Cultural factors in social anxiety: a comparison of social phobia symptoms and Taijin kyofusho.

Kleinknecht RA, Dinnel DL, Kleinknecht EE, Hiruma N, Harada N.

Department of Psychology, Western Washington University, Bellingham 98225-9089, USA. KNECHT CC.WWU.EDU

The present study examined two forms of culturally-defined social anxiety: social anxiety or phobia, as defined by DSM-IV; (i.e., a concern of public scrutiny or embarrassment) and Taijin Kyofusho (TKS), a Japanese form of social anxiety centered around concern for offending others with inappropriate behavior or offensive appearance. These versions of social anxiety are also examined in relation to culturally-determined self definition as independent and interdependent. One hundred eighty-one U.S. students and 161 students enrolled in Japanese universities were administered scales to assess social anxiety and phobia and TKS symptoms and behaviors, as well as construal of self as independent or interdependent. Factor analyses of the three scales used to assess social anxiety yielded three factors, each clearly corresponding to the respective scales and defining TKS and DSM-defined social anxiety. A case analysis indicated that there was an approximate 50% co-occurrence between high scorers on the TKS and social phobia scales. Multiple regression analyses resulted in a different set of predictors of TKS and SPS for the U.S. and Japanese respondents. Results were interpreted as suggesting that cultural variables can mediate the expression of social anxiety but that both forms of social anxiety can be found in each sample.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9168340&dopt=Abstract anxiety medicine




Relationship between perception of facial emotions and anxiety in clinical depression: does anxiety-related perception predict persistence of depression?

Bouhuys AL, Geerts E, Mersch PP.

Dept. of Psychiatry, University of Groningen, Academic Hospital, The Netherlands. a.l.bouhuys med.rug.nl

Within the framework of interpersonal theories on depression, it was postulated 1) that an anxiety-related mood-congruent bias with respect to the perception of facial expressions could be demonstrated in clinically depressed patients: 2) that the perception of negative facial emotions would be associated with co-occurring anxiety levels rather than with depression, and 3) that the putative anxiety-related bias would predict the subsequent course of depression. Such relationships would support the possible causal role of negative biases for the persistence of depression. Thirty-nine depressed patients (thirty-six patients met the criteria for major depression, two had a dysthymic disorder and one patient suffered from a cyclothymic disorder) were studied. The patients judged schematic faces with respect to the emotions they express (fear, happiness, anger, sadness, disgust, surprise, rejection and invitation) at admission (T0), and after 6 (T1) and 30 (T2) weeks. Severity of depression (BDI) and anxiety (SCL-90) were assessed at these three points. We found considerable support for the first 2 hypotheses: a) The perception of negative emotions was related to anxiety but not to depression (at T0 this association was significant and at T1 and T2 tendencies were found); b) When the level of depression was controlled for, significant relationships remained (emerged) between anxiety and the perception of negative emotions at each of the three different time points; c) Anxiety and perception of negative emotions covaried within subjects when large changes in depression/anxiety were involved, i.e. after 30 weeks. This relationship disappeared when depression change was partialled out. The third hypothesis was not confirmed: The perception of negative emotions did not predict the course of depression. Although a direct relationship with depression persistence and a negative bias in the perception of interaction-relevant stimuli (i.e. facial emotions) in anxious depressed patients could not be found, the existence of such anxiety-related negative bias forms indirect evidence for the notion that this negative bias may mediate rejective attitudes of others towards depressives and consequently may contribute to an unfavorable course of depression.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9186792&dopt=Abstract anxiety medicine




Alterations of benzodiazepine receptor binding potential in anxiety and somatoform disorders measured by 123I-iomazenil SPECT.

Tokunaga M, Ida I, Higuchi T, Mikuni M.

Department of Nuclear Medicine and Diagnostic Radiology, Gunma University School of Medicine, Maebashi, Japan.

123I-iomazenil (IMZ), a newly developed radioligand which acts on benzodiazepine receptors (BZR) as a partial inverse agonist, made it possible to evaluate the function of central BZR by single photon emission tomography (SPECT). To examine the alterations of the binding potential (BP) in the anxiety state, 123I-IMZ SPECT was performed in five patients with anxiety and somatoform disorders, and five epileptic patients without anxiety symptoms served as a reference. The BP of BZR was determined by using a table look-up procedure based on a three-compartment, two-parameter model in the bilateral superior frontal, inferior frontal, temporal, parietal, occipital, and cerebellar cortex. The mean BP of patients with anxiety and somatoform disorders was significantly decreased in the superior frontal, temporal, and parietal cortex, in comparison with that of epileptic patients. A significant correlation was observed between the anxiety levels scored on the Hamilton anxiety scale and BP in the right temporal cortex and left superior frontal cortex. These changes in BZR revealed by SPECT suggest the usefulness of 123I-IMZ SPECT to objectively evaluate anxiety levels in patients with anxiety symptoms.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9278373&dopt=Abstract anxiety medicine




Defense style in depressed and anxious psychiatric outpatients: an explorative study.

Spinhoven P, Kooiman CG.

Department of Psychiatry, Leiden University, The Netherlands.

The aim of the present study was threefold: (a) to investigate whether anxiety or depressive disorders are related to the use of specific defenses; (b) to evaluate which defenses are associated with self-report measures for anxiety and depression; and (c) to assess whether the association between defenses and anxiety or depression is gender specific. Subjects were 483 consecutive psychiatric outpatients with the following DSM-III-R diagnoses: (a) V-code or no psychiatric diagnosis (N = 71) (controls); (b) one or two anxiety diagnoses (N = 116), among which 47 patients with a single diagnosis of panic disorder; (c) one or two depressive disorder diagnoses (N = 93), among which 35 patients with a single diagnosis of dysthymia and 51 with a single diagnosis of major depression; and (d) 203 otherwise. Defense use was measured with the Defense Style Questionnaire-36 and level of anxiety and depression with the Symptom Checklist-90. Compared to controls, anxiety and depressive disorder patients scored higher for the immature defense style. Moreover, anxiety disorder patients obtained significantly higher scores for the neurotic defense style than both depressive disorder patients and controls. Panic patients made more use of the defense mechanisms of somatization, devaluation, and idealization, and dysthymic patients of somatization, devaluation, and isolation. Both anxiety and depression scores were positively related to the immature and neurotic, and negatively to the mature defense style. Anxiety was predominantly related to somatization and depression to projection. No evidence for a gender specific association between defense and anxiety or depression was found. It is concluded that the observed differences in defense between groups may be a consequence of the nature of the psychiatric disorder irrespective of gender. Prospective studies of persons at risk are needed to evaluate whether specific defenses are predictive of anxiety or depressive disorders and/or symptoms.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9048700&dopt=Abstract anxiety medicine




Screening for anxiety and depression in primary care with the Duke Anxiety-Depression Scale.

Parkerson GR Jr, Broadhead WE.

Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA. parke001 me.duke.edu

BACKGROUND AND OBJECTIVES: Anxiety and depression are highly prevalent and underdiagnosed in primary care. This study tested the seven-item Duke Anxiety-Depression Scale (DUKE-AD) in primary care adult patients as a screener for anxiety and depression as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). METHODS: Receiver operating characteristic curves (ROC) and odds ratios were used to test screener accuracy, and sensitivities and specificities were used to test screener efficiency in patients with anxiety and/ or depression. RESULTS: In 481 patients, the ROC area for patients with major anxiety disorders (panic disorder, agoraphobia, or generalized anxiety) was 72.3%. The ROC area for major depressive disorders (major depressive disorder and/or dysthymia) was 78.3%, and the ROC area for both major anxiety and/or depressive disorders was 76.2%. Odds ratios for these same groups after controlling for sociodemographic factors were 1.043, 1.057, and 1.053, respectively. Sensitivities and specificities for these groups at the DUKE-AD score cutoff point of > 30 on a 0-100 scale were 71.4% and 59.2%, 81.8% and 63.6%, and 73.9% and 66.1%, respectively. CONCLUSIONS: The DUKE-AD is a brief, easily scored questionnaire that serves as a valid screener for DSM-III-R anxiety and depression in the primary care setting.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9085098&dopt=Abstract anxiety medicine




Dental anxiety and illness behaviour.

Portmann K, Radanov BP.

University of Bern, Inselspital, Switzerland.

BACKGROUND: To analyse the relationship between dental anxiety and illness behaviour. METHODS: Dental anxiety was assessed in 165 patients from private practice using the Dental Anxiety Scale (DAS), aspects of illness behaviour were evaluated by the Illness Attitude Scale (IAS), and aspects of general anxiety were analysed by the State Trait Anxiety Inventory (STAI). Dental status was documented using the DMFS index and Bleeding-on-Probing index (BOP). RESULTS: Multiple regression analysis (explained proportion of variance = 32%) showed that dental anxiety was significantly correlated with female gender (t = 3.109, p < 0.002) and IAS health habits (t = -2.210, p < 0.03). In addition, a correlation trend was found between dental anxiety and BOP index (t = -1.789, p < 0.08). CONCLUSION: Dental anxiety appears to be a gender-specific phenomenon. Results indicate a tendency towards abnormal illness behaviour (i.e. denial of dental anxiety) in a considerable proportion of subjects and as a consequence display of poor health habits (i.e. counterphobic behaviour). The latter may lead to an increased tendency to develop gingivitis as indicated by the correlation trend between dental anxiety and BOP index.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9176907&dopt=Abstract anxiety medicine




Discriminating between generalized anxiety disorder and anxiety disorder not otherwise specified in a Hispanic population: is it only a matter of worry?

Street LL, Salman E, Garfinkle R, Silvestri J, Carrasco J, Cardenas D, Zinbarg R, Barlow DH, Liebowitz MR.

Department of Psychiatry, George Washington University Medical Center, Washington, DC 20037, USA.

One hundred and two Hispanic persons who presented for treatment at a specialized anxiety disorders clinic were evaluated at intake using the Anxiety Disorders Interview Schedule-Revised (ADIS-R; DiNardo and Barlow [1988] Albany: Center for Stress and Anxiety Disorders, State University of New York at Albany). Results indicated that 14% of these patients suffered from anxiety and/or affective disorders that were not adequately captured by our current diagnostic system. Given that the majority of these cases were characterized by predominantly anxious features, further investigation was undertaken to determine the degree of overlap between these patients (anxiety disorder, not otherwise specified; NOS) and those with generalized anxiety disorder (GAD). The two groups differed only with regard to the number of excessive worries they reported and not in terms of somatic symptomatology, psychosocial stressors, or demographic variables. These data suggest that excessive worry may be a discriminating factor between the GAD and NOS groups, providing support for the notion of GAD as a disorder of chromic worry. Future research is needed to tease apart the relative influences of culture and socioeconomic status on our findings.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9250434&dopt=Abstract anxiety medicine




A prospective study of childhood anxiety disorders.

Last CG, Perrin S, Hersen M, Kazdin AE.

Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, FL, USA.

OBJECTIVE: To evaluate course and outcome of DSM-III-R anxiety disorders prospectively in clinically referred children. METHOD: Children were blindly and repeatedly assessed with a structured diagnostic interview over a 3- to 4-year period to determine recovery from anxiety disorder and development of new psychiatric disorders. Both psychopathological (attention-deficit hyperactivity disorder, n = 50) and never psychiatrically ill (NPI, n = 83) controls served as comparison groups for children with anxiety disorders (n = 84). RESULTS: The majority of children (82%) were free from their intake anxiety disorders by the end of the follow-up. Relapse of these anxiety disorders after remission was rare (8%). During follow-up, anxious children were more likely to develop new psychiatric disorders (30%), primarily new anxiety disorders (16%), than were NPI children (11% and 2%, respectively), but not psychopathological controls (42% and 10%, respectively). CONCLUSIONS: Overall, results suggest a favorable outcome with respect to diagnostic status for clinically referred children with anxiety disorders. However, these children may be at risk for new psychiatric disorders over time.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8936917&dopt=Abstract anxiety medicine




Mice lacking the serotonin transporter exhibit 5-HT(1A) receptor-mediated abnormalities in tests for anxiety-like behavior.

Holmes A, Yang RJ, Lesch KP, Crawley JN, Murphy DL.

Laboratory of Behavioral Neuroscience, National Institute of Mental Health, NIH, Bethesda, MD 20892, USA. aholmes intra.nimh.nih.gov

The serotonin transporter (5-HTT) regulates serotonergic neurotransmission via clearance of extracellular serotonin. Abnormalities in 5-HTT expression or function are found in mood and anxiety disorders, and the 5-HTT is a major target for antidepressants and anxiolytics. The 5-HTT is further implicated in the pathophysiology of these disorders by evidence that genetic variation in the promoter region of the HTT (SLC6A4) is associated with individual differences in anxiety and neural responses to fear. To further evaluate the role of the 5-HTT in anxiety, we employed a mouse model in which the 5-HTT gene (htt) was constitutively inactivated. 5-HTT -/- mice were characterized for anxiety-related behaviors using a battery of tests (elevated plus maze, light<-->dark exploration test, emergence test, and open field test). Male and female 5-HTT -/- mice showed robust phenotypic abnormalities as compared to +/+ littermates, suggestive of increased anxiety-like behavior and inhibited exploratory locomotion. The selective 5-HT(1A) receptor antagonist, WAY 100635 (0.05-0.3 mg/kg), produced a significant anxiolytic-like effect in the elevated plus maze in 5-HTT -/- mice, but not +/+ controls. The present findings demonstrate abnormal behavioral phenotypes in 5-HTT null mutant mice in tests for anxiety-like and exploratory behavior, and suggest a role for the 5-HT(1A) receptor in mediating these abnormalities. 5-HTT null mutant mice provide a model to investigate the role of the 5-HTT in mood and anxiety disorders.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12968128&dopt=Abstract anxiety medicine