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Fuchshuber J, Andres D, Prandstätter T, Roithmeier L, Schmautz B, Schwerdtfeger A, Unterrainer HF. Influence of anxious attachment on the relationship between primary emotions and substance-related addictive behaviors. Front Public Health 2024; 12:1380539. [PMID: 38952738 PMCID: PMC11215174 DOI: 10.3389/fpubh.2024.1380539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/05/2024] [Indexed: 07/03/2024] Open
Abstract
Objectives To date there is no universally accepted model that describes the development of substance related addictive behavior. In order to address this gap, the study sought to examine whether the association between primary emotions and the inclination toward addictive behavior is mediated by an anxious attachment style. Methods The total sample consisted of 900 German speaking non-clinical adults (age: M = 27; SD = 9.60; 71.6% female). Structural Equation Modeling (SEM) was applied to examine the connection between the primary emotions (SADNESS and ANGER), and the latent variables attachment anxiety and symptoms of addictive behavior. Results Substance use symptomatology was correlated with higher attachment anxiety (r = 0.15), SADNESS (r = 0.15), and ANGER (r = 0.11). The effect of SADNESS on addictive behavior is mediated by attachment anxiety (p < 0.01) whereas ANGER had a direct effect on addictive behavior (p < 0.01). The final SEM explains 4% of the variance of addictive behaviors and 22% of attachment anxiety. Conclusion Our findings suggest that both SADNESS and ANGER, along with attachment anxiety, are dispositions that contribute to the risk of engaging in addictive behavior. However, while ANGER directly influences addictive behavior, SADNESS acts through its impact on attachment anxiety.
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Affiliation(s)
- Jürgen Fuchshuber
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University Vienna, Vienna, Austria
| | - Deborah Andres
- Institute of Psychology, University of Graz, Graz, Austria
| | | | - Lisa Roithmeier
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University Vienna, Vienna, Austria
| | - Beate Schmautz
- Institute of Psychology, University of Graz, Graz, Austria
| | | | - Human-Friedrich Unterrainer
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria
- Institute of Psychology, University of Graz, Graz, Austria
- University Clinic for Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
- Department of Religious Studies, University of Vienna, Vienna, Austria
- Faculty of Psychotherapy Science, Sigmund Freud University, Vienna, Austria
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2
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Krause K, Zhang XC, Schneider S. Long-Term Effectiveness of Cognitive Behavioral Therapy in Routine Outpatient Care for Youth with Anxiety Disorders. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:181-190. [PMID: 38615662 PMCID: PMC11151973 DOI: 10.1159/000537932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 02/14/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION This study examined the long-term effectiveness of cognitive behavioral therapy (CBT) (≥ 2 years after the end of therapy) in the routine care of youth (mean 11.95 years; SD = 3.04 years) with primary anxiety disorder (AD). METHODS Two hundred and ten children with any AD as a primary diagnosis and with any comorbidity were included in the "Kids Beating Anxiety (KibA)" clinical trial and received evidence-based CBT. Diagnoses, severity of diagnoses, and further dimensional outcome variables of symptoms and functioning were assessed before (baseline), after the last treatment session (POST), and at two follow-up (FU) assessments in the child and caregiver report: 6 months (6MONTHS-FU) and >2 years (mean 4.31; SD = 1.07 years) after the last treatment session (long-term FU). RESULTS At POST, 61.38% showed total remission of all and any ADs. At long-term FU, the remission rate was 63.64%. Compared to baseline, ratings of severity, anxiety, impairment/burden, and life quality improved significantly after CBT in child and caregiver report. All pre-post/FU improvements and global success ratings were stable in child (Pre-Post: Hedges' g = 3.57; Pre-6MONTHS-FU: Hedges' g = 3.43; Pre-LT-FU: Hedges' g = 2.34) and caregiver report (Pre-Post: Hedges' g = 2.00; Pre-6MONTHS-FU: Hedges' g = 2.31; Pre-LT-FU: Hedges' g = 2.31) across all POST- and FU-assessment points. Some outcomes showed further significant improvement, and no deterioration was found over the course of time. Effect sizes calculated in the present study correspond to, or even exceed, effect sizes reported in previous meta-analysis. CONCLUSIONS Stable long-term effects of "KibA" CBT for youth with ADs, comparable to those results from efficacy studies, were achieved in a routine practice setting by applying treatment manuals tested in randomized controlled trials. These findings are remarkable, as the patient group studied here consisted of an age group within the main risk phase of developing further mental disorders, and therefore an increase in new-onset anxiety and further mental disorders would be expected over the long time span studied here.
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Affiliation(s)
- Karen Krause
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Xiao Chi Zhang
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
- Deutsches Zentrum für Psychische Gesundheit (DZPG), Bochum, Germany
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3
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Chen SZ, Zainal NH, Newman MG. Elevated depression and anxiety predict future patterns of individualistic and collectivistic cultural values: A cross-lagged longitudinal network analysis. J Affect Disord 2024; 349:310-320. [PMID: 38181844 PMCID: PMC10950001 DOI: 10.1016/j.jad.2023.12.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Specific components of independent and interdependent self-construal have been associated with psychopathology. However, most studies on this topic have been cross-sectional, precluding causal inferences. We used contemporaneous and temporal cross-lagged network analysis to establish weak causal effects in understanding the association between self-construal and psychopathology components. METHODS Middle-aged and older community-dwelling adults (n = 3294) participated in the Midlife Development in the United States study across two time-points, spaced nine years apart. Six self-construal (interdependence: connection to others, commitment to others, receptiveness to influence; independence: behavioral consistency, sense of difference from others, self-reliance) and three psychopathology nodes (major depressive disorder (MDD), generalized anxiety disorder (GAD), and panic disorder (PD) symptom severity) were examined. All network analyses controlled for age, sex, race, and number of chronic illnesses as covariates. RESULTS Contemporaneous and temporal networks yielded relations between elevated MDD and PD and increased receptiveness to influence. Heightened GAD symptom severity was associated with future increased difference from others and decreased connection to others, commitment to others, and receptiveness to influence. Higher MDD, GAD, and PD severity were associated with future lower self-reliance. Network comparison tests revealed no consistent network differences across sex and race. LIMITATIONS DSM-III-R measures of MDD, GAD, and PD were used. Results may not generalize to culturally diverse racial groups. CONCLUSIONS Changes in self-construal may result from increased MDD, GAD, and PD severity. Findings suggest the importance of targeting common mental health symptoms to positively influence how individuals view the self and others in various social contexts.
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Affiliation(s)
- Serena Z Chen
- The Pennsylvania State University, United States of America.
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4
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Pflug V, Schneider S. [School Absenteeism and Anxiety Disorders]. Psychother Psychosom Med Psychol 2024; 74:134-148. [PMID: 38552620 DOI: 10.1055/a-2245-5427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Many children and adolescents in Germany do not attend school regularly despite compulsory school attendance. Some of them only miss a few lessons, while others stay away from school for whole days, months or even years. The article shows how anxiety disorders can be the cause of school absenteeism and how this can be treated therapeutically.
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Bleich C, Kachel L, Milde C, In-Albon T. Originalarbeiten / Original Articles. Entwicklung und Evaluation einer Aufklärungsbroschüre zu Ängsten und Angststörungen für Jugendliche. Prax Kinderpsychol Kinderpsychiatr 2024; 73:114-129. [PMID: 38569151 DOI: 10.13109/prkk.2024.73.2.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Development and Evaluation of an Information Brochure on Anxiety and Anxiety Disorders for Adolescents Low mental health literacy and fear of being stigmatized are two main barriers that detain adolescents fromseeking professional help. An information brochure about anxiety disorders for adolescents was developed. To make a first statement about the quality of the brochure, 19 experts, consisting of (child and adolescents) psychotherapists, psychiatrists, and psychologists, rated a first version of the brochure regarding content validity and age-appropriatness. To evaluate the efficacy in knowledge and the acceptance of the brochure, a revised version was evaluated by N = 174 adolscents (106 female-, 66 male- and two non-binary) between 14 and 17 years of age (M = 16.56 years.; SD = 0.57).The experts' approval of all content items totals a mean average of 95.2 % (range: 84.2-100 %). In the adolescent sample, the intervention increased knowledge about anxiety disorders (d = 1.04) and improved attitudes about coping strategies (d = 0.99). Results of the experts' rating showed that content validity of the brochure can be assumed.The revised brochure seems to be a useful and effective tool to inform adolescents about anxiety disorders.
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Pini S, Milrod B, Baldwin DS, Schiele MA, Massimetti G, Costa B, Martini C, Bandelow B, Domschke K, Abelli M. The relationship of separation anxiety with the age of onset of panic disorder. Early Interv Psychiatry 2023; 17:1172-1179. [PMID: 37051643 DOI: 10.1111/eip.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 01/16/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
AIM This study aimed to investigate whether separation anxiety (SA) constitutes a dimension related to age at onset of panic disorder (PD), in homogeneous subgroups of outpatients with PD, based on their age of onset and symptom severity. METHODS A sample of 232 outpatients with PD was assessed with the Panic Disorder Severity Scale (PDSS) and the Sheehan Disability Scale (SDS) for functional impairments. Separation anxiety was evaluated using structured interviews and questionnaires. We applied a K-Means Cluster Analysis based on the standardized "PD age of onset" and "the PDSS total score" to identify distinct but homogeneous groups. RESULTS We identified three groups of patients: group 1 ("PD early onset/severe", N = 97, 42%, onset 23.2 ± 6.7 years), group 2 ("PD early onset/not severe", N = 76, 33%, onset 23.4 ± 6.0 years) and group 3 ("PD adult onset/not severe", N = 59, 25%, onset 42.8 ± 7.0 years). Patients with early onset/severe PD had significantly higher scores on all SA measures than PD late-onset/not severe. Regression analyses showed that SA scores, but not PDSS scores, were predictive of impairment in SDS work/school, social life, and family functioning domains. CONCLUSIONS Our data indicate a significant relationship between SA and PD with an earlier age of onset and an impact on individual functioning. This may have important implications for implementing preventive interventions targeting early risk factors for the subsequent onset of PD.
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Affiliation(s)
- Stefano Pini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Barbara Milrod
- Albert Einstein College of Medicine, PRIME, (Psychiatric Research Institute of Montefiore Einstein), New York, New York, USA
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, Academic Centre, College Keep, University of Southampton, Southampton, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Miriam A Schiele
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Barbara Costa
- Department of Pharmacy, University of Pisa, Pisa, Italy
| | | | - Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Center Gottingen, Göttingen, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marianna Abelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Warner EN, Ammerman RT, Glauser TA, Pestian JP, Agasthya G, Strawn JR. Developmental Epidemiology of Pediatric Anxiety Disorders. Child Adolesc Psychiatr Clin N Am 2023; 32:511-530. [PMID: 37201964 DOI: 10.1016/j.chc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
This review summarizes the developmental epidemiology of childhood and adolescent anxiety disorders. It discusses the coronavirus disease of 2019 (COVID-19) pandemic, sex differences, longitudinal course, and stability of anxiety disorders in addition to recurrence and remission. The trajectory of anxiety disorders-whether homotypic (ie, the same anxiety disorder persists over time) or heterotypic (ie, an anxiety disorder shifts to a different diagnosis over time) is discussed with regard to social, generalized, and separation anxiety disorders as well as specific phobia, and panic disorder. Finally, strategies for early recognition, prevention, and treatment of disorders are discussed.
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Affiliation(s)
- Emily N Warner
- University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Environmental and Public Health Sciences, University of Cincinnati.
| | - Robert T Ammerman
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tracy A Glauser
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - John P Pestian
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Greeshma Agasthya
- Oak Ridge National Laboratory, Computational Sciences and Engineering Division, Advanced Computing for Health Sciences Section
| | - Jeffrey R Strawn
- University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Psychiatry, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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8
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Higher polygenic risk scores for anxiety disorders are associated with reduced area in the anterior cingulate gyrus. J Affect Disord 2023; 320:291-297. [PMID: 36150406 DOI: 10.1016/j.jad.2022.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/27/2022] [Accepted: 09/19/2022] [Indexed: 02/02/2023]
Abstract
Anxiety disorders are heterogeneous, show a moderate genetic contribution and are associated with inconsistent cortical structure alterations. Here, we investigated whether genetic factors for anxiety disorders contribute to cortical alterations by conducting polygenic risk score (PRS) analyses. We calculated PRSs for anxiety disorders at several P value thresholds (from PT ≤ 5.0 × 10-8 to PT ≤ 1.0) based on the latest large-scale genome-wide association study of anxiety disorders from the UK biobank (25,453 cases; 58,113 controls) in an independent sample of psychiatrically and physically healthy subjects (n = 174). Using regression after adjusting for confounding factors, we tested whether these PRSs were associated with the surface area and cortical thickness in 34 bilateral brain regions extracted using FreeSurfer. A higher PRS for anxiety disorders at PT ≤ 1.0 was significantly associated with a reduced right caudal anterior cingulate area (beta = -0.25, puncorrected = 9.51 × 10-4, pcorrected = 0.032). PRSs based on more common SNPs, especially from PT ≤ 0.01 to PT ≤ 1.0, were associated with the right caudal anterior cingulate area (a maximum at PT ≤ 0.5: R2 = 0.066, beta = -0.27, puncorr = 3.81 × 10-4, pcorr = 0.013). Furthermore, individuals in the highest quartile for anxiety disorder PRS had lower surface area and volume in the right anterior cingulate gyrus than those in the lowest quartile. We suggest a shared genetic etiology between anxiety disorders and structural features of the anterior cingulate gyrus, possibly contributing to the pathogenesis of anxiety disorders via emotional dysregulations. Our findings suggest the potential usefulness of PRS to reduce pathological heterogeneity among anxiety disorders.
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Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C): Development and evaluation of a new instrument measuring anticipatory avoidance-based emotion regulation in anxiety eliciting situations. PLoS One 2023; 18:e0279658. [PMID: 36638101 PMCID: PMC9838827 DOI: 10.1371/journal.pone.0279658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/13/2022] [Indexed: 01/14/2023] Open
Abstract
Avoidance-based emotion regulation plays a central role in the development and maintenance of anxiety disorders across the life span. However, measures for children that account for different avoidance strategies, are scarce. Derived from Gross' Process Model of Emotion Regulation, the Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C) was developed to assess avoidance strategies (cognitive avoidance, behavioural avoidance, verbal reassurance, and social reassurance) and reappraisal in anticipatory anxious situations. In the present study, the BAER-C was administered to 129 school children aged 8 to 14 and 199 children with anxiety disorders aged 8 to 16 and their parents, along with established measures on anxiety, psychopathology, and emotion regulation. Factor structure, internal consistency, convergent, divergent and construct validity were analysed. Results of the anxious sample showed a satisfactory internal consistency (McDonald's ω = .94) for all scales as well as positive correlations with anxiety symptoms (all rs > .17, all ps < .05). Factor analysis supported a five-factor model. This model was confirmed in the student sample. Children with an anxiety disorder scored higher on behavioural avoidance, verbal reassurance, and social reassurance than school children (F (5,304) = 12.63, p = .003, ηp2 = .17). Results for construct validity were ambiguous. Our analyses suggest that the BAER-C is a promising theory-based new instrument to reliably assess different avoidance strategies in children. More research is needed to further analyse construct validity with other emotion regulation questionnaires.
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Rosa DS, Frias AT, Vilela-Costa HH, Junior AS, Sant’Ana AB, Fusse EJ, Suchecki D, Campos AC, Lovick TA, Zangrossi H. Neonatal maternal deprivation facilitates the expression of a panic-like escape behavior in adult rats. Behav Brain Res 2022; 434:114031. [DOI: 10.1016/j.bbr.2022.114031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 11/02/2022]
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11
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Measuring Extinction Learning across the Lifespan – Adaptation of an optimized paradigm to closely match exposure treatment procedures. Biol Psychol 2022; 170:108311. [DOI: 10.1016/j.biopsycho.2022.108311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/18/2022]
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12
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The Cool Kids as a School-Based Universal Prevention and Early Intervention Program for Anxiety: Results of a Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020941. [PMID: 35055763 PMCID: PMC8775776 DOI: 10.3390/ijerph19020941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/11/2022]
Abstract
The efficacy of the Cool Kids program has been consistently demonstrated both within Australia and internationally, but limited data are available on the use of Cool Kids as a universal program. The purpose of the study is to evaluate Cool Kids as a universal program for preventing childhood anxiety in the school context. There were 73 Italian children (35 boys and 36 girls, ages 10–13 years) attending the last year of primary school and the first year of middle school who participated in an active intervention based on a school adaptation of the Cool Kids protocol. Results of t-test analyses highlighted a downward trend of anxiety symptoms, especially in total anxiety, somatic anxiety, generalized anxiety, separation anxiety, social anxiety and school phobia at post-treatment assessed by children. Even the score of depression symptoms, measured as a second outcome measure, decreased after the treatment. This study contributes to the evidence base for the Cool Kids program as a universal program for preventing childhood anxiety in the school context. Although these preliminary results show some promise, their replication in future research is necessary given current study limitations.
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Giani L, Caputi M, Forresi B, Michelini G, Scaini S. Evaluation of Cognitive-Behavioral Therapy Efficacy in the Treatment of Separation Anxiety Disorder in Childhood and Adolescence: a Systematic Review of Randomized Controlled Trials. Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00129-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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14
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Lippert MW, Sommer K, Flasinski T, Pflug V, Rölver A, Christiansen H, In-Albon T, Knappe S, Romanos M, Tuschen-Caffier B, Schneider S. Personalized Assessment of Anxiety and Avoidance in Children and Their Parents-Development and Evaluation of the Anxiety and Avoidance Scale for Children. Front Psychol 2021; 12:703784. [PMID: 34867587 PMCID: PMC8635988 DOI: 10.3389/fpsyg.2021.703784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/27/2021] [Indexed: 01/25/2023] Open
Abstract
In treating childhood anxiety disorders, therapists use highly individualized anxiety hierarchies to assess anxiety-eliciting situations and to personalize treatment. In contrast, psychometric assessment of anxiety symptoms in children usually consists of standardized questionnaires, assessing either total anxiety or disorder-specific symptom scores, prioritizing comparability over individual information. To account for interindividual differences, the Anxiety and Avoidance Scale for Children (AVAC) was developed, following a precise, personalized, assessment approach. In responding to the questionnaire, children and parents identify the most anxiety-eliciting situations before starting treatment, and rate them for anxiety and avoidance. Ratings are repeated over the course of treatment. The aim of this study is to introduce the new questionnaire and present first data on psychometric properties. The AVAC was administered to 389 children with separation anxiety disorder (N = 148), social anxiety disorder (N = 110) or specific phobia (N = 131) aged 8 to 16 and their parents, along with other measures of anxiety and psychopathology before and after cognitive behavioral treatment. Results showed adequate to good test-retest reliability. The AVAC items correlated significantly with established anxiety questionnaires, indicating convergent construct validity. Regarding divergent construct validity, the AVAC showed only small correlations with externalizing symptoms, demonstrating its precision in measuring anxiety and avoidance. The questionnaire was also sensitive to change after treatment, with medium to large effects in the reduction of anxiety and avoidance. The present analyses suggest that the new personalized assessment approach with the AVAC is a reliable and valid assessment of individualized anxiety and avoidance, as well as change in those constructs over the course of CBT treatment.
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Affiliation(s)
- Michael W. Lippert
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Katharina Sommer
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Tabea Flasinski
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Verena Pflug
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Angela Rölver
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Clinic Münster, Münster, Germany
| | - Hanna Christiansen
- Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy, University of Koblenz-Landau, Landau, Germany
| | - Susanne Knappe
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
| | | | - Silvia Schneider
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
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Gagliardi M. How Our Caregivers Shape Who We Are: The Seven Dimensions of Attachment at the Core of Personality. Front Psychol 2021; 12:657628. [PMID: 34276482 PMCID: PMC8280313 DOI: 10.3389/fpsyg.2021.657628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
Psychology defines personality as the stable traits of an individual, and cognitive research suggests that a set of core beliefs is at the root of these traits. From this perspective, two major questions remain unanswered: (1) What are the core beliefs that make up personality? (2) How are they acquired? An interesting answer is provided by attachment theory, according to which attachment is at the basis of personality. The current theoretical formulation, however, does not sufficiently clarify the relationship between the two. Adopting a cognitive-clinical approach, we put forward a novel version of attachment theory, arguing that it can better account for the relationship between attachment and personality, thereby providing more convincing answers to questions (1) and (2). In particular, we propose that: (A) attachment information is acquired over seven dimensions; (B) the acquisition of each dimension is induced by a specific caregiving feature and (C) realized through a specific acquisition mechanism - imprinting. In a nutshell, we propose an Attachment-Personality Model (APM) according to which seven attachment dimensions constitute the knowledge core of personality. We finally discuss the significant implications of the model, especially its clinical application in terms of conception, assessment, and treatment of mental disorders. The model can be empirically tested, and we suggest three ways to do that.
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Affiliation(s)
- Marcantonio Gagliardi
- Department of Computer Science, The University of Sheffield, Sheffield, United Kingdom
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Ruiz-García A, Jiménez Ó, Resurrección DM, Ferreira M, Reis-Jorge J, Fenollar-Cortés J. Portuguese validation of the Adult Separation Anxiety-Questionnaire (ASA-27). PLoS One 2021; 16:e0248149. [PMID: 33690669 PMCID: PMC7946201 DOI: 10.1371/journal.pone.0248149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/22/2021] [Indexed: 11/20/2022] Open
Abstract
Adult separation anxiety disorder (ASAD) is characterized by developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached. Despite the high rates of this diagnosis among Portuguese adults, there is a lack of measures to assess it. In this study, we assessed the psychometric properties of a Portuguese adaptation of the Adult Separation Anxiety questionnaire (ASA-27) on a sample of 267 adults (72.7% women) aged 18–80 years (M = 40.5, SD = 13.1). Factor structure, internal consistency, and convergence validity were examined. This study confirmed the single-factor structure of the Portuguese version of ASA-27. Consistency was high for the total sample (ω = .92) and by gender (ω = .93 and 92, men and women groups, respectively). The scale was positively related to the Portuguese version of State-Trait Anxiety Inventory (STAI) (r = .57, p< .001, for both State and trait anxiety scales) and Composite Codependency Scale total score (r = .29, p< .001). In addition, the ASA-27 total score showed incremental validity in the explanation of anxiety measured by STAI. In conclusion, results show that the Portuguese version of the ASA-27 is a reliable and valid measure of ASAD.
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Affiliation(s)
| | - Óliver Jiménez
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, Universidad de Málaga, Málaga, Spain
| | | | - Marco Ferreira
- Instituto Superior de Educação e Ciências, ISEC Lisboa, Lisboa, Portugal
| | - José Reis-Jorge
- Instituto Superior de Educação e Ciências, ISEC Lisboa, Lisboa, Portugal
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Elbay RY, Görmez A, Kılıç A, Avcı SH. Separation anxiety disorder among outpatients with major depressive disorder: Prevalence and clinical correlates. Compr Psychiatry 2021; 105:152219. [PMID: 33378709 DOI: 10.1016/j.comppsych.2020.152219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022] Open
Abstract
Prior studies have reported that separation anxiety disorder (SEPAD) can continue into or may begin in adulthood. Association of SEPAD with other psychiatric disorders has been frequently examined, and high rates of comorbidities have been found. The aim of this study was to investigate the prevalence and clinical correlation of SEPAD in adult patients undergoing treatment for major depressive disorder (MDD). The study sample was comprised of 100 outpatients. Participants underwent a DSM-5-based comprehensive assessment. Purposefully-designed semi-structured sociodemographic information and illness history forms were filled out by the researchers, and diagnoses of SEPAD were made using the Structured Clinical Interview for Separation Anxiety Symptoms, Separation Anxiety Symptom Inventory and Adult Separation Anxiety Survey. The frequency of SEPAD was 41% in patients with MDD, three-quarters of whom were adult onset. The use of new-generation antidepressants, adjunctive medications and comorbidity of other anxiety disorders were higher in patients with SEPAD (p < 0.05). SEPAD was highly prevalent, with a majority of cases starting in adulthood among patients with MDD, while SEPAD comorbidity was associated with high levels of anxiety and an increased likelihood of suboptimal response to usual depression treatment. Further studies are required to define the relevance and pathological basis for the comorbidity of SEPAD in people with MDD.
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Affiliation(s)
- Rümeysa Yeni Elbay
- Istanbul Medeniyet University, Faculty of Medicine, Psychiatry Department, Turkey.
| | - Aynur Görmez
- Istanbul Medeniyet University, Faculty of Medicine, Psychiatry Department, Istanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi, Merdivenköy Poliklinikleri, Merdivenköy Mahallesi, Ressam Salih Ermez Cd. No:14, Kadıköy, İstanbul, Turkey
| | - Alperen Kılıç
- Istanbul Medipol University, Faculty of Medicine, Psychiatry Department, TEM Avrupa Otoyolu Göztepe Çıkışı No:1, 34214 Bağcılar, İstanbul, Turkey
| | - Selma Hilal Avcı
- Istanbul Medeniyet University, Faculty of Medicine, Psychiatry Department, İstanbul Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi, Merdivenköy Poliklinikleri, Merdivenköy Mahallesi, Ressam Salih Ermez Cd. No:14, Kadıköy, İstanbul, Turkey
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Dogan B, Kocabas O, Sevincok D, Baygin C, Memis CO, Sevincok L. Separation Anxiety Disorder in Panic Disorder Patients with and without Comorbid Agoraphobia. Psychiatry 2021; 84:68-80. [PMID: 33577430 DOI: 10.1080/00332747.2021.1875730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: Previous studies have focused on the relationship between childhood separation anxiety disorder (SAD) and adult panic disorder (PD)-agoraphobia. It is not clear enough whether SAD, which continues into adulthood, is associated with PD with and without comorbid agoraphobia in adult patients. Our primary hypothesis was that PD patients with comorbid agoraphobia had a higher rate of SAD that continues into adulthood than those without agoraphobia. We also hypothesized that adulthood SAD symptoms were more likely to be associated with PD-agoraphobia than PD without agoraphobia.Method: 151 patients who were diagnosed with PD with (n = 106), and without comorbid agoraphobia (n = 45) were compared using Panic and Agoraphobia Scale, Structured Clinical Interview for Separation Anxiety Symptoms, Separation Anxiety Symptom Inventory, Adult Separation Anxiety Questionnaire, and State-Trait Anxiety Inventory. We performed Student's t-test, Pearson correlation test, and multiple linear regression analysis in this study.Results: PD patients with comorbid agoraphobia were more likely to have SAD both in childhood and adulthood (p = .028), than those without agoraphobia. There were mild to moderate significant correlations between PD severity and state anxiety (p = .002), trait anxiety (p = .006), and SAD in childhood (p = .049), and in adulthood (p = .001). SAD in adulthood (β = 0.278, Exp(B) = 0.136, p = .003), and state anxiety (β = 0.236, Exp(B) = 0.164, p = .012) significantly predicted the severity of PD in patients with comorbid agoraphobia.Conclusion: SAD that continues in adulthood may be related to the severity of PD in patients with agoraphobia. Our findings might provide some evidence of the role of SAD in adulthood in patients with adult-onset PD-agoraphobia.
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Adolph D, Margraf J, Schneider S. Your Fear is My Fear: The Relationship Between Parental and Offspring Anxieties. Child Psychiatry Hum Dev 2021; 52:772-781. [PMID: 32948972 PMCID: PMC8405516 DOI: 10.1007/s10578-020-01060-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2020] [Indexed: 11/26/2022]
Abstract
Contrary to the well-documented link between parental and offspring clinical anxiety, little is known about the relationship between parental everyday-life anxieties (e.g., concerning family, finances, health) and offspring anxieties. To close this gap, we assessed the frequency of parental symptoms of DSM-IV anxiety disorders and everyday-life anxieties, as well as the frequency of offspring anxiety symptoms in a representative sample by self-report. Parents reported that 48.4% of the children were free of specific symptoms of DSM-IV anxiety disorders within the last 12 months, 39.2% showed low symptom load (1-3 symptoms) and 12.4% were moderately or severely strained (4-10 symptoms). Replicating previous studies, parental DSM-IV symptoms increased offspring risk for the same symptoms. In addition, parental everyday-life anxieties showed a positive relationship with offspring symptom severity. Demographic variables (female sex, low socioeconomic status and younger age) and parental anxiety markers explained 18% of variance in offspring symptom severity. The data are discussed in light of current models of familial transmission.
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Affiliation(s)
- Dirk Adolph
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Massenbergstrasse 9-13, 44847, Bochum, Germany.
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Massenbergstrasse 9-13, 44847, Bochum, Germany
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Massenbergstrasse 9-13, 44847, Bochum, Germany
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20
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Ford JD, Spinazzola J, van der Kolk B. Psychiatric comorbidity of developmental trauma disorder and posttraumatic Stress disorder: findings from the DTD field trial replication (DTDFT-R). Eur J Psychotraumatol 2021; 12:1929028. [PMID: 34249242 PMCID: PMC8245086 DOI: 10.1080/20008198.2021.1929028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Background: Developmental Trauma Disorder (DTD) has extensive comorbidity with internalizing and externalizing disorders distinct from posttraumatic stress disorder (PTSD). Objective: To replicate findings of DTD comorbidity and to determine whether this comorbidity is distinct from, and extends beyond, comorbidities of PTSD. Method: DTD was assessed by structured interview, and probable DSM-IV psychiatric disorders were identified with KSADS-PL screening modules, in a multi-site sample of 271 children (ages 8-18 years old; 47% female) in outpatient or residential mental health treatment for multiple (M = 3.5 [SD = 2.4]) psychiatric diagnoses other than PTSD or DTD. Results: DTD (N = 74, 27%) and PTSD (N = 107, 39%) were highly comorbid and shared several DSM-IV internalizing and externalizing disorder comorbidities. Children with DTD with or without PTSD had more comorbid diagnoses (M = 5.7 and 5.2 [SD = 2.4 and 1.7], respectively) than children with PTSD but not DTD (M = 3.8[SD = 2.1]) or neither PTSD nor DTD (M = 2.1[SD = 1.9]), F[3,267] = 55.49, p < .001. Further, on a multivariate basis controlling for demographics and including all potential comorbid disorders, DTD was associated with separation anxiety disorder, depression, and oppositional defiant disorder after controlling for PTSD, while PTSD was associated only with separation anxiety disorder after controlling for DTD. Both DTD and PTSD were associated with suicidality. Conclusions: DTD is associated with psychiatric comorbidity beyond that of PTSD, and DTD warrants assessment for treatment planning with children in intensive psychiatric services.
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Affiliation(s)
- Julian D Ford
- University of Connecticut School of Medicine, Farmington, CT, USA
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21
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Schiele MA, Domschke K. [Separation anxiety disorder]. DER NERVENARZT 2020; 92:426-432. [PMID: 33319254 DOI: 10.1007/s00115-020-01037-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 11/25/2022]
Abstract
In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) separation anxiety disorder has been included in the chapter on anxiety disorders, thereby removing the age of onset restriction that previously required first onset during childhood or adolescence. Separation anxiety disorder has a lifetime prevalence of 4.8% and onset often occurs after the age of 18 years. Despite the high prevalence, separation anxiety disorder is often underdiagnosed and subsequently remains untreated. This narrative review summarizes the etiology, clinical features, diagnostic criteria as well as important differential diagnostic aspects, common comorbidity profiles and treatment implications of separation anxiety disorder. Furthermore, relevant implications for everyday practice and future perspectives for treatment and research are discussed.
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Affiliation(s)
- M A Schiele
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hauptstraße 5, 79104, Freiburg, Deutschland.
| | - K Domschke
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Hauptstraße 5, 79104, Freiburg, Deutschland
- Center for Basics in NeuroModulation, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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22
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Kölch MG, Romanos M, Roth-Sackenheim C, Schramm E. [Anxiety and Depression in Transition - Desiderata for Improved Care and Research: Results of the Joint Task Force Transition of DGPPN and DGKJP]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 48:429-433. [PMID: 32615864 DOI: 10.1024/1422-4917/a000739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Anxiety and Depression in Transition - Desiderata for Improved Care and Research: Results of the Joint Task Force Transition of DGPPN and DGKJP Abstract. Affective disorders (e. g., anxiety, depression) frequently begin during adolescence. Yet therapeutic approaches during adolescence differ in some respects from those employed during adulthood. During the transition from adolescence to adulthood, there is a high risk of discontinuation of therapeutic treatment, which may consequently affect integration in employment. There is a need for age-specific therapeutic strategies that address the relevant issues of adolescents as well as the presently unmet needs in research and treatment for this specific population.
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Affiliation(s)
- Michael G Kölch
- Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsmedizin Rostock
| | - Marcel Romanos
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg
| | | | - Elisabeth Schramm
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg
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23
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Fullana MA, Tortella-Feliu M, Fernández de la Cruz L, Chamorro J, Pérez-Vigil A, Ioannidis JPA, Solanes A, Guardiola M, Almodóvar C, Miranda-Olivos R, Ramella-Cravaro V, Vilar A, Reichenberg A, Mataix-Cols D, Vieta E, Fusar-Poli P, Fatjó-Vilas M, Radua J. Risk and protective factors for anxiety and obsessive-compulsive disorders: an umbrella review of systematic reviews and meta-analyses. Psychol Med 2020; 50:1300-1315. [PMID: 31172897 DOI: 10.1017/s0033291719001247] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND A multitude of risk/protective factors for anxiety and obsessive-compulsive disorders have been proposed. We conducted an umbrella review to summarize the evidence of the associations between risk/protective factors and each of the following disorders: specific phobia, social anxiety disorder, generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder, and to assess the strength of this evidence whilst controlling for several biases. METHODS Publication databases were searched for systematic reviews and meta-analyses examining associations between potential risk/protective factors and each of the disorders investigated. The evidence of the association between each factor and disorder was graded into convincing, highly suggestive, suggestive, weak, or non-significant according to a standardized classification based on: number of cases (>1000), random-effects p-values, 95% prediction intervals, confidence interval of the largest study, heterogeneity between studies, study effects, and excess of significance. RESULTS Nineteen systematic reviews and meta-analyses were included, corresponding to 216 individual studies covering 427 potential risk/protective factors. Only one factor association (early physical trauma as a risk factor for social anxiety disorder, OR 2.59, 95% CI 2.17-3.1) met all the criteria for convincing evidence. When excluding the requirement for more than 1000 cases, five factor associations met the other criteria for convincing evidence and 22 met the remaining criteria for highly suggestive evidence. CONCLUSIONS Although the amount and quality of the evidence for most risk/protective factors for anxiety and obsessive-compulsive disorders is limited, a number of factors significantly increase the risk for these disorders, may have potential prognostic ability and inform prevention.
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Affiliation(s)
- Miquel A Fullana
- Institute of Neurosciences, Hospital Clinic, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Miquel Tortella-Feliu
- University Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Mallorca, Spain
| | - Lorena Fernández de la Cruz
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Jacobo Chamorro
- Anxiety Unit, Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Barcelona, Spain
| | - Ana Pérez-Vigil
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - John P A Ioannidis
- Department of Medicine, Stanford Prevention Research Center, Stanford, CA, USA
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
- Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA, USA
- Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA
| | - Aleix Solanes
- FIDMAG Germanes Hospitalaries, CIBERSAM, Barcelona, Spain
- Department of Psychiatry and Forensic Medicine, School of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | | | - Valentina Ramella-Cravaro
- Early Psychosis: Interventions and Clinical-detection Lab (EPIC), Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Mental Health, Florence Public Health Center, Florence, Italy
| | - Ana Vilar
- Institut de Neuropsiquiatria i Addiccions, CSMIJ Sant Martí-La Mina, Parc de Salut Mar, Barcelona, Spain
- Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Abraham Reichenberg
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Eduard Vieta
- Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, Barcelona, Spain
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection Lab (EPIC), Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Mar Fatjó-Vilas
- FIDMAG Germanes Hospitalaries, CIBERSAM, Barcelona, Spain
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain
| | - Joaquim Radua
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- FIDMAG Germanes Hospitalaries, CIBERSAM, Barcelona, Spain
- Early Psychosis: Interventions and Clinical-detection Lab (EPIC), Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, Barcelona, Spain
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Francesetti G, Alcaro A, Settanni M. Panic disorder: attack of fear or acute attack of solitude? Convergences between affective neuroscience and phenomenological-Gestalt perspective. ACTA ACUST UNITED AC 2020; 23:421. [PMID: 32913822 PMCID: PMC7451360 DOI: 10.4081/ripppo.2020.421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 02/19/2020] [Indexed: 11/23/2022]
Abstract
There is consensus among scientists in considering Panic Attack (PA) as an exaggerated fear response triggered by intense activation of the amygdala and related Fear brain network. Current guidelines for treatment (e.g. National Institute for Clinical Excellence, NICE, 2011), that are based on this view, do not achieve satisfactory results: one-third of all treated patients report persistent PAs and other Panic Disorder (PD) symptoms, and several meta-analyses report the high likelihood of relapse. Here we review findings from Affective Neuroscience and clinical insights from a phenomenological-Gestalt perspective, putting into question the link between PD and activation of the Fear brain network. We propose an alternative hypothesis about PD etiology: PD is mainly connected to the Panic system, that is activated in situations of separation from affective support and overexposure to the environment. In our view, PA can be understood as an acute attack of solitude which is not adequately recognized by the patient due to the intervention of a dissociative component that makes it impossible to integrate all neuro-physiological responses activated by the Panic/Separation brain system within a coherent emotional feeling. This perspective can explain many evidences that otherwise remain isolated elements without a comprehensive frame: i.e., the association with agoraphobia, the onset of PD during adolescence and young adult life, the need to be accompanied, the connection with air hunger and other respiratory anomalies, the efficacy of antidepressants and the lack of activation of the Hypothalamic-Pituitary-Adrenal (HPA) axe. We discuss future steps to test this hypothesis and the consequences for psychotherapeutic treatment.
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Affiliation(s)
- Gianni Francesetti
- International Institute for Gestalt Therapy and Psychopathology - IPsiG.,Department of Psychology, University of Turin
| | - Antonio Alcaro
- Santa Lucia Foundation, European Centre for Brain Research, Italy
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Milrod B, Keefe JR, Choo TH, Arnon S, Such S, Lowell A, Neria Y, Markowitz JC. Separation anxiety in PTSD: A pilot study of mechanisms in patients undergoing IPT. Depress Anxiety 2020; 37:386-395. [PMID: 32097526 PMCID: PMC7207264 DOI: 10.1002/da.23003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Separation anxiety disorder (SAD) comprises one aspect of attachment dysregulation or insecurity. Although SAD aggravates posttraumatic stress disorder (PTSD) risk, no clinical research has tracked how many patients with PTSD have SAD, its clinical associations, or its response to PTSD treatment. Our open trial of interpersonal psychotherapy (IPT) for veterans with PTSD assessed these SAD domains. METHODS Twenty-nine veterans diagnosed with chronic PTSD on the Clinician-Administered PTSD Scale were assessed for SAD using the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), and for Symptom-Specific Reflective Function (SSRF), another dysregulated-attachment marker capturing patients' emotional understanding of their symptoms. Patients received 14 IPT sessions for PTSD with assessments at baseline, Week 4 (SCI-SAS and SSRF), and termination for SAD, PTSD, and depression. RESULTS At baseline, 69% of patients met SAD criteria. Separation anxiety did not correlate with baseline PTSD severity, depressive severity, or age when traumatized; patients with and without SAD had comparable PTSD and depression severity. Patients with baseline comorbid SAD who completed IPT (N = 17) reported significantly improved adult separation anxiety (p = .009). Adult SAD improvements predicted depressive improvement (p = .049). Patients with SAD showed a stronger relationship between early SSRF gains and subsequent adult SAD improvement (p = .021) compared with patients without SAD. DISCUSSION This first exploration of dysregulated/insecure attachment features among patients with PTSD found high SAD comorbidity and adult SAD improvement among patients with SAD following IPT. Highly impaired attachment patients normalized attachment posttreatment: 14-session IPT improved attachment dysregulation. This small study requires replication but begins to broaden clinical understanding of separation anxiety, attachment dysregulation, and PTSD.
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Affiliation(s)
- Barbara Milrod
- Department of Psychiatry, Weill Medical College of Cornell University, New York City, New York
| | - John R Keefe
- Department of Psychiatry, Weill Medical College of Cornell University, New York City, New York
| | - Tse-Hwei Choo
- Department of Psychiatry, Vagelos College of Physicians and Surgeons of Columbia University, New York City, New York
| | - Shay Arnon
- Anxiety Disorders Clinic, New York State Psychiatric Institute, New York City, New York
| | - Sara Such
- Anxiety Disorders Clinic, New York State Psychiatric Institute, New York City, New York
| | - Ari Lowell
- Department of Psychiatry, Vagelos College of Physicians and Surgeons of Columbia University, New York City, New York
- Anxiety Disorders Clinic, New York State Psychiatric Institute, New York City, New York
| | - Yuval Neria
- Department of Psychiatry, Vagelos College of Physicians and Surgeons of Columbia University, New York City, New York
- Anxiety Disorders Clinic, New York State Psychiatric Institute, New York City, New York
| | - John C Markowitz
- Department of Psychiatry, Vagelos College of Physicians and Surgeons of Columbia University, New York City, New York
- Anxiety Disorders Clinic, New York State Psychiatric Institute, New York City, New York
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Schiele MA, Bandelow B, Baldwin DS, Pini S, Domschke K. A neurobiological framework of separation anxiety and related phenotypes. Eur Neuropsychopharmacol 2020; 33:45-57. [PMID: 32046934 DOI: 10.1016/j.euroneuro.2020.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/25/2019] [Accepted: 01/22/2020] [Indexed: 01/09/2023]
Abstract
In the DSM-5, separation anxiety disorder (SAD) is newly classified in the chapter on anxiety, renewing research efforts into its etiology. In this narrative review, we summarize the current literature on the genetic, endocrine, physiological, neural and neuropsychological underpinnings of SAD per se, SAD in the context of panic disorder, separation anxiety symptoms, and related intermediate phenotypes. SAD aggregates in families and has a heritability of ~43%. Variants in the oxytocin receptor, serotonin transporter, opioid receptor µ1, dopamine D4 receptor and translocator protein genes have all been associated with SAD. Dysregulation of the hypothalamus-pituitary-adrenal axis, dysfunctional cortico-limbic interaction and biased cognitive processing seem to constitute further neurobiological markers of separation anxiety. Hypersensitivity to carbon dioxide appears to be an endophenotype shared by SAD, panic disorder and anxiety sensitivity. The identification of biological risk markers and its multi-level integration hold great promise regarding the prediction of SAD risk, maintenance and course, and in the future may allow for the selection of indicated preventive and innovative, personalized therapeutic interventions.
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Affiliation(s)
- Miriam A Schiele
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Borwin Bandelow
- Department of Psychiatry and Psychotherapy, University Medical Centre Göttingen, Germany
| | - David S Baldwin
- Clinical and Experimental Sciences, University of Southampton, Faculty of Medicine, Southampton, United Kingdom; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Germany.
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Park SC, Kim YK. Anxiety Disorders in the DSM-5: Changes, Controversies, and Future Directions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1191:187-196. [DOI: 10.1007/978-981-32-9705-0_12] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Anxiety disorders anticipate the diagnosis of bipolar disorder in comorbid patients: Findings from an Italian tertiary clinic. J Affect Disord 2019; 257:376-381. [PMID: 31302527 DOI: 10.1016/j.jad.2019.07.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/18/2019] [Accepted: 07/04/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Studies indicate bipolar disorder (BD) syndromal symptoms are commonly preceded by sub-syndromal BD symptoms, dysregulated sleep, irritability, and anxiety. We aimed to evaluate prevalence and clinical correlates of anxiety disorders (ADs) at BD onset in outpatients with versus without at least one AD at BD onset. METHODS 246 bipolar spectrum outpatients, according to the text revision of the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM- IV-TR), attending Sacco University Hospital in Milan, were recruited and their onset and clinical features assessed retrospectively. Patients were stratified into those with versus without an AD at BD onset (w/A and wo/A), according to a semi-structured clinical interview to provide diagnoses according to (DSM- IV-TR). RESULTS 29% of patients reported being w/A, among whom Panic Disorder (PD, in 55.6%) was the most frequent AD, and first AD occurred approximately 4 years before BD diagnosis. Patients w/A versus wo/A had higher (p < 0.05) rates of BDII and first mood episode being depression versus elevation (mania/hypomania), and lifetime rates of separation anxiety disorder, substance poly-abuse and benzodiazepine abuse. In contrast, patients wo/A had higher lifetime rates of alcohol and illicit drug use. CONCLUSION In this naturalistic sample, ADs, in particular PD, preceded BD in almost 1/3 of BD outpatients, and had distinctive clinical correlates. Further investigation into relationships between BD and AD at onset may enhance early BD diagnosis and treatment.
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Ströhle A, Gensichen J, Domschke K. The Diagnosis and Treatment of Anxiety Disorders. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 155:611-620. [PMID: 30282583 DOI: 10.3238/arztebl.2018.0611] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 04/30/2018] [Accepted: 07/31/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anxiety disorders are the most common type of mental illness in Europe, with a 12-month prevalence of 14% among persons aged 14 to 65. Their onset is usually in adolescence or early adulthood. The affected patients often develop further mental or somatic illnesses (sequential comorbidity). METHODS This review is based on pertinent publications retrieved by a selective search in PubMed. RESULTS The group of anxiety disorders includes generalized anxiety disorder (GAD), phobic disorders, panic disorders, and two disorders that are often restricted to childhood-separation anxiety and selective mutism. A comprehensive differential diag- nostic evaluation is essential, because anxiety can be a principal manifestation of other types of mental or somatic illness as well. Psychotherapy and treatment with psychoactive drugs are the therapeutic strategies of first choice. Of all types of psycho- therapy, cognitive behavioral therapy has the best documented efficacy. Modern antidepressants are the drugs of first choice for the treatment of panic disorders, agoraphobia, social phobia, and GAS; pregabalin is a further drug of first choice for GAS. CONCLUSION In general, anxiety disorders can now be effectively treated. Patients should be informed of the therapeutic options and should be involved in treatment planning. Current research efforts are centered on individualized and therefore, it is hoped, even more effective treatment approaches than are available at present.
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Affiliation(s)
- Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (CCM), Charité-Universitätsmedizin Berlin; Institute of General Practice, Faculty of Medicine, Ludwig-Maximilians-Universität München; Department of Psychiatry and Psychotherapy, University Hospital of Freiburg
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Keefe JR, Huque ZM, DeRubeis RJ, Barber JP, Milrod BL, Chambless DL. In-session emotional expression predicts symptomatic and panic-specific reflective functioning improvements in panic-focused psychodynamic psychotherapy. Psychotherapy (Chic) 2019; 56:514-525. [PMID: 30869969 DOI: 10.1037/pst0000215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In panic-focused psychodynamic psychotherapy (PFPP), exploration and interpretation of avoided and conflicted emotions and fantasies surrounding anxiety are thought to promote panic-specific reflective functioning (PSRF), which drives panic disorder improvements. Patient emotional expression within a session may be a marker of engaged processing and experiencing of affectively charged material. Degree of in-session expressed emotion, indicating both verbal and nonverbal emotions, was examined across three early therapy sessions for prediction of subsequent outcomes. We further investigated whether personality disorder traits, theorized to relate to constricted (obsessive-compulsive) or heightened (borderline) emotions, moderated this relationship. Emotional expression in Sessions 2, 5, and 10 of a 24-session PFPP protocol was assessed by blinded observers in 44 patients randomized to PFPP in a two-site randomized controlled trial of psychotherapies for panic disorder. Robust regressions were conducted to examine the relationship between average emotional expression across the measured sessions and symptom and PSRF changes subsequent to the sampled sessions, as well as moderation by personality disorder criteria, controlling for early outcomes. Higher levels of emotional expression across the early sessions predicted greater subsequent symptom and PSRF improvement. Elevations in expression of grief/sadness drove the symptomatic finding. Patients meeting more borderline criteria experienced a smaller and potentially negative relationship between emotional expression and symptom improvement. Emotional expression in PFPP may be an indicator of positive therapy process for patients without comorbid borderline personality traits, predicting prospective improvements in both a key mediator (PSRF) and symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Fuchshuber J, Hiebler-Ragger M, Kresse A, Kapfhammer HP, Unterrainer HF. Do Primary Emotions Predict Psychopathological Symptoms? A Multigroup Path Analysis. Front Psychiatry 2019; 10:610. [PMID: 31543836 PMCID: PMC6730598 DOI: 10.3389/fpsyt.2019.00610] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 07/31/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Research involving animal models has repeatedly proposed dysregulations in subcortically rooted affective systems as a crucial etiological factor in the development of a variety of psychiatric disorders. However, empirical studies with human participants testing these hypotheses have been sparse. Associations between primary emotions systems and different psychiatric symptoms were investigated in order to gain insights into the influence of evolutionary-rooted primary emotions on psychopathology. Material and Methods: The community sample included 616 adults (61.9% female). 243 reported a psychiatric lifetime diagnosis. By applying path analysis, we estimated paths between SEEKING, ANGER, FEAR, SADNESS, CARE, and PLAY (Affective Neuroscience Personality Scales; ANPS) and symptoms of substance abuse (Alcohol, Smoking, and Substance Involvement Screening Test; ASSIST) as well as depression, anxiety, and somatization (Brief Symptom Inventory; BSI-18). To examine the moderator effects of gender and psychiatric lifetime diagnosis, multigroup analysis was applied. Results: Substance abuse was associated with male sex (β = -.25), SADNESS (β = .25), and ANGER (β = .10). Depression was associated with SADNESS (β = .53), FEAR (β = .10), SEEKING (β = -.10), and PLAY (β = -.15). Anxiety was linked to SADNESS (β = .33), FEAR (β = .21) and PLAY (β = -.10). Somatization was associated with SADNESS (β = .26) and PLAY (β = -.12; all p < .001). Multigroup analysis revealed no differences in paths between tested groups (all p > .01). The model explained 14% of the variance of substance abuse, 52% of depression, 32% of anxiety, and 14% of somatization. Conclusions: The results further our understanding of the differential role of primary emotions in the development of psychopathology. In this, the general assumption that primary emotion functioning might be a valuable target in mental health care is underlined.
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Affiliation(s)
- Jürgen Fuchshuber
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria.,University Clinic for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Michaela Hiebler-Ragger
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria.,University Clinic for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Adelheid Kresse
- Institute for Pathophysiology und Immunology, Medical University of Graz, Graz, Austria
| | - Hans-Peter Kapfhammer
- University Clinic for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria
| | - Human Friedrich Unterrainer
- Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria.,University Clinic for Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.,Department of Religious Studies, University of Vienna, Vienna, Austria
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Elliott JG, Place M. Practitioner Review: School refusal: developments in conceptualisation and treatment since 2000. J Child Psychol Psychiatry 2019; 60:4-15. [PMID: 29197106 DOI: 10.1111/jcpp.12848] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND A generation has passed since the literature on the conceptualisation, assessment and treatment of school refusal was reviewed in this journal (Elliott, ). In the light of considerable gaps in the literature, identified at that time, and growing international interest, the current paper sought to identify progress subsequently made this century. METHODS We open with discussion of continuing conceptual uncertainty as to whether school refusal should incorporate both truancy and absenteeism marked by anxiety and distress. We then consider progress in treatment, and conclude by examining prognosis and subsequent adult functioning. In selecting intervention studies for review, our primary focus has been upon RCTS, systematic reviews and meta-analyses. RESULTS The literature review indicates that, since the turn of the century, there has been little substantial advance in knowledge that can guide practitioners. Many of the issues raised in the 1999 paper, in particular, conceptual confusion over this heterogeneous condition, a dearth of rigorous RCT designs, limited knowledge of underlying mechanisms and uncertainty as to the long-term effects of specific forms of intervention, are little clearer than before. CONCLUSIONS While several sound publications are available to guide intervention for school refusal, there is a continuing need for rigorous studies that can provide evidence to support individualised and tailored responses to an incapacitating problem with many causes and manifestations. While a multisystemic response to intervention approach is considered attractive, the practicalities of operating this across disparate professional borders are likely to present a long-term challenge.
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Klein AM, Flokstra E, van Niekerk R, Klein S, Rapee RM, Hudson JL, Bögels SM, Becker ES, Rinck M. The Role of Self-reports and Behavioral Measures of Interpretation Biases in Children with Varying Levels of Anxiety. Child Psychiatry Hum Dev 2018; 49:897-905. [PMID: 29681000 PMCID: PMC6208989 DOI: 10.1007/s10578-018-0804-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We investigated the role of self-reports and behavioral measures of interpretation biases and their content-specificity in children with varying levels of spider fear and/or social anxiety. In total, 141 selected children from a community sample completed an interpretation bias task with scenarios that were related to either spider threat or social threat. Specific interpretation biases were found; only spider-related interpretation bias and self-reported spider fear predicted unique variance in avoidance behavior on the Behavior Avoidance Task for spiders. Likewise, only social-threat related interpretation bias and self-reported social anxiety predicted anxiety during the Social Speech Task. These findings support the hypothesis that fearful children display cognitive biases that are specific to particular fear-relevant stimuli. Clinically, this insight might be used to improve treatments for anxious children by targeting content-specific interpretation biases related to individual disorders.
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Affiliation(s)
- Anke M Klein
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE, Nijmegen, The Netherlands.
| | - Emmelie Flokstra
- Clinical Psychology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Rianne van Niekerk
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE, Nijmegen, The Netherlands
| | - Steven Klein
- Clinical Psychology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Jennifer L Hudson
- Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Susan M Bögels
- Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Eni S Becker
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE, Nijmegen, The Netherlands
| | - Mike Rinck
- Behavioural Science Institute, Radboud University Nijmegen, PO Box 9104, 6500 HE, Nijmegen, The Netherlands
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Avedisova AS, Arkusha IA, Zakharova KV. [Separation anxiety disorder in adults - a new diagnostic category]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:66-75. [PMID: 30499500 DOI: 10.17116/jnevro201811810166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anxiety separation disorder (SAD) became the subject of increased attention of researchers in recent decades. DSM-5 and project of ICD-11 allow us to treat this disorder as an independent nosological unit without attachment to age. The review provides information on the prevalence, clinical manifestations and diagnosis of SAD in adults, summarizes information on the etiopathogenesis, relations to other psychiatric disorders, and highlights the lack of modern therapeutic approaches to SAD. The purpose of this review is to raise the level of knowledge about SAD and its new positioning in classification systems.
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Affiliation(s)
- A S Avedisova
- Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - I A Arkusha
- Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - K V Zakharova
- Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russia
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Do Youth with Separation Anxiety Disorder Differ in Anxiety Sensitivity From Youth with Other Anxiety Disorders? Child Psychiatry Hum Dev 2018; 49:888-896. [PMID: 29666976 DOI: 10.1007/s10578-018-0805-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Studies on the relationship between separation anxiety disorder (SAD) in childhood and panic disorder (PD) in adolescence and adulthood have yielded results which suggest a common underlying vulnerability for both disorders. In this study, we examined whether one such possible vulnerability-anxiety sensitivity-differed for youth diagnosed with SAD versus other anxiety disorders. Anxiety sensitivity was assessed using the Childhood Anxiety Sensitivity Index (CASI) in 315 clinic-referred youth (ages 6-17, 113 girls). 145 children (46%) were diagnosed with one or more primary anxiety disorder, including SAD (n = 22), generalized anxiety (GAD) (n = 79), social anxiety (SocA) (n = 55), and specific phobia (SP) (n = 45). Children with SAD reported higher levels of anxiety sensitivity and fears of physical symptoms than children with SP and SocA, but not children with GAD. We speculate that children who have SAD and GAD and high anxiety sensitivity may be more vulnerable to develop PD.
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Matthies S, Schiele MA, Koentges C, Pini S, Schmahl C, Domschke K. Please Don't Leave Me-Separation Anxiety and Related Traits in Borderline Personality Disorder. Curr Psychiatry Rep 2018; 20:83. [PMID: 30155649 DOI: 10.1007/s11920-018-0951-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW In light of the apparent symptomatic resemblance of separation anxiety disorder (SAD) symptoms on the one hand and abandonment fears, anxiousness, and separation insecurity central to borderline personality disorder (BPD) on the other hand, a comprehensive overview of separation anxiety and related traits in BPD is provided. RECENT FINDINGS Epidemiological, environmental, psychological, and neurobiological data connecting BPD to separation events, feelings of loneliness, insecure attachment styles, dimensional separation anxiety as well as SAD per se suggest a partly shared etiological pathway model underlying BPD and SAD. Differential diagnostic aspects and implications for treatment are discussed, highlighting separation anxiety as a promising transdiagnostic target for specific psychotherapeutic and pharmacological treatment approaches in BPD. This innovative angle on cross-disorder symptomatology might carry potential for novel preventive and therapeutic avenues in clinical practice by guiding the development of interventions specifically targeting separation anxiety and attachment-related issues in BPD.
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Affiliation(s)
- Swantje Matthies
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104, Freiburg, Germany
| | - Miriam A Schiele
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104, Freiburg, Germany
| | - Christa Koentges
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104, Freiburg, Germany
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104, Freiburg, Germany.
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Symptoms of swallowing anxiety in panic disorder patients and associated psychopathologic factors. Eat Weight Disord 2018; 23:487-497. [PMID: 28229356 DOI: 10.1007/s40519-017-0367-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 01/30/2017] [Indexed: 01/18/2023] Open
Abstract
AIM The aim of this study was to investigate symptoms of swallowing difficulty in Panic Disorder (PD) patients and the factors associated with these symptoms. METHODS In the pre-phase of the study, 22 PD patients who were treated in psychiatry outpatient clinics and who were found to have swallowing difficulty were evaluated. PD patients were asked to write about their thoughts, feelings and behaviors associated with swallowing difficulty. Later, these texts were examined and 41 expressions were identified in which patients described their swallowing difficulty. These expressions were evaluated by mental health workers in the field and twelve different swallowing difficulty items were defined. In the main phase of the study, 119 PD outpatients were evaluated using twelve different swallowing difficulty items and psychometric tests [Panic and Agoraphobia Scale (PAS), Separation Anxiety Symptom Inventory (SASI), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI-1/STAI-2)]. RESULTS As a result of the validity and reliability analysis, a valid one-factor instrument with ten items was obtained. Cronbach's alpha value for this measurement tool was 0.89 and it was termed the "Swallowing Anxiety Scale (SAS)". It was found that SAS items "always" accompany PD patients at rates of 5-20.2%. According to hierarchical regression analysis, 35% of SAS scores were explained by PAS, SASI, STAI-2 and BDI scores. CONCLUSION Swallowing difficulty items in PD patients involved anxious, phobic and somatic symptoms associated with swallowing. In addition, swallowing difficulty symptoms in PD patients can be confounded with eating disorder symptoms.
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Helene Deutsch (1928) Zur Genese der Platzangst. FORUM DER PSYCHOANALYSE 2018. [DOI: 10.1007/s00451-018-0297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Borges-Aguiar AC, Schauffer LZ, de Kloet ER, Schenberg LC. Daily maternal separations during stress hyporesponsive period decrease the thresholds of panic-like behaviors to electrical stimulation of the dorsal periaqueductal gray of the adult rat. Behav Brain Res 2018; 344:132-144. [PMID: 29466713 DOI: 10.1016/j.bbr.2018.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/29/2018] [Accepted: 02/16/2018] [Indexed: 02/04/2023]
Abstract
The present study examined whether early life maternal separation (MS), a model of childhood separation anxiety, predisposes to panic at adulthood. For this purpose, male pups were submitted to 3-h daily maternal separations along postnatal (PN) days of either the 'stress hyporesponsive period' (SHRP) from PN4 to PN14 (MS11) or throughout lactation from PN2 to PN21 (MS20). Pups were further reunited to conscious (CM) or anesthetized (AM) mothers to assess the effect of mother-pup interaction upon reunion. Controls were subjected to brief handling (15 s) once a day throughout lactation (BH20). As adults (PN60), rats were tested for the thresholds to evoke panic-like behaviors upon electrical stimulation of dorsal periaqueductal gray matter and exposed to an elevated plus-maze, an open-field, a forced swim and a sucrose preference test. A factor analysis was also performed to gain insight into the meaning of behavioral tests. MS11-CM rather than MS20-CM rats showed enhanced panic responses and reductions in both swimming and sucrose preference. Panic facilitations were less intense in mother-neglected rats. Although MS did not affect anxiety, MS11-AM showed robust reductions of defecation in an open-field. Factor analysis singled out anxiety, hedonia, exploration, coping and gut activity. Although sucrose preference and coping loaded on separate factors, appetite (adult weight) correlated with active coping in both forced swim and open-field (central area exploration). Concluding, whereas 3h-daily maternal separations during SHRP increased rat's susceptibility to experimental panic attacks, separations throughout lactation had no effects on panic and enhanced active coping.
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Affiliation(s)
- Ana Cristina Borges-Aguiar
- Department of Physiological Sciences, Health Science Center, Federal University of Espírito Santo, Brazil
| | - Luana Zanoni Schauffer
- Department of Physiological Sciences, Health Science Center, Federal University of Espírito Santo, Brazil
| | - Edo Ronald de Kloet
- Division of Endocrinology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Luiz Carlos Schenberg
- Department of Physiological Sciences, Health Science Center, Federal University of Espírito Santo, Brazil.
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Giannese F, Luchetti A, Barbiera G, Lampis V, Zanettini C, Knudsen GP, Scaini S, Lazarevic D, Cittaro D, D'Amato FR, Battaglia M. Conserved DNA Methylation Signatures in Early Maternal Separation and in Twins Discordant for CO 2 Sensitivity. Sci Rep 2018; 8:2258. [PMID: 29396481 PMCID: PMC5797081 DOI: 10.1038/s41598-018-20457-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/18/2018] [Indexed: 01/07/2023] Open
Abstract
Respiratory and emotional responses to blood-acidifying inhalation of CO2 are markers of some human anxiety disorders, and can be enhanced by repeatedly cross-fostering (RCF) mouse pups from their biological mother to unrelated lactating females. Yet, these dynamics remain poorly understood. We show RCF-associated intergenerational transmission of CO2 sensitivity in normally-reared mice descending from RCF-exposed females, and describe the accompanying alterations in brain DNA methylation patterns. These epigenetic signatures were compared to DNA methylation profiles of monozygotic twins discordant for emotional reactivity to a CO2 challenge. Altered methylation was consistently associated with repeated elements and transcriptional regulatory regions among RCF-exposed animals, their normally-reared offspring, and humans with CO2 hypersensitivity. In both species, regions bearing differential methylation were associated with neurodevelopment, circulation, and response to pH acidification processes, and notably included the ASIC2 gene. Our data show that CO2 hypersensitivity is associated with specific methylation clusters and genes that subserve chemoreception and anxiety. The methylation status of genes implicated in acid-sensing functions can inform etiological and therapeutic research in this field.
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Affiliation(s)
- Francesca Giannese
- Centre for Translational Genomics and Bioinformatics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Luchetti
- Institute of Cell Biology and Neurobiology, National Research Council, Rome, Italy
| | - Giulia Barbiera
- Centre for Translational Genomics and Bioinformatics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | | | - Claudio Zanettini
- Institute of Cell Biology and Neurobiology, National Research Council, Rome, Italy.,National Institute on Drug Abuse, Medication Development Program Molecular Targets and Medications Discovery Branch, Intramural Research Program, NIH, Baltimore, USA
| | - Gun Peggy Knudsen
- The Norwegian Institute of Public Health Department of Genetics, Environment and Mental Health, Oslo, Norway
| | - Simona Scaini
- Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Dejan Lazarevic
- Centre for Translational Genomics and Bioinformatics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | - Davide Cittaro
- Centre for Translational Genomics and Bioinformatics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | - Francesca R D'Amato
- Institute of Cell Biology and Neurobiology, National Research Council, Rome, Italy.
| | - Marco Battaglia
- Department of Psychiatry, the University of Toronto, Toronto, Canada. .,Division of Child, Youth and Emerging Adulthood, Centre for Addiction and Mental Health, Toronto, Canada.
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Domschke K, Akhrif A, Romanos M, Bajer C, Mainusch M, Winkelmann J, Zimmer C, Neufang S. Neuropeptide S Receptor Gene Variation Differentially Modulates Fronto-Limbic Effective Connectivity in Childhood and Adolescence. Cereb Cortex 2018; 27:554-566. [PMID: 26503268 DOI: 10.1093/cercor/bhv259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The neuropeptide S (NPS) system contributes to the pathogenesis of anxiety. The more active T allele of the functional rs324981 variant in the neuropeptide S receptor gene (NPSR1) is associated with panic disorder (PD) and distorted cortico-limbic activity during emotion processing in healthy adults and PD patients. This study investigated the influence of NPSR1 genotype on fronto-limbic effective connectivity within the developing brain. Sixty healthy subjects (8-21 years) were examined using an emotional go-nogo task and fMRI. Fronto-limbic connectivity was determined using Dynamic Causal Modeling. In A allele carriers, connectivity between the right middle frontal gyrus (MFG) and the right amygdala was higher in older (≥14 years) than that in younger (<14 years) probands, whereas TT homozygotes ≥14 years showed a reduction of fronto-limbic connectivity between the MFG and both the amygdala and the insula. Fronto-limbic connectivity varied between NPSR1 genotypes in the developing brain suggesting a risk-increasing effect of the NPSR1T allele for anxiety-related traits via impaired top-down control of limbic structures emerging during adolescence. Provided robust replication in longitudinal studies, these findings may constitute valuable biomarkers for early targeted prevention of anxiety disorders.
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Affiliation(s)
| | - Atae Akhrif
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Christina Bajer
- Department of Diagnostical and Interventional Neuroradiology.,Department of Neurology and
| | - Margrit Mainusch
- Department of Diagnostical and Interventional Neuroradiology.,Department of Neurology and
| | - Juliane Winkelmann
- Institute of Human Genetics, Technical University Munich, Munich, Germany.,Institute of Human Genetics, Helmholtz Center Munich, German Research Center for Environmental Health, Neuherberg, Germany
| | - Claus Zimmer
- Department of Diagnostical and Interventional Neuroradiology
| | - Susanne Neufang
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
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Battaglia M, Khan WU. Reappraising Preclinical Models of Separation Anxiety Disorder, Panic Disorder, and CO 2 Sensitivity: Implications for Methodology and Translation into New Treatments. Curr Top Behav Neurosci 2018; 40:195-217. [PMID: 29696603 DOI: 10.1007/7854_2018_42] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Separation anxiety applies to multiple forms of distress responses seen in mammals during postnatal development, including separation from a caregiver. Childhood separation anxiety disorder is an important risk factor for developing panic disorder in early adulthood, and both conditions display an increased sensitivity to elevated CO2 concentrations inhaled from the air. By interfacing epidemiological, genetic, and physiological knowledge with preclinical animal research models, it is possible to decipher the mechanisms that are central to separation anxiety and panic disorders while also suggesting possible therapies. Preclinical research models allow for environmentally controlled studies of early interferences with parental care. These models have shown that different forms of early maternal separation in mice and rats induce elevated CO2 respiratory sensitivity, an important biomarker of separation anxiety and panic disorders. In mice, this is likely due to gene-environment interactions that affect multiple behavioural and physical phenotypes after exposure to this early adversity. Although several questions regarding the causal mechanism of separation anxiety and panic disorder remain unanswered, the identification and improved understanding of biomarkers that link these mental health conditions under the guise of preclinical research models in conjunction with human longitudinal cohort studies can help resolve these issues.
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Affiliation(s)
- Marco Battaglia
- Division of Child, Youth and Emerging Adulthood Psychiatry, Centre for Addiction & Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Waqas Ullah Khan
- Division of Child, Youth and Emerging Adulthood Psychiatry, Centre for Addiction & Mental Health, Toronto, ON, Canada
- School of Medicine, Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland
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Battaglia M, Garon-Carrier G, Côté SM, Dionne G, Touchette E, Vitaro F, Tremblay RE, Boivin M. Early childhood trajectories of separation anxiety: Bearing on mental health, academic achievement, and physical health from mid-childhood to preadolescence. Depress Anxiety 2017; 34:918-927. [PMID: 28833904 DOI: 10.1002/da.22674] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Separation anxiety disorder is the most prevalent childhood anxiety condition, but no study assessed children for separation anxiety at preschool age and followed them longitudinally and directly until mid-childhood/early adolescence. METHODS Multi-informant (children, teachers, family), multipoint (at age 8, 10, 12, 13) assessments of 1,290 children of the Quebec Longitudinal Study of Child Development, who had been categorized between age 1.5 and 6 into four specific separation anxiety trajectories (1, low-persistent; 2, low-increasing; 3, high-decreasing, and the less common: 4, high-increasing) by growth mixture modeling. Participants in the high-increasing trajectory were compared to participants in the other three trajectories for: (a) child's internalizing and externalizing problem behavior; (b) physical health; (c) academic achievement; (d) maternal anxiety. RESULTS Multivariate analyses of variance/covariance at separate time points showed the high-increasing trajectory mostly associated with: (a) higher internalizing, but not externalizing, behavior; (b) worse academic achievement (most consistently by comparisons to the normative low-persistent trajectory; (c) higher rates of maternal panic/agoraphobic anxiety; (d) worse physical health (most consistently by comparisons to the low-persistent trajectory). The high-increasing trajectory had twofold to threefold higher incidences of physical illnesses than the normative low-persistent group; this was specific for headaches at age 12 years, chronic asthma at age 10 and 13, and having received asthma-related medication during the past 12 months. CONCLUSIONS High-increasing separation anxiety in preschool maintains longitudinal relationships to independent health and academic outcomes, at least until preadolescence. This knowledge can inform the deployment of clinical resources at the earlier signs of the more impairing manifestations.
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Affiliation(s)
- Marco Battaglia
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Division of Child Youth and Emerging Adult Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Sylvana M Côté
- Department of Pediatrics and Psychology, Université de Montréal, Montréal, Canada
| | - Ginette Dionne
- GRIP, School of Psychology, Université Laval, Québec, Canada
| | - Evelyne Touchette
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Québec, Canada
| | - Frank Vitaro
- Department of Psychoeducation, Université de Montréal, Montréal, Canada
| | - Richard E Tremblay
- Department of Pediatrics and Psychology, Université de Montréal, Montréal, Canada.,School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland.,Institute of Genetic, Neurobiological, and Social Foundations of Child Development, Tomsk State University, Tomsk, Russian Federation
| | - Michel Boivin
- GRIP, School of Psychology, Université Laval, Québec, Canada.,Institute of Genetic, Neurobiological, and Social Foundations of Child Development, Tomsk State University, Tomsk, Russian Federation
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Popp L, Neuschwander M, Mannstadt S, In-Albon T, Schneider S. Parent-Child Diagnostic Agreement on Anxiety Symptoms with a Structured Diagnostic Interview for Mental Disorders in Children. Front Psychol 2017; 8:404. [PMID: 28396644 PMCID: PMC5366335 DOI: 10.3389/fpsyg.2017.00404] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 03/03/2017] [Indexed: 01/15/2023] Open
Abstract
Objective: In clinical structured diagnostic interviews, diagnoses based on parent and child reports have low to moderate agreement. The aims of the present study are (1) to examine diagnostic agreement on anxiety disorders between parents and children on the levels of current and lifetime diagnostic category and diagnoses focusing in particular on diagnostic criteria and (2) to identify parent- and child-related predictors for diagnostic agreement. Method: The sample consisted of 166 parent-child dyads interviewed with the Structured Diagnostic Interview for Mental Disorders in Children (Kinder-DIPS, Schneider et al., 2009). The children (51.8% girls) were between the ages of 7 and 18 years (M = 10.94; SD = 2.22). Results: Overall, parent-child agreement on the diagnostic category of anxiety disorder (k = 0.21; k = 0.22) and the specific anxiety diagnoses (base rate > 10%) of social phobia, specific phobia and separation anxiety disorder (k = 0.24–0.52; k = 0.19–0.43) and corresponding diagnostic criteria (k = 0.22–0.67; k = 0.24–0.41) were low to moderate with the highest agreement on separation anxiety disorder (k > 0.43). Lower maternal depression, and higher social support reported by mother and father were associated with higher parent-child agreement. Maternal depression was indicated as the strongest predictor. Parental sense of competence, parental anxiety, the amount of parent-child interaction and the child's age and gender had no predictive value. Conclusions: Parent-child agreement can be expected to be higher on the level of anxiety criteria compared to specific anxiety diagnoses and diagnostic anxiety category. Psychological strains in the family—especially maternal depression and low social support—lower the parent-child agreement on anxiety symptoms. Child- and relation-related variables (age, gender, amount of time parent(s) and children interact) play no role in the prediction of low parent-child agreement.
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Affiliation(s)
- Lukka Popp
- Clinical Child and Adolescent Psychology, Department of Psychology, Ruhr-Universität Bochum Bochum, Germany
| | - Murielle Neuschwander
- Clinical Child and Adolescent Psychology, Department of Psychology, Ruhr-Universität Bochum Bochum, Germany
| | - Sandra Mannstadt
- Kinder- und Jugendpsychiatrische Klinik, Universitäre Psychiatrische Kliniken Basel, Switzerland
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy, University of Koblenz-Landau Landau, Germany
| | - Silvia Schneider
- Clinical Child and Adolescent Psychology, Department of Psychology, Ruhr-Universität Bochum Bochum, Germany
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Furber G, Leach M, Guy S, Segal L. Developing a broad categorisation scheme to describe risk factors for mental illness, for use in prevention policy and planning. Aust N Z J Psychiatry 2017; 51:230-240. [PMID: 27117756 DOI: 10.1177/0004867416642844] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The prevention of mental illness involves identifying and modifying those characteristics and exposures of an individual that threaten their mental health - commonly referred to as risk factors. Existing categorisations of risk factors for mental illness are either limited in their scope or oversimplified in their description. As part of a large mental health workforce and service planning project, we set out to develop a more detailed and comprehensive categorisation scheme to describe risk factors for mental illness. METHODS We conducted a rapid review of MEDLINE and Google Scholar for meta-analytic studies that examined the characteristics and exposures that typify the population with mental illness in order to identify and categorise potential risk factors. RESULTS The search uncovered 1628 relevant studies, from which 10 primary and 23 secondary categories of risk factors were identified, ranging from genetic and biomedical to psychological and sociocultural. The review revealed interesting distortions in the focus of the literature, with the majority of studies focused on a few disorders (schizophrenia, depression and neurodegenerative disorders) and genetic, psychological and physiological risks. In contrast, environmental (e.g. media exposure) and occupational (e.g. employee health) were under-represented. CONCLUSION The categorisation scheme developed in this paper is a step towards a more detailed taxonomy of risk factors for mental illness; this will be most useful in guiding clinicians, researchers and policy-makers in driving the prevention agenda forward.
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Affiliation(s)
- Gareth Furber
- 1 Health Economics and Social Policy Group, Centre for Population Health Research, University of South Australia, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Matthew Leach
- 2 School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia
| | - Sophie Guy
- 1 Health Economics and Social Policy Group, Centre for Population Health Research, University of South Australia, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Leonie Segal
- 1 Health Economics and Social Policy Group, Centre for Population Health Research, University of South Australia, South Australian Health & Medical Research Institute (SAHMRI), Adelaide, SA, Australia
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Lahey BB, Krueger RF, Rathouz PJ, Waldman ID, Zald DH. A hierarchical causal taxonomy of psychopathology across the life span. Psychol Bull 2017; 143:142-186. [PMID: 28004947 PMCID: PMC5269437 DOI: 10.1037/bul0000069] [Citation(s) in RCA: 249] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We propose a taxonomy of psychopathology based on patterns of shared causal influences identified in a review of multivariate behavior genetic studies that distinguish genetic and environmental influences that are either common to multiple dimensions of psychopathology or unique to each dimension. At the phenotypic level, first-order dimensions are defined by correlations among symptoms; correlations among first-order dimensions similarly define higher-order domains (e.g., internalizing or externalizing psychopathology). We hypothesize that the robust phenotypic correlations among first-order dimensions reflect a hierarchy of increasingly specific etiologic influences. Some nonspecific etiologic factors increase risk for all first-order dimensions of psychopathology to varying degrees through a general factor of psychopathology. Other nonspecific etiologic factors increase risk only for all first-order dimensions within a more specific higher-order domain. Furthermore, each first-order dimension has its own unique causal influences. Genetic and environmental influences common to family members tend to be nonspecific, whereas environmental influences unique to each individual are more dimension-specific. We posit that these causal influences on psychopathology are moderated by sex and developmental processes. This causal taxonomy also provides a novel framework for understanding the heterogeneity of each first-order dimension: Different persons exhibiting similar symptoms may be influenced by different combinations of etiologic influences from each of the 3 levels of the etiologic hierarchy. Furthermore, we relate the proposed causal taxonomy to transdimensional psychobiological processes, which also impact the heterogeneity of each psychopathology dimension. This causal taxonomy implies the need for changes in strategies for studying the etiology, psychobiology, prevention, and treatment of psychopathology. (PsycINFO Database Record
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Affiliation(s)
| | | | - Paul J Rathouz
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine
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Abstract
In the present chapter, we review the literature focusing on oxytocin (OT)-centered research in anxiety spectrum conditions, comprising separation anxiety disorder, specific phobias, social anxiety disorder (SAD), panic disorder, generalized anxiety disorder, and anxiety-related endophenotypes (e.g., trust behavior, behavioral inhibition, neuroticism, and state/trait anxiety). OT receptor gene (OXTR) polymorphisms have been implicated in gene-environment interactions with attachment style and childhood maltreatment and to influence clinical outcomes, including SAD intensity and limbic responsiveness. Epigenetic OXTR DNA methylation patterns have emerged as a link between categorical, dimensional, neuroendocrinological, and neuroimaging SAD correlates, highlighting them as potential peripheral surrogates of the central oxytocinergic tone. A pathophysiological framework of OT integrating the dynamic nature of epigenetic biomarkers and the summarized genetic and peripheral evidence is proposed. Finally, we emphasize opportunities and challenges of OT as a key network node of social interaction and fear learning in social contexts. In conjunction with multi-level investigations incorporating a dimensional understanding of social affiliation and avoidance in anxiety spectrum disorders, these concepts will help to promote research for diagnostic, state, and treatment response biomarkers of the OT system, advancing towards indicated preventive interventions and personalized treatment approaches.
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Affiliation(s)
- Michael G Gottschalk
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University of Würzburg, Margarete-Höppel-Platz 1, Würzburg, 97080, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, Freiburg im Breisgau, 79104, Germany.
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Blatter-Meunier J, Kreißl MW, Schneider S. Familienstrukturen in Familien von Kindern mit einer Störung mit Trennungsangst. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2016. [DOI: 10.1026/1616-3443/a000384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Die Störung mit Trennungsangst ist eine der häufigsten psychischen Erkrankung im Kindesalter, bei der das Familiensystem in besonderem Ausmaß mit betroffen ist. Untersuchungen mit Kindern mit Schulverweigerung und komorbider Trennungsangst weisen darauf hin, dass in Familien dieser Kinder häufiger dysfunktionale Familienkonstellationen vorliegen. Fragestellung: Die vorliegende Studie hat das Ziel zu überprüfen, ob Familien mit Trennungsangst häufiger dysfunktionale Familienstrukturen aufweisen als Familien von Kindern mit anderen Angststörungen oder ohne psychische Störung. Methode: 71 Familien von Kindern mit Trennungsangst, 25 Familien mit Kindern mit anderen Angststörungen und 21 Familien mit Kindern ohne psychische Störungen wurden mit dem Familiensystemtest (FAST) untersucht. Ergebnisse: Die Gruppen unterscheiden sich nicht signifikant in der Häufigkeit dysfunktionaler Familienstrukturen. Diskussion: Dysfunktionale (verstrickte) Familienstruktur und Trennungsangst zeigen keinen Zusammenhang. Weitere vertiefende Untersuchungen sind notwendig, um den möglichen Zusammenhang von dysfunktionalen Familienstrukturen und Angststörungen zu prüfen.
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Affiliation(s)
| | | | - Silvia Schneider
- Ruhr-Universität Bochum, Klinische Kinder- und Jugendpsychologie
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Adolph D, Schneider S, Margraf J. German Anxiety Barometer-Clinical and Everyday-Life Anxieties in the General Population. Front Psychol 2016; 7:1344. [PMID: 27667977 PMCID: PMC5016627 DOI: 10.3389/fpsyg.2016.01344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 08/22/2016] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to test a time-efficient screening instrument to assess clinically relevant and everyday-life (e.g., economic, political, personal) anxieties. Furthermore, factors influencing these anxieties, correlations between clinical and everyday anxieties and, for the first time, anxiety during different stages of life were assessed in a representative sample of the general population (N = 2229). Around 30% of the respondents manifested at least one disorder-specific key symptom within 1 year (women > men), 8% reported severe anxiety symptoms. Two thirds of respondents reported minor everyday anxieties and 5% were strongly impaired, whereby persons with severe clinical symptoms were more frequently affected. A variety of potential influencing factors could be identified. These include, in addition to socioeconomic status, gender, general health, risk-taking, and leisure behavior, also some up to now little investigated possible protective factors, such as everyday-life mental activity. The observed effects are rather small, which, however, given the heterogeneity of the general population seems plausible. Although the correlative design of the study does not allow direct causal conclusions, it can, however, serve as a starting point for experimental intervention studies in the future. Together with time series from repeated representative surveys, we expect these data to provide a better understanding of the processes that underlie everyday-life and clinical anxieties.
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Affiliation(s)
- Dirk Adolph
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr Universität BochumBochum, Germany; Department of Clinical Child and Adolescent Psychology, Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr University BochumBochum, Germany
| | - Silvia Schneider
- Department of Clinical Child and Adolescent Psychology, Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr University Bochum Bochum, Germany
| | - Jürgen Margraf
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr Universität Bochum Bochum, Germany
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Abstract
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) categorization of mental disorders places "separation anxiety disorder" within the broad group of anxiety disorders, and its diagnosis no longer rests on establishing an onset during childhood or adolescence. In previous editions of DSM, it was included within the disorders usually first diagnosed in infancy, childhood, or adolescence, with the requirement for an onset of symptoms before the age of 18 years: symptomatic adults could only receive a retrospective diagnosis, based on establishing this early onset. The new position of separation anxiety disorder is based upon the findings of epidemiological studies that revealed the unexpectedly high prevalence of the condition in adults, often in individuals with an onset of symptoms after the teenage years; its prominent place within the DSM-5 group of anxiety disorders should encourage further research into its epidemiology, etiology, and treatment. This review examines the clinical features and boundaries of the condition, and offers guidance on how it can be distinguished from other anxiety disorders and other mental disorders in which "separation anxiety" may be apparent.
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