Maternal anxiety and attitudes to universal neonatal hearing screening.

Watkin PM, Baldwin M, Dixon R, Beckman A.

Audiology Services, Forest Healthcare, Whipps Cross Hospital, Leytonstone, London.

Neonatal hearing screening of all babies within the maternity unit is now feasible using transient evoked otoacoustic emission (TEOAE) recording. However, in many maternity units in the United Kingdom, the majority of babies are discharged within the first 48 hours. During the first two days of life, there is a higher proportion of babies in whom emissions cannot be recorded. A universal TEOAE hearing screen has been implemented in Whipps Cross Hospital. As 70% of the babies are discharged from the maternity unit before they are 48 hours old, a two stage screen was implemented, with failure at the initial TEOAE test being followed by a retest after 4-6 weeks. The maternal anxiety caused by this model was investigated in 288 mothers enrolled for the initial TEOAE test. Generally, anxiety was low and attitudes towards the screen were positive. Ninety-seven per cent of mothers considered the screen to be worthwhile at the initial test with 15% feeling it had caused some anxiety but less than 1% being very worried. The mothers who had some anxieties were not dissatisfied with the screen, and within this group there was no increase in the proportion of babies who had failed the initial test. At the retest, two of 57 mothers (3.5%) considered they were very worried, but there was no significant deterioration in attitude towards the screen. Spielberger's State-Trait Anxiety Inventory revealed no significant difference in the anxiety state of the retest group when compared with a control group whose babies had not received a neonatal hearing test. The results of the initial test and the retest did not influence the anxiety state of the mothers. Ways of minimizing anxiety caused to a minority of mothers whilst maintaining positive attitudes to the screen are discussed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9643305&dopt=Abstract anxiety medicine




[The characteristics of the functional activity of the brain serotoninergic system in the manifestation of natural and pathological anxiety in mice: the effect of the genotype]

[Article in Russian]

Avgustinovich DF, Lipina TV, Alekseenko OV, Amstislavskaia TG, Kudriatseva NN.

Institute of Cytology and Genetics, Russian Academy of Sciences, Siberian Branch, Novosibirsk.

Anxiety was estimated in intact male mice of C57BL/6J (C57) and (CBA) and CBA/Lac (CBA) strains and in males of both strains after the repeated experience of social defeats (losers) in 10 daily aggressive confrontations. A plus-maze test for behavior in a novel situation and a partition test for communicative activity were applied. Tryptophan hydroxylase (TPH) activity, 5-hydroxytryptamine (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) levels were measured in the midbrain, hypothalamus, amygdala, hippocampus, and striatum in losers and controls (5 days of individual housing of intact animals). Intact C57 mice which demonstrated active avoidance in the maze had reduced TPH activity in the all studied brain regions compared to the intact CBA mice with passive behavior. The 5-HT catabolism in intact C57 was lower in the midbrain and hypothalamus and higher in amygdala, hippocampus, and striatum than in CBA mice. Chronic social stress led to expressed anxiety revealed by both tests in C57 losers in contrast to CBA ones. This anxiety was accompanied by an increase in 5-HIAA level and 5-HIAA/5-HT ratio in the midbrain as well as by an increase in 5-HT level and decrease in 5-HIAA level and 5-HIAA/5-HT ratio in the hippocampus of C57 losers in comparison with the controls. Flesinoxan (0.5 mg/kg, i.p.), 5-HT1A receptor agonist, changed the communicative behavior of controls but was ineffective in losers. Thus, a decrease in sensitivity of 5-HT1A receptors was suggested in stress-induced anxiety of C57 losers. The less expressed anxiety in CBA losers was associated with less expressed changes in serotonergic metabolism. It is concluded that serotonergic mechanisms of pathological anxiety induced by the long-term social stress and those of natural anxiety in intact mice are different.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9644814&dopt=Abstract anxiety medicine




A retrospective study of the learning history origins of anxiety sensitivity.

Watt MC, Stewart SH, Cox BJ.

Department of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada.

Anxiety sensitivity (AS; the fear of anxiety-related sensations) has been proposed as a risk factor for the development of panic disorder. The present study involved a conceptual replication of Ehlers' (1993, Behaviour Research and Therapy, 31, 269-278) study on childhood learning experiences and panic attacks, but also extended her work by investigating the relationship between early learning experiences and the development of AS, in a non-clinical sample. A sample of 551 university students participated in a retrospective assessment of their childhood and adolescent instrumental and vicarious learning experiences with respect to somatic symptoms (i.e. anxiety and cold symptoms, respectively) using an expanded version of Ehler's (1993) Learning History Questionnaire. AS levels were assessed using the Anxiety Sensitivity Index, and panic history was obtained using the Panic Attack Questionnaire, Revised. Contrary to hypotheses, the learning experiences of high AS individuals were not found to be specific to anxiety symptoms, but involved parental reinforcement of sick-role behavior related to somatic symptoms in general. High AS subjects reported both more anxiety and cold symptoms prior to age 18 than individuals with lower levels of AS. In addition, both cold and anxiety symptoms elicited more special attention and/or instructions from parents for high AS individuals to take special care of themselves. These findings are contrasted with the results for self-reported panickers who reported more learning experiences (modeling and parental reinforcement) specific to anxiety-related symptoms, than the non-panickers. The results suggest that higher-than-normal levels of AS may arise from learning to catastrophize about the occurrence of bodily symptoms in general, rather than anxiety-related symptoms in particular.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9648327&dopt=Abstract anxiety medicine




Social anxiety in children with anxiety disorders: relation with social and emotional functioning.

Ginsburg GS, La Greca AM, Silverman WK.

Division of Applied Psychology and Quantitative Methods, University of Baltimore, Maryland 21201, USA.

Investigated the psychometric properties of the Social Anxiety Scale for children-Revised (SASC-R) as well as relations between social anxiety and children's social and emotional functioning. Participants were a clinic sample of children, ages 6-11 with anxiety disorders (N = 154) who completed the SASC-R. For a subset of these children, parent ratings of social skills, and self-ratings of perceived competence and peer interactions were also obtained. Factor analysis of the SASC-R supported the original three-factor solution and internal consistencies were in the acceptable range. Among children with simple phobia, scores on the SASC-R differentiated those with and without a comorbid social-based anxiety disorder. Social anxiety was also associated with impairments in social and emotional functioning. Specifically, highly socially anxious children reported low levels of social acceptance and global self-esteem and more negative peer interactions. Girls with high levels of social anxiety were also rated by parents as having poor social skills, particularly in the areas of assertive and responsible social behavior.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9650624&dopt=Abstract anxiety medicine




Moderators of the relationship between trait anxiety and information received by patients post-myocardial infarction.

Yarcheski A, Proctor TF, Oriscello RG.

College of Nursing, Rutgers University, Newark, New Jersey, USA.

The purpose of this study was to examine the relationship between trait anxiety and patients' evaluation of information they received during hospitalization post-myocardial infarction (MI), and to test the extent to which state anxiety and gender moderate this relationship. At the time of discharge from the hospital, 68 adult men and women who had had an MI responded to a demographic data sheet and to instruments measuring state anxiety, trait anxiety, and the quality of information they received during hospitalization. Data analysis indicated that the higher their trait anxiety, the less positively patients rated the quality of information they received during hospitalization post-MI. A series of regression analysis procedures designed to test for moderation indicated that neither state anxiety nor gender had a moderator effect on the relationship between trait anxiety and the quality of information received. The findings are interpreted within the theoretical perspectives that guided the study. Clinical implications of the findings are discussed.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9526313&dopt=Abstract anxiety medicine




Refugee children from the Middle East.

Montgomery E.

Rehabilitation and Research Centre for Torture Victims, Copenhagen.

OBJECTIVE: To map the frequency (prevalence) of torture victims among parents in asylum seeking Middle Eastern refugee families, to map the occurrence (prevalence) of experiences of war and other forms of organised violence among the children in these families, to map the occurrence (prevalence) of emotional symptoms and behavioural problems among the children, and to identify risk indicators and modifying factors for anxiety symptoms among the children. DESIGN: Interview with parents using a structured interview questionnaire developed for this study. Validated through a blinded semi-structured interview conducted with approximately 1/3 of the families. AUSPICES: The study has been carried out by the Rehabilitation and Research Centre for Torture Victims (RCT) in cooperation with the Danish Red Cross. MATERIAL: Structured interviews with parents regarding 311 children aged 3-15 from 149 families, all registered as asylum seekers from the Middle East between February 1, 1992 and April 30, 1993. The response was 90.4%. PRINCIPAL VARIABLES: Background (past-past)--social and demographic data; trauma complex (past)--war-related life circumstances (conditions) and experiences of war and other forms of organized violence such as loss, separation, direct exposure to violence and witnessing acts of violence (specific events and changes of life conditions); present life context (past-present)--family circumstances upon arrival in Denmark; effect (present)--the child's current psychological state. RESULTS: 28% of the parents (44% of the fathers and 13% of the mothers) had been tortured, to the effect that 51% of the children were part of a family including a survivor of torture. The most frequent specific types of violence-related events or circumstances were 'lived in a refugee camp outside the home country' (92%), 'lived under conditions of war' (89%) and 'been on the run with parents' (89%). Twenty percent of the children had lost one parent, and another 60% had been separated from one parent for more than a month. The highest prevalence of emotional symptoms were found within the anxiety dimension, as 67% of the children were assessed as being clinically anxious. The most important risk indicators for anxiety were 'lived in a refugee camp outside the home country', 'part of a torture surviving family', 'lack of opportunities for play with other children', 'beaten/kicked by an official', and 'loss of father'. Current parental behaviour was also an important risk indicator for anxiety, if the mother or father hit or punished the child more than was the case prior to arrival in Denmark. The most important anxiety-modifying factor was arrival in Denmark in the company of both parents. CONCLUSIONS: Asylum seeking refugee children from the Middle East have had many experiences of war and other forms of organised violence. The children frequently reacted with anxiety and with other symptoms of emotional instability. Prevalent anxiety symptoms correlated both with previous living conditions and present family situation. Living under prolonged conditions influenced by war and other forms of organised violence (prevalence) were found to a higher degree to be risk indicators for anxiety than were specific events or changes of life conditions (incidence).

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9526769&dopt=Abstract anxiety medicine




[Analysis of patients' perception of their stay in a medical intensive care unit. Les trois equipes d'infirmieres]

[Article in French]

Brullmann F, Guidet B, Maury E, Vassal T, Offenstadt G.

Service de Reanimation medicale, Hopital Saint-Antoine, Paris.

OBJECTIVES: Evaluate patients' appraisal of their stay in a medical intensive care unit and analyze their anxiety. PATIENTS AND METHODS: Two 5-month prospective studies with specific questionnaires were filled out by patients with the help of a psychologist. The first study (61 patients) evaluated global appraisal of the stay and the second study (53 patients) focused on anxiety using questionnaires also filled out by nurses. RESULTS: The study population was not different from the global population admitted to intensive care during the same period. The patients felt secure in 97% of the cases but suffered pain (53%), insomnia (62%), discomfort due to noise (49%) or light (37%), and expressed anxiety (55%). The second study confirmed the anxiety in 61% of the patients. Using surrogate markers of anxiety, the psychologist judged that anxiety was underestimated in 20% of the cases. In 17%, anxiety was expressed by patients but not felt to be present by nurses. DISCUSSION: In order to decrease the anxiety of patients admitted to a medical intensive care unit, every effort should be made to lessen pain and unnecessary discomfort. All personnel working in the unit should be able to recognize the patients' anxiety.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9536992&dopt=Abstract anxiety medicine




Social anxiety and history of behavioral inhibition in young adults.

Mick MA, Telch MJ.

University of Texas at Austin 78712, USA.

To evaluate the relationship between the childhood temperament behavioral inhibition (BI) and anxiety symptomology, we investigated differences in retrospective reports of childhood BI among undergraduates reporting one of the following: (a) Social anxiety (n = 10), (b) generalized anxiety (n = 13), (c) both social and generalized anxiety (n = 15), and (d) minimal social and generalized anxiety (n = 38). Contrary to the hypothesis that BI acts as a nonspecific risk factor for anxiety symptoms, our findings revealed that a history of childhood BI was associated with symptoms of social phobia but not generalized anxiety disorder. Moreover, participants displaying symptoms of both generalized anxiety disorder and social phobia were no more likely to show a childhood history of BI than participants displaying social phobia symptoms alone. These data suggest that a childhood history of BI may be more strongly associated with adult social anxiety than some other types of anxiety pathology.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9549606&dopt=Abstract anxiety medicine




Individual and familial predictors of impairment in childhood anxiety disorders.

Manassis K, Hood J.

Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.

OBJECTIVE: To determine which correlates of childhood anxiety disorders are predictive of impaired functioning as judged by clinicians. METHOD: Seventy-four families of children with anxiety disorders attending a hospital outpatient clinic completed questionnaires measuring child symptoms of anxiety and depression, maternal psychopathology, maternal ratings of child psychopathology, and developmental and environmental difficulties. Clinicians completed the Global Assessment of Functioning (GAF) for each child, and correlations between it and the other measures were ascertained. RESULTS: Maternal ratings of child conduct problems, child symptoms of depression, maternal phobic anxiety, developmental difficulties, and psychosocial adversity were significantly correlated with GAF. Results of a multiple regression analysis revealed that these variables accounted for 25% of the variance in GAF scores. The first four variables were significant predictors of impairment in children with phobic disorders. Psychosocial adversity was the only significant predictor of impairment in children with generalized anxiety disorder. CONCLUSIONS: In addition to child depression and developmental or psychosocial adversity, impairment in childhood anxiety disorders appears to be related to parental anxiety and behavior management difficulties, particularly in phobic disorders. Addressing the latter factors may enhance treatment efficacy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9549964&dopt=Abstract anxiety medicine