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PubMedDate not supplied

Selective serotonin reuptake inhibitor use in the treatment of the pediatric non-obsessive-compulsive disorder anxiety disorders.

The non-OCD (obsessive-compulsive disorder) anxiety disorders in the pediatric population- separation anxiety disorder, generalized anxiety disorder, and social phobia and others- are arguably the most common psychiatric disorders in this age group. Anxiety disorders, in addition to being common, also significantly impair the affected child at home, school, and with peers. A small developing evidence base suggests the selective serotonin reuptake inhibitors (SSRIs) are the pharmacological treatment of choice for pediatric non-OCD anxiety disorders. In clinical trials, SSRIs are often very effective in reducing symptoms and improving functioning and generally well tolerated. The U.S. Food and Drug Administration's (FDA) review of the safety of antidepressants in the pediatric population suggest a small, but significant, increased relative risk for suicidality adverse events on antidepressant versus placebo. Despite the apparent increased risk, the larger magnitude of benefit of the SSRIs for pediatric non-OCD anxiety disorders compared to depression suggests the benefit/risk ratio for anxiety disorders is more favorable than that for depression. This paper will review available studies on the treatment of non-OCD childhood anxiety disorders with antidepressants, including the SSRIs, and discuss pertinent safety issues.

Adolescent↗
PubMed2002

Increased incidence of affective disorders, anxiety disorders, and non-natural mortality in women after breast cancer diagnosis: a nation-wide cohort study in Denmark.

OBJECTIVE: To investigate whether breast cancer patients have increased incidence of psychiatric admission with affective disorders, anxiety disorders, or non-natural mortality compared with the general female population. METHOD: Register-linkage between nation-wide registries: The Danish Psychiatric Central Register, The Danish Cancer Registry, and The Danish National Register of Causes of Death. A total of 61 709 women registered with primary invasive breast cancer between 1970 and 1993 were included and 356 023 person-years were accrued. RESULTS: The standardized incidence ratio of first-ever psychiatric admission with affective disorder was 1.49 (95% CI: 1.35-1.63) and with anxiety disorder 1.25 (95% CI: 1.06-1.46). The standardized non-natural mortality ratio during the first year after breast cancer diagnosis was 1.54 (95% CI: 1.27-1.87). All analyses were adjusted for age, calendar period, and place of residence. CONCLUSION: Breast cancer patients have significantly increased incidence of psychiatric admission with affective disorders, anxiety disorders, and non-natural mortality.

Adolescent↗
PubMed2002

Health functioning impairments associated with posttraumatic stress disorder, anxiety disorders, and depression.

Although anxiety disorders have been associated with impairments in self-reported health functioning, the relative effect of various anxiety disorders has not been studied. We compared health functioning of patients with a principal diagnosis of posttraumatic stress disorder (PTSD), panic disorder (PD), generalized anxiety disorder (GAD), and major depressive disorder (MDD). Patients with PTSD and MDD were equally impaired on overall mental health functioning, and both were significantly worse than patients with PD and GAD. PTSD was associated with significantly worse physical health functioning relative to PD, GAD, and MDD. Hierarchical regression showed that the association of PTSD with physical health functioning was unique and was not caused by the effects of age, depression, or comorbid anxiety disorders. Both PTSD and comorbid anxiety accounted for unique variance in mental functioning. These results highlight the association of PTSD with impaired physical and mental functioning and suggest that effective treatment of PTSD may affect overall health.

Adult↗
PubMed2006

Affective disorders, anxiety disorders and psychological distress in non-drinkers.

BACKGROUND: Non-drinkers have elevated levels of psychological distress but a recent study reported no elevation in prevalence of diagnosed disorders. We aimed to determine the prevalence of affective and anxiety disorders (from the CIDI-A) in current abstainers and contrast results with findings for psychological distress (K10) in the same sample. METHODS: Cross-sectional, representative household survey of adult Australians. RESULTS: Non-/occasional drinkers had higher levels of psychological distress than light drinkers, and distress in heavy drinkers was even higher. Heavy drinkers also had the highest rates of most disorders. Non-/occasional drinkers showed significantly elevated prevalence only of dysthymia, agoraphobia and posttraumatic stress disorder compared with light drinkers. LIMITATIONS: Statistical power was limited for investigating low prevalence disorders. History of alcohol consumption was not collected. The CIDI-A and K10 have finite validity. CONCLUSIONS: This study confirmed J-shaped relationships between psychological distress and alcohol consumption. Although affective and anxiety disorders also showed non-linear relationships with alcohol consumption, non-/occasional drinkers are not at increased risk for all disorders compared to light drinkers. The pattern of symptomatology in non-/occasional drinkers may be of a different character to that in heavy drinkers, as well as being less severe.

Adolescent↗
PubMed2006

What is worse for asthma control and quality of life: depressive disorders, anxiety disorders, or both?

BACKGROUND: The high burden of asthma appears to be related to poor asthma control. Although previous studies have reported associations between depressive disorders (DDs) and anxiety disorders (ADs) and worse asthma control and quality of life, the relative impact of these disorders on asthma control and quality of life has not been explored. This study evaluated the relative impact of having a DD and/or AD on asthma control and quality of life. METHOD: Five hundred four consecutive adults with confirmed, physician-diagnosed asthma underwent a brief, structured psychiatric interview using the Primary Care Evaluation of Mental Disorders. Asthma control and asthma-related quality of life were assessed using the Asthma Control Questionnaire (ACQ) and the Asthma Quality of Life Questionnaire (AQLQ). All patients underwent standard spirometry. RESULTS: Thirty-one percent of patients (n = 157) met the diagnostic criteria for one or more psychiatric disorders (8% had DD only, 12% had AD only, and 11% had both). Analyses revealed independent effects for DDs on total ACQ scores (p < 0.01), and for DDs and ADs on total AQLQ scores and all four AQLQ subscales (p < 0.05). There were no interaction effects. CONCLUSIONS: Results suggest that DDs and ADs are associated with worse asthma-related quality of life, but only DDs are associated with worse asthma control. Interestingly, having both a DD and an AD did not confer additional risk for worse asthma control or quality of life. Physicians may want to consider the differential impact of negative mood states when assessing levels of asthma control and quality of life.

Adult↗
PubMed1999

Obsessive-compulsive disorder, anxiety disorders, and self-esteem: an exploratory study.

In a preliminary investigation of the link between self-esteem and obsessional problems, patients with OCD were compared with people suffering from other anxiety disorders and non-anxious controls. A questionnaire was devised which allowed the reliable coding of open ended responses focussed on issues surrounding self-worth; standardized measures of self-esteem and clinical symptomatology were also administered. Results indicated that both clinical groups differed significantly from non-clinical controls on generalized self-esteem assessments. There was some evidence of OCD specific effects; obsessionals were more likely than anxious controls to link their self-worth to other people and their relationships. They also regarded the possibility of causing harm as likely to result in other people making extreme negative and critical judgements of them; the other groups expected the responses of others towards them to be more lenient. The implications for future research and for treatment of OCD are discussed.

Adult↗
PubMed2006

The relationship of anxiety disorders, anxiety sensitivity and pulmonary dysfunction with dyspnea-related distress and avoidance.

Little is known about factors that mediate the relationship between anxiety and respiratory-related distress and disability. We hypothesized that elevations in anxiety sensitivity would be associated with greater severity of dyspnea, greater dyspnea-related avoidance, and poorer subjective assessment of health in patients with dyspnea referred for pulmonary function testing, regardless of objective evidence of pulmonary dysfunction. A total of 182 consecutive patients receiving pulmonary function tests to evaluate dyspnea were screened with a patient-rated Primary Care Evaluation of Mental Disorders and completed the Anxiety Sensitivity Index and questionnaires assessing symptom severity and avoidance. Anxiety Sensitivity Index score predicted more severe subjective dyspnea and greater dyspnea-related avoidance, even after adjustment for anxiety disorders and pulmonary dysfunction. Despite some limitations, these data provide preliminary support that strategies to identify, measure, and address high levels of anxiety sensitivity should be examined to reduce subjective distress and improve functioning for patients with dyspnea.

Anxiety Disorders↗
PubMed2006

What is the threshold for symptomatic response and remission for major depressive disorder, panic disorder, social anxiety disorder, and generalized anxiety disorder?

OBJECTIVE: Symptom-free remission is a goal for treatment in depression and anxiety disorders, but there is no consensus regarding the threshold for determining remission in individual disorders. We sought to determine these thresholds by comparing, in a post hoc analysis, scores on the Clinical Global Impressions scale (CGI) and disorder-specific symptom severity rating scales from all available studies of the treatment of major depressive disorder, panic disorder, generalized anxiety disorder, and social anxiety disorder with the same medication (escitalopram). We also sought to compare the standardized effect sizes of escitalopram for these 4 psychiatric disorders. DATA SOURCES AND STUDY SELECTION: Raw data from all randomized, double-blind, placebo-controlled, acute treatment studies sponsored by H. Lundbeck A/S (Copenhagen, Denmark) or Forest Laboratories, Inc. (New York, N.Y.), published through March 1, 2004, with patients treated with escitalopram for DSM-IV major depressive disorder (5 studies), panic disorder (1 study), generalized anxiety disorder (4 studies), or social anxiety disorder (2 studies) were compared with regard to the standardized effect sizes of change in CGI score and scores on rating scales that represent the "gold standard" for assessment of these disorders (the Montgomery-Asberg Depression Rating Scale, the Panic and Agoraphobia Scale, the Hamilton Rating Scale for Anxiety, and the Liebowitz Social Anxiety Scale, respectively). DATA SYNTHESIS: In all indications, treatment with escitalopram showed differences from placebo in treatment effect from 0.32 to 0.59 on the CGI-S and CGI-I and standardized effect sizes from 0.32 to 0.50 on the standard rating scales. There were no significant differences among the different disorders. Moderate to high correlations were found between scores on the CGI and the standard scales. The corresponding standard scale scores for CGI-defined "response" and "remission" were determined. CONCLUSION: Comparison of scores on the standard scales and scores on the CGI suggest that the traditional definition of response (i.e., a 50% reduction in a standard scale) may be too conservative.

Anxiety Disorders↗
PubMed2004

Use of benzodiazepines in social anxiety disorder, generalized anxiety disorder, and posttraumatic stress disorder.

Benzodiazepines are advantageous treatments for anxiety disorders because they work quickly. However, benzodiazepines can vary in terms of efficacy across anxiety disorders. Benzodiazepines have been found to be a superior treatment in social anxiety disorder. While benzodiazepines are effective in the treatment of generalized anxiety disorder, other treatments such as selective serotonin reuptake inhibitors may be more effective. Also, research indicates that benzodiazepines may not be effective in the treatment of posttraumatic stress disorder. Therefore, physicians need to consider the type of anxiety disorder before prescribing a benzodiazepine as a treatment.

Anxiety Disorders↗
PubMed2001

Parental anxiety disorders, child anxiety disorders, and the perceived parent-child relationship in an Australian high-risk sample.

This study was designed to explore the role of perceived parenting behavior in the relationship between parent and offspring anxiety disorders in a high-risk sample of adolescents. We examined the relationship between parental and child anxiety disorders and tested whether perceived parenting behavior acted as a mediator between these variables. Analyses were performed on a high-risk sample of 816 fifteen-year-olds drawn from a birth cohort in Queensland, Australia. Parental depression and income were covaried. Maternal anxiety disorder significantly predicted the presence of anxiety disorders in children; the association between paternal anxiety disorder and child anxiety disorder was not significant. There was no evidence that perceived parenting played a mediating role in the association between mother and child anxiety disorders. These results replicate earlier studies' findings of elevated rates of anxiety disorders among the offspring of anxious parents, but only when the child's mother is the anxious parent.

Adolescent↗
PubMed1997

Discriminating between generalized anxiety disorder and anxiety disorder not otherwise specified in a Hispanic population: is it only a matter of worry?

One hundred and two Hispanic persons who presented for treatment at a specialized anxiety disorders clinic were evaluated at intake using the Anxiety Disorders Interview Schedule-Revised (ADIS-R; DiNardo and Barlow [1988] Albany: Center for Stress and Anxiety Disorders, State University of New York at Albany). Results indicated that 14% of these patients suffered from anxiety and/or affective disorders that were not adequately captured by our current diagnostic system. Given that the majority of these cases were characterized by predominantly anxious features, further investigation was undertaken to determine the degree of overlap between these patients (anxiety disorder, not otherwise specified; NOS) and those with generalized anxiety disorder (GAD). The two groups differed only with regard to the number of excessive worries they reported and not in terms of somatic symptomatology, psychosocial stressors, or demographic variables. These data suggest that excessive worry may be a discriminating factor between the GAD and NOS groups, providing support for the notion of GAD as a disorder of chromic worry. Future research is needed to tease apart the relative influences of culture and socioeconomic status on our findings.

Adult↗
PubMedDate not supplied

Quality of life in anxiety disorders: a comparison of obsessive-compulsive disorder, social anxiety disorder, and panic disorder.

BACKGROUND: There is growing recognition that the anxiety disorders are disabling disorders associated with substantial morbidity and impaired quality of life (QOL). Nevertheless, there have been few studies comparing QOL across these conditions. SAMPLING AND METHODS: 337 outpatients with obsessive-compulsive disorder (OCD; n = 220), panic disorder (PD; n = 53), or social anxiety disorder (SAD; n = 64) were compared using a number of assessment scales to compare objective and subjective impairment in QOL. The association of QOL with symptom severity and comorbid depression was also assessed. RESULTS: The extent of impairment due to OCD, PD or SAD appears to be similar across the QOL scales. However, various domains are differentially affected in each of the disorders; OCD patients had more impairment in family life and activities of daily living; SAD patients had more impairment in social life and leisure activities, and PD patients were less able to avoid the use of nonprescribed drugs. QOL was lower in patients with increased symptom severity as well as in those with comorbid depression. CONCLUSIONS: While the extent of impairment appears similar across a number of different anxiety disorders, characteristic symptoms of each disorder may be associated with differential impairment of various domains of function, and may require specifically tailored interventions.

Activities of Daily Living↗
PubMed2003

Establishment of remission criteria for anxiety disorders.

Anxiety disorders such as generalized anxiety disorder, social anxiety disorder, panic disorder, and posttraumatic stress disorder are typically chronic conditions associated with high health care costs and are often accompanied by psychiatric comorbidity, including major depressive disorder, substance abuse, and other anxiety disorders. Anxiety disorders are associated with significant functional impairment in social, vocational, and familial spheres and with diminished overall quality of life. The following clinical overview provides informal guidelines for identifying remission in patients with an anxiety disorder. A systematic approach to treatment that includes patient education, encouragement of exposure, attention to relevant comorbidities, use of empirically proven pharmacotherapies, and psychosocial interventions of adequate intensity and duration will improve outcomes and move patients toward marked improvement and remission.

Anxiety Disorders↗
PubMed2005

Overview of diagnosis and drug treatments of anxiety disorders.

Anxiety disorders are common and often disabling. They fall into five main categories: panic disorder, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder and posttraumatic stress disorder, each of which have characteristic symptoms and cognitions. All anxiety disorders respond to drugs and psychological treatments. This review will focus on drug treatments. Recent research has emphasized the value of antidepressants especially the selective serotonin reuptake inhibitors, benzodiazepines, and related sedative-like compounds. The common co-existence of depression with all of the anxiety disorders means that the selective serotonin reuptake inhibitors are now generally considered to be the first-line treatments but the benzodiazepines have some utility especially in promoting sleep and working acutely to reduce extreme distress.

Anti-Anxiety Agents↗
PubMed2001

Recent perspectives on the diagnosis and treatment of generalized anxiety disorder.

Anxiety disorders are common mental disorders, encompassing a group of conditions that share extreme or pathological anxiety as the primary disturbance in mood or emotional tone. Anxiety disorders include generalized anxiety disorder (GAD), panic disorder, agoraphobia, specific phobias, social anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. Individual anxiety disorders have considerable symptomatic overlap in their expression. The life-time prevalence of all anxiety disorders in the general population is about 25%. There is familial aggregation of anxiety and mood disorders such as major depression. Genetic factors and life experiences both contribute to the likelihood of developing anxiety disorders. GAD is characterized by excessive anxiety and uncontrollable worry, is present for longer than 6 months, and tends to occur comorbidly with other conditions, including other anxiety disorders and major depression as well as general medical conditions. GAD, given its chronic nature, is associated with significant impairment. GAD is responsive to pharmacological treatments, such as anxiolytics and antidepressants, as well as psychotherapies such as cognitive therapy.

Anti-Anxiety Agents↗
PubMed1997

A risk-benefit assessment of buspirone in the treatment of anxiety disorders.

Anxiety disorders include generalised anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD) and social phobia. Consideration of the chronicity of these disorders reveals that anxiety disorders first occur during early adolescence or young adulthood, and can wax and wane over periods of 5 to 10 years. Thus, in considering treatment, the emphasis must be placed on long term, rather than short term, management. Comorbidity studies reveal that untreated patients with anxiety disorders are at risk of social and psychological consequences, as well as disability resulting from comorbid and secondary disorders. Comparisons between buspirone and the benzodiazepines in treating patients with generalised anxiety disorder reveal that long term use of benzodiazepines is associated with adverse effects, particularly in elderly patients. Buspirone appears to have an onset of action equivalent to that of the benzodiazepines, to be well tolerated in the long term, to lack problems of habituation and withdrawal, and to be useful in patients with masked comorbid depression. In patients with panic disorder and social phobia, buspirone has not been clearly shown to be effective in comparison with the reference standards; in those patients with OCD, there are only preliminary indications of efficacy, which merit a more adjunctive role.

Anti-Anxiety Agents↗
PubMed1994

Management of common anxiety disorders.

Anxiety disorders affect 16 percent of the U.S. population. Family physicians treat 90 percent of patients presenting with one or more anxiety disorders. Common anxiety disorders include generalized anxiety disorder, panic disorder and social phobia. Differentiation among these disorders may be difficult, since symptoms and presentations are often similar. Underlying medical disorders and depressive illness may mimic or coexist with anxiety disorders. The chronic, remitting and relapsing nature of anxiety disorders requires the institution of a long-term plan of care. The integration of pharmacologic and psychotherapeutic interventions generally produces the greatest benefit to patients. Pharmacotherapeutic options frequently prescribed by family physicians include benzodiazepines, beta blockers, monoamine oxidase inhibitors, tricyclic antidepressants and azapirones. Useful psychotherapeutic models featuring brief interventions include supportive and cognitive approaches, and behavioral therapies, such as biofeedback, in vivo exposure and systematic desensitization.

Anti-Anxiety Agents↗
PubMed2002

New advances in the management of anxiety disorders.

Anxiety disorders are highly prevalent and associated with significant symptomatic distress, increased morbidity, and increased mortality. Although efficacious pharmacologic and psychosocial therapies for the anxiety disorders are available, many patients who improve with treatment remain at least somewhat symptomatic. This article reviews the epidemiology, phenomenology, and associated complications of panic disorder, social anxiety disorder, posttraumatic stress disorder, and generalized anxiety disorder. Recent guidelines developed for application in the assessment of outcome of the anxiety disorders are discussed, and illustrative data from a number of treatment trials integrating remission data in assessment of outcome are examined.

Anxiety Disorders↗