分离性焦虑障碍史与成年期精神疾病的关系(综述)

本文对早期分离性焦虑障碍史与成年期精神疾病两者关系的国外研究文献进行了综述。分析表明:分离性焦虑障碍史与成年期多种精神疾病之间存在关联,纵向研究结果支持分离性焦虑障碍史作为成年期焦虑障碍谱系及抑郁的风险因素,但其是否作为成年期心境恶劣、双相情感障碍、人格障碍、进食障碍的风险因素还需纵向研究的确认。此外,在儿童期,分离性焦虑障碍与性别认同障碍存在共患关系,可能对个体性心理发展产生影响。现有研究中存在的不足是,在检验分离性焦虑障碍史与成年期精神疾病两者关系时,未见有对遗传和环境变量的控制,也少见有对共病进行控制,而这类控制对确认其是否作为风险及风险大小是十分必要的。     

失眠会增加心脏病和卒中风险

美国心脏协会《循环》杂志刊登的一篇来自100万人的研究数据显示,失眠的遗传因素可能增加冠状动脉疾病、心力衰竭和卒中的风险。在缺血性卒中中,失眠症的遗传主要与大动脉卒中的风险增加有关。研究发现,患有失眠的人患冠状动脉疾病、心力衰竭和卒中的风险增加。先前的观察性研究发现失眠影响着多达30%的普通人群,并且增加了患心脏病和卒中的风险。     

湖南地区6～16岁焦虑障碍患儿生活质量及影响因素

目的:了解儿童青少年焦虑障碍患儿生活质量的水平及特点,并探讨其生活质量的影响因素.方法:本研究数据来自课题组2014年2-7月大型流行病学调查数据,研究对象来自湖南省长沙市和益阳市,采用C#程序1:2筛选出497例患有焦虑障碍的儿童作为病例组,性别、年龄与其匹配的994例健康儿童作为对照组,分别采用儿童期虐待问卷(CT...     

伴与不伴焦虑症状抑郁症患者的自杀风险

目的:比较伴与不伴焦虑症状抑郁症患者的自杀风险,分析抑郁症患者自杀风险的危险因素。方法:对2010年9月1日至2011年2月28日"中国双相情感障碍患者诊断评估服务"研究项目的数据进行二次分析,纳入分析的抑郁症患者共1172例,根据简明国际神经精神访谈(M.I.N.I)焦虑模块,分为伴焦虑症状抑郁症组728例(62.1%)及不伴焦虑症状组444例(37.9%)。采用M.I.N.I自杀模块评估自杀风险,比较伴与不伴焦虑症状抑郁症患者的自杀风险,通过logistic回归分析探讨抑郁症患者自杀风险的相关因素。结果:伴焦虑症状抑郁症患者中有自杀风险者331例(45.5%);不伴焦虑症状者中有自杀风险者54例(12.2%)。与不伴焦虑症状抑郁症患者比较,伴焦虑症状者自杀风险更高(P0.001)。Logistic回归分析显示,抑郁发作频繁(OR=2.07)、伴精神病性症状(OR=2.01)、伴焦虑症状(OR=3.18)、伴忧郁型特征(OR=2.90)与抑郁症患者的自杀风险相关。结论:伴焦虑症状抑郁症患者可能有更高的自杀风险。发作频繁、伴精神病性症状、伴焦虑症状或伴忧郁型特征可能是抑郁症患者自杀风险的危险因素。     

HLA基因及儿童期经历在抑郁障碍发病机制中的 作用及其交互影响关系

在抑郁障碍的发病机制中,基因-环境交互作用学说得到了许多研究者的支持。同时抑郁障碍已经被许多研究广泛证实为与免疫密切相关的疾病,抑郁障碍患者中枢神经系统的免疫因子水平紊乱,个体对环境的高敏感状态等免疫系统亢进的表现已经被揭示。而儿童期遭遇的长期或重大的应激经历及创伤体验会显著增加个体罹患抑郁障碍的风险,这种早期的负性体验也会导致成年后机体免疫系统的亢进。HLA基因作为自身免疫过程的起点,其表达产物的类型及水平都会对个体的免疫系统产生重大影响。但是目前针对HLA基因在精神障碍的发病机制中的研究较为缺乏。本文分析了HLA基因对抑郁障碍发病可能存在的影响,总结了儿童期经历对个体抑郁障碍易感性的影响,并探索性的讨论了HLA基因以及儿童期经历在抑郁障碍发病机制中所起到的作用以及其相互间的交互作用存在的可能性机制。     

脑源性神经营养因子基因变异会导致焦虑

据2010年1月21日Science报道,美国研究人员Soliman F等发现人类和老鼠身上具有相同的＂焦虑＂相关基因,表明实验室动物研究可以用来研究相关人类行为。这项研究结果可帮助科学家开发出新的临床药物,治疗人类的恐惧症和创伤后应激障碍等焦虑相关疾病。     

多巴胺转运体基因与双相情感障碍

为了对双相情感障碍病因学进行研究，运用分子遗传学技术，首次将多巴胺转运体基因用于双相情感障碍的关联分析、连锁分析及家系中传递情况分析。发现双相情感障碍与多巴胺转运体基因缺乏关联和连锁，但是，在２个高发家系中首次发现存在多巴胺转运体基因４０ｂｐ可变串联重复序列遗传不稳定现象，该现象可能与疾病发生有关，值得进一步研究。     

癌症患者焦虑状态的相关因素

本文探讨癌症患者的心身特点与焦虑障碍的相关因素,对癌症患者的焦虑障碍引起临床重视,早期给予心理干预或药物治疗。对象和方法1.1对象入选病例来自于2005年3～6月在苏州大学附属第一人民医院肿瘤科与血液科住院的患者,共105例,病理确诊均为恶性肿瘤,患者既往无重大器质性疾病     

服刑人员述情障碍与自杀风险的关系：抑郁焦虑的中介作用

目的:探讨监狱服刑人员中的自杀风险与述情障碍、抑郁焦虑的关系。方法:采用自杀行为问卷(SBQ-R)、多伦多述情障碍量表(TAS-20)、贝克抑郁量表第2版(BDI-Ⅱ)、贝克焦虑量表(BAI)对广东省广州市某监狱的456名成年男性服刑人员进行集体施测。结果:述情障碍、重度抑郁症状、重度焦虑症状、高自杀风险检出率分别为28.2%、22.2%、10.4%、12.6%。服刑人员的述情障碍得分在入狱前是否有职业和教育程度在统计学上有差异(t=-2.10,P0.05;F=6.28,P0.01);服刑人员的抑郁、焦虑和自杀风险得分在刑期上的差异有统计学意义(F=7.34,P0.001;F=3.51,P0.01;F=4.52,P0.01);Pearson相关分析结果显示述情障碍、抑郁、焦虑和自杀风险两两之间均成正相关(r=0.37～0.67,P0.01);述情障碍通过抑郁焦虑情绪障碍的中介作用对自杀风险产生影响。结论:服刑人员存在严重的心理健康问题,抑郁、焦虑发生率和严重程度均较高,高述情障碍和高自杀风险检出率均较高。述情障碍、抑郁、焦虑和自杀风险两两之间均成正相关;抑郁焦虑的情绪障碍在述情障碍和自杀风险中存在完全中介效应。     

焦虑障碍与利钠肽-HPA轴的关系

焦虑障碍的发病机制虽已有较多的研究,但到目前为止,尚未完全明了,探索焦虑障碍的发病机制,已成为精神卫生领域及中西医药研究领域的一项重要课题。新近研究表明焦虑障碍的发生和HPA轴功能紊乱关系密切,而心脏分泌的激素利钠肽异常与焦虑障碍也有关联,且利钠肽在中枢有调节HPA轴的作用,故此本文提出“利钠肽-HPA轴异常可能是焦虑障碍的重要发病机制之一”的新观点。为此,本文拟从焦虑障碍与心脏利钠肽、HPA轴、中枢利钠肽-HPA轴三个方面,对焦虑障碍与利钠肽-HPA轴的关系进行分析。     

No effect of trait anxiety on differential fear conditioning or fear generalization

Previous studies have shown that individuals with anxiety disorders exhibit deficits in fear inhibition and excessive generalization of fear, but little data exist on individuals at risk from these disorders. The present study examined the role of trait anxiety in the acquisition and generalization of fear in 126 healthy participants selected on the basis of their trait-anxiety scores. Measures of conditioning included fear-potentiated startle, skin conductance response and online risk ratings for the unconditioned stimulus. Contrary to our hypotheses, trait anxiety did not have any effect either on the acquisition or the generalization of fear. Our results suggest that these fear conditioning processes are not impaired in individuals at risk from anxiety.     

Genetic association analysis of behavioral inhibition using candidate loci from mouse models

Genes influence the development of anxiety disorders, but the specific loci involved are not known. Genetic association studies of anxiety disorders are complicated by the complexity of the phenotypes and the difficulty in identifying appropriate candidate loci. We have begun to examine the genetics of behavioral inhibition to the unfamiliar (BI), a heritable temperamental predisposition that is a developmental and familial risk factor for panic and phobic disorders. Specific loci associated with homologous phenotypes in mouse models provide compelling candidate genes for human BI. We conducted family-based association analyses of BI using four genes derived from genetic studies of mouse models with features of behavioral inhibition. The sample included families of 72 children classified as inhibited by structured behavioral assessments. We observed modest evidence of association (P = 0.05) between BI and the glutamic acid decarboxylase gene (65 kDA isoform), which encodes an enzyme involved in GABA synthesis. No significant evidence of association was observed for the genes encoding the adenosine A(1A) receptor, the adenosine A(2A) receptor, or preproenkephalin. This study illustrates the potential utility of using candidate genes derived from mouse models to dissect the genetic basis of BI, a possible intermediate phenotype for panic and phobic disorders.     

Maternal anxiety during the transition to parenthood: a prospective study

BACKGROUND: This prospective study used both self-report (STAI) and clinical diagnostic interview (MINI-Plus) to examine the course of maternal anxiety across the transition to parenthood. The study also assessed i) the validity of the STAI for antenatal use in an Australian sample and ii) the relative utility of the MINI-Plus and STAI scales as antenatal measures of risk for postnatal anxiety and mood disorders. METHODS: Participants were 100 women recruited during routine antenatal assessment at a major obstetric hospital in Sydney. An antenatal screening instrument (ANRQ) identified half the sample as being at "high risk" for developing postnatal anxiety and/or depression. Participants completed the STAI during the third trimester of pregnancy and the MINI-Plus was administered during pregnancy and during the seventh postnatal month to assess anxiety and depression meeting DSM-IV criteria. RESULTS: The data indicated considerable stability in anxiety and depression from pregnancy through the postnatal period, as assessed by both diagnostic interview and maternal self-report. Antenatal anxiety meeting diagnostic criteria and antenatal trait anxiety exceeding a cut-off score of 40 on the STAI were both found to be significant predictors of postnatal anxiety and mood disorders (p-values<.05). Further analyses revealed that the measures were equivalent in their predictive utility. Finally, the STAI state and trait anxiety scales demonstrated a reasonable estimation of antenatal clinical state when tested against the MINI-Plus diagnostic interview during pregnancy. CONCLUSIONS: The findings from this study suggest that antenatal anxiety as assessed by either clinical interview or maternal self-report is an important predictor of postnatal anxiety and mood disorders. The validity of the STAI scales for use during pregnancy was also demonstrated for the first time in an Australian sample.     

Support for involvement of glutamate decarboxylase 1 and neuropeptide Y in anxiety susceptibility

Genetic mapping efforts have identified putative susceptibility genes for human anxiety disorders. The most intensively studied genes are involved in neurotransmitter metabolism and signaling or stress response. In addition, neuropeptides and targets of anxiolytics have been examined. It has become apparent that gene?×?environment interactions may explain individual variation in stress resilience and predisposition to mental disorders. We aimed to replicate previous genetic findings in 16 putative anxiety susceptibility genes and further test whether they modulate the risk for developing an anxiety disorder in adulthood after childhood stress exposure. We tested 93 single-nucleotide polymorphisms (SNPs) for genetic association to anxiety disorders in the Finnish population-based Health 2000 sample (282 cases and 575 matched controls). In addition, we examined by logistic regression modeling whether the SNP genotypes modified the effect of the number of self-reported childhood adversities on anxiety disorder risk. The most significant evidence for association was observed in glutamate decarboxylase 1 (GAD1) with phobias (P?=?0.0005). A subsequent meta-analysis (N?=?1985) incorporating previously published findings supported involvement of a single GAD1 risk haplotype in determining susceptibility to a broad range of internalizing disorders (P?=?0.0009). We additionally found that SNPs and haplotypes in neuropeptide Y (NPY) modified the effect of childhood adversities on anxiety susceptibility (P?=?0.003). In conclusion, we provide further support for involvement of mainly GAD1, but also NPY in determining predisposition to anxiety disorders.     

Childhood adversities and adult depression: an experimental study on childhood depressogenic markers

Our study was aimed at verifying whether the number and frequency of childhood neurotic traits and stressful experiences in depressed subjects are statistically different from those seen in the general population or in patients with anxiety disorders. The three groups of subjects completed the MMPI and data on early adverse events were obtained retrospectively by means of a structured interview. The comparison among the groups and between the depressed group and the group with anxiety disorders revealed in the depressed group a number and frequency of some childhood adversities significantly different from the other groups. These results confirm the hypothesis that childhood adversities can increase the risk of adult depression. Our results also provide data on which childhood stressful experiences should be focused on for reducing the risk of depression in adulthood.     

Anxiety disorders and suicidal behaviours in adolescence and young adulthood: findings from a longitudinal study

BACKGROUND: The aim of this study was to estimate the extent to which anxiety disorders contribute to an increase in suicidal behaviour after controlling for both observed and non-observed sources of confounding. METHOD: Data were collected from the Christchurch Health and Development Study (CHDS), a 25-year longitudinal study of over 1000 participants. Measures of anxiety disorders [phobia, generalized anxiety disorder (GAD), panic disorder], major depression (MD), substance use disorders, conduct/antisocial personality disorder, stressful life events, unemployment, and suicidal ideation/attempts for subjects aged 16-18, 18-21 and 21-25 years were used to fit random and fixed effects regression models of the associations between anxiety disorders and suicidal behaviours. RESULTS: Anxiety disorders were strongly associated with suicidal ideation/attempts. Any single anxiety disorder increased the odds of suicidal ideation by 7.96 times [95% confidence interval (CI) 5.69-11.13] and increased the rate of suicide attempts by 5.85 times (95% CI 3.66-9.32). Control for co-occurring mental disorders, non-observed fixed confounding factors and life stress reduced these associations [suicidal ideation odds ratio (OR) 2.80, 95% CI 1.71-4.58; suicide attempts incidence rate ratio (IRR) 1.90, 95% CI 1.07-3.39]. Rates of suicidal behaviour also increased with the number of anxiety disorders. Estimates of the population attributable risk suggested that anxiety disorders accounted for 7-10% of the suicidality in the cohort. CONCLUSIONS: Anxiety disorders may be a risk factor for suicidality, even after controlling for confounding, with risks increasing with multiple anxiety disorders. Management of anxiety disorders may be an important component in strategies to reduce population rates of suicide.     

Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: results from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND: This study addressed the prevalences, correlates, co-morbidity and disability of DSM-IV generalized anxiety disorder (GAD) and other psychiatric disorders in a large national survey of the general population, the National Institute on Alcohol Abuse and Alcoholism's (NIAAA) National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The study presents nationally representative data, for the first time, on prevalence, correlates, co-morbidity, and comparative disability of DSM-IV GAD.METHOD: Data are taken from a large (n=43093) representative sample of the adult USA population.R: Prevalences of 12-month and lifetime GAD were 2.1% and 4.1%. Being female, middle-aged, widowed/separated/divorced, and low income increased risk, while being Asian, Hispanic, or Black decreased risk. GAD was highly co-morbid with substance use, and other anxiety, mood, and personality disorders. Co-morbidity in GAD was not substantially greater than for most other Axis I and II disorders. Disability and impairment in pure GAD were equivalent to pure mood disorders, but significantly greater than in pure substance use, and other anxiety and personality disorders. Individuals co-morbid for GAD and each mood disorder were more disabled than those with pure forms of GAD or each mood disorder. When co-morbid with GAD, nicotine dependence and other anxiety and personality disorders were not associated with increased disability over that associated with pure GAD, but GAD did show increased disability over that due to each of these disorders in pure form.Conclusions. Associations between GAD and Axis I and II disorders were strong and significant, with variation among specific disorders. Results strongly support GAD as an independent disorder with significant impairment and disability.     

Psychiatric disorders associated with risk for the development of eating disorders during adolescence and early adulthood

Longitudinal data were used to investigate whether anxiety, depressive, disruptive, personality, or substance use disorders are associated with risk for the development of eating disorders during adolescence or early adulthood. Psychiatric disorders were assessed among 726 youths from a random community sample during adolescence and early adulthood. Depressive disorders during early adolescence were associated with elevated risk for the onset of eating disorders, dietary restriction, purging behavior, and recurrent weight fluctuations after preexisting eating problems and other psychiatric disorders were controlled statistically. Disruptive and personality disorders were independently associated with elevated risk for specific eating or weight problems. The present findings suggest that depressive disorders during early adolescence may contribute to the development of eating disorders during middle adolescence or early adulthood.     

Suicide risk in patients with anxiety disorders: a meta-analysis of the FDA database

BACKGROUND: Previous reports of suicide risk in patients with anxiety disorders have been inconsistent. METHODS: Using the FDA database, we assessed suicide and suicide attempt risk among patients, participating in recent clinical trials evaluating new anti-anxiety medications, with diagnosis of panic disorder (PD), social anxiety disorder or social phobia (SP), generalized anxiety disorder (GAD), post traumatic stress disorder (PTSD), and obsessive compulsive disorder (OCD). RESULTS: Overall, among 20076 participating anxious patients, 12 committed suicide and 28 attempted suicide. The annual suicide risk rate was 193/100000 patients and annual suicide attempt risk was 1350/100000 patients. LIMITATIONS: Clinical trial data have limited applicability to clinical practice. Participants in clinical trials are a highly selected, nonrepresentative sample of the clinical population. A number of patients never complete clinical trials and thus data are based on a limited sub-sample. These trials were not primarily designed to assess suicide risk. CONCLUSIONS: Suicide risk in patients with anxiety disorders is higher than previously thought. Patients with anxiety disorders warrant explicit evaluation for suicide risk.     

Peripartum changes in social support among women with and without anxiety and depressive disorders prior to pregnancy: a prospective-longitudinal study

This study aims to prospectively examine peripartum changes in social support in women with and without anxiety and depressive disorders prior to pregnancy. Data come from the Maternal Anxiety in Relation to Infant Development (MARI) Study, a prospective-longitudinal investigation among n?=?306 expectant mothers. DSM-IV anxiety and depressive disorders were assessed in early pregnancy using the Composite International Diagnostic Interview for Women (CIDI-V). Social support was assessed with the Social Support Questionnaire during pregnancy as well as 4 and 16 months postpartum. Perceived social support in the total sample declined from prepartum to postpartum. Levels of prepartum and postpartum social support were lower in women with comorbid anxiety and depressive disorders compared to those with pure depressive disorder(s), pure anxiety disorder(s), or comorbid anxiety and depressive disorders prior to pregnancy. Moreover, social support more strongly declined from prepartum to postpartum in women with comorbid anxiety and depressive disorders compared to those without anxiety and depressive disorder prior to pregnancy. Findings suggest that women with a previous history of comorbid anxiety and depressive disorders are at particular risk for deficient social support during pregnancy and after delivery and might thus profit from targeted early interventions.