The comorbidity of anxiety and depression.

Rodney J, Prior N, Cooper B, Theodoros M, Browning J, Steinberg B, Evans L.

Mood Disorders Unit, New Farm Clinic, Queensland, Australia.

OBJECTIVE: This study explored the effect of comorbid anxiety disorders in patients admitted to an inpatient specialist Mood Disorders Unit for the treatment of a primary major depressive episode. METHOD: Subjects were assessed on admission and discharge. DSM-III-R diagnoses for major depression and anxiety disorders were established using CIDI-Auto; comorbid anxiety disorders were coexistent in time with the major depression, with both conditions meeting diagnostic criteria at the time of assessment. Severity of illness was assessed using the Hamilton Depression/Melancholia Scale, the revised Hamilton Anxiety Scale and the revised Beck Depression Inventory. RESULTS: For the analysis, the study cohort was divided into three groups: depression alone (n = 33), one comorbid anxiety disorder (n = 15), and two or more comorbid anxiety disorders (n = 24). No particular anxiety disorder predominated. Interestingly, the presence or absence of comorbid anxiety with severe major depression made no significant difference to treatment choice or outcome results. Specifically, there was no significant difference between the three groups in the utilisation of electroconvulsive therapy and pharmacotherapy (including antidepressants, benzodiazepines and neuroleptics); all subjects improved significantly on both depression and anxiety ratings, and length of inpatient stay did not vary significantly between the three groups. CONCLUSIONS: The existence of comorbid anxiety disorders in those patients who presented for treatment of a primary major depressive episode did not significantly effect choice of treatment or treatment outcome, suggesting that there is a close interrelationship between the two conditions.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9400876&dopt=Abstract anxiety medicine




The relation between anxiety sensitivity and depression in children and adolescents referred for anxiety.

Weems CF, Hammond-Laurence K, Silverman WK, Ferguson C.

Department of Psychology, Florida International University, Miami 33199, USA.

Research conducted with adult samples suggests that anxiety sensitivity is positively related to depression (Otto et al., 1995, Journal of Anxiety Disorders, 10, 117-123). The Childhood Anxiety Sensitivity Index (CASI, Silverman et al., 1991, Journal of Clinical Child Psychology, 20 162-168) was used in this study to provide an examination of the relation between anxiety, anxiety sensitivity, and depression in a sample of children and adolescents (N = 234) referred for anxiety disorders. A significant correlation between depression and anxiety sensitivity was found. This relation remained statistically significant when controlling for other aspects of anxiety (i.e. worry, physiological anxiety, and concentration). The similarities between these findings and findings obtained with adults are discussed, as well as suggestions for future research.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9401137&dopt=Abstract anxiety medicine




Mother-child agreement on self-report of anxiety in abused children.

Kenny MC, Faust J.

Florida International University, College of Education, Educational Psychology and Special Education, Miami, FL 33199, USA. kennym servmx.fiu.edu

This study investigates the lack of agreement in maternal and child report of child anxiety with a sample of abused and nonabused clinic-referred children. Based on the literature, it was predicted that nonabused clinic-referred children would report more symptoms of anxiety than their mothers would report for them. It was also predicted that mothers of abused children would report greater anxiety symptoms for their children than the children's self-report. Finally, it was predicted that maternal psychopathology, specifically anxiety, would increase the probability that mothers would overreport their children's anxiety. Mother-child agreement based on anxiety symptoms assessed by the Quay Behavior Problem Checklist and the Revised-Children's Manifest Anxiety Scale was obtained on 54 male and female outpatients, 5 to 16 years of age. Overall, mothers reported significantly more anxiety for their children, than the children's own self-report, irrespective of abuse history. The implications of the findings are discussed with respect to the validity of maternal and child report. Directions for future research are also offered.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9407266&dopt=Abstract anxiety medicine




[Stress, anxiety and and event related potentials]

[Article in French]

Boudarene M, Timsit-Berthier M.

Laboratoire Universitaire de Psychophysiologie Cognitive Appliquee, CHP Petit Bourgogne, Liege, Belgique.

Our aim was to study the relationships between stress and anxiety with both psychological and neurophysiological (Events Related Potentials: CNV and P300) methods. The study was divided into 2 parts. In the first part, the research was carried out among 32 out-patients suffering from anxiety disorders (generalized anxiety disorders) according to DSM IV. All of them were drug free and displayed scores higher than 45 on the Spielberger Anxiety State and Trait Scale. They were compared to 40 controls paired in age and sex. The 2 groups displayed a score higher than 200 on the Amiel-Lebigre Life Events scale. In the second part, the control subjects were divided into 2 sub-groups The first one displayed scores higher than 45 (anxious controls) on the Spielberger Anxiety-State Scale while the second one displayed scores lower than 45 (non anxious controls). Two ERPs were recorded, the P300 by using the classical "Oddball" experimental paradigm in auditive modality and the Contingent Negative Variation (CNV) by using a reaction time task with warning stimulus. The results showed not only clear differences between the subjects who suffered from anxiety and the controls but also showed opposite results between anxious out-patients (anxiety disorders) and anxious controls. The non anxious controls were intermediate. While the outpatients showed a decreased P300, the group of anxious control showed an increase of this potential. The first one displayed a CNV/M1 (contingent negativity variation/early part) increase and a longest reaction time, while the second one exhibit an early CNV decrease and normally reaction time. It appears that the stress response expressed itself differently according to the psychological state and the stress situation. The behavioral and neurophysiological data will be discussed in the framework of cognitive, behavioral and psychophysiological theories.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9417388&dopt=Abstract anxiety medicine




The effect of psychological management on dental anxiety in children.

Folayan MO, Ufomata D, Adekoya-Sofowora CA, Otuyemi OD, Idehen E.

Department of Preventive Dentistry, Obafemi Awolowo University, Ie-Ife, Nigeria. mukpong2 yahoo.com

The aim of this study was to determine the effect of using of psychological management techniques on the level of anxiety in Nigerian children during dental management. The Short Form of the Dental Anxiety Survey Schedule was administered to 81 children who were attending a suburban dental clinic for the first time. This schedule was re-administered again two weeks later when they came for a follow up visit. The age of the patients was recorded. The types as well as number of psychological techniques employed during treatment were also noted. The overall mean dental anxiety level of the children decrease from an average of 15.23 +/- 5.03 before treatment to 13.40 + 4.13 after treatment (p < 0.001). However, the mean dental anxiety score in children in whom no psychological technique was employed during treatment increased after treatment. On the other hand, there was also a statistically significant decrease in the mean dental anxiety level of children treated using either a single psychological technique or combined psychological techniques after treatment. Better results were obtained when combined psychological techniques where used than when only a single technique was used. It was concluded that psychological techniques used in the management of dental anxiety in children are highly effective in decreasing dental anxiety levels. Better results are obtained when a number of techniques are combined effectively.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12924737&dopt=Abstract anxiety medicine




Child and parent reports of childhood anxiety: differences in coping styles.

Manassis K, Mendlowitz S, Menna R.

University of Toronto, Canada.

This study compares children anxious only on parent report (PR) with those anxious on self-report (SR) and self- and parent report (SPR) to examine the reasons for the reporting differences. Sixty-five children aged 7-12 years who met criteria for one or more Axis I anxiety disorders (25% with comorbid nonanxiety diagnoses) completed standardized measures of anxiety, depression, and coping style. Parents completed measures of child psychopathology and adult coping style. Assessing clinicians completed the Global Assessment of Functioning. All parents endorsed anxiety in their children. Based on their responses on standardized self-report measures of anxiety, children were classified as endorsing anxiety (SPR group) or not endorsing anxiety (PR group). Multivariate analysis of variance revealed that children in the SPR group endorsed more depression and employed a greater variety of coping strategies than children in the PR group. The two groups did not differ on parent or clinician measures. These findings suggest that reporting differences may be related to differences in coping styles in anxious children. SPR children may over report anxiety symptoms due to feelings of decreased self-worth associated with depressive thinking, whereas PR children may be able to distract themselves from their anxieties. The lack of difference in functioning between the two groups suggests that self-report anxiety questionnaire scores are not necessarily indicative of severity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9451547&dopt=Abstract anxiety medicine




Dental anxiety among middle-aged and elderly women in Sweden. A study of oral state, utilisation of dental services and concomitant factors.

Hagglin C, Berggren U, Hakeberg M, Ahlqwist M.

Department of Endodontology and Oral Diagnosis, Faculty of Odontology, Goteborg University, Sweden.

The aim of this project was to investigate dental anxiety and its expression in utilisation of dental services, oral health and oral symptoms. In a cross-sectional study of women's health in Goteborg (population 432,000), Sweden, 1016 women aged 38 to 84 years participated. This randomly selected population took part in a series of investigative procedures including medical and dental clinical examinations, interviews and questionnaires. Levels of dental anxiety were measured on the Corah Dental Anxiety Scale (DAS). The average DAS score obtained was 7.2. The study showed that older women were significantly less anxious than younger ones. Severe dental anxiety (DAS > or = 15) was experienced by 3.9% of the participants. This frequency corresponds well with findings by Hallstrom and Halling in their analysis of data from the first Goteborg study of women's health 24 years ago. High levels of dental anxiety were correlated with longer intervals between dental visits, poorer oral function and aesthetics and a higher frequency of oral symptoms. Headaches were more prevalent in the younger age groups and a correlation with dental anxiety was revealed. Our previous studies have shown that symptoms such as tension headaches are prevalent among dental phobic patients and that they are reported to be reduced by therapy for dental fear. The clinical and radiographical examinations revealed a generally poorer oral status, with a statistically significant higher number of decayed teeth among women with high dental anxiety.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9452639&dopt=Abstract anxiety medicine




Separation anxiety in adulthood: a phenomenological investigation.

Manicavasagar V, Silove D, Curtis J.

Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales at Liverpool Hospital, Australia.

Separation anxiety disorder is well recognized as a juvenile psychiatric disorder, but it appears to be rarely diagnosed in adulthood. Drawing on our clinical impressions and a review of the relevant literature, we sought to investigate whether separation anxiety symptoms could be identified in adulthood. Forty-four subjects recruited by a media campaign were administered a semistructured interview and a self-report checklist for adult separation anxiety (ASA) symptoms, as well as the Separation Anxiety Symptom Inventory (SASI), a retrospective measure of early separation anxiety symptoms. Diagnoses of major depressive disorder (MDD), panic disorder (PD), agoraphobia (Ag), and dependent personality disorder were made using the SCID-P and SCID-II. Thirty-six subjects met criteria for a putative diagnosis of ASA based on a global clinical rating and/or endorsement of DSM-IV-derived criteria. Although most subjects dated the separation anxiety symptoms to their juvenile years, it was notable that one third reported the first onset of separation anxiety symptoms in adulthood. Although comorbid lifetime anxiety or depressive disorders were common, the majority of subjects reported that the separation anxiety symptoms predated other axis I disorders. Only six subjects (17%) were diagnosed with dependent personality disorder. Although limited by the method of sampling, this preliminary study suggests the need to examine more systematically whether a form of separation anxiety disorder may occur in adulthood.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9298320&dopt=Abstract anxiety medicine




Responses of consecutive patients to reassurance after gastroscopy: results of self administered questionnaire survey.

Lucock MP, Morley S, White C, Peake MD.

Department of Clinical Psychology, Pontefract General Infirmary.

OBJECTIVE: To study the time course and prediction of responses to reassurance after gastroscopy showing no serious illness. DESIGN: Selection of consecutive patients were assessed before gastroscopy, immediately after reassurance, and at follow up at 24 hours, 1 week, 1 month, and 1 year. Responses of subgroups of patients identified as high, medium, and low health anxiety by the health anxiety questionnaire were analysed. SETTING: Endoscopy clinic in a general hospital. INTERVENTION: Oral reassurance that there was "nothing seriously wrong." SUBJECTS: One consultant physician and 60 patients aged 18-74 referred for gastroscopy. MAIN OUTCOME MEASURES: Physician's and patients' ratings of the extent of the reassurance and patients' ratings of their anxiety about their health and of their illness belief. RESULTS: There was good agreement between the patients and the physician about whether reassurance had been given. Health anxiety and illness belief decreased markedly after reassurance. Patients with high health anxiety showed a significant resurgence in their worry and illness belief at 24 hours and 1 week, and these levels were maintained at 1 months and 1 year later. Patients with medium levels of health anxiety showed a reduction in worry and illness belief after reassurance, and this was generally maintained during follow up. Patients with low health anxiety maintained low levels of health worry and illness belief throughout the study. Partial correlation analyses showed that the levels of worry and illness belief after reassurance were predicted by the health anxiety questionnaire. This measure also had predictive value beyond that of a measure of general anxiety. CONCLUSIONS: Medical reassurance results in a reduction of worry about health and of illness belief, but this may be very short term. Measurable individual differences in health anxiety can be used to predict the response to reassurance.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9302953&dopt=Abstract anxiety medicine