Anxiety Disorders

Background-From an affective neuroscience perspective, our understanding of psychiatric illness may be advanced by neuropsychological test paradigms probing emotional processes. Reversal learning is one such process, whereby subjects must first acquire stimulus/reward and stimulus/punishment associations through trial and error and then reverse them. We sought to determine the specificity of previously demonstrated reversal learning impairments in youths with bipolar disorder (BD) by now comparing BD youths to those with severe mood dysregulation (SMD), major depressive disorder (MDD), anxiety (ANX), and healthy controls.

Some but not all models of obsessive–compulsive disorder (OCD) emphasize the role of dysfunctional beliefs in the etiology and maintenance of this disorder. Clinical observations suggest that some OCD patients have prominent dysfunctional beliefs associated with their obsessions and compulsions, while other patients do not show this pattern. It is possible that dysfunctional beliefs play a role in only a

Previous research has supported the immediate activation of patient's strengths (resource activation) as an important mechanism of change in psychotherapy. We designed a brief (10 min) priming procedure in which therapists' attention was focused on the patients' individual strengths before each therapy session (resource priming). In a preliminary study, the priming procedure was carried out before each of the first five sessions (N 5 20). Preliminary results indicated that this brief preparatory intervention boosted resource activation as perceived by independent observers, fostered attachment and mastery experiences by the patient, and improved therapy outcome at Session 20. Improvement was assessed in comparison to a pairwise matched, nonrandomized control group of patients treated previously with the same treatment protocol at the same clinic.

This article reviews the state-of-the-art research in posttraumatic stress disorder (PTSD) from several perspectives: (1) Sex differences: PTSD is more frequent among women, who tend to have different types of precipitating traumas and higher rates of comorbid panic disorder and agoraphobia than do men. (2) Risk and resilience: The presence of Group C symptoms after exposure to a disaster or act of terrorism may predict the development of PTSD as well as comorbid diagnoses. (3) Impact of trauma in early life: Persistent increases in CRF concentration are associated with early life trauma and PTSD, and may be reversed with paroxetine treatment. (4) Imaging studies: Intriguing findings in treated and untreated depressed patients may serve as a paradigm of failed brain adaptation to chronic emotional stress and anxiety disorders. (5) Neural circuits and memory: Hippocampal volume appears to be selectively decreased and hippocampal function impaired among PTSD patients. (6) Cognitive behavioral approaches: Prolonged exposure therapy, a readily disseminated treatment modality, is effective in modifying the negative cognitions that are frequent among PTSD patients. In the future, it would be useful to assess the validity of the PTSD construct, elucidate genetic and experiential contributing factors (and their complex interrelationships), clarify the mechanisms of action for different treatments used in PTSD, discover ways to predict which treatments (or treatment combinations) will be successful for a given individual, develop an operational definition of remission in PTSD, and explore ways to disseminate effective evidence-based treatments for this condition.

Despite the established evidence for threat-related attention bias in anxiety, the mechanisms underlying this bias remain unclear. One important unresolved question is whether disorder-congruent threats capture attention to a greater extent than do more general or disorder-incongruent threat stimuli. Evidence for attention bias specificity in anxiety would implicate involvement of previous learning and memory processes in threat-related attention bias, whereas lack of content specificity would point to perturbations in more generic attention processes. Enhanced clarity of mechanism could have clinical implications for the stimuli types used in Attention Bias Modification Treatments (ABMT). Content specificity of threat-related attention bias in anxiety and potential moderators of this effect were investigated. A systematic search identified 37 samples from 29 articles (N=866). Relevant data were extracted based on specific coding rules, and Cohen's d effect size was used to esti...

An epidemiological study of Attention Deficit / Hyperactivity Disorder (ADHD) suggests that the prevalence may be two to three times higher than the figure of 3 ± 5% often cited. In addition, the data suggest that both underdiagnosis and overdiagnosis occur frequently. Rodent animal models of ADHD, like the Spontaneously Hypertensive Rat (SHR) and other rat models such as those with chemical and radiationinduced brain lesions and cerebellar stunting, and the Coloboma mouse model exhibit clear similarities with several aspects of the human disorder and should prove useful in studying specific traits. Operant behavioral tasks that model learning, short -term memory and simple discriminations are sensitive to ADHD and methylphenidate has been shown to normalize ADHD performance in a short -term memory task. Recent findings challenge not only the current postulate that response inhibition is a unique deficit in ADHD, but also the concepts of ADHD and its treatment, which presume intact perceptual abilities. Time perception deficits may account, in part, for the excessive variability in motor response times on speeded reaction time tasks, motor control problems and motor clumsiness associated with ADHD. The Multimodality Treatment Study of ADHD (MTA) provided data suggesting that pharmacological interventions that included systematic and frequent follow -up with parents and teachers, with or without psychosocial interventions, are superior to psychosocial interventions or standard community care alone. Additionally, the MTA was one of the first studies to demonstrate benefits of multimodal and pharmacological interventions lasting longer than 1 year. Imaging studies have demonstrated differences in brain areas in children with ADHD: anterior corpus callosum, right anterior white matter, and cerebellar volumes are all decreased in children with ADHD and there is less brain asymmetry in ADHD subjects. Additionally, functional imaging studies, coupled with pharmacological manipulations, suggest decreased blood flow and energy utilization in prefrontal cortex and striatum, and the dysregulation of catecholamine systems in persons with ADHD. D (M.G. Paule).

Anxiety disorders are common in adolescents (ages 12 to 18) and contribute to a range of impairments. There has been speculation that adolescents with anxiety are at risk for being treatment nonresponders. In this review, the authors examine the efficacy of cognitive-behavioral therapy (CBT) for adolescents with anxiety. Outcomes from mixed child and adolescent samples and from adolescent-only samples indicate that approximately two-thirds of youths respond favorably to CBT. CBT produces moderate to large effects and shows superiority over control/comparison conditions. The literature does not support differential outcomes by age: adolescents do not consistently manifest poorer outcomes relative to children. Although extinction paradigms find prolonged fear extinction in adolescent samples, basic research does not fully align with the processes and goals of real-life exposure. Furthermore, CBT is flexible and allows for tailored application in adolescents, and it may be delivered in...

Research has shown that mindfulness-based treatment interventions may be effective for a range of mental and physical health disorders in adult populations, but little is known about the effectiveness of such interventions for treating adolescent conditions. The present randomized clinical trial was designed to assess the effect of the mindfulness-based stress reduction (MBSR) program for adolescents age 14 to 18 years with heterogeneous diagnoses in an outpatient psychiatric facility (intent-to-treat N ϭ 102). Relative to treatment-as-usual control participants, those receiving MBSR self-reported reduced symptoms of anxiety, depression, and somatic distress, and increased self-esteem and sleep quality. Of clinical significance, the MBSR group showed a higher percentage of diagnostic improvement over the 5-month study period and significant increases in global assessment of functioning scores relative to controls, as rated by condition-naïve clinicians. These results were found in both completer and intent-to-treat samples. The findings provide evidence that MBSR may be a beneficial adjunct to outpatient mental health treatment for adolescents.

Sexual assault survivors with post-traumatic stress disorder (PTSD) were assessed for frequency of nightmares, measured retrospectively on the Nightmare Frequency Questionnaire (NFQ) and prospectively on nightmare dream logs (NLOG). Retrospective frequency was extremely high, averaging occurrences every other night and an estimated number of nightmares greater than ®ve per week. Test±retest reliability data on the NFQ yielded weighted kappa coef®cients of .85 (95% CI, .74±.95) for nights and .90 (95% CI, .83±.97) for nightmares. Correlations between retrospective and prospective nightmare frequencies ranged between .53 (P :001) for nights and .63 (P :001) for nightmares. Correlations between frequency and distress measures (anxiety, depression, post-traumatic stress) yielded coef®cients ranging from (r :28±.53). Compared with intrusive, cumbersome and time-consuming prospective measurements, the NFQ appears reliable, convenient, and equally useful in assessing nightmare frequency in a group of sexual assault survivors. Nightmare frequency, prevalence, distress and impairment are discussed. #

Despite the growing evidence that perfectionism is associated with adolescent psychological distress, few studies have investigated this relationship prospectively with measures designed for use in adolescent populations. In the present study, within a diathesis-stress framework, we investigated the extent to which perfectionism and acute life stress predict depression, anxiety and self-harm among adolescent school children (n ¼ 515) over a 6 month period (Time 1-Time 2). Socially prescribed perfectionism (SPP), self-oriented perfectionism-critical (SOP-critical) and the associated interactions with acute life stress differentially predicted anxiety, depression and self-harm. Acute life stress was an independent predictor of depression, anxiety and self-harm. SPP predicted depression and interacted with acute life stress to predict self-harm. SOP-critical and the SOP-critical by acute life stress interaction predicted anxiety. Self-oriented perfectionismstriving (SOP-striving) did not predict any of the Time 2 measures of distress. The dimensions of perfectionism are differentially associated with psychological distress. Tailored clinical interventions focused on adolescent perfectionism should offer promise in tackling psychological morbidity in adolescence.

Objective To determine the prevalence of depression and anxiety in terminally ill patients pursuing aid in dying from physicians. Design Cross sectional survey. Setting State of Oregon, USA. Participants 58 Oregonians, most terminally ill with cancer or amyotrophic lateral sclerosis, who had either requested aid in dying from a physician or contacted an aid in dying advocacy organisation. Main outcome measures Diagnosis of depression or anxiety according to the hospital anxiety and depression scale and the structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders. Results 15 study participants met "caseness" criteria for depression, and 13 met criteria for anxiety. 42 patients died by the end of the study; 18 received a prescription for a lethal drug under the Death with Dignity Act, and nine died by lethal ingestion. 15 participants who received a prescription for a lethal drug did not meet criteria for depression; three did. All three depressed participants died by legal ingestion within two months of the research interview. Conclusion Although most terminally ill Oregonians who receive aid in dying do not have depressive disorders, the current practice of the Death with Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug.

Mental health outcomes for survivors of critical congenital heart disease (CHD) remain under-investigated. We sought to examine psychiatric disorders and psychosocial functioning in adolescents with single ventricle CHD and to explore whether patient-related risk factors predict dysfunction. This cohort study recruited 156 adolescents with single ventricle CHD who underwent the Fontan procedure and 111 healthy referents. Participants underwent comprehensive psychiatric evaluation including a clinician-rated psychiatric interview and parent- and self-report ratings of anxiety, disruptive behavior, including attention-deficit/hyperactivity disorder (ADHD), and depressive symptoms. Risk factors for dysfunction included IQ, medical characteristics, and concurrent brain abnormalities. Adolescents with single ventricle CHD had higher rates of lifetime psychiatric diagnosis compared with referents (CHD: 65%, referent: 22%; P < .001). Specifically, they had higher rates of lifetime anxie...

e Abstract-Objective: The aim of this study was to determine the prevalence of anxiety and depressive disorders in patients presenting with chest pain to the Emergency Department (ED) and determine if there is a relationship between these and cardiac vs. non-cardiac chest pain. Methods: This prospective cross-sectional study was performed in an urban tertiary care hospital between March and October 2005. Consecutive patients presenting with chest pain were enrolled in the study. The prevalence of anxiety and depressive disorders in patients with chest pain were determined by using the Hospital Anxiety and Depression Scale. Results: A total of 324 patients presented to the ED with chest pain during the study period. The mean age of the patients studied was 50.5 ؎ 14 years; 67% were men and 33% were women. Of the 324 study patients, 194 (59.9%) patients were diagnosed with non-cardiac chest pain, 16 (4.9%) with stable angina, 84 (25.9%) with unstable angina, and 30 (9.3%) with acute myocardial infarction. No statistically significant differences were determined between patients with cardiac and non-cardiac chest pain both for anxiety (40% vs. 38.1%, respectively; p ‫؍‬ 0.737) and depressive disorders (52.3% vs. 52.1%, respectively; p ‫؍‬ 0.965). Conclusion: Anxiety and depressive disorders are common among patients presenting with chest pain to the ED. However, the prevalence of anxiety and depressive disorders is similar between patients with chest pain of cardiac and non-cardiac origin. Chest pain should not be attributed to an anxiety or depressive disorder before organic etiologies are excluded.

The purpose of the present study was to investigate gender-related sociodemographic and clinical differences among Turkish patients with obsessive-compulsive disorder (OCD). A total of 169 patients diagnosed with OCD by DSM-III-R or DSM-IV criteria were included in this study. Male (n ‫؍‬ 73) and female (n ‫؍‬ 96) OCD patients were compared with respect to the demographic variables and the scores obtained from the Hamilton Rating Scale for Anxiety (HRSA), the Hamilton Rating Scale for Depression (HRSD) and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). We found a significantly earlier age at onset in male patients. No significant difference in terms of HARS, HDRS, and Y-BOCS scores was detected between the two groups. We observed a significantly higher frequency of contamination obsessions in females, and that of agression and sexual obsessions in males. There was no significant difference in terms of the frequency of compulsions between the two groups. We also found that compulsion severity on obsessions/compulsions was higher in females and comorbidity rates of social phobia and schizophrenia were higher in males. Considering our results in combination with those of other studies, similarities rather than differences in gender-related sociodemographic and clinical characteristics of OCD patients across different populations seem to be present.

Background. Research on the dimensional structure and reliability of the Hospital Anxiety and Depression Scale (HADS) and its relationship with age is scarce. Moreover, its efficacy in determining the presence of depression in different patient groups has been questioned. Methods. Psychometric properties of the HADS were assessed in six different groups of Dutch subjects (N l 6165) : (1) a random sample of younger adults (age 18-65 years) (N l 199) ; (2) a random sample of elderly subjects of 57 to 65 years of age (N l 1901) ; (3) a random sample of elderly subjects of 66 years or older (N l 3293) ; (4) a sample of consecutive general practice patients (N l 112) ; (5) a sample of consecutive general medical outpatients with unexplained somatic symptoms (N l 169) ; and (6) a sample of consecutive psychiatric outpatients (N l 491). Results. Evidence for a two-factor solution corresponding to the original two subscales of the HADS was found, although anxiety and depression subscales were strongly correlated. Homogeneity and test-retest reliability of the total scale and the subscales were good. The dimensional structure and reliability of the HADS was stable across medical settings and age groups. The correlations between HADS scores and age were small. The total HADS scale showed a better balance between sensitivity and positive predictive value (PPV) in identifying cases of psychiatric disorder as defined by the Present State Examination than the depression subscale in identifying cases of unipolar depression as defined by ICD-8. Conclusions. The moderate PPV suggests that the HADS is best used as a screening questionnaire and not as a ' case-identifier ' for psychiatric disorder or depression.

Despite its theoretical importance, personal goal motivation has rarely been examined in clinical depression. Here we investigate whether clinically depressed persons (n = 23) differ from never-depressed persons (n = 26) on number of freely generated approach and avoidance goals, appraisals of these goals, and reasons why these goals would and would not be achieved. Participants listed approach and avoidance goals separately and generated explanations for why they would (pro) and would not (con) achieve their most important approach and avoidance goals, before rating the importance, likelihood and perceived control of goal outcomes. Counter to hypothesis, depressed persons did not differ from neverdepressed controls on number of approach or avoidance goals, or on the perceived importance of these goals. However, compared to never-depressed controls, depressed individuals gave lower likelihood judgements for desirable approach goal outcomes, tended to give higher likelihood judgements for undesirable to-be-avoided goal outcomes, and gave lower ratings of their control over goal outcomes. Furthermore, although controls generated significantly more pro than con reasons for goal achievement, depressed participants did not. These results suggest that depressed persons do not lack valued goals but are more pessimistic about their likelihood, controllability and reasons for successful goal attainment. Personal goals systems and depression 3 Although goal dysregulation has been implicated in affective disorders (Johnson, Carver, & Fulford, 2010) and goal pursuit is considered to be central to human motivation (Klinger, 1977), goal-based perspectives on depression have received little attention. Goals provide meaning, purpose, and direction in life, as well as a framework for interpreting life experience (Schmuck & Sheldon, 2001). It remains unclear whether depression is characterized by a general deficit in goal motivation, or by a profile of decreased approach motivation and increased avoidance motivation. It is also unclear whether depression biases Means (SDs) for Number of Goals and Goal Ratings by Group and Condition Number of goals Importance Likelihood Control Group App Avd App Avd App Avd App Avd Control 6.5 (1.9) 4.8 (1.6) 5.8 (0.9) 5.9 (0.7) 5.5 (0.7) 3.4 (0.9) 5.7 (0.8) 5.3 (0.7) Depressed 6.8 (2.5) 5.7 (2.1) 5.9 (0.7) 5.8 (1.1) 4.9 (1.1) 4.0 (1.4) 4.7 (1.2) 4.5 (1.0) Note. App = approach goals, Avd = avoidance goals. Personal goals systems and depression 22 Table 2 Means (SDs) for Number of Reasons by Group and Goal Condition Approach goals Avoidance goals Group Pro Con Pro Con Control 4.5 (1.5) 3.7 (1.9) 4.5 (1.6) 3.7 (1.3) Depressed 4.3 (1.6) 4.2 (1.8) 3.8 (1.8) 4.0 (1.8)

Plasma catecholamines and heart rate were determined in drug-free groups of anxious patients and normal controls before and 20 min after intramuscular injection of 0.01 mg/kg of 1/1000 diluted epinephrine. Levels of anxiety after the injection were determined via the State Anxiety Scale of State Trait Anxiety Inventory. Both groups showed substantial increases in plasma levels of epinephrine and norepinephrine and heart rate after the injection. However, there were no significant differences between anxious patients and controls on plasma catecholamines and heart rate before or after the injection and post injection levels of State Anxiety. The anxious subjects showed a significant correlation between post injection heart rate and State Anxiety.

This paper explores how symptoms of mental health problems influence acquired immune deficiency syndrome-related risk behaviors, and how changes in those symptoms relate to risk behaviors engaged in by young adults. Repeated interviews with 602 youths since 1984 provide a history of change in behaviors. Mental health symptoms during adolescence (alcohol/drug [r = .28]; conduct disorder [r = .27]; depression [r = .16]; suicide [r = .14]; anxiety [r = .16]; and posttraumatic stress [r = .09]) are associated with higher numbers of risk behaviors (specifically, prostitution, use of intravenous drugs, and choice of a high-risk sex partner) during young adulthood. Changes in mental health symptoms between adolescence and young adulthood are related to the number of risk behaviors engaged in by young adulthood (total number of symptoms [B = .10], alcohol/drug abuse or dependence [B = .34], depression [B = .20], suicidality [B = .35], anxiety [B = .13], and posttraumatic stress [B = .14]). Changes in symptoms of mental health problems are associated specifically with those risk behaviors that are initiated primarily in young adulthood: intravenous drug use, prostitution, and choice of risky partners. The findings show that prevention and treatment of mental health problems are important components of preventive interventions for human immunodeficiency virus infection in high-risk teens and young adults.

The 30 patients who underwent lung transplantation between 1990 and 1996 were included in this study, and data were analyzed to find predictors of 1-year survival posttransplantation. All patients were followed throughout the posttransplantation period. Fifteen patients had ...

This is a cross-sectional study of coping strategies in 174 healthy women who fulfill clinical criteria for familial breast/ovarian cancer in the absence of demonstrated mutations (ADM) compared to 68 healthy women with BRCA1 carrier status. Both groups got a mailed questionnaire after genetic counseling and testing, respectively. The questionnaire included demographic and cancer-related variables as well as the Hospital Anxiety and Depression Scale (HADS) and the Coping Orientation to Problems Experienced Scale (COPE). In both groups 24% of the women had an anxiety disorder. Coping strategies which helped the women to accept and make the best out of their situation were most frequently applied in both the ADM and the carrier groups. Compared to the carrier group, the ADM group had higher mean levels on both emotion-focused and problem-focused strategies. The emotion-focused strategies were all significantly associated with presence of HADS-defined anxiety disorder in the ADM group. In the carrier group problem-focused strategies were significantly associated with increased prevalence of such anxiety disorder. In multivariate analysis 'focus on emotions' was significantly associated with increased prevalence of HADS-defined anxiety disorder in both groups, and 'acceptance' was associated with reduced prevalence in both groups.

The selective serotonin reuptake inhibitors (SSRIs) are now being employed in the treatment of the full spectrum of anxiety disorders. In comparative trials, the SSRIs are proving to be equal or superior in efficacy to traditional antianxiety medications. Due to their favorable side effect profile, safety, and tolerability, they are rapidly replacing older agents in the treatment of anxiety. Neuroanatomical pathways that may be important in the antianxiety effect of the SSRIs are outline and discussed, followed by a review of the clinical evidence supporting the efficacy of this class of medications in the treatment of anxiety disorders.

To evaluate the impact of a Mindfulness Based Stress Reduction (MBSR) program in patients with chronic bothersome tinnitus on the (1) severity of symptoms of tinnitus and (2) functional connectivity in neural attention networks. Open-label interventional pilot study. Outpatient academic medical center. A total of 13 adult participants with a median age of 55 years, suffering from bothersome tinnitus. An 8-week MBSR program was conducted by a trained MBSR instructor. The primary outcome measure was the difference in patient-reported tinnitus symptoms using the Tinnitus Handicap Index (THI) and Tinnitus Functional Index (TFI) between pre-intervention, post-MBSR, and 4-week post-MBSR assessments. Secondary outcomes included change in measurements of depression, anxiety, mindfulness, and cognitive abilities. Functional connectivity magnetic resonance imaging (MRI) was performed at pre- and post-MBSR intervention time points to serve as a neuroimaging biomarker of critical cortical netwo...

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This paper describes a study to examine how a social situation can be simulated in a virtual environment, and how to provoke the same behavioral response as in a real life social situation. The aim is to create new Virtual Reality worlds for treating social phobia. Two cases were examined in a virtual environment to assess whether it was able to recreate social behavior of people. First, we examined if participants who enter a crowded room in the virtual environment prefer to take a seat in a chair that is close to them. ...

We performed a quantitative review of associations between the higher order personality traits in the Big Three and Big Five models (i.e., neuroticism, extraversion, disinhibition, conscientiousness, agreeableness, and openness) and specific depressive, anxiety, and substance use disorders (SUD) in adults. This approach resulted in 66 meta-analyses. The review included 175 studies published from 1980 to 2007, which yielded 851 effect sizes. For a given analysis, the number of studies ranged from three to 63 (total sample size ranged from 1,076 to 75,229). All diagnostic groups were high on neuroticism (mean Cohen's d ϭ 1.65) and low on conscientiousness (mean d ϭ Ϫ1.01). Many disorders also showed low extraversion, with the largest effect sizes for dysthymic disorder (d ϭ Ϫ1.47) and social phobia (d ϭ Ϫ1.31). Disinhibition was linked to only a few conditions, including SUD (d ϭ 0.72). Finally, agreeableness and openness were largely unrelated to the analyzed diagnoses. Two conditions showed particularly distinct profiles: SUD, which was less related to neuroticism but more elevated on disinhibition and disagreeableness, and specific phobia, which displayed weaker links to all traits. Moderator analyses indicated that epidemiologic samples produced smaller effects than patient samples and that Eysenck's inventories showed weaker associations than NEO scales. In sum, we found that common mental disorders are strongly linked to personality and have similar trait profiles. Neuroticism was the strongest correlate across the board, but several other traits showed substantial effects independent of neuroticism. Greater attention to these constructs can significantly benefit psychopathology research and clinical practice.

After reading vignettes, a group of spider-phobic girls (n=18) and a group of nonphobic girls (n=18) rated the subjective probability of spiders entering their private living space, their tendency to approach and make physical contact, and the subjective probability of spiders doing physical harm. In addition, they indicated their eagerness to eat a favorite food item before as well as after it had been shortly contacted by spiders. In support of the idea that spider phobia results from the convergence of spiders’ disgusting properties and the subjective probability of involuntary contact, phobic girls reported relatively high ratings concerning: (a) the probability of spiders entering their room; (b) spiders’ tendency to approach and make physical contact; and (c) spiders’ disgust-evoking status. Finally, regression analysis indicated that spiders’ disgust-evoking status is the single best predictor of spider phobia, whereas the independent contribution of the perceived probability of spiders doing physical harm was found to be negligible. All in all, the present findings strongly support the idea that spider phobia essentially reflects a fear of physical contact with a disgusting stimulus.

Background  Trafficking in women is a widespread human rights violation commonly associated with poor mental health. Yet, to date, no studies have used psychiatric diagnostic assessment to identify common forms of mental distress among survivors returning to their home country. Methods  A longitudinal study was conducted of women aged 18 and over who returned to Moldova between December 2007 and December 2008

Two hundred one non-treatment seeking women with alcoholism, anxiety disorders, alcoholism and anxiety disorders, or neither alcoholism nor anxiety disorders were interviewed to assess core psychopathology associated with eating disorders using the Eating Disorders Examination and DSM-IIIR psychiatric diagnoses using the Schedule of Affective Disorders and Schizophrenia-Lifetime version. Alcoholic women had significantly higher mean scores on each of the Eating Disorders Examination subscales of Restraint, Overeating, Eating Concern, Shape Concern, and Weight Concern compared with nonalcoholic women. Women with anxiety disorders had significantly elevated scores on subscales of Overeating, Eating Concern, and Weight Concern compared with women without anxiety disorders. Women with both alcoholism and anxiety disorders had higher rates of bulimia nervosa and/or eating disorder NOS compared with women wfth either disorder alone. Implications of these findings are discussed in the context of the co-morbid association between alcoholism, eating disorders, and anxiety disorders.

Patients with panic disorder and patients with vestibular disorders often share symptomatology, such as dizziness, spatial disorientation, and anxiety in particular environments. Because of the similar clinical presentations, it is not always apparent whether these symptoms are due primarily to a vestibular disorder or to panic disorder. Depending on where and how these patients enter the medical system, their symptoms may be remedied by treatment from behavioral therapists or physical therapists trained in vestibular rehabilitation. Although vestibular rehabilitation developed independently of behavioral treatment for anxiety disorders, there are remarkable similarities in treatment conceptualization and implementation. For example, both use exposure procedures designed to produce habituation of dizziness and disorientation, as well as enhancing functional compensation. Furthermore, there appears to be a subset of individuals with panic disorder who also have vestibular pathology and thus, may benefit from both interventions. In this paper, similarities and differences in the clinical presentation, treatment goals, and specific interventions for patients with panic disorder or vestibular pathology is examined, and future implications are discussed. D Dizziness, spatial disorientation, and unsteadiness are common complaints among individuals with vestibular dysfunction and/or those with panic disorder 0887-6185/01/$ ± see front matter D 2001 Elsevier Science Inc. All rights reserved. PII: S 0 8 8 7 -6 1 8 5 ( 0 0 ) 0 0 0 4 6 -3

The present study investigated the contribution of parental modeling to the fearfulness of children. Forty children (aged 9-12) who were referred to an outpatient treatment centre filled out the trait version of the Spielberger State-Trait Anxiety Inventory for Children (STAIC) and the revised version of the Fear Survey Schedule for Children (FSSC). The parents of the children completed adult versions of the STAI-trait and the FSS. In addition, parents rated to what extent they generally expressed fears to their children. Results showed that trait anxiety in children was positively associated with trait anxiety of both the mother (r = 0.34, P < 0.05) and the father (r = 0.31, P < 0.05). Fearfulness of the children was only related to fearfulness of the mother (r = 0.56, P < 0.001). Most importantly, the data showed that modeling played a role in this relationship. A linear association between FSSC scores and mothers' rating of expressing fears to their children was found. That is to say, children of mothers who never expressed their fears had the lowest FSSC scores, children of mothers who often expressed their fears had the highest FSSC scores, whereas children of mothers who sometimes expressed their fears scored in between.

Background: Psychotherapy is apparently an insufficient treatment for some patients with mood or anxiety disorder. In this study the effectiveness of short-term and long-term psychotherapies was compared with that of psychoanalysis. Methods: A total of 326 psychiatric outpatients with mood or anxiety disorder were randomly assigned to solution-focused therapy, short-term psychodynamic and long-term psychodynamic psychotherapies. Additionally, 41 patients suitable for psychoanalysis were included in the study. The patients were followed from the start of the treatment and assessed 9 times during a 5-year follow-up. The primary outcome measures on symptoms were the Beck Results: A reduction in psychiatric symptoms and improvement in work ability and functional capacity was noted in all treatment groups during the 5-year follow-up. The short-term therapies were more effective than psychoanalysis during the first year, whereas the long-term therapy was more effective after 3 years of follow-up. Psychoanalysis was most effective at the 5-year follow-up, which also marked the end of the psychoanalysis. Conclusions: Psychotherapy gives faster benefits than psychoanalysis, but in the long run psychoanalysis seems to be more effective. Results from trials, among patients suitable for psychoanalysis and with longer follow-up, are needed before firm conclusions about the relative effectiveness of psychoanalysis and psychotherapy in the treatment of mood and anxiety disorders can be drawn.

This book (in Dutch) is an attempt to provide a conceptual framework that helps the reader to integrate the existential dimension of anxiety with other clinical and explanatory approaches to anxiety.
The book is no longer in print. This is a pre-print (uncorrected) WORD-file of the entire manuscript, which was published by BOOM (Amsterdam) in 2001

Using a sample of 781 adolescents (ages 13-17, 52.8% male) from a community survey, this study examined gender differences in the co-occurrence of specific anxiety disorders with substance use in adolescents. The associations between anxiety disorders and substance use differed according to the particular anxiety disorders and forms of substance use being examined, as well as by gender. Social phobia was associated with cigarette smoking among boys only. For girls, social phobia appeared to be negatively associated with drug use. For the other anxiety disorders, the associations with substance use tended to be stronger among girls. These findings highlight the need to improve clinical recognition of the anxiety disorders and to improve treatment access for afflicted adolescents. Future studies based on longitudinal data could further elucidate the relationships among anxiety disorders, gender, and substance use.

Objective: To examine whether age of first use or frequency of use of cannabis is associated with anxiety and depression (AD) in young adults, independent of known potential confounders, including the use of other illicit drugs. Method: A cohort of 3,239 Australian young adults was followed from birth to the age of 21 when data on AD were obtained from sample members along with information on their use of cannabis at 21 years. Potential confounding factors were prospectively measured when the child was born and at 14 years. Results: After controlling for confounding factors, those who started using cannabis before age 15 years and used it frequently at 21 years were more likely to report symptoms of AD in early adulthood (odds ratio 3.4; 95% CI 1.9Y6.1). This association was of similar magnitude for those who had only used cannabis and those who reported having used cannabis and other illicit drugs. Conclusion: The relationship between early-onset and frequent use of cannabis and symptoms of AD is independent of individual and family backgrounds.

Psychogenic movement disorders (PMD) are a diagnostic fascinating challenge in both neurologic and psychiatric setting. Many factors influence response to treatment, but few treatment strategies are available. Physical activity proves to be effective in the treatment of depression, anxiety, and other psychiatric disorders, but the effects of regular walking exercise on patients with PMD have never been investigated in a single-blind study. Sixteen outpatients [13 women; mean age 33.0 years (range 22-51)] with primarily mild-to-moderate PMD completed a thrice-weekly, 12-weeks mild walking program. Assessments included DSM-IV interview, the Psychogenic Movement Disorder Rating Scale (PMDRS), Beck Anxiety Inventory (BAI), Hamilton Depression Scale (HDS), V02 Max, and body mass index (BMI). Changes in total score on the PMDRS were the primary endpoint. A comparison of all measures taken at study onset and after completing the exercise program indicates statistically significant improvements. We observed a relevant improvement in 10 of 16 patients (62%). The mean difference for the primary outcome (PMDRS total) corresponded to about 70%. Compliance was good, and there were no adverse effects. This study provides preliminary evidence for regular low-medium intensity exercise as a safe, adequate, and pleasing intervention for PMD. Furthermore, well-designed studies appear justified to confirm these findings.

The relative efficacy of two psychotherapeutic approaches to panic disorder, namely, focused cognitive therapy (FCT)and standard cognitive therapy (SCT) was examined. FCT focused specifically on the "catastrophic misinterpretation" of physical and psychological sensations experienced during panic attacks induced in the office or occurring spontaneously between sessions. SCT focused primarily on the cognition and beliefs relevant to interpersonal concerns involved in generalized anxiety. We hypothesized that FCT would be more effective than SCT since the latter did not include an induced panic exercise (exposure condition) specific to the patient's panicogenic cognition. Forty patients diagnosed with panic disorder were randomly assigned to the SCT and FCT groups for approximately 12 to 18 sessions of treatment. Both groups reported significant decreases in the severity of the clinical measures at termination. Moreover, 89.5% of the SCT group and 84.2% of the FCT group were free of panic attacks at l-year follow-up. Contrary to the predictions, the results for measures of panic attack frequency, anxiety, and depression did not reveal any significant differences between the two groups. Results suggest that in-office "exposure" is not necessary for improvement and that a primary focus on cognition associated with generalized anxiety may be an effective intervention. However, since improvement in panic was correlated with normalizing of panic-related beliefs in both conditions, it is suggested that cognitive change may be a crucial ingredient of improvement in panic episodes. @ 1997 Elsevier Science Ltd Focused cognitive therapy for panic disorder was developed from a theoretical model of panic disorder (Beck, Emery, & Greenberg, 1985; Clark, 1986), which proposes that panic attacks occur when benign physical sensations or psychological experiences are interpreted as dangerous. This catastrophic ap