Attrition in the treatment of childhood anxiety disorders

The present study explored the differences between completers and terminators (including both refusers and dropouts) of an individual cognitive-behavioral treatment for childhood anxiety. Participants were 190 children with anxiety disorders and their parents: 146 completed treatment and 44 terminated. Terminators were more likely to live in a single-parent household, be ethnic minorities, and self-report less anxious symptomatology. Follow-up interviews indicated that identifiable child factors were influential in terminators' decisions to discontinue treatment. Among terminators, differences between refusers and dropouts were also investigated.     

Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders

Chromosome analysis of G-banded peripheral blood lymphocytes was performed on two groups of plutonium workers with 20-50% and >50% maximum permissible body burdens (MPBB) of plutonium from the British Nuclear Fuels plc (BNFL) facility at Sellafield, UK, 10 years after an earlier study had reported increases in both symmetrical and asymmetrical aberrations. For each plutonium exposure group there was a significant difference in frequencies of symmetrical aberrations between plutonium workers, workers with similar histories of exposure to mainly external gamma radiation but with little or no intakes of plutonium, and controls with negligible exposure (<50 mSv). In contrast, no significant differences for asymmetrical aberrations were found, and since these are short-lived, this suggests that recent exposure of mature lymphocytes was minimal. Frequencies of symmetrical aberrations had increased significantly since the earlier sampling time. Additional external radiation exposure was negligible in the plutonium worker groups over this period. These results are consistent with the hypothesis that hemopoietic precursor cells are being irradiated by internally deposited plutonium with subsequent selection resulting in only cells with symmetrical aberrations reaching the peripheral lymphocyte pool. After removal of aberrations involving only chromosomes 7 and/or 14, which are thought to arise in vivo during immunological development, the breakpoints involved in the aberrations were distributed randomly among the chromosomes according to length in all three groups of workers. Within the chromosomes the distribution between terminal, interstitial and centromeric regions for the plutonium workers did not conform to that expected, there being an excess in the terminal regions and a deficit in the interstitial regions.     

Psychosocial correlates of recurrent childhood pain: A comparison of pediatric patients with recurrent abdominal pain, organic illness, and psychiatric disorders.

Pediatric patients with recurrent abdominal pain (RAP) were compared with patients with peptic disease, patients with emotional disorders, and well children with regard to (1) emotional and somatic symptoms and (2) theoretically derived variables, including negative life events, competence, family functioning, and the modeling and encouragement of illness behavior. RAP patients had levels of emotional distress and somatic complaints higher than those of well children and lower than those of psychiatric patients, but not different from those of patients with peptic disease. RAP patients had fewer negative life events, better family functioning, and higher competence than children with emotional disorders. In comparison with well children and psychiatric patients, both RAP and peptic disease patients had a higher incidence of illness in other family members and perceived greater parental encouragement of illness behavior for abdominal symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A multiple-stage screening procedure for the identification of childhood anxiety disorders.

Examined the usefulness of a multiple-stage screening procedure in the identification of youth experiencing elevated levels of anxiety. 758 children in Grades 4–7 completed a 3-stage screening procedure. During the 1st and 2nd stages, Ss completed the Revised Children's Manifest Anxiety Scale; the 3rd stage involved a clinical interview with the S based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Results were similar to those found when the procedure was used to identify children with depression. Nearly 18% of the original sample was identified in the 1st stage. Of the 124 children who completed the 2nd stage, over 69% met the cutoff criteria for the 3rd stage interview, where 41% of that subset exhibited an anxiety disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

DSM-III-R personality disorders in a mood and anxiety disorders clinic: prevalence, comorbidity, and clinical correlates

This study examined the prevalence, comorbidity, and clinical correlates of personality disorders in an outpatient sample (N = 352) with anxiety and depression. Subjects were diagnosed using the Structured Clinical Interview for DSM-III-R (SCID) on Axes I and II, and they also completed interview and self-report measures of symptoms. Subjects with a personality disorder were less likely to be married, more likely to be single or divorced, had lower family incomes, had more severe symptoms of both anxiety and depression, and had a greater number of lifetime Axis I diagnoses. Subjects with dysthymic and bipolar disorders were more likely, and subjects with panic disorder uncomplicated by agoraphobia were less likely to have a personality disorder compared to the rest of the sample. The most prevalent personality disorders were Avoidant, Obsessive-Compulsive, Paranoid, and Borderline. Paranoid co-occurred with Narcissistic, and Borderline co-occurred with Histrionic personality disorder significantly more often than chance and base rates would predict.     

In-session exposure tasks and therapeutic alliance across the treatment of childhood anxiety disorders.

The study examined the shape of therapeutic alliance using latent growth curve modeling and data from multiple informants (therapist, child, mother, father). Children (n = 86) with anxiety disorders were randomized to family-based cognitive–behavioral treatment (FCBT; N = 47) with exposure tasks or to family education, support, and attention (FESA; N = 39). Children in FCBT engaged in exposure tasks in Sessions 9–16, whereas FESA participants did not. Alliance growth curves of FCBT and FESA youths were compared to examine the impact of exposure tasks on the shape of the alliance (between-subjects). Within FCBT, the shape of alliance prior to exposure tasks was compared with the shape of alliance following exposure tasks (within-subjects). Therapist, child, mother, and father alliance ratings indicated significant growth in the alliance across treatment sessions. Initial alliance growth was steep and subsequently slowed over time, regardless of the use of exposure tasks. Data did not indicate a rupture in the therapeutic alliance following the introduction of in-session exposures. Results are discussed in relation to the processes, mediators, and ingredients of efficacious interventions as well as in terms of the dissemination of empirically supported treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychoneuroendocrinology of anxiety disorders

This article focuses on neuroendocrine measures in anxiety disorders and their relationships to neurotransmitter and neuroendocrine function. In particular, the hypothalamic-pituitary-somatotropin and the hypothalamic-pituitary-adrenal (HPA) axes are emphasized, and a role for extrahypothalamic corticotropin releasing factor is proposed. Additional neuroactive hormones are also considered. A nonhuman primate model of anxiety is discussed in terms of its neuroendocrine relevance. And, throughout, a hypothetical functional-anatomic model for anxiety and panic is proposed using the findings of cognitive neuroscience fear research. Finally, an effort is made to synthesize existing psychoneuroendocrinologic data into a current conceptualization of the pathophysiology of anxiety disorders.     

Psychosocial precursors and correlates of migraine headache.

Tested the interactions of migraine headache cycles and sufferers' daily experiences of stressful events, emotional arousal, and physical activity. Hypotheses were that patterns of these variables would be associated with the episodic onset of migraine headache and that frequency of attacks could be predicted by combinations of personality and behavioral variables. 33 23–63 yr old migraine sufferers were interviewed; administered the Minnesota Multiphasic Personality Inventory (MMPI); and given a 4-wk diary for recording daily headache activity, physical activity, stressful events, and emotional states. Repeated-measures analyses found significant elevations of stressful events over the 4 days leading up to and including a migraine day. Physical activity declined over the same period. Emotional arousal tended to significance. Regression analyses identified sets of personality and behavioral predictors accounting for substantial variance in the reported numbers of migraine and headache-free days. Results support a model of migraine characterized by parallel physiological and psychosocial instability during a 4-day cycle and by an interaction of personality and behavioral (self-reported stress) functions. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial correlates of chest pain among African-American women

While 10-30% of individuals with chest pain who undergo cardiac arteriography are found to have no demonstrable pathology, women are far more likely than men to have normal coronary arteries in the presence of angina. Black women, in particular, frequently seek medical attention for persistent episodes of chest pain. This cross-sectional study was designed to examine the potential role of psychological and social factors in relation to chest pain among black women. Among our population-based sample of 188 women, 48% reported experiencing chest pain. Seventeen of these cases met the Rose criteria for classification as cardiac pain while 74 of them reported pain not consistent with cardiac origin. A statistically significant difference was observed in the stress scores among the women; the highest stress scores occurred among those with Rose angina and the lowest scores were obtained from those women reporting no chest pain experiences (p < 0.001). There was no association detected between the presence and type of chest pain and psychosocial measures of depression and coping abilities. These results confirm the high rates of chest pain experienced among black women, and provide insight into the role of psychological factors that should be considered in the identification of treatment options.     

Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents

We examine the lifetime comorbidity among anxiety disorders, and between anxiety disorders and other mental disorders, in a large (n = 1,507) community sample of high school students on whom extensive diagnostic data were available. Three diagnostic groups were formed: those with a lifetime anxiety disorder (n = 134); those with a nonanxiety disorder (n = 510); and those who had never met criteria for a mental disorder (n = 863). The intra-anxiety comorbidity rate was relatively low (18.7%), and was strongly associated with being female (92%). The lifetime comorbidity between anxiety and other mental disorders (primarily MDD) was substantial (73.1%) and was not associated with being female.     

Psychosocial correlates of heterosexual condom use: a meta-analysis

Despite increasing incidence of HIV/AIDS, there has been no systematic review of correlates of condom use among heterosexual samples. To rectify this, the present study used meta-analysis to quantify the relationship between psychosocial variables and self-reported condom use. Six hundred sixty correlations distributed across 44 variables were derived from 121 empirical studies. Variables were organized in terms of the labeling, commitment, and enactment stages of the AIDS Risk Reduction Model (Catania, Kegeles, & Coates, 1990). Findings showed that demographic, personality, and labeling stage variables had small average correlations with condom use. Commitment and enactment stage variables fared better, with attitudes toward condoms, behavioral intentions, and communication about condoms being the most important predictors. Overall, findings support a social psychological model of condom use highlighting the importance of behavior-specific cognitions, social interaction, and preparatory behaviors rather than knowledge and beliefs about the threat of infection.     

The neurobiology of anxiety disorders

The use of pharmacologic challenges and the application of new brain imaging technologies in the study of patients with anxiety disorders have led to an improvement in the understanding of the neurobiologic basis of these disorders. Abnormal function of noradrenergic, serotonergic, GABAergic, and dopaminergic neural systems as well as abnormal chemoreceptor reactivity have all been implicated in the pathophysiology of anxiety. Functional imaging data have revealed abnormal patterns of cortical and subcortical activity in anxiety patients. These data have allowed significant improvements in the available anatomic models of the anxiety disorders. Further improvements in research technique and technology likely will lead in the near future to a significantly clearer image of the neurobiologic processes involved in anxiety disorders.     

Psychosocial correlates of chronic fatigue syndrome in adolescent girls

Behavior problems and family functioning were investigated in a sample of 10 adolescent girls with chronic fatigue syndrome (CFS), 10 matched healthy adolescent girls, and 10 adolescents with childhood cancer in remission. Based on the adolescent girls' reports, the CFS group had significantly higher scores than the cancer and healthy comparison adolescent girls on somatic complaints and also significantly higher scores than the cancer controls on internalizing symptoms and depression. Parent reports resulted in significantly higher scores in the CFS group than the adolescent girls from the healthy comparison groups on internalizing scores and somatic complaints. There were no significant differences on any family variables.     

Psychosocial correlates of depressive symptomatology in adult women.

Investigated the relationship between depressive symptomatology and a set of demographic and psychosocial variables presumed to be depression-susceptibility factors. 499 22–59 yr old women completed the Center for Epidemiologic Studies—Depression Scale (CESD), a demographic assessment, and measures of 4 psychosocial variables: life control, perceived accomplishment, derived identity, and social support. Higher CESD scores were associated with less perceived life control, less perceived accomplishment, higher derived identity, lower social support, lower education, lower or unemployment, younger age, and lower family income. A hierarchical multiple regression was conducted with demographic variables entered first, followed by the psychosocial variables, and then the interaction variables. Psychosocial variables accounted for an additional 28% of depression variance beyond the 11% accounted for by the demographic variables. Perceived life control was the strongest contributor to the final regression equation. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medico-socioeconomic impact of anxiety disorders

Budgetary control policies implemented in order to cope with the increase in health costs in industrialized countries and with the desequilibrium of the national health insurance accounts, give rise to the problem of preserving the quality of care and quality of life of the patients. Only health economic studies evaluating the possible different therapeutic strategies, will enable us to reconcile the 2 terms of the equation whose contradiction might be only apparent. This is particularly true for the treatment of psychiatric diseases, and especially anxiety. Budgetary control cannot be reduced to a simple management of penury, since the cheapest treatments are not necessarily the most profitable. In this context, new strategies are proposed: it is suggested that thorough diagnosis (avoiding both the non acknowledgement of the illness and the overconsumption of anxiolytic drugs) and early optimal treatment, of adequate duration, of the anxiety disorders might be the most economic attitude in the management of this pathology. On the other hand, the impact of the treatment of anxiety on the quality of life of the patient has a direct effect on costs if one considers the supplement to medical consumption and the social deficit induced by therapeutic failure in particular anxiety disorders. It remains that the evaluation of the health economics of anxiety is difficult, because of the complexity of the parameters involved. Though rather well developed in the UK and in North America, this evaluation still has to be introduced in France.     

Aversive Pavlovian conditioning in childhood anxiety disorders: Impaired response inhibition and resistance to extinction.

Learning-based models of anxiety disorders emphasize the role of aversive conditioning and retarded extinction in the etiology and maintenance of anxiety disorders. Yet few studies have examined these underlying processes in children, despite that some anxiety disorders typically onset during childhood. The authors examined the acquisition and extinction of conditioned responses in 17 anxious children and 18 nonanxious control children between 8 and 12 years old using a discriminative Pavlovian conditioning procedure. One geometric shape conditional stimulus was paired with an unpleasant loud tone unconditional stimulus (CS+) whereas another geometric shape was presented alone (CS?). In the context of similar levels of discriminative conditioning in both groups, anxious children showed larger skin conductance responses to the CS+ and the CS? during acquisition and evaluated the CS+ as more arousing than the CS? compared with control children. They also showed greater resistance to extinction in skin conductance responses but not in arousal ratings to the CS+ vs. the CS? relative to control children. Results suggest that deficits in response inhibition to safety cues and retarded extinction may underlie learning processes involved in the pathogenesis of childhood anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of parental anxiety in the treatment of childhood anxiety

Sixty-seven children aged 7 to 14 who met diagnostic criteria for an anxiety disorder were assigned to conditions according to parental anxiety level. Within these conditions, children were randomly assigned to 1 of 2 treatments: child-focused cognitive-behavioral therapy (CBT) or child-focused CBT plus parental anxiety management (CBT + PAM). At posttreatment, results indicated that within the child-anxiety-only condition, 82% of the children in the CBT condition no longer met criteria for an anxiety disorder compared with 80% in the CBT + PAM condition. Within the child + parental anxiety condition, 39% in the CBT condition no longer met criteria compared with 77% in the CBT + PAM condition. At follow-up, these differences were maintained, with some weakening over time. Results were not consistent across outcome measures. The interpretation and potential clinical implications of these findings are discussed.     

Psychosocial correlates of empirical types of multiple drug abusers.

Drug use and psychosocial data were collected from 440 clients, average age 30.5 yrs, in 4 drug and alcohol treatment programs. Ss were administered the Buss-Durkee Hostility Inventory, the Guilt Inventory, the Social Readjustment Rating Scale, a self-concept measure and 34 other psychosocial scales. A cluster analysis was performed on chronicity/frequency indices that had been calculated for each of 15 drug classes. Four multiple drug clusters were identified: (a) cocaine/other opiates and synthetics/methaqualone/illegal methadone; (b) inhalants/codeine/nonnarcotic analgesics; (c) marihuana/amphetamines/hallucinogens; (d) minor tranquilizers/barbiturates. Heroin and alcohol did not cluster with any other substances but were frequently used by this sample, and consequently were retained in further analyses, yielding 6 basic drug clusters. Next, a typology of drug abusers was developed empirically by means of proximity cluster analysis. Eight quantitatively and qualitatively distinct types of multiple drug abusers were identified solely by analysis of their standing on the use of the 6 basic clusters of drugs. Finally, the set of psychosocial measures was found to be differentially related to use of the 6 types of drugs and to the 8 types of drug abusers. These differential findings are discussed in terms of the adequacy of the theory underlying the measures and in terms of alternative analytic strategies. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of personality disorders among patients with anxiety disorders

Outpatients with a principal diagnosis of an anxiety disorder (n = 347) were administered the Structured Clinical Interview for DSM-III-R/Axis II Disorders (SCID-II) during their intake evaluation. At least one personality disorder was found in 35% of these patients. Patients with social phobia (61%) and generalized anxiety disorder (49%) were most often diagnosed with a personality disorder. Patients with simple phobia were rarely diagnosed with a personality disorder (12%). The most commonly diagnosed personality disorders were from the "anxious/fearful" cluster (27% received at least one diagnosis from cluster C), most notably avoidant and obsessive-compulsive personality. Our findings suggest that personality disorders, in general, are less prevalent among anxious patients than among depressive patients.