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Studying the incidence of depression: an ,interval' effectINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2000
Jane M. Murphy
Abstract A review of studies about the incidence of depression suggested that the length of the ,interval' of follow up may influence the findings. Exploration of these issues is carried out using data from the Stirling County Study, an investigation of psychiatric epidemiology in a general population. The study's customary method of diagnosis, DePression and AnXiety (DPAX), and the Diagnostic Interview Schedule (DIS) were used in an incidence investigation whose ,interval' was less than three years. Average annual incidence rates of depression for both DPAX and DIS were about 15 per 1000. Where longer intervals were used in the Stirling Study, rates were close to four per 1000. Projected lifetime risk based on the lower rates was more congruent with reported lifetime prevalence than that based on the higher rates. Irrespective of method, 90% or more of the incident cases gave an onset that predated the initial interview, suggesting poor reliability. This was often due to the fact that information given in the first interview met some but not all of the criteria for diagnosis. Being in the ,borderline' category at the beginning of the study significantly increased incidence. Thus, evidence from the Stirling County Study replicated findings that suggest an ,interval effect' and pointed to the need in incidence studies for distinguishing between the onset of the prodrome and the onset of diagnosable depression. Copyright © 2000 Whurr Publishers Ltd. [source]
Women's Travel, Dance, and British Metropolitan Anxieties, 1890,1939GENDER & HISTORY, Issue 2 2000
First page of article [source]
Cosmopolitan Anxieties: Turkish Challenges to Citizenship and Belonging in Germany by Ruth MandelAMERICAN ANTHROPOLOGIST, Issue 4 2009
No abstract is available for this article. [source]
Cosmopolitan Anxieties: Turkish Challenges to Citizenship and Belonging in Germany by Ruth MandelNATIONS AND NATIONALISM, Issue 1 2009
TOBIAS G. EULE
Cosmopolitan Anxieties: Turkish Challenges to Citizenship and Belonging in Germany by Ruth MandelAMERICAN ETHNOLOGIST, Issue 4 2009
No abstract is available for this article. [source]
On Integrating Immigrants in GermanyPOPULATION AND DEVELOPMENT REVIEW, Issue 3 2006
Article first published online: 8 SEP 200
Immigration to Germany in the decades following World War II made the Federal Republic the host of the largest number of immigrants in Europe. The size of the population with an immigration background is on the order of 15 million, nearly one-fifth of the total population. (Many of these are ethnic German returnees.) Although restrictive policies and a less dynamic economy in recent years slowed the annual number of immigrants and asylum seekers, the interrelated demographic influences of very low fertility, negative natural population increase, and population aging make continuing future immigration likely and, judged by influential domestic interests, desirable. Anxieties about inadequate integration of immigrants in German society are, however, apparently strongly felt by large segments of the native population. The "Grand Coalition" government that took office in November 2005 considers the formation of an effective policy of integration a high priority. On 14 July 2006 an "Integration Summit" was convened in the Chancellery with the active participation of representatives of immigrant groups. Chancellor Angela Merkel called the Summit "an almost historical event." Reproduced below in full is a non-official English translation of a government statement (entitled "Good coexistence,Clear rules") presented to the participants at the opening of the meeting. Intended as a "start of the development of a national integration plan," the statement highlights existing deficiencies of integration, especially problems with second- and third-generation immigrants: lack of mastery of the German language, weaknesses in education and training, high unemployment, lack of acceptance of the basic rules of coexistence, and violation of the law. The importance of these issues is underlined by a demographic fact noted in the statement: by 2010 it is expected that in Germany's large cities 50 percent of the population under age 40 will have an immigrant background. The statement recognizes the government's responsibility to help immigrants learn German and become better informed about the country's laws, culture, history, and political system. In turn, it demands reciprocal efforts from migrants living permanently and lawfully in Germany. The original German text of the statement is available at the Bundeskanzleramt home page: «http://www.bundesregierung.d» [source]
Type 1, tents, take-aways and toilets: how to manage at a music festivalPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 7 2010
J Charlton BSc, PgCTLHE
Abstract Maintaining optimal glycaemic control in people with type 1 diabetes is challenging. Attending a weekend music festival encompasses lifestyle activities that increase the challenge. These include: increased exercise, and changes in eating and alcohol consumption. The practicalities of blood glucose monitoring and insulin injections are also a consideration. The aim of this project was to identify realistic problems for people with type 1 diabetes attending a music festival, and to review current written advice and available literature in order to provide relevant information. No literature was identified. Fifty people with type 1 diabetes aged 18,40 years were randomly selected and sent a questionnaire enquiring about experiences. Thirteen responded (26%). The mean duration of diabetes was 11.7 years (range 1.5,28 years). All 13 respondents had attended a music festival; of these, 46% had attended one for the first time. Some of the concerns included: hypoglycaemia (31%), lack of food (23%), losing insulin and equipment (23%), and maintaining blood glucose levels (23%). Anxieties regarding hypoglycaemia resulted in 38% running blood glucose levels higher than normal. Thirty-eight percent experienced hypoglycaemia, the reasons being: increased activity (38%), eating less carbohydrate (8%), and reduced blood glucose testing (8%). Twenty-three percent attended the first aid tent: 15% regarding injections and 8% for non-diabetic reasons. An information leaflet regarding managing diabetes when attending a festival has been designed which includes feedback and tips from patients. The leaflet was evaluated by 50 people with type 1 diabetes, and 20 health care professionals. Currently, negotiations are underway with Diabetes UK, T in the Park festival organisers and the St Andrew's Ambulance Service to have an advice stand at the festival. Copyright © 2010 John Wiley & Sons. [source]
Supersizing America: Fatness and Post-9/11 Cultural AnxietiesTHE JOURNAL OF POPULAR CULTURE, Issue 3 2010
First page of article [source]
Corticosteroid phobia and other confounders in the treatment of childhood atopic dermatitis explored using parent focus groupsAUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 3 2010
Saxon D Smith
ABSTRACT Background/Objectives:, Anxieties associated with corticosteroid treatment and preference for ,safer natural therapy' are common in parents of children with atopic dermatitis. We used focus groups to explore the source of these attitudes. Methods:, The study involved 16 parents. Parents expressed difficulties with living with and treating atopic dermatitis which were categorized into themes using qualitative data analysis software. Results:, Themes identified include: emotional impact of atopic dermatitis; difficulty in accepting ,control' verses ,cure'; topical corticosteroid negative perceptions; anxiety and confusion with treatment; preference for ,natural' therapy; and attitude-changing positive experiences. Conclusions:, Our findings illustrate the emotional impact of atopic dermatitis and the frustration with the lack of potential cure. ,Corticosteroid phobia' was universal among parents in our cohort and is a fear generated by doctors, pharmacists, close acquaintances and information from the internet. Participants expressed high levels of parental guilt linked to a desire for an eradicable ,cause' for atopic dermatitis, despite intellectually understanding this is a genetically determined condition. Parents were willing to change attitudes with accurate information from perceived reliable sources, positive hospitalization experiences and a relationship with a trusted dermatologist. Parents' suggestions to improve confidence included the provision of readily available information and better access to doctor- and nurse-led paediatric dermatology services. [source]
Pregnancy Stories Real Women Share the Joys, Fears, Thrills, and Anxieties of Pregnancy from Conception to BirthBIRTH, Issue 1 2002
Sarah Teres BA
No abstract is available for this article. [source]
Impaired psychosocial outcome of donors after living donor liver transplantation: a qualitative case studyCLINICAL TRANSPLANTATION, Issue 4 2006
Abstract:, Adult-to-adult living donor liver transplantation (LDLT) of the right hepatic lobe has been developing into an established therapy for treating pre-terminal liver diseases. There is little experience available on the psychosocial outcome of living donors. The aim of this first qualitative case study was to investigate the patterns for impaired psychosocial outcome in donors after LDLT. Donor hepatectomies were performed in 30 donors at the Charité Berlin. Six months after surgery, the six of the 30 donors with negative moods and physical complaints in psychometric monitoring were examined. The post-operative interviews were transcribed and analysed using current qualitative research methods. These six donors (20%) reported various unspecific complaints and psychological conflicts. Sadness was expressed about organ rejection and death of the recipient. Anxieties about the recipient and their own health were verbalized. Disappointment and anger refer to the experience that they were not as fully appreciated by the medical system and their social environment as expected. The negative emotions of donors with impaired psychosocial outcome could be related to a decrease in self-esteem in the post-operative course. Adequate medical and psychological treatment opportunities for these donors should be provided. [source]
Conceptual background, development, and preliminary data from the unified protocol for transdiagnostic treatment of emotional disorders,DEPRESSION AND ANXIETY, Issue 10 2010
Zofia A. Wilamowska M.A.
Abstract Anxiety and mood disorders are common, chronic, costly, and characterized by high comorbidity. The development of cognitive behavioral approaches to treating anxiety and mood disorders has left us with highly efficacious treatments that are increasingly widely accepted. The proliferation of treatment manuals targeting single disorders, sometimes with trivial differences among them, leaves the mental health professional with no clear way to choose one manual over another and little chance of ever becoming familiar with most of them, let alone trained to competence in their delivery. Deepening understanding of the nature of emotional disorders reveals that commonalities in etiology and latent structures among these disorders supersedes differences. Based on empirical evidence from the domains of learning, emotional development and regulation, and cognitive science, we have distilled a set of psychological procedures that comprise a unified intervention for emotional disorders. The Unified Protocol (UP) is a transdiagnostic, emotion-focused cognitive behavioral treatment, which emphasizes the adaptive, functional nature of emotions, and seeks to identify and correct maladaptive attempts to regulate emotional experiences, thereby facilitating appropriate processing and extinction of excessive emotional responding to both internal (somatic) and external cues. The treatment components of the UP are briefly outlined. Theory and rationale supporting this new approach are described along with some preliminary evidence supporting its efficacy. Implications for the treatment of emotional disorders using the UP are discussed. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]
A review of empirically supported psychological therapies for mood disorders in adultsDEPRESSION AND ANXIETY, Issue 10 2010
Steven D. Hollon Ph.D.
Abstract Background: The mood disorders are prevalent and problematic. We review randomized controlled psychotherapy trials to find those that are empirically supported with respect to acute symptom reduction and the prevention of subsequent relapse and recurrence. Methods: We searched the PsycINFO and PubMed databases and the reference sections of chapters and journal articles to identify appropriate articles. Results: One hundred twenty-five studies were found evaluating treatment efficacy for the various mood disorders. With respect to the treatment of major depressive disorder (MDD), interpersonal psychotherapy (IPT), cognitive behavior therapy (CBT), and behavior therapy (BT) are efficacious and specific and brief dynamic therapy (BDT) and emotion-focused therapy (EFT) are possibly efficacious. CBT is efficacious and specific, mindfulness-based cognitive therapy (MBCT) efficacious, and BDT and EFT possibly efficacious in the prevention of relapse/recurrence following treatment termination and IPT and CBT are each possibly efficacious in the prevention of relapse/recurrence if continued or maintained. IPT is possibly efficacious in the treatment of dysthymic disorder. With respect to bipolar disorder (BD), CBT and family-focused therapy (FFT) are efficacious and interpersonal social rhythm therapy (IPSRT) possibly efficacious as adjuncts to medication in the treatment of depression. Psychoeducation (PE) is efficacious in the prevention of mania/hypomania (and possibly depression) and FFT is efficacious and IPSRT and CBT possibly efficacious in preventing bipolar episodes. Conclusions: The newer psychological interventions are as efficacious as and more enduring than medications in the treatment of MDD and may enhance the efficacy of medications in the treatment of BD. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]
The relationship between anxiety disorders and suicide attempts: findings from the National Epidemiologic Survey on Alcohol and Related ConditionsDEPRESSION AND ANXIETY, Issue 9 2010
Josh Nepon M.D.
Abstract Background: Previous work has suggested that anxiety disorders are associated with suicide attempts. However, many studies have been limited by lack of accounting for factors that could influence this relationship, notably personality disorders. This study aims to examine the relationship between anxiety disorders and suicide attempts, accounting for important comorbidities, in a large nationally representative sample. Methods: Data came from the National Epidemiologic Survey on Alcohol and Related Conditions Wave 2. Face-to-face interviews were conducted with 34,653 adults between 2004 and 2005 in the United States. The relationship between suicide attempts and anxiety disorders (panic disorder, agoraphobia, social phobia, specific phobia, generalized anxiety disorder, posttraumatic stress disorder (PTSD)) was explored using multivariate regression models controlling for sociodemographics, Axis I and Axis II disorders. Results: Among individuals reporting a lifetime history of suicide attempt, over 70% had an anxiety disorder. Even after adjusting for sociodemographic factors, Axis I and Axis II disorders, the presence of an anxiety disorder was significantly associated with having made a suicide attempt (AOR=1.70, 95% confidence interval (CI): 1.40,2.08). Panic disorder (AOR=1.31, 95% CI: 1.06,1.61) and PTSD (AOR=1.81, 95% CI: 1.45,2.26) were independently associated with suicide attempts in multivariate models. Comorbidity of personality disorders with panic disorder (AOR=5.76, 95% CI: 4.58,7.25) and with PTSD (AOR=6.90, 95% CI: 5.41,8.79) demonstrated much stronger associations with suicide attempts over either disorder alone. Conclusion: Anxiety disorders, especially panic disorder and PTSD, are independently associated with suicide attempts. Clinicians need to assess suicidal behavior among patients presenting with anxiety problems. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]
Depression and obesity: do shared genes explain the relationship?DEPRESSION AND ANXIETY, Issue 9 2010
Niloofar Afari Ph.D.
Abstract Background: Studies have found a modest association between depression and obesity, especially in women. Given the substantial genetic contribution to both depression and obesity, we sought to determine whether shared genetic influences are responsible for the association between these two conditions. Methods: Data were obtained from 712 monozygotic and 281 dizygotic female twin pairs who are members of the community-based University of Washington Twin Registry. The presence of depression was determined by self-report of doctor-diagnosed depression. Obesity was defined as body mass index of ,30,kg/m2, based on self-reported height and weight. Generalized estimating regression models were used to assess the age-adjusted association between depression and obesity. Univariate and bivariate structural equation models estimated the components of variance attributable to genetic and environmental influences. Results: We found a modest phenotypic association between depression and obesity (odds ratio=1.6, 95% confidence interval=1.2,2.1). Additive genetic effects contributed substantially to depression (57%) and obesity (81%). The best-fitting bivariate model indicated that 12% of the genetic component of depression is shared with obesity. Conclusions: The association between depression and obesity in women may be in part due to shared genetic risk for both conditions. Future studies should examine the genetic, environmental, social, and cultural mechanisms underlying the relationship between this association. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]
Previous experience of spontaneous or elective abortion and risk for posttraumatic stress and depression during subsequent pregnancyDEPRESSION AND ANXIETY, Issue 8 2010
Abstract Background: Few studies have considered whether elective and/or spontaneous abortion (EAB/SAB) may be risk factors for mental health sequelae in subsequent pregnancy. This paper examines the impact of EAB/SAB on mental health during subsequent pregnancy in a sample of women involved in a larger prospective study of posttraumatic stress disorder (PTSD) across the childbearing year (n=1,581). Methods: Women expecting their first baby completed standardized telephone assessments including demographics, trauma history, PTSD, depression, and pregnancy wantedness, and religiosity. Results: Fourteen percent (n=221) experienced a prior elective abortion (EAB), 13.1% (n=206) experienced a prior spontaneous abortion (SAB), and 1.4% (n=22) experienced both. Of those women who experienced either an EAB or SAB, 13.9% (n=220) appraised the EAB or SAB experience as having been "a hard time" (i.e., potentially traumatic) and 32.6% (n=132) rated it as their index trauma (i.e., their worst or second worst lifetime exposure). Among the subset of 405 women with prior EAB or SAB, the rate of PTSD during the subsequent pregnancy was 12.6% (n,51), the rate of depression was 16.8% (n=68), and 5.4% (n,22) met criteria for both disorders. Conclusions: History of sexual trauma predicted appraising the experience of EAB or SAB as "a hard time." Wanting to be pregnant sooner was predictive of appraising the experience of EAB or SAB as the worst or second worst (index) trauma. EAB or SAB was appraised as less traumatic than sexual or medical trauma exposures and conveyed relatively lower risk for PTSD. The patterns of predictors for depression were similar. Depression and Anxiety, 2010.© 2010 Wiley-Liss, Inc. [source]
Psychological resilience and neurocognitive performance in a traumatized community sample,DEPRESSION AND ANXIETY, Issue 8 2010
Aliza P. Wingo M.D.
Abstract Background: Whether psychological resilience correlates with neurocognitive performance is largely unknown. Therefore, we assessed association between neurocognitive performance and resilience in individuals with a history of childhood abuse or trauma exposure. Methods: In this cross-sectional study of 226 highly traumatized civilians, we assessed neurocognitive performance, history of childhood abuse and other trauma exposure, and current depressive and PTSD symptoms. Resilience was defined as having ,1 trauma and no current depressive or PTSD symptoms; non-resilience as having ,1 trauma and current moderate/severe depressive or PTSD symptoms. Results: The non-resilient group had a higher percentage of unemployment (P=.006) and previous suicide attempts (P<.0001) than the resilient group. Both groups had comparable education and performance on verbal reasoning, nonverbal reasoning, and verbal memory. However, the resilient group performed better on nonverbal memory (P=.016) with an effect size of .35. Additionally, more severe childhood abuse or other trauma exposure was significantly associated with non-resilience. Better nonverbal memory was significantly associated with resilience even after adjusting for severity of childhood abuse, other trauma exposure, sex, and race using multiple logistic regression (adjusted OR=1.2; P=.017). Conclusions: We examined resilience as absence of psychopathology despite trauma exposure in a highly traumatized, low socioeconomic, urban population. Resilience was significantly associated with better nonverbal memory, a measure of ability to code, store, and visually recognize concrete and abstract pictorial stimuli. Nonverbal memory may be a proxy for emotional learning, which is often dysregulated in stress-related psychopathology, and may contribute to our understanding of resilience. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]
The Attentional Resource Allocation Scale (ARAS): psychometric properties of a composite measure for dissociation and absorption,DEPRESSION AND ANXIETY, Issue 8 2010
R. N. Carleton M.A.
Abstract Background: Differences in attentional processes have been linked to the development and maintenance of psychopathology. Shifts in such processes have been described by the constructs Dissociation and Absorption. Dissociation occurs when external and/or internal stimuli are excluded from consciousness due to discrepant, rather than unitary, manifestations of cognitive awareness [Erdelyi MH. 1994: Int J Clin Exp Hypnosis 42:379,390]. In contrast, absorption can be conceptualized by a focus on limited stimuli, to the exclusion of other stimuli, because of unifying, rather than discrepant, manifestations of cognitive awareness. The Dissociative Experiences Scale [DES; Bernstein EM, Putnam FW. 1986: J Nerv Ment Dis 174:727,735] and Tellegen Absorption Scale [TAS; Tellegen A, Atkinson G. 1974: J Abnorm Psychol 83:268,277] are common measures of each construct; however, no factor analyses are available for the TAS and despite accepted overlap, no one has assessed the DES and TAS items simultaneously. Previous research suggests the constructs and factor structures need clarification, possibly including more parsimonious item inclusion [Lyons LC, Crawford HJ. 1997: Person Individ Diff 23:1071,1084]. The purpose of this study was to evaluate the factor structure of the DES and TAS and create a psychometrically stable measure of Dissociation and Absorption. Methods: This study included data from an undergraduate (n=841; 76% women) and a community sample (n=233; 86% women) who each completed the DES and TAS. Results: Exploratory factor analyses [Osborne JW (ed). 2008: Best Practices in Quantitative Methods. Los Angeles: Sage Publications Inc.] with all DES and TAS items suggested a 15-item 3-factor solution (i.e., imaginative involvement, dissociative amnesia, attentional dissociation). Confirmatory factor analyses resulted in excellent fit indices for the same solution. Conclusions: The items and factors were conceptualized in line with precedent research as the Attentional Resource Allocation Scale (ARAS). Comprehensive results, implications, and future research directions are discussed. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]
Child sexual abuse in the etiology of depression: A systematic review of reviewsDEPRESSION AND ANXIETY, Issue 7 2010
Roberto Maniglio Psy.D. Ph.D.
Abstract Background: Despite a large amount of research, there is considerable controversy about the role that child sexual abuse plays in the etiology of depression. To prevent interpretative difficulties, mistaken beliefs, or confusion among professionals who turn to this literature for guidance, this article addresses the best available scientific evidence on the topic, by providing a systematic review of the several reviews that have investigated the literature on the issue. Methods: Seven databases were searched, supplemented with hand search of reference lists from retrieved papers. The author and a psychiatrist independently evaluated the eligibility of all studies identified, abstracted data, and assessed study quality. Disagreements were resolved by consensus. Results: Four reviews, including about 60,000 subjects from 160 studies and having no limitations that could invalidate their results, were analyzed. There is evidence that child sexual abuse is a significant, although general and nonspecific, risk factor for depression. The relationship ranges from small-to-medium in magnitude and is moderated by sample source. Additional variables may either act independently to promote depression in people with a history of sexual abuse or interact with such traumatic experience to increase the likelihood of depression in child abuse survivors. Conclusions: For all victims of abuse, programs should focus not only on treating symptoms, but also on reducing additional risk factors. Depressed adults who seek psychiatric treatment should be enquired about early abuse within admission procedures. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]
Obsessive,compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V,DEPRESSION AND ANXIETY, Issue 6 2010
James F. Leckman M.D.
Abstract Background: Since the publication of the DSM-IV in 1994, research on obsessive,compulsive disorder (OCD) has continued to expand. It is timely to reconsider the nosology of this disorder, assessing whether changes to diagnostic criteria as well as subtypes and specifiers may improve diagnostic validity and clinical utility. Methods: The existing criteria were evaluated. Key issues were identified. Electronic databases of PubMed, ScienceDirect, and PsycINFO were searched for relevant studies. Results: This review presents a number of options and preliminary recommendations to be considered for DSM-V. These include: (1) clarifying and simplifying the definition of obsessions and compulsions (criterion A); (2) possibly deleting the requirement that people recognize that their obsessions or compulsions are excessive or unreasonable (criterion B); (3) rethinking the clinical significance criterion (criterion C) and, in the interim, possibly adjusting what is considered "time-consuming" for OCD; (4) listing additional disorders to help with the differential diagnosis (criterion D); (5) rethinking the medical exclusion criterion (criterion E) and clarifying what is meant by a "general medical condition"; (6) revising the specifiers (i.e., clarifying that OCD can involve a range of insight, in addition to "poor insight," and adding "tic-related OCD"); and (7) highlighting in the DSM-V text important clinical features of OCD that are not currently mentioned in the criteria (e.g., the major symptom dimensions). Conclusions: A number of changes to the existing diagnostic criteria for OCD are proposed. These proposed criteria may change as the DSM-V process progresses. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]
Should an obsessive,compulsive spectrum grouping of disorders be included in DSM-V?,DEPRESSION AND ANXIETY, Issue 6 2010
Katharine A. Phillips M.D.
Abstract The obsessive,compulsive (OC) spectrum has been discussed in the literature for two decades. Proponents of this concept propose that certain disorders characterized by repetitive thoughts and/or behaviors are related to obsessive,compulsive disorder (OCD), and suggest that such disorders be grouped together in the same category (i.e. grouping, or "chapter") in DSM. This article addresses this topic and presents options and preliminary recommendations to be considered for DSM-V. The article builds upon and extends prior reviews of this topic that were prepared for and discussed at a DSM-V Research Planning Conference on Obsessive,Compulsive Spectrum Disorders held in 2006. Our preliminary recommendation is that an OC-spectrum grouping of disorders be included in DSM-V. Furthermore, we preliminarily recommend that consideration be given to including this group of disorders within a larger supraordinate category of "Anxiety and Obsessive,Compulsive Spectrum Disorders." These preliminary recommendations must be evaluated in light of recommendations for, and constraints upon, the overall structure of DSM-V. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]
Multicenter, randomized, double-blind, active comparator and placebo-controlled trial of a corticotropin-releasing factor receptor-1 antagonist in generalized anxiety disorder,DEPRESSION AND ANXIETY, Issue 5 2010
Vladimir Coric M.D.
Abstract Background: Antagonism of corticotropin-releasing factor (CRF) receptors has been hypothesized as a potential target for the development of novel anxiolytics. This study was designed to determine the safety and efficacy of pexacerfont, a selective CRF-1 receptor antagonist, in the treatment of generalized anxiety disorder (GAD). Method: This was a multicenter, randomized, double-blind, placebo-controlled and active comparator trial. Two hundred and sixty patients were randomly assigned to pexacerfont 100,mg/day (after a 1 week loading dose of 300,mg/day), placebo or escitalopram 20,mg/day in a 2:2:1 ratio. The primary outcome was the mean change from baseline to end point (week 8) in the Hamilton Anxiety Scale total score. Results: Pexacerfont 100,mg/day did not separate from placebo on the primary outcome measure. The half-powered active comparator arm, escitalopram 20,mg/day, demonstrated efficacy with significant separation from placebo at weeks 1, 2, 3, 6, and 8 (P<.02). Response rates for pexacerfont, placebo, and escitalopram were 42, 42, and 53%, respectively. Genetic and psychometric rating scale data was obtained in 175 randomized subjects. There was a significant association between a single nucleotide polymorphism (SNP) of the gene encoding plexin A2 (PLXNA2-2016) with the HAM-A psychic subscale score for the entire cohort at baseline (FDR-adjusted P=.015). Conclusions: Pexacerfont did not demonstrate efficacy compared to placebo for the treatment of GAD. Whether these findings are generalizable to this class of agents remains to be determined. Our preliminary genetic finding of an association between a SNP for the gene encoding plexin A2 and an anxiety phenotype in this study merits further exploration. The trial was registered at clinicaltrials.gov (NCT00481325) before enrollment. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]
Preventing depression: a randomized trial of interpersonal psychotherapy-adolescent skills training,DEPRESSION AND ANXIETY, Issue 5 2010
Jami F. Young Ph.D.
Abstract Background: The study evaluated the efficacy of an indicated prevention program for adolescent depression. Methods: Fifty-seven adolescents with elevated depression symptoms were randomized to receive Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST) or school counseling (SC). Hierarchical linear modeling examined differences in rates of change in depression symptoms and overall functioning and analysis of covariance examined mean differences between groups. Rates of depression diagnoses in the 18-month follow-up period were compared. Results: Adolescents in IPT-AST reported significantly greater rates of change in depression symptoms and overall functioning than SC adolescents from baseline to post-intervention. At post-intervention, IPT-AST adolescents reported significantly fewer depression symptoms and better overall functioning. During the follow-up phase, rates of change slowed for the IPT-AST adolescents, whereas the SC adolescents continued to show improvements. By 12-month follow-up, there were no significant mean differences in depression symptoms or overall functioning between the two groups. IPT-AST adolescents reported significantly fewer depression diagnoses in the first 6 months following the intervention but by 12-month follow-up the difference in rates of diagnoses was no longer significant. Conclusions: IPT-AST leads to an immediate reduction in depression symptoms and improvement in overall functioning. However, the benefits of IPT-AST are not consistent beyond the 6-month follow-up, suggesting that the preventive effects of the program in its current format are limited. Future studies are needed to examine whether booster sessions lengthen the long-term effects of IPT-AST. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]
Depression gets old fast: do stress and depression accelerate cell aging?,DEPRESSION AND ANXIETY, Issue 4 2010
Owen M. Wolkowitz M.D.
Abstract Depression has been likened to a state of "accelerated aging," and depressed individuals have a higher incidence of various diseases of aging, such as cardiovascular and cerebrovascular diseases, metabolic syndrome, and dementia. Chronic exposure to certain interlinked biochemical pathways that mediate stress-related depression may contribute to "accelerated aging," cell damage, and certain comorbid medical illnesses. Biochemical mediators explored in this theoretical review include the hypothalamic,pituitary,adrenal axis (e.g., hyper- or hypoactivation of glucocorticoid receptors), neurosteroids, such as dehydroepiandrosterone and allopregnanolone, brain-derived neurotrophic factor, excitotoxicity, oxidative and inflammatory stress, and disturbances of the telomere/telomerase maintenance system. A better appreciation of the role of these mediators in depressive illness could lead to refined models of depression, to a re-conceptualization of depression as a whole body disease rather than just a "mental illness," and to the rational development of new classes of medications to treat depression and its related medical comorbidities. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]
The impact of panic-agoraphobic comorbidity on suicidality in hospitalized patients with major depressionDEPRESSION AND ANXIETY, Issue 3 2010
Lily A. Brown B.S.
Abstract Background: Previous research in outpatient samples suggests that panic and agoraphobic comorbidity is related to suicidality in outpatients with major depression. The purpose of the study was to further investigate this relationship specifically in a hospitalized sample. Method: This study examined the severity of current suicidal ideation and behaviors in a psychiatric hospital sample diagnosed with major depressive disorder alone (MDD; n=28) versus MDD plus panic-agoraphobic spectrum disorders (MDD+PAS; n=69). Results: Members of the MDD+PAS group were significantly more likely to have had a suicide attempt history, higher current depression severity, and higher current suicidal severity compared with individuals in the MDD alone group. The relationship between the current suicidality and comorbid PAS remained significant after controlling for the overall depression severity and other clinical factors. Conclusions: These findings suggest that panic-agoraphobic comorbidity is associated with a greater risk for suicidality in hospitalized patients, which cannot be adequately explained by the level of current depression alone. The clinical and research implications for these findings are discussed. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]
Race and religion: differential prediction of anxiety symptoms by religious coping in African American and European American young adults,DEPRESSION AND ANXIETY, Issue 3 2010
L. Kevin Chapman Ph.D.
Abstract Background: Psychosocial factors, including religious coping, consistently have been implicated in the expression of anxiety disorders. This study sought to investigate the relationship between religious coping on anxiety symptoms among a nonclinical sample of African American and European American young adults. Methods: One hundred twenty-one European American and 100 African American young adults completed measures of anxiety and religious coping. Results: As predicted, results differed according to race. African Americans reported significantly more positive religious coping, less negative religious coping, and experienced fewer anxiety symptoms than European Americans. European Americans demonstrated a significant, positive relationship between negative religious coping and anxiety symptoms, and an opposite trend related to anxiety and positive religious coping. However, no such relationships emerged among the African American sample. Conclusions: Implications and suggestions for future research are discussed. Depression and Anxiety, 2010. © 2008 Wiley-Liss, Inc. [source]
Panic disorder: a review of DSM-IV panic disorder and proposals for DSM-V,DEPRESSION AND ANXIETY, Issue 2 2010
Michelle G. Craske Ph.D
Abstract This review covers the literature since the publication of DSM-IV on the diagnostic criteria for panic attacks (PAs) and panic disorder (PD). Specific recommendations are made based on the evidence available. In particular, slight changes are proposed for the wording of the diagnostic criteria for PAs to ease the differentiation between panic and surrounding anxiety; simplification and clarification of the operationalization of types of PAs (expected vs. unexpected) is proposed; and consideration is given to the value of PAs as a specifier for all DSM diagnoses and to the cultural validity of certain symptom profiles. In addition, slight changes are proposed for the wording of the diagnostic criteria to increase clarity and parsimony of the criteria. Finally, based on the available evidence, no changes are proposed with regard to the developmental expression of PAs or PD. This review presents a number of options and preliminary recommendations to be considered for DSM-V. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]
Agoraphobia: a review of the diagnostic classificatory position and criteria,,DEPRESSION AND ANXIETY, Issue 2 2010
Hans-Ulrich Wittchen Ph.D.
Abstract The status of agoraphobia (AG) as an independent diagnostic category is reviewed and preliminary options and recommendations for the fifth edition of The Diagnostic and Statistical Manual (DSM-V) are presented. The review concentrates on epidemiology, psychopathology, neurobiology, vulnerability and risk factors, clinical course and outcome, and correlates and consequences of AG since 1990. Differences and similarities across conventions and criteria of DSM and ICD-10 are considered. Three core questions are addressed. First, what is the evidence for AG as a diagnosis independent of panic disorder? Second, should AG be conceptualized as a subordinate form of panic disorder (PD) as currently stipulated in DSM-IV-TR? Third, is there evidence for modifying or changing the current diagnostic criteria? We come to the conclusion that AG should be conceptualized as an independent disorder with more specific criteria rather than a subordinate, residual form of PD as currently stipulated in DSM-IV-TR. Among other issues, this conclusion was based on psychometric evaluations of the construct, epidemiological investigations which show that AG can exist independently of panic disorder, and the impact of agoraphobic avoidance upon clinical course and outcome. However, evidence from basic and clinic validation studies remains incomplete and partly contradictory. The apparent advantages of a more straightforward, simpler classification without implicit hierarchies and insufficiently supported differential diagnostic considerations, plus the option for improved further research, led to favoring the separate diagnostic criteria for AG as a diagnosis independent of panic disorder. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]
Diversity of effective treatments of panic attacks: what do they have in common?,DEPRESSION AND ANXIETY, Issue 1 2010
Walton T. Roth M.D.
Abstract By comparing efficacious psychological therapies of different kinds, inferences about common effective treatment mechanisms can be made. We selected six therapies for review on the basis of the diversity of their theoretical rationales and evidence for superior efficacy: psychoanalytic psychotherapy, hypercapnic breathing training, hypocapnic breathing training, reprocessing with and without eye-movement desensitization, muscle relaxation, and cognitive behavior therapy. The likely common element of all these therapies is that they reduce the immediate expectancy of a panic attack, disrupting the vicious circle of fearing fear. Modifying expectation is usually regarded as a placebo mechanism in psychotherapy, but may be a specific treatment mechanism for panic. The fact that this is seldom the rationale communicated to the patient creates a moral dilemma: Is it ethical for therapists to mislead patients to help them? Pragmatic justification of a successful practice is a way out of this dilemma. Therapies should be evaluated that deal with expectations directly by promoting positive thinking or by fostering non-expectancy. Depression and Anxiety, 2010. Published 2009 Wiley-Liss, Inc. [source]
Efficacy of interpersonal therapy-group format adapted to post-traumatic stress disorder: an open-label add-on trialDEPRESSION AND ANXIETY, Issue 1 2010
Rosaly F.B. Campanini MSc.
Abstract Background: Post-traumatic stress disorder (PTSD) is a highly prevalent condition, yet available treatments demonstrate only modest efficacy. Exposure therapies, considered by many to be the "gold-standard" therapy for PTSD, are poorly tolerated by many patients and show high attrition. We evaluated interpersonal therapy, in a group format, adapted to PTSD (IPT-G PTSD), as an adjunctive treatment for patients who failed to respond to conventional psychopharmacological treatment. Methods: Research participants included 40 patients who sought treatment through a program on violence in the department of psychiatry of Federal University of São Paulo (UNIFESP). They had received conventional psychopharmacological treatment for at least 12 weeks and failed to have an adequate clinical response. After signing an informed consent, approved earlier by the UNIFESP Ethics Review Board, they received a semi-structured diagnostic interview (SCID-I), administered by a trained mental health worker, to confirm the presence of a PTSD diagnosis according to DSM-IV criteria. Other instruments were administered, and patients completed out self-report instruments at baseline, and endpoint to evaluate clinical outcomes. Results: Thirty-three patients completed the trial, but all had at least one second outcome evaluation. There were significant improvements on all measures, with large effect sizes. Conclusions: IPT-G PTSD was effective not only in decreasing symptoms of PTSD, but also in decreasing symptoms of anxiety and depression. It led to significant improvements in social adjustment and quality of life. It was well tolerated and there were few dropouts. Our results are very preliminary; they need further confirmation through randomized controlled clinical trials. Depression and Anxiety, 2010. © 2009 Wiley-Liss, Inc. [source]