents completed all questionnaires. Results show a clear correlation between daily stressful situations at the age of 3 and dental anxiety at the age of 3 (r = .62, p < 0.01, two-tailed) and at the age of 4 (r = .49, p < 0.01, two-tailed). Regression analyses revealed that the ISS at the age of 3 predicted dental anxiety at the age of four; however, it did not contribute additionally if the CFSS-DS score at the age of three was included. CONCLUSION: Daily anxiety-provoking situations in 3-year-old children may be related to dental anxiety at the age of 4.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12613317&dopt=Abstract anxiety medicine




Social instability in female rats: effects on anxiety and buspirone efficacy.

Haller J, Baranyi J, Bakos N, Halasz J.

Institute of Experimental Medicine, PO Box 67, 1450 Budapest, Hungary. haller koki.hu

RATIONALE: Buspirone produces inconsistent effects in laboratory rodents. Individual housing increases the efficacy of buspirone in male rats, suggesting that the effects of this (and other) compounds become conspicuous in animals showing anxiety-like states. The effect of individual housing was, however, weak, and evident only when the locomotor suppressive effects of buspirone dissipated (i.e. 4 h after treatment). OBJECTIVES: The effects of social instability, a recently developed model of social stress in female rats, was investigated on both anxiety and the anxiolytic efficacy of buspirone. METHODS: Female rats were exposed to alternate days of isolation and moderate crowding for 2 weeks. Group composition was changed for each crowding phase. Basal anxiety and the anxiolytic efficacy of buspirone were assessed by the social interaction test of anxiety 24 h after the last crowding phase. RESULTS: Crowding appeared stressful, as it increased plasma glucocorticoid levels in less than 1 h. Anxiety-like behaviours were increased by social instability compared with stable group housing. In group housed controls, buspirone markedly suppressed locomotion, without clear effects on anxiety-related behaviours. Social instability attenuated the locomotor suppressive effects of buspirone, but made the anxiolytic effects of the compound more conspicuous. The effects of individual housing (assessed earlier) and social instability (assessed here) on buspirone efficacy appear qualitatively different. CONCLUSIONS: Buspirone abolishes stress-induced anxiety, but has no anxiolytic effects in controls. This is consistent with clinical findings, as the drug decreases anxiety in anxious patients but not in healthy humans. Laboratory models involving stress-induced anxiety-like states can improve our understanding of drug effects and efficacy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14760513&dopt=Abstract anxiety medicine




Remission: Today's Target in the Treatment of Mood and Anxiety Disorders.

Nemeroff CB.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA.

Advances in the treatment of mood and anxiety disorders have been significant in recent years. The expectation among psychiatrists that patients can achieve remission is increasing, particularly with the advent of antidepressants with differing modes of action. It was my pleasure to be involved in the development of, and to chair, a series of global neuroscience summit meetings, for which a panel of internationally recognized psychiatrists with academic and clinical expertise in mood and anxiety disorders were brought together to share their knowledge and experience with participants from around the world. The program, developed by the panel, provided an excellent educational and highly interactive forum to discuss clinical and research aspects of unipolar major depressive disorder and anxiety disorders, particularly generalized anxiety disorder. The Global Neuroscience Summit was specifically designed to gain worldwide consensus on key issues relative to response-versus-remission in the management and treatment of mood and anxiety disorders. Each of the regional summits (Latin America, Asia-Pacific, Europe, the Middle East and Africa, and North America) were represented by a co-chair, who provided regional expertise and encouraged participants to actively contribute to the discussions and interact with the assembled, distinguished faculty. This supplement presents the diverse range of topics presented at the Global Neuroscience Summit meetings and includes both plenary and workshop presentations. The topics range from our understanding of the neurobiology of mood and anxiety disorders and the evolution of our understanding of neurotransmitters in the pathophysiology of these disorders, to the clinical course of mood and anxiety disorders, the use of brain-imaging techniques to further understand the etiology of psychiatric disorders, and the influence that treatment has on the central nervous system. The program was sponsored by an unrestricted educational grant from Wyeth and reflects the company's commitment to the management of disorders of the central nervous system.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12490819&dopt=Abstract anxiety medicine




Long-term treatment strategies in anxiety disorders.

Allgulander C, Hirschfeld RM, Nutt DJ.

Karolinska Institute, Neurotec Department, Huddinge University Hospital, Stockholm, Sweden. Allgulander neurotec.ki.se

Anxiety disorders are prevalent and associated with increased morbidity and mortality. Some chronic anxiety disorders, including generalized anxiety disorder (GAD), may be characterized by an underlying high level of anxiety on which exacerbations of symptoms are superimposed. Effective treatment of anxiety disorders should therefore strive to attain both an acute reduction in the symptoms of anxiety (a response) and sustained resolution of the symptoms of any underlying chronic anxiety (remission). This strategy may necessitate long-term treatment of these disorders by pharmacotherapy and/or psychotherapy. Studies using the serotonin and norepinephrine reuptake inhibitor (SNRI), venlafaxine extended release (XR), suggest that these aims may be achieved using this newer class of drugs. Studies with venlafaxine XR in patients with GAD have demonstrated robust anxiolytic efficacy over placebo, particularly regarding worry, cognitive dysfunction, and muscular tension, which are specific to GAD. Administration of venlafaxine XR over both short- (8-week) and long-term (6-month) periods resulted in a significantly greater number of patients achieving response and remission than obtained with placebo. Long-term treatment with venlafaxine XR in patients with GAD showed greater efficacy than that observed in short-term studies. This was achieved without any loss of short-term efficacy and patients' social functioning was also restored. While available data indicate that venlafaxine XR is an appropriate choice of agent in the long-term treatment of GAD, more studies are needed to determine how to further increase remission rates and to maintain remission beyond 6 months.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12490824&dopt=Abstract anxiety medicine




Can we distinguish anxiety from depression?

Baldwin DS, Evans DL, Hirschfeld RM, Kasper S.

Department of Psychiatry, University of Southampton, Hampshire, United Kingdom. dsb1 soton.ac.uk

It is becoming increasingly apparent that although anxiety and depression are separate syndromes and can be identified as such, there is considerable overlap of clinical symptoms and pathophysiological processes. Data indicate that comorbid anxiety and depression is more common than either disorder alone. A large US study found that 58% of individuals with a history of depression also had an anxiety disorder, and a study by the World Health Organization showed that anxiety and depression were the most common coexisting psychological problems in primary care. Generalized anxiety disorder in particular is strongly comorbid with, and commonly precedes, major depression. The implications of comorbid anxiety and depression are significant, with increased social and psychological impairment, and poorer clinical outcomes and prognosis. Anxiety and depression coexist at much higher rates than would be expected by chance alone, suggesting that the two disorders are closely related and may have a common cause. Disturbances of serotonin and norepinephrine neurotransmission are both implicated in anxiety and depression, and new evidence suggests that these systems may provide a mechanistic link between the two disorders, with changes in one system being reflected in the other. Abnormal homeostasis of these two systems may result in anxiety and depression. New theories hypothesize a continuum of illness, with anxiety and depression possibly being different phenotypic expressions of a common neurobiological origin. There is still uncertainty regarding the neurobiological cause, but it is probably linked to dysregulation in the serotonergic and noradrenergic systems.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12490832&dopt=Abstract anxiety medicine




Raising the expectations of long-term treatment strategies in anxiety disorders.

Keller MB.

Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA. sheri_harrison brown.edu

This article describes the long-term course of anxiety disorders based on the findings of the Harvard/Brown Anxiety Research Program (HARP) study-a prospective, naturalistic, longitudinal study of patients with anxiety disorders. Data from the HARP study emphasize both the chronicity of anxiety disorders and their frequent psychiatric comorbidity with other anxiety disorders and depression. Social phobia and generalized anxiety disorder are more chronic than panic disorder, although the latter has higher rates of relapse following recovery. Anxiety disorders have a major impact on the everyday lives of sufferers. The detrimental effects on social, psychological, and physical functioning are comparable with other chronic medical and psychiatric conditions, including diabetes, heart disease, and depression. Comorbidity with depression significantly increases the probability of suicide and is associated with poorer outcome. Findings from the HARP study have significant implications for treatment, which currently tends to focus on short-term outcomes. Future studies should emphasize the role of preventive pharmacotherapy to improve the long-term course of anxiety and to reduce its associated suffering, suicide, and occupational and social impairment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12490833&dopt=Abstract anxiety medicine




Predictive validity of an Implicit Association Test for assessing anxiety.

Egloff B, Schmukle SC.

Department of Psychology, Johannes Gutenberg-University Mainz, Germany. egloff mail.uni-mainz.de

The Implicit Association Test (IAT) was adapted to measure anxiety by assessing associations of self (vs. other) with anxiety-related (vs. calmness-related) words. Study 1 showed that the IAT-Anxiety exhibited good internal consistency and adequate stability. Study 2 revealed that the IAT-Anxiety was unaffected by a faking instruction. Study 3 examined the predictive validity of implicit and explicit measures and showed that the IAT-Anxiety was related to changes in experimenter-rated anxiety and performance decrements after failure. Study 4 found that several behavioral indicators of anxiety during a stressful speech were predicted by the IAT. Taken together, these studies show that the IAT-Anxiety is a reliable measure that is able to predict criterion variables above questionnaire measures of anxiety and social desirability.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12500823&dopt=Abstract anxiety medicine




[Behavioral consequences of isolation in early ontogeny in rats: selectivity of anxiety conditions]

[Article in Russian]

Khonicheva NM, Czabak-Garbacz R, Krupina NA.

Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow.

Multiparameter scale for evaluation of anxiety-phobic state in rats reveals significant enhancement of anxiety in rat pups after 6-week isolation (beginning from the 21st day from birth) as compared to grouped controls of the same litter: the locomotion and exploration that appear in test areas are suppressed, and species-specific fear reactions are enhanced. These changes considered as signs of situational anxiety are not eliminated by 2.5-month keeping in groups. Nevertheless, they are not correlated with parameters of the acoustic startle reflex that (by the data of literature) is thought to be related with fear and anxiety. On the basis of the discrepancy it is proposed that state of anxiety is selective. This suggestion is confirmed by individual behavioral variations characterized by a combination of a low level of situational anxiety and a high level of acoustic anxiety observed in both experimental and control groups. These variations may explain the existence of atypical "emotional resonance"-like behavior according to P.V. Simonov. Attention is given to selectively enhanced acoustic startle reflex in the group of active control as an evidence for critical importance of any manipulations with social context in early ontogeny.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12528379&dopt=Abstract anxiety medicine