Anxiety Disorders: Columbia University

Marsh R, Maia TV, Peterson BS. · Department of Psychiatry, Division of Child and Adolescent Psychiatry, Columbia College of Physicians and Surgeons, New York State Psychiatric Institute, 1051 Riverside Dr., Unit 74, New York, NY 10032, USA. · Am J Psychiatry. · Pubmed #19448188 No free full text.

Abstract: OBJECTIVE: Neuroimaging studies of healthy individuals inform us about the normative maturation of the frontostriatal circuits that subserve self-regulatory control processes. Findings from these studies can be used as a reference frame against which to compare the aberrant development of these processes in individuals across a wide range of childhood psychopathologies. METHOD: The authors reviewed extensive neuroimaging evidence for the presence of abnormalities in frontostriatal circuits in children and adults with Tourette's syndrome and obsessive-compulsive disorder (OCD) as well as a more limited number of imaging studies of adolescents and adults with anorexia nervosa or bulimia nervosa that, together, implicate dysregulation of frontostriatal control systems in the pathogenesis of these eating disorders. RESULTS: The presence of an impaired capacity for self-regulatory control that derives from abnormal development of frontostriatal circuits likely interacts in similar ways with normally occurring somatic sensations and motor urges, intrusive thoughts, sensations of hunger, and preoccupation with body shape and weight to contribute, respectively, to the development of the tics of Tourette's syndrome, the obsessions of OCD, the binge eating behaviors of bulimia, and the self-starvation of anorexia. CONCLUSIONS: Analogous brain mechanisms in parallel frontostriatal circuits, or even in differing portions of the same frontostriatal circuit, may underlie the differing behavioral disturbances in these multiple disorders, although further research is needed to confirm this hypothesis.

Weissman M. · Department of Psychiatry, College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, 1051 Riverside Drive, New York, NY 10032, USA. · Ann Epidemiol. · Pubmed #19344866 No free full text.

Abstract: This is an invited article on how my career as an epidemiologist studying depression unfolded. The role of the Civil Rights movement in opening the PhD doors to women at Yale began my career. The unfolding of depression studies are described. These studies included a clinical trial of medication and what later was known as interpersonal psychotherapy (IPT), the first community survey of psychiatric disorder, family genetic and brain imaging studies or depression and anxiety disorders. I hope the new generation will have the wonderful opportunities I have had.

Markowitz JC, Milrod B, Bleiberg K, Marshall RD. · New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA. · J Psychiatr Pract. · Pubmed #19339847 No free full text.

Abstract: Exposure to reminders of trauma underlies the theory and practice of most treatments for post-traumatic stress disorder (PTSD), yet exposure may not be the sole important treatment mechanism. Interpersonal features of PTSD influence its onset, chronicity, and possibly its treatment. The authors review interpersonal factors in PTSD, including the critical but underrecognized role of social support as both protective posttrauma and as a mechanism of recovery. They discuss interpersonal psychotherapy (IPT) as an alternative treatment for PTSD and present encouraging findings from two initial studies. Highlighting the potential importance of attachment and interpersonal relationships, the authors propose a mechanism to explain why improving relationships may ameliorate PTSD symptoms.

Sullivan GM, Neria Y. · Columbia University College of Physicians & Surgeons, Department of Psychiatry, New York, NY 10032, USA. · Curr Opin Investig Drugs. · Pubmed #19127485 No free full text.

Abstract: This review discusses evidence-based pharmacotherapies for post-traumatic stress disorder (PTSD). The epidemiology of PTSD and its phenomenological characteristics are summarized. Focus is placed on the major classes of drugs for which at least a minimum of evidence-based outcome data are available from randomized controlled trials (RCTs). Drugs for the total symptom constellation of the disorder, specific PTSD symptoms, such as nightmares, and prevention of PTSD development post-trauma, are discussed. Where appropriate, RCT methodological problems that limit the conclusions drawn are discussed. In addition, recommendations for research to fill critical gaps in the knowledge of PTSD treatment are offered.

Markowitz JC. · New York State Psychiatric Institute, 1051 Riverside Drive, Unit #129, New York, NY 10032, USA. · Curr Psychiatry Rep. · Pubmed #18980727 No free full text.

Abstract: Clinicians should think carefully before deciding on the initial treatment for a patient with major depressive disorder. The author argues that this does not happen often enough, and that psychotherapy may be overlooked too often as a first treatment option. Based on the research literature and the American Psychiatric Association Practice Guidelines, this article reviews potential cautions and relative indications for initiating treatment with evidence-based psychotherapies for major depressive disorder. Potential indications include 1) patient preference; 2) symptom severity; 3) relative contraindications to pharmacotherapy; 4) prior treatment history; 5) nature of symptoms; 6) psychosocial context, including a life crisis or complicated bereavement; 7) control and credit; and 8) new and enduring skills.

Sher L. · Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY 10032, USA. · Minerva Pediatr. · Pubmed #18971900 No free full text.

Abstract: Post-traumatic stress disorder (PTSD) is a common psychiatric disorder which is frequently comorbid with major depressive disorder (MDD). It has been suggested that some or all individuals diagnosed with comorbid PTSD and MDD have a separate psychobiological condition that can be termed ''post-traumatic mood disorder'' (PTMD). The idea was based on the fact that a significant number of studies suggested that patients suffering from comorbid PTSD and MDD differed clinically and biologically from individuals with PTSD alone or MDD alone. Individuals with comorbid PTSD and MDD are characterized by greater severity of symptoms and the higher level of impairment in social and occupational functioning compared to individuals with PTSD alone or MDD alone. Neurobiological evidence supporting the concept of PTMD includes the findings from neuroendocrine challenge, cerebrospinal fluid, neuroimaging, sleep and other studies. It has been demonstrated that child abuse increases the risk for PTSD, MDD, and suicidal behavior in adolescents and adults. Many victims of childhood abuse develop comorbid PTSD and depression, i.e., they develop PTMD. PTMD is associated with suicidal behavior. The link between childhood abuse, suicidal behavior in adolescents and PTMD indicates that it is important to develop interventions to prevent PTMD in victims of child abuse; to develop measures to prevent suicidal behavior in adolescents with PTMD; and to study psychobiology of PTMD in order to develop treatments for PTMD. Priorities for intervening to reduce adolescent suicidal behavior lie with interventions focused upon the improved recognition, treatment and management of adolescents with psychiatric disorders including PTMD.

Shapiro PA, Fedoronko DA, Epstein LA, Mirasol EG, Desai CV. · Department of Psychiatry, Columbia University, New York, NY 10032, USA. · Crit Care Clin. · Pubmed #18929947 No free full text.

Abstract: Psychiatric issues are important in the management of patients with heart and lung disease in acute, intensive, and critical care. Adjustment disorders, anxiety disorders, depression, and delirium, sometimes in association with substance abuse and withdrawal problems, are the most common issues, and may affect risk and prognosis of the associated general medical conditions and management in the acute care setting. In children with lung and heart diseases requiring critical care, appreciation of cognitive and social-psychologic developmental milestones is necessary to provide adequate care.

Maia TV, Cooney RE, Peterson BS. · Columbia University and New York State Psychiatric Institute, NY 10032, USA. · Dev Psychopathol. · Pubmed #18838041 No free full text.

Abstract: Functional imaging studies have reported with remarkable consistency hyperactivity in the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), and caudate nucleus of patients with obsessive-compulsive disorder (OCD). These findings have often been interpreted as evidence that abnormalities in cortico-basal ganglia-thalamo-cortical loops involving the OFC and ACC are causally related to OCD. This interpretation remains controversial, however, because such hyperactivity may represent either a cause or a consequence of the symptoms. This article analyzes the evidence for a causal role of these loops in producing OCD in children and adults. The article first reviews the strong evidence for anatomical abnormalities in these loops in patients with OCD. These findings are not sufficient to establish causality, however, because anatomical alterations may themselves be a consequence rather than a cause of the symptoms. The article then reviews three lines of evidence that, despite their own limitations, permit stronger causal inferences: the development of OCD following brain injury, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, and neurosurgical lesions that attenuate OCD. Converging evidence from these various lines of research supports a causal role for the cortico-basal ganglia-thalamo-cortical loops that involve the OFC and ACC in the pathogenesis of OCD in children and adults.

Goodwin RD. · Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, Rm 1706, New York, New York 10032, USA. · Addict Behav. · Pubmed #18657913 No free full text.

Abstract: There has been growing evidence of a link between chronic respiratory diseases, asthma in particular, and mental disorders among youth. The mechanism for this link remains unknown. Several studies have empirically addressed the question of this pathway, and accumulating results may shed new light on the nature of this association. The goal of the current paper is to provide an integrative summary of the literature to date and to present a new interdisciplinary hypothesis for one possible mechanism explaining the link between asthma and anxiety/depression among youth. This hypothesis posits that comorbid anxiety/depression and nicotine dependence among adults, may be one pathway leading to the comorbidity of asthma and anxiety/depression among youth. We propose this mechanism operates via exposure to environmental tobacco smoke and/or prenatal tobacco use, which confers an increased risk for asthma, and parental anxiety/depression which confers increased risk of anxiety/depression among offspring via familial transmission. We predict that further testing of this hypothesis will help to reveal the largely neglected problem of nicotine dependence especially among women - and the far-reaching impact of this addiction on the health of children.

Harding KJ, Skritskaya N, Doherty E, Fallon BA. · Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive, Unit 69, New York, NY 10032, USA. · Curr Psychiatry Rep. · Pubmed #18627669 No free full text.

Abstract: Illness anxiety, also known in its more severe form as hypochondriasis, is a debilitating and chronic condition in which normal bodily symptoms are misinterpreted as signs of serious medical illness. Patients suffer with the fear that they are ill despite reassurance to the contrary and often overuse medical services in the process. This article critically evaluates the recent literature on illness anxiety and related, medically unexplained symptoms, highlighting new and interesting findings in the areas of prevalence, classification/diagnosis, management, and evidence-based treatment and new frontiers in understanding illness anxiety, such as brain imaging, neuroimmunology, and cyberchondria.

Pickering TG, Clemow L. · Center for Behavioral Cardiovascular Health, Columbia University Medical College, New York, NY 10032, USA. · J Clin Hypertens (Greenwich). · Pubmed #18607143 No free full text.

Abstract: This paper reviews the limited literature on paroxysmal hypertension. A case report describes the clinical picture frequently seen in specialty hypertension practice, a patient with paroxysmal or intermittent hypertension who proves not to have a pheochromocytoma. The variety of diagnostic labels given to these patients is reviewed, including pseudopheochromocytoma, panic attacks, and hyperventilation syndrome. The clinical features, pathology, diagnosis, and treatment of these syndromes are outlined. It is proposed that successful management of these patients may be best achieved by collaborative care between a hypertension specialist and a psychiatrist or clinical psychologist with expertise in cognitive-behavioral panic management, stress-reduction techniques including controlled breathing, and treating health anxiety. The use of drugs effective for treatment of panic disorder can also be helpful in managing these patients.

Sher L. · Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA. · Minerva Pediatr. · Pubmed #18449137 No free full text.

Abstract: Depression and suicidal behavior in adolescents are frequently comorbid with alcohol and drug abuse. Alcohol abuse may lead to the deficiency of micronutrients including selenium, an essential trace element. In addition, dietary intake of selenium in some geographic areas is low. The combination of these two factors may result in significant selenium deficiency. Selenium plays an important role in brain function. Selenium is a potent protective agent for neurons through the expression of selenoproteins. Studies suggest that low selenium status is associated with depressed mood, anxiety, and cognitive decline. A tremendous amount of structural and functional brain development takes place during the teenage years. Many of the changes that take place during the second decade of life are novel and do not simply represent the remnants of childhood plasticity. Considerable evidence suggests that alcohol affects brain function and behavior differently during adolescence than during adulthood. Adolescents are more vulnerable to the long-term effects of alcohol abuse. The adolescent brain may be especially sensitive to a harmful combination of alcohol abuse and selenium deficiency. This combination may contribute to depression and suicidal behavior in adolescents. Recent research opens new avenues for the potential development of selenium containing compounds as preventive or therapeutic agents in psychiatric and neurological conditions. Healthy nutrition and possibly mineral supplementations should be a part of the treatment plan of adolescents with alcohol use disorders especially when alcohol misuse is comorbid with depression.

Mann SJ. · New York Presbyterian Hospital-Weill/Cornell Medical School, 450 East 69th Street, New York, NY 10021, USA. · Curr Hypertens Rep. · Pubmed #18367021 No free full text.

Abstract: Paroxysmal hypertension always engenders a search for a catecholamine-secreting pheochromocytoma. Yet 98% of people with paroxysmal hypertension do not have this tumor. The cause and management of paroxysmal hypertension remain a mystery, and the subject of remarkably few papers. This review presents an approach to understanding and successfully treating this disorder. Patients experience symptomatic blood pressure surges likely linked to sympathetic nervous system stimulation. A specific personality profile associated with this disorder suggests a psychological basis, attributable to repressed emotion related to prior emotional trauma or a repressive (nonemotional) coping style. Based on this understanding, three forms of intervention, alone or in combination, appear successful: antihypertensive therapy with agents directed at the sympathetically mediated blood pressure elevation (eg, combined alpha- and beta-blockade or central alpha-agonists such as clonidine); psychopharmacologic interventions including anxiolytic and/or antidepressant agents; and psychological intervention, particularly reassurance and increased psychological awareness. An appropriately selected intervention can reduce or eliminate attacks in most patients.

Samet S, Waxman R, Hatzenbuehler M, Hasin DS. · New York State Psychiatric Institute, New York, New York 10032, USA. · Addict Sci Clin Pract. · Pubmed #18292706 links to  free full text

Abstract: Efficient, organized assessment of substance use disorders is essential for clinical research, treatment planning, and referral to adjunctive services. In this article, we discuss the basic concepts of formalized assessment for substance abuse and addiction, as established by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, and describe six widely used structured assessment instruments. Our aim is to help researchers and clinical programs identify the instruments that best suit their particular situations and purposes.

Bonanno GA, Mancini AD. · Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 W 120th St, New York, NY 10027, USA. · Pediatrics. · Pubmed #18245429 links to  free full text

Abstract: For decades, researchers have documented remarkable levels of resilience in children who were exposed to corrosive early environments, such as those in which poverty or chronic maltreatment were present; however, relatively little research has examined resilience in children or adults who were exposed to isolated and potentially traumatic events. The historical emphasis on psychological and physiologic dysfunction after potentially traumatic events has suggested that such events almost always produce lasting emotional damage. Recent research, however, has consistently shown that across different types of potentially traumatic events, including bereavement, serious illness, and terrorist attack, upward of 50% of people have been found to display resilience. Research has further identified substantial individual variation in response to potentially traumatic events, including 4 prototypical and empirically derived outcome trajectories: chronic dysfunction, recovery, resilience, and delayed reactions. Factors that promote resilience are heterogeneous and include a variety of person-centered variables (eg, temperament of the child, personality, coping strategies), demographic variables (eg, male gender, older age, greater education), and sociocontextual factors (eg, supportive relations, community resources). It is surprising that some factors that promote resilience to potentially traumatic events may be maladaptive in other contexts, whereas other factors are more broadly adaptive. Given the growing evidence that resilience is common, psychotherapeutic treatment should be reserved for those in genuine need.

Hasin D, Katz H. · Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, Box 123, New York, NY 10032, USA. · Psychosom Med. · Pubmed #18040097 No free full text.

Abstract: OBJECTIVE: To review the potential for diagnostic difficulties and overlap in a number of symptoms of somatoform disorders and symptoms of withdrawal from alcohol and drugs, and to review epidemiologic, family, and clinical studies addressing comorbidity between somatoform and substance use disorders. The comorbidity between somatoform disorders and substance use disorders has rarely been studied. METHODS: Symptoms of somatoform disorders and substance withdrawal were compared. A PubMed-based literature review was conducted. RESULTS: Somatoform and withdrawal symptoms overlap considerably. Few studies, however, have addressed comorbidity between somatoform and substance use disorders. Although results are inconsistent, a number of studies suggest that an association exists. CONCLUSION: More research on this type of comorbidity is warranted because the associations may be stronger than generally assumed. Such research should address methodological problems to produce studies with clearer findings.

Berkowitz RL, Coplan JD, Reddy DP, Gorman JM. · Department of Psychiatry, College of Physicians and Surgeons of Columbia University, Brooklyn, NY, USA. · Rev Neurosci. · Pubmed #18019606 No free full text.

Abstract: Numerous studies suggest that the amygdala is critical for the acquisition and expression of fear. Conditioned fear in animals has been considered a good model for human anxiety disorders, but animal models of anxiety have several limitations. Conditioned fear in animals can be directed to a specific stressor and is easily extinguished. Furthermore, animals do not seem to be able to develop the capacity to worry excessively about the future. While animal models are useful and can demonstrate psychiatric illnesses, they do not completely mimic the complex cognitive processes that occur in anxious humans. Thus, we hypothesize that human anxiety disorders are caused at least in part by differential activity in the prefrontal cortex, the brain region that most separates us from our nearest genetic neighbors. The human prefrontal cortex has not only been shown to be more developed than that of other mammals, but it also has unique morphology and gene expression. Neuroimaging studies repeatedly show abnormalities in the prefrontal cortex in anxious individuals. Thus, we suggest that the very same cortical complexity that allows us to produce a vibrant culture is also the seat of anxiety disorders. Interestingly, preclinical studies have shown that the prefrontal cortex inhibits the amygdala. There appears to be a distinction between two classes of anxiety disorders. Those disorders involving intense fear and panic--panic disorder, post-traumatic stress disorder, and phobias--seem to be characterized by an underactivity of the prefrontal cortex, thus disinhibiting the amygdala. Disorders such as generalized anxiety disorder and obsessive-compulsive disorder, which involve worry and rumination, on the other hand, seem to be characterized by an overactivity of the prefrontal cortex. Studies of prefrontal cortical function in psychiatric illness should be a fruitful method for identifying effective treatment approaches.

Amiel JM, Mathew SJ. · Columbia University Department of Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA. · Curr Psychiatry Rep. · Pubmed #17880858 No free full text.

Abstract: Anxiety disorders are among the most prevalent psychiatric disorders, but they represent a particular challenge for treatment. The standard first-line treatments, including antidepressants, benzodiazepines, and buspirone, result in significant response rates for a majority of patients; however, unfavorable side effect profiles or risk for dependency for particular agents might limit their use by anxious patients, who often have low thresholds for medication discontinuation. Novel pharmacologic agents that modulate particular receptors, ion channels, or transporters relevant to glutamatergic neurotransmission may represent a new approach to the treatment of anxiety disorders, with generally more favorable side effect profiles. Although the role of glutamate in the pathophysiology of anxiety disorders is still being elucidated, the use of these agents in treatment of anxiety disorders and commonly comorbid conditions such as substance abuse and mood disorders will continue to increase.

Leonardo ED, Hen R. · Department of Psychiatry, Columbia University, New York, NY, USA. · Neuropsychopharmacology. · Pubmed #17851538 links to  free full text

Abstract: There is increasing recognition that many psychiatric disorders including anxiety disorders are neurodevelopmental in their origins. Here, we review and integrate data from human studies and from animal models that point to a critical period during which neural circuits that mediate anxiety develop. We then postulate that this highly plastic critical period is a time of heightened responsiveness that is particularly susceptible to adverse events. We discuss these concepts in the context the current heightened interest in gene by environment interactions in psychiatric illness emphasizing the importance of the temporal relationship between gene action and environmental milieu.

Neria Y, Nandi A, Galea S. · Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY 10032, USA. · Psychol Med. · Pubmed #17803838 No free full text.

Abstract: BACKGROUND: Disasters are traumatic events that may result in a wide range of mental and physical health consequences. Post-traumatic stress disorder (PTSD) is probably the most commonly studied post-disaster psychiatric disorder. This review aimed to systematically assess the evidence about PTSD following exposure to disasters.MethodA systematic search was performed. Eligible studies for this review included reports based on the DSM criteria of PTSD symptoms. The time-frame for inclusion of reports in this review is from 1980 (when PTSD was first introduced in DSM-III) and February 2007 when the literature search for this examination was terminated. RESULTS: We identified 284 reports of PTSD following disasters published in peer-reviewed journals since 1980. We categorized them according to the following classification: (1) human-made disasters (n=90), (2) technological disasters (n=65), and (3) natural disasters (n=116). Since some studies reported on findings from mixed samples (e.g. survivors of flooding and chemical contamination) we grouped these studies together (n=13). CONCLUSIONS: The body of research conducted after disasters in the past three decades suggests that the burden of PTSD among persons exposed to disasters is substantial. Post-disaster PTSD is associated with a range of correlates including sociodemographic and background factors, event exposure characteristics, social support factors and personality traits. Relatively few studies have employed longitudinal assessments enabling documentation of the course of PTSD. Methodological limitations and future directions for research in this field are discussed.

Preter M, Klein DF. · New York State Psychiatric Institute, Columbia University College of Physicians & Surgeons, 1160 Fifth Avenue, Suite 112, New York, NY 10029, USA. · Prog Neuropsychopharmacol Biol Psychiatry. · Pubmed #17765379 links to  free full text

Abstract: This review paper presents an amplification of the suffocation false alarm theory (SFA) of spontaneous panic [Klein DF (1993). False suffocation alarms, spontaneous panics, and related conditions. An integrative hypothesis. Arch Gen Psychiatry; 50:306-17.]. SFA postulates the existence of an evolved physiologic suffocation alarm system that monitors information about potential suffocation. Panic attacks maladaptively occur when the alarm is erroneously triggered. That panic is distinct from Cannon's emergency fear response and Selye's General Alarm Syndrome is shown by the prominence of intense air hunger during these attacks. Further, panic sufferers have chronic sighing abnormalities outside of the acute attack. Another basic physiologic distinction between fear and panic is the counter-intuitive lack of hypothalamic-pituitary-adrenal (HPA) activation in panic. Understanding panic as provoked by indicators of potential suffocation, such as fluctuations in pCO(2) and brain lactate, as well as environmental circumstances fits the observed respiratory abnormalities. However, that sudden loss, bereavement and childhood separation anxiety are also antecedents of "spontaneous" panic requires an integrative explanation. Because of the opioid system's central regulatory role in both disordered breathing and separation distress, we detail the role of opioidergic dysfunction in decreasing the suffocation alarm threshold. We present results from our laboratory where the naloxone-lactate challenge in normals produces supportive evidence for the endorphinergic defect hypothesis in the form of a distress episode of specific tidal volume hyperventilation paralleling challenge-produced and clinical panic.

Ponniah K, Hollon SD. · New York State Psychiatric Institute, New York and Department of Psychiatry, Columbia University, New York, NY, USA. · Psychol Med. · Pubmed #17640438 No free full text.

Abstract: BACKGROUND: Social phobia is a chronic disorder that results in substantial impairment. We conducted a qualitative review of randomized controlled trials (RCTs) of psychological interventions for social phobia. METHOD: Articles were identified through searches of electronic databases and manual searches of reference lists. They were classified by psychological interventions evaluated. Data regarding treatment, participants and results were then extracted and tabulated. We identified which psychological interventions are empirically supported, using the scheme proposed by Chambless & Hollon (Journal of Consulting and Clinical Psychology 1998, 66, 7-18). RESULTS: Thirty studies evaluating the efficacy of social skills training (SST), exposure therapy and/or cognitive treatments were identified. Cognitive behavior therapy (CBT), involving cognitive restructuring and exposure to feared and avoided social situations or behavioral experiments, was found to be an efficacious and specific treatment for social phobia. Exposure therapy was found to be an efficacious treatment since most of the evidence of its efficacy was from comparisons with no treatment. There were mixed findings regarding the relative efficacy of CBT and in vivo exposure. Some studies reported that the interventions were equivalent, while others found that patients treated with CBT had a better outcome. There was little evidence to support the use of SST. CONCLUSIONS: CBT is the psychological intervention of choice for social phobia. The findings of this review are compared to those of other major reviews and limitations are discussed.

Shear MK, Bjelland I, Beesdo K, Gloster AT, Wittchen HU. · School of Social Work, Columbia University, New York, USA. · Int J Methods Psychiatr Res. · Pubmed #17623395 No free full text.

Abstract: Anxiety disorders, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), comprise a relatively heterogeneous group of clinical conditions that range from specific phobias to obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). The grouping under one heading refers to the fact that these seemingly heterogeneous disorders share a number of common psychopathological features and also share at least some common principles in treatment. Among the shared elements are broadly defined prototypical anxiety reactions, panic attacks, anticipatory anxiety, avoidance behaviour, a predominantly early onset, and relatively high persistence rates over time. Many of the shared diagnostic features of anxiety disorders are by their nature dimensional, and hundreds of psychometric scales have been developed to measure these diagnostic constructs across anxiety disorder and for specific diagnostic classes. This paper explores different types of dimensional approaches used in the literature and discusses how an integrated categorical/dimensional strategy might enhance the usefulness of the DSM-V. We suggest the use of cross-cutting dimensional ratings that might ultimately lead to an improved classification model. We also suggest that a staging approach to illness, based upon supplementary dimensional rating could provide useful information for clinical and research purposes.

Brunelli SA, Hofer MA. · Developmental Neuroscience, New York State Psychiatric Institute, New York, NY 10032, · Behav Brain Res. · Pubmed #17543397 No free full text.

Abstract: Human depression and anxiety disorders show inherited biases across generations, as do antisocial disorders characterized by aggression. Each condition is preceded in children by behavioral inhibition or aggressive behavior, respectively, and both are characterized by separation anxiety disorders. In affected families, adults and children exhibit different forms of altered autonomic nervous system regulation and hypothalamic-pituitary-adrenal activity in response to stress. Because it is difficult to determine mechanisms accounting for these associations, animal studies are useful for studying the fundamental relationships between biological and behavioral traits. Pharmacologic and behavioral studies suggest that infant rat ultrasonic vocalizations (USV) are a measure of an early anxiety-like state related to separation anxiety. However, it was not known whether or not early ultrasound emissions in infant rats are markers for genetic risk for anxiety states later in life. To address these questions, we selectively bred two lines of rats based on high and low rates of USV to isolation at postnatal (P) 10 days of age. To our knowledge, ours is the only laboratory that has ever selectively bred on the basis of an infantile trait related to anxiety. The High and Low USV lines show two distinct sets of patterns of behavior, physiology and neurochemistry from infancy through adulthood. As adults High line rats demonstrate "anxious"/"depressed" phenotypes in behavior and autonomic nervous system (ANS) regulation to standard laboratory tests. In Lows, on the other hand, behavior and autonomic regulation are consistent with an "aggressive" phenotype. The High and Low USV lines are the first genetic animal models implicating long-term associations of contrasting "coping styles" with early attachment responses. They thus present a potentially powerful model for examining gene-environment interactions in the development of life-long affective regulation.

Makhija NJ, Sher L. · Department of Neuroscience, New York State Psychiatric Institute, New York 10032, USA. · Int J Adolesc Med Health. · Pubmed #17458324 No free full text.

Abstract: Adolescent suicide is an escalating crisis that needs to be addressed by clinicians and researchers. Alcohol use has consistently been implicated in adolescent suicide and it is generally assumed that alcohol use leads to an increased risk in suicidality, suicide attempts and completed suicides. It can lead to adolescent suicidality through alcohol myopia, disinhibition, and impaired judgment. Multiple genetically related intermediate phenotypes might contribute to the risk of alcohol misuse and suicidal behavior in adolescents. Genetic variations that enhance the risk for mood and anxiety symptoms or susceptibility to stress might increase risk through different mechanisms. Comorbid disorders such as depression are frequently exhibited in adolescents who misuse alcohol, therefore any adolescent who appears to be at risk for alcoholism or depression should always be screened for all other psychiatric disorders and for suicidality; some signs suicidal adolescents may exhibit include withdrawal, personality change, and a loss of interest in pleasurable activities. While assessment is important, prevention is crucial in any attempt to decrease the incidence of adolescent suicide. The US Center for Disease Control and Prevention (CDC) has established a set of seven guidelines that can be implemented from kindergarten through high school in order to establish alcohol prevention efforts in schools. Through beginning prevention efforts at a young age, it is hopeful that both alcohol misuse and adolescent suicide can be reduced.