Cognitive and affective processing has been the central focus of brain-related functions in psychology and psychiatry for many years. Much less attention has been paid to, what could be considered the primary function of the brain, to regulate the function of the body. Recent developments, which include the conceptualization of interoception as a process consisting of integrating the information coming from the inside of the body in the central nervous system (CNS) and the appreciation that complex emotional processes are fundamentally affected by the processing and regulation of somatic states, have profoundly changed the view of the function and dysfunction of the brain. This review focuses on the relationship between breathing and anxiety. Several anxiety disorders have been associated with altered breathing, perception of breathing and response to manipulations of breathing. Both clinical and experimental research studies are reviewed that relate breathing dysfunctions to anxiety. Altered breathing may be useful as a physiological marker of anxiety as well as a treatment target using interoceptive interventions.
Sleep disturbance (SD) has complex associations with depression, both preceding and following the onset and recurrence of depression. We hypothesized that students with depressive symptoms with SD would demonstrate a greater burden of comorbid psychiatric symptoms and functional impairment compared to students with depressive symptoms without SD.
During a mental health screening, 287 undergraduate students endorsed symptoms of depression (Beck Depression Inventory [BDI] ≥ 13) and filled out the following self-report measures: demographic questionnaire, BDI, Anxiety Symptom Questionnaire—intensity and frequency (ASQ), Beck Hopelessness Scale (BHS), Beck Anxiety Inventory (BAI), Quality of Life Enjoyment and Satisfaction Questionnaire (QLESQ), and the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ). SD was measured using the BDI sleep item #16 dichotomized (score 0: no SD; or score > 0: some SD).
Students with depressive symptoms and SD (n = 220), compared to those without SD (n = 67), endorsed significantly more intense and frequent anxiety and poorer cognitive and physical functioning. Students with depressive symptoms with and without SD did not significantly differ in depressive severity, hopelessness, or quality of life.
College students with depressive symptoms with SD may experience a greater burden of comorbid anxiety symptoms and hyperarousal, and may have impairments in functioning, compared to students with depressive symptoms without SD. These findings require replication. Depression and Anxiety 00:1–8, 2013.
sleep; depression; anxiety; hopelessness; functioning; quality of life; college students; mental health screening; hyperarousal
Transdiagnostic cognitive-behavioral treatments for anxiety disorders have been gaining increased attention and empirical study in recent years. Despite this, research on transdiagnostic anxiety treatments has, to date, relied on open trials, or comparisons to waitlist conditions, published benchmarks, or relaxation-based interventions.
The current study was a randomized clinical trial examining the efficacy of a 12-week transdiagnostic cognitive-behavioral group treatment in comparison to 12-week diagnosis-specific group CBT protocols for panic disorder, social anxiety disorder and generalized anxiety disorder.
Results from 46 treatment initiators suggested significant improvement during treatment, strong evidence for treatment equivalence across transdiagnostic and diagnosis-specific CBT conditions, and no differences in treatment credibility.
This study provides evidence supporting the efficacy of transdiagnostic CBT by comparison to current gold-standard diagnosis-specific CBT for social anxiety disorder, generalized anxiety disorder, and panic disorder. Transdiagnostic group CBT has the benefit of potentially easing dissemination and increasing access to evidence based treatments for anxiety without sacrificing efficacy.
Transdiagnostic; Cognitive-Behavioral Therapy; Non-Inferiority; Group Therapy
Findings regarding the relationship between patient treatment preference and treatment outcome are mixed. This is a secondary data analysis investigating the relationship between treatment preference, and symptom outcome and attrition in a large 2-phase depression treatment trial.
Patients met DSM-IV criteria for chronic forms of depression. Phase I was a 12-week, nonrandomized, open-label trial in which all participants (n=785) received antidepressant medication(s) (ADM). Phase I nonremitters were randomized to Phase II, in which they received 12 weeks of either Cognitive-Behavioral System of Psychotherapy (CBASP) + ADM (n=193), Brief Supportive Psychotherapy (BSP) + ADM (n=187), or ADM only (n=93). Participants indicated their treatment preference (medication only, combined treatment or no preference) at study entry. Symptoms were measured at 2-week intervals with the 24-item Hamilton Rating Scale for Depression (HAM-D).
A large majority of patients reported a preference for combined treatment. Patients who preferred medication only were more likely to endorse a chemical imbalance explanation for depression, whereas those desiring combined treatment were more likely to attribute their depression to stressful experiences. In Phase I, patients who expressed no treatment preference showed greater rates of HAM-D symptom reduction than those with any preference, and patients with a preference for medication showed higher attrition than those preferring combined treatment. In Phase II, baseline treatment preference was not associated with symptom reduction or attrition.
Treatment preferences may moderate treatment response and attrition in unexpected ways. Research identifying factors associated with differing preferences may enable improved treatment retention and response.
treatment outcome; treatment engagement
Brain serotonin-1A receptors (5-HT1A) are implicated in anxiety. We compared regional brain 5-HT1A binding in medication-free participants with posttraumatic stress disorder (PTSD) and healthy volunteers using fully quantitative positron emission tomography (PET) methods.
Twenty patients with DSM-IV PTSD (13 with comorbid major depressive disorder, [MDD]) and 49 healthy volunteers underwent PET imaging with 5-HT1A antagonist radioligand [C-11]WAY100635. Arterial blood sampling provided a metabolite-corrected input function and the concentration of free ligand in plasma (fP) for estimation of regional binding potential, BPF ( = Bavailable /KD). Linear mixed modeling compared BPF between groups across regions of interest (ROIs).
The PTSD group had higher 5-HT1A BPF across brain ROIs (P = .0006). Post hoc comparisons showed higher 5-HT1A BPF in PTSD in all cortical ROIs (26–33%), amygdala (34%), and brainstem raphe nuclei (43%), but not hippocampus. The subgroup of seven PTSD patients without comorbid MDD had higher 5-HT1A BPF compared with healthy volunteers (P = .03).
This is the first report of higher brainstem and forebrain 5-HT1A binding in vivo in PTSD. The finding is independent of MDD. PTSD and MDD have in common an upregulation of 5-HT1A binding including midbrain autoreceptors that would favor less firing and serotonin release. This abnormality may represent a common biomarker of these stress-associated brain disorders.
posttraumatic stress disorder (PTSD); serotonin-1A (5-HT1A); positron emission tomography; WAY100635; major depressive disorder
Previous work has shown that inhibition of fear is impaired in posttraumatic stress disorder (PTSD) resulting from both civilian and combat trauma. The purpose of the present study was to investigate the inhibition of learned fear in traumatized individuals diagnosed with either acute stress disorder (ASD) or PTSD. This is the first study to use a conditioned inhibition paradigm with traumatized individuals within a month of trauma exposure. We hypothesized that impaired fear inhibition would be evident in PTSD, but not ASD.
Using established translational, psychophysiological methods including fear-potentiated startle, and skin conductance, we examined fear acquisition, stimulus discrimination, and the transfer of learned safety in a Croatian population with ASD or PTSD. This cross-sectional study included three age-matched groups: healthy nontrauma controls (n = 27), a group with chronic PTSD (10 or more years since trauma exposure, n = 24), and a group with ASD (30 days or less since trauma exposure, n = 27).
The presence of trauma-related psychopathology, whether acute or chronic, was associated with an impaired ability to transfer learned safety based on fear-potentiated startle measures, while healthy control subjects showed significant fear inhibition in the presence of the safety cue compared to the danger cue, F(1,26) = 12.64, P = .001.
These data expand our previously observed findings of PTSD-associated fear inhibition deficits by demonstrating that trauma-related impairments in safety learning are evident within 30 days of trauma exposure.
anxiety disorders; biological markers; PTSD; startle; trauma
It has been suggested that clinician-rated scales and self-report questionnaires may be interchangeable in the measurement of depression severity, but it has not been tested whether clinically significant information is lost when assessment is restricted to either clinician-rated or self-report instruments. The aim of this study is to test whether self-report provides information relevant to short-term treatment outcomes that is not captured by clinician-rating and vice versa.
In genome-based drugs for depression (GENDEP), 811 patients with major depressive disorder treated with escitalopram or nortriptyline were assessed with the clinician-rated Montgomery–Åsberg Depression Rating Scale (MADRS), Hamilton Rating Scale for Depression (HRSD), and the self-report Beck Depression Inventory (BDI). In sequenced treatment alternatives to relieve depression (STAR*D), 4,041 patients treated with citalopram were assessed with the clinician-rated and self-report versions of the Quick Inventory of Depressive Symptomatology (QIDS-C and QIDS-SR) in addition to HRSD.
In GENDEP, baseline BDI significantly predicted outcome on MADRS/HRSD after adjusting for baseline MADRS/HRSD, explaining additional 3 to 4% of variation in the clinician-rated outcomes (both P < .001). Likewise, each clinician-rated scale significantly predicted outcome on BDI after adjusting for baseline BDI and explained additional 1% of variance in the self-reported outcome (both P < .001). The results were confirmed in STAR*D, where self-report and clinician-rated versions of the same instrument each uniquely contributed to the prediction of treatment outcome.
Complete assessment of depression should include both clinician-rated scales and self-reported measures.
depression; assessment/diagnosis; clinical trials; antidepressants; treatment; mood disorders
Although cognitive-behavioral therapy (CBT) is efficacious in the treatment of generalized anxiety disorder (GAD), many individuals remain symptomatic following treatment, indicating a need for further treatment development. As a result, many researchers have developed unique cognitive-behavioral therapies that highlight specific targets for intervention. The current study examined the effect of an acceptance-based behavioral therapy for GAD on the proposed targets for intervention highlighted in several of these theoretical models: emotion regulation difficulties, intolerance of uncertainty, and low perceptions of control. Clients were randomly assigned to immediate (n = 15) or delayed (n = 16) treatment. Individuals treated with the acceptance-based behavioral therapy reported significantly fewer difficulties in emotion regulation and fear of emotional responses, as well as greater tolerance of uncertainty and perceived control over anxiety than individuals in the waitlist control condition. In addition, these effects were maintained at 3- and 9-month follow-up assessments.
generalized anxiety disorder; mindfulness; worry; emotion regulation; perceived control
Anxiety disorders are among the most common psychiatric disorders; meditative therapies are frequently sought by patients with anxiety as a complementary therapy. Although multiple reviews exist on the general health benefits of meditation, no review has been focused on the efficacy of meditation for anxiety specifically.
Major medical databases were searched thoroughly with keywords related to various types of meditation AND anxiety. Over 1000 abstracts were screened, and 200+ full articles were reviewed. Only RCTs were included. The Boutron (2005) checklist to evaluate a report of a non-pharmaceutical trial (CLEAR-NPT) was used to assess study quality; 90% authors were contacted for additional information. Review Manager 5 was used for meta-analysis.
A total of 36 RCTs were included in the meta-analysis (2,466 observations). Most RCTs were conducted among patients with anxiety as a secondary concern. The study quality ranged from 0.3 to 1.0 on the 0.0–1.0 scale (mean = 0.72). Standardized mean difference (SMD) was −0.52 in comparison with waiting-list control (p < .001; 25 RCTs), −0.59 in comparison with attention control (p < .001; 7 RCTs), and −0.27 in comparison with alternative treatments (p < 0.01; 10 RCTs). 25 studies reported statistically superior outcomes in the meditation group compared to control. No adverse effects were reported.
This review demonstrates some efficacy of meditative therapies in reducing anxiety symptoms, which has important clinical implications for applying meditative techniques in treating anxiety. However, most studies measured only improvement in anxiety symptoms, but not anxiety disorders as clinically diagnosed.
meditation; meditative therapies; anxiety; systematic review; meta-analysis
Maternal depression is associated with a higher incidence of behavioral problems in infants, but the effects of maternal depression as early as 1 month are not well characterized. The objective of this study is to determine the neurobehavioral effects of maternal depression on infants exposed and not exposed to methamphetamine (MA) using the NICU Network Neurobehavioral Scale (NNNS).
Four hundred twelve mother–infant pairs were enrolled (MA = 204) and only biological mothers with custody of their child were included in the current analysis. At the 1-month visit (n = 126 MA-exposed; n = 193 MA-unexposed), the Beck Depression Inventory-II (BDI-II) was administered, and the NNNS was administered to the infant. Exposure was identified by self-report and/or gas chromatography/mass spectroscopy confirmation of amphetamine and metabolites in newborn meconium. Unexposed subjects were matched, denied amphetamine use, and had negative meconium screens. General Linear Models tested the effects of maternal depression and prenatal MA exposure on NNNS, with significance accepted at P < .05.
The MA group had an increased incidence of depression-positive diagnosis and increased depression scores on the BDI-II. After adjusting for covariates, MA exposure was associated with increased arousal and handling scores, and a decreased ability to self-regulate. Maternal depression was associated with higher autonomic stress and poorer quality of movement. No additional differences were observed in infants whose mothers were both depressed and used MA during pregnancy.
Maternal depression is associated with neurodevelopmental patterns of increased stress and decreased quality of movement, suggesting maternal depression influences neurodevelopment in infants as young as 1 month.
amphetamine; drug; antenatal
Maternal depressive symptoms are a strong predictor of increases in depressive symptoms in offspring, yet knowledge of individual differences that may moderate the association between youth and maternal symptoms is still relatively scant. Youth genetic susceptibility to maternal depressive symptoms in particular is a nearly unexplored area of research.
This study used a multiwave prospective design and lagged hierarchical linear modeling analyses to examine whether youth 5-HTTLPR genotype moderated the longitudinal association between mother and youth depressive symptoms in a community sample (N = 241 youth). Maternal and youth symptoms were assessed every 3 months over 1 year (five waves of data).
Youth 5-HTTLPR interacted with idiographic elevations in maternal depressive symptoms (elevations relative to mothers’ average level of symptoms) to predict prospective increases in youth symptoms 3 months later. Youth with the SS genotype experienced greatest increases in depressive symptoms when exposed to elevations in maternal symptoms. Youth 5-HTTLPR did not interact with maternal nomothetic elevations in depressive symptoms (severity of symptoms compared to the sample as a whole).
These findings advance knowledge on genetic susceptibility for intergenerational transmission of depression between mothers and their children.
child/adolescent; depression; gene–environment; maternal child; mood disorders
Attention bias for socially threatening information, an empirically supported phenomenon, figures prominently in models of social phobia. However, all published studies examining this topic to date have relied on group means to describe attention bias patterns; research has yet to examine potential subgroups of attention bias among individuals with social phobia (e.g., vigilant or avoidant). Furthermore, almost no research has examined how attention biases in either direction may predict change in symptoms as a result of treatment.
This study (N=24) compared responses to cognitive behavioral therapy (CBT) for social phobia between individuals with avoidant and vigilant biases for threatening faces at pretreatment.
Participants with avoidant biases reported significantly and clinically higher symptom levels at posttreatment than did those with vigilant biases.
These findings suggest that an avoidant attention bias may be associated with reduced response to CBT for social phobia.
attention biases; social phobia; treatment response
There is evidence that negative affect (NA) and anxiety sensitivity (AS) predict the development of anxiety disorders, particularly panic disorder (PD). The main purpose of this study was to examine whether NA and AS will also predict the clinical course of PD.
Participants were 136 individuals with a DSM-III-R diagnosis of PD (with or without agoraphobia) enrolled in a naturalistic and longitudinal study of anxiety disorders, the Harvard/Brown Anxiety Research Project (HARP). Participants were administered the Anxiety Sensitivity Index and the Negative Affect Scales of the Positive and Negative Affect Schedule-Expanded Form (PANAS-X-NA) and their percentage of time in PD episode was followed for 1 year after the administration of the measures.
Multiple regression analyses indicated that AS, but not NA, was a significant predictor of percentage of time in PD episode after controlling for previous time in PD episodes, comorbid depression, other anxiety disorders, and exposure to psychopharmacological and behavioral treatments. As expected, the Physical Concerns subscale of the Anxiety Sensitivity Index had a significant independent contribution in predicting the course of the disorder.
Overall, these findings suggest that AS, as a unique construct, may be predictive of the amount of time patients are in episode of PD.
panic disorder; anxiety sensitivity; negative affect; clinical course; anxiety disorders; longitudinal studies; risk factors
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.
The current 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).
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 current suicidality and comorbid PAS remained significant after controlling for overall depression severity and other clinical factors.
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.
Suicidality; Depression; Panic Disorder; Agoraphobia; Psychiatric Hospitalization; Comorbidity
Selective serotonin reuptake inhibitors (SRIs) relieve irritability within days in women with premenstrual dysphoric disorder (PMDD); however, the effects on other affective symptoms in PMDD remain to be demonstrated.
We performed hourly ratings in women with PMDD to test the specificity of the therapeutic effects of SRIs and to determine whether the kinetics of these effects differ from those of the symptom offset accompanying menses. Twelve women with PMDD received fluoxetine (20 mg daily) during the luteal phase of the menstrual cycle. Twelve other women with PMDD received no treatment. Outcome measures included a visual analogue scale completed hourly before and after either the start of SRIs or at menses-onset in the untreated women and the premenstrual tension syndrome (PMTS) scale completed daily. Data were analyzed by ANOVA-R.
Hourly VAS scores significantly improved after SRI in irritability as well as sadness, anxiety, and mood swings. Compared with the symptomatic pretreatment baseline, PMTS scores significantly improved on the second day after the start of SRI (p < .01). An identical time course of symptom improvement occurred after both SRI and menses-onset.
Conclusion and Discussion
These data document that the rapid response to SRI was not limited to irritability. The similar kinetics in the remission of PMDD after SRIs and after menses-onset suggest both a phenotype reflecting the relative capacity to rapidly change affective state, and a possible therapeutic mechanism by which SRIs recruit this endogenous capacity to change state, normally expressed around menses-onset in women with PMDD.
premenstrual dysphoric disorder; fluoxetine; selective serotonin reuptake inhibitors; treatment response
A notable portion (21%) of female patients receiving treatment for depression in community mental health centers (CMHC) has childhood sexual abuse (CSA) histories. Treatment outcomes in this population are heterogeneous; identifying factors associated with differential outcomes could inform treatment development. This exploratory study begins to address the gap in what is known about predictors of treatment outcomes among depressed women with sexual abuse histories.
Seventy women with major depressive disorder and CSA histories in a CMHC were randomly assigned to Interpersonal Psychotherapy (n = 37) or usual care (n = 33). Using generalized estimating equations, we examined four pre-treatment predictor domains (i.e., sociodemographic characteristics, clinical features, social and physical functioning, and trauma features) potentially related to depression treatment outcomes.
Among sociodemographic characteristics, Black race/ethnicity, public assistance income, and unemployment were associated with less depressive symptom reduction over the course of treatment. Two clinical features, chronic depression and borderline personality disorder, were also related to less reduction in depressive symptoms across the treatment period.
Our results demonstrate the clinical relevance of attending to predictors of depressed women with CSA histories being treated in public sector mental health centers. Particular sociodemographic characteristics and clinical features among these women may be significant indicators of risk for relatively poorer treatment outcomes.
adult survivors of child abuse; major depressive disorder; treatment resistance; community mental health services; IPT/interpersonal psychotherapy
Stressful life events (SLEs) are associated with the onset of psychiatric disorders but little is known about the effects of SLEs on individuals already diagnosed with an anxiety disorder, particularly generalized anxiety disorder (GAD) in which worry about life events is a defining characteristic. This study examined the impact of SLEs on relapse in adults already diagnosed with GAD.
Data are obtained from the Harvard/Brown Anxiety Research Project (HARP), a naturalistic longitudinal study of adults with a current or past history of anxiety disorders. One hundred and twelve adults recovered from an episode of GAD and 27 subsequently relapsed during the study. Eight categories of SLEs were assessed via interview and were examined as predictors of GAD relapse.
An increased total number of SLEs was associated with a higher cumulative probability of relapse into episode of GAD and there was a nonsignificant statistical trend indicating specific categories of SLEs including health, death, and family/friends/household were related to an increased probability of relapse into episodes of GAD.
SLEs impact the course of GAD and certain types of stressors may be more relevant to symptomatology than others. The change and uncertainty associated with SLEs may exacerbate existing worry tendencies even among those who have recovered from GAD.
anxiety; course; adults; longitudinal; psychiatric
The memory deficit hypothesis has been used to explain the maintenance of repetitive behavior in individuals with obsessive–compulsive disorder, yet the majority of studies focusing on verbal memory show mixed results. These studies primarily evaluated memory accuracy via the inclusion or omission of previously encountered material, as opposed to false recognition (i.e., the inclusion of erroneous material). We evaluated false memories and memory processes in individuals with obsessive–compulsive washing symptoms (OC), individuals matched on depression and anxiety without OC symptoms (D/A), and in nonanxious individuals (NAC).
Twenty-eight OC, 28 D/A, and 29 NAC individuals read OC-threat relevant, positive, and neutral scenarios and then performed a recognition test. Erroneous recognition of words associated to encoded, but not previously viewed, scenarios were classified as false memories. To evaluate processes underlying memory, participants completed a modified remember/know task to examine whether the OC individuals differed from the other individuals in recollective clarity for false memories of OC-relevant (e.g., germs), positive (e.g., lottery), and neutral (e.g., bread) material.
The OC individuals used “know” more than the D/A and NAC individuals for false memories of threat. For veridical memories, the OC individuals used “know” more than the NAC, but not, D/A individuals.
The greater reliance on “know” (i.e., feelings of familiarity) in general and false threat memories in particular in individuals with OC symptoms may add to feelings of uncertainty for threat-relevant material, which may contribute to compulsive behavior.
Threat; Recognition; Deficit; Remember; Know
The high prevalence of trauma exposure and subsequent negative consequences for both survivors and society as a whole emphasize the need for secondary prevention of posttraumatic stress disorder. However, clinicians and relief workers remain limited in their ability to intervene effectively in the aftermath of trauma and alleviate traumatic stress reactions that can lead to chronic PTSD. The scientific literature on early intervention for PTSD is reviewed, including early studies on psychological debriefing, pharmacological, and psychosocial interventions aimed at preventing chronic PTSD. Studies on fear extinction and memory consolidation are discussed in relation to PTSD prevention and the potential importance of immediate versus delayed intervention approaches and genetic predictors are briefly reviewed. Preliminary results from a modified prolonged exposure intervention applied within hours of trauma exposure in an emergency room setting are discussed, along with considerations related to intervention reach and overall population impact. Suggestions for future research are included. Prevention of PTSD, although currently not yet a reality, remains an exciting and hopeful possibility with current research approaches translating work from the laboratory to the clinic.
secondary prevention; early intervention; PTSD; ASD
A better understanding of the role of both family- and neighborhood-level socioeconomic characteristics in the development of anxiety disorders is important for identifying salient target populations for intervention efforts. Little research has examined the question of whether associations between anxiety and socioeconomic status (SES) differ depending upon the level at which SES is measured or way in which anxiety manifests. We studied associations between both household- and neighborhood-level income and four different manifestations of anxiety in a community sample of young adolescents.
We conducted a cross-sectional analysis of data on 498 subjects aged 11–13 from a cohort study of Seattle-area middle school students. Generalized estimating equations were used to examine the association between both annual household income and neighborhood median income and each of four anxiety subscale scores from the multidimensional anxiety scale for children (MASC): physical symptoms, harm avoidance, social anxiety, and separation/panic anxiety.
A negative association was found between household income and scores on two of the four MASC subscales—physical symptoms and separation/panic anxiety. In contrast, at equivalent levels of household income, adolescents living in higher income neighborhoods reported higher physical and harm avoidance symptom scores.
The role that SES plays in the development of childhood anxiety appears to be complex and to differ depending on the specific type of anxiety that is manifest and whether income is evaluated at the household or neighborhood level.
adolescence; child and adolescent anxiety; residence characteristics; socioeconomic position; epidemiology
Anxiety disorders are commonly comorbid with bipolar disorder (BP) and may worsen course of illness, but differential impact of specific anxiety disorders in men and women remains unknown.
We measured the impact of comorbid panic disorder (PD), social phobia, specific phobia, and obsessive-compulsive disorder (OCD) in 460 women and 276 men with Bipolar I Disorder (BPI) or schizoaffective disorder, bipolar type from the National Institute of Mental Health Bipolar Genetics Initiative. We compared clinical characteristics in BP with and without each anxiety disorder in men and women separately correcting for family relatedness.
Comorbid PD, OCD, and specific phobia were more common in women with BP than men. Comorbid social phobia correlated with increased risk of alcohol abuse in BP women, but not men. Women with comorbid PD attended fewer years of school. Comorbidity with OCD was associated with earlier age at the onset of BP for both genders. Comorbid PD, OCD, and specific phobia were associated with more antidepressant trials in BP, across both genders, compared to BP patients without these anxiety disorders.
In BP, comorbid anxiety disorders are associated with increased risk for functional impairment, and women had differently associated risks than men. Clinicians should be aware of an increased risk for comorbid PD, OCD, and specific phobia in women with BP, and an increased risk of alcohol abuse in women with BD and comorbid social phobia.
psychiatry; panic; obsessive-compulsive; social phobia; specific phobia; depression; mania; alcohol; female