Anxiety Disorders: Columbia University

Jacobson CM, Gould M. · Columbia University/New York State Psychiatric Institute, New York, New York 10032, USA. · Arch Suicide Res. · Pubmed #17453692 No free full text.

Abstract: This article critically reviewed the research addressing the epidemiology and phenomenology of non-suicidal self-injury (NSSI) among adolescents. Articles were identified through a search of Medline and Psychinfo. Findings indicate a lifetime prevalence of NSSI ranging from 13.0% to 23.2%. Reasons for engaging in NSSI include to regulate emotion and to elicit attention. Correlates of NSSI include a history of sexual abuse, depression, anxiety, alexithymia, hostility, smoking, dissociation, suicidal ideation, and suicidal behaviors. Suggested areas of future research include identifying the psychiatric diagnoses associated with NSSI among adolescents, determining the temporal link between NSSI and suicide attempts, learning more about the course of NSSI, understanding the biological underpinnings of NSSI, and identifying effective treatments for NSSI in adolescents.

Opler LA, Grennan MS, Opler MG. · New York University School of Medicine, and New York-Presbyterian Hospital/Columbia University Medical Center, Department of Psychiatry, New York, New York 10032, USA. · Drugs Today (Barc). · Pubmed #17285153 No free full text.

Abstract: In the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III, DSM-III-R and DSM-IV, the diagnosis of post-traumatic stress disorder (PTSD) requires the presence of three symptom clusters: re-experiencing, avoidance and hyperarousal. The selective serotonin reuptake inhibitors (SSRIs), in particular sertraline and paroxetine, have emerged as the treatment of choice for trauma victims experiencing these three symptom clusters. While not approved by the U.S. Food and Drug Administration, other pharmacological agents are often used, some for symptoms found in victims of early, chronic or extreme stress. Referred to as having type II trauma, complex PTSD, disorders of extreme stress and enduring personality change after catastrophic experience, these patients, with symptoms such as dissociation, somatization and self-injurious behavior, need to be recognized as suffering from a trauma-related disorder qualitatively different from that presently captured in the DSM-IV. In this paper we will refer to DSM-IV's construct as simple PTSD (sPTSD); to complex PTSD/disorders of extreme stress as cPTSD/DES; and to both as PTSD. We will review existing evidence for the efficacy of SSRIs in treating sPTSD as well as different pharmacological interventions that are necessary for the treatment of cPTSD/DES. In addition, since both sPTSD and cPTSD/DES frequently coexist with other mental disorders, treatment of comorbid PTSD will be addressed. Finally, given that existing rating scales are not designed to measure symptoms of cPTSD/DES, we will describe the Symptoms of Trauma Scale (SOTS), designed to measure symptoms of both sPTSD and cPTSD.

Gorenstein EE, Papp LA. · Behavioral Medicine Program, Department of Psychiatry, Columbia University, 622 West 168th Street, New York, NY 10032, USA. · Curr Psychiatry Rep. · Pubmed #17257509 No free full text.

Abstract: Anxiety is a significant problem among the elderly. Due to complexities in the medical management of elderly patients, researchers and clinicians have sought psychosocial alternatives to pharmacotherapy in order to treat anxiety in the elderly. Cognitive-behavioral therapy (CBT) in particular has been investigated as a promising treatment. Research conducted to date has established that CBT produces significant improvement in anxiety symptoms among the elderly. However, there is some concern that CBT does not benefit elderly anxiety patients as much as it does younger patients. Investigators are seeking methods of augmenting or supplementing CBT in order to develop more effective treatments for anxiety in the elderly.

Rosenfeld JE. · Columbia University and St. Luke's - Roosevelt Hospital Center, New York, NY, USA. · Anadolu Kardiyol Derg. · Pubmed #17162263 links to  free full text

Abstract: Hypertrophic cardiomyopathy (HCM) exposes young patients to the risk of sudden death. The risk of sudden death separates the young patient from his peers, but connects him more closely to his physician. The physician may have a powerful effect replacing uninformed fears with accurate knowledge, restoring hope, and helping the patient shift focus from the fear of dying to engaging in life and living with a medical illness. Depression and panic disorder are two psychiatric illnesses that are common in cardiac practices, cause significant morbidity and mortality, and may be overlooked and undertreated. Depression is a significant cardiac risk factor. Panic disorder may be confused with cardiac illness and complicate cardiac treatment. The cardiologist should recognize these illnesses and help patients who have them receive treatment for the psychiatric as well as the cardiac causes of their distress. There is a possibility that treating these psychiatric illnesses may actually improve cardiac outcome. Cardiac and psychotropic medications may have additive side effects or interact by altering drug metabolism. Many psychotropic medications cause orthostatic hypotension that may worsen obstructive HCM.

Spitzer RL, First MB, Wakefield JC. · Columbia University, USA. · J Anxiety Disord. · Pubmed #17141468 No free full text.

Abstract: Papers in this special issue of the Journal of Anxiety Disorders concern critical issues and core assumptions that underlie the diagnostic construct of posttraumatic stress disorder. Rather than addressing specific points raised in these papers, we consider the issues and their implications for redefining PTSD and associated disorders in the DSM-V. Specific proposals are advanced to tighten definitional criteria for traumatic events and posttraumatic symptoms. We believe the more stringent criteria express the intent of the PTSD category and will promote more effective research on whether that intent was legitimate or based on misconceptions.

Hertz JA, Knight JR. · Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA. · Adolesc Med Clin. · Pubmed #17030290 No free full text.

Abstract: Misuse of prescription drugs has been a growing problem in the United States affecting all age groups, including adolescents. Recent years have produced many advances in medical management of chronic pain, depression and anxiety, and attention-deficit/hyperactivity disorder. Many of the medications used to treat these disorders, such as the opioids, benzodiazepines, and psychostimulants, also have potential for abuse and dependence. The challenge for the clinician today is to maximize safe and effective treatment with available medication, while preventing the diversion of prescribed medication or the development of substance-related disorders in patients receiving these medications.

Schneier FR. · Anxiety Disorders Clinic, New York State Psychiatric Institute, New York, NY 10032, USA. · N Engl J Med. · Pubmed #16957148 No free full text.

This publication has no abstract.

Zalsman G, Oquendo MA, Greenhill L, Goldberg PH, Kamali M, Martin A, Mann JJ. · Department of Psychiatry, Division of Neuroscience, Columbia University, New York, NY 10032, USA. · Child Adolesc Psychiatr Clin N Am. · Pubmed #16952764 No free full text.

Abstract: This article reviews classical and updated studies of the neurobiology of depressive disorders in children and adolescents. Most studies of childhood and adolescent depression and suicide have followed up the observations and methods used in studies in adults. These studies include neuroendocrine studies, which particularly look at the hypothalamic-pituitary-adrenal axis, the serotonergic system, peripheral blood and cerebrospinal fluid biologic markers, genetics, gene-environment interactions and sleep studies, and neuroimaging and postmortem studies, although in these areas the number of studies is limited.

Mancini AD, Bonanno GA. · Clinical Psychology Program, Columbia University, New York, NY 10027, USA. · J Clin Psychol. · Pubmed #16700017 No free full text.

Abstract: Many persons exposed to loss or potentially traumatic events manage the stresses of these experiences with minimal to no impact on their daily functioning. The prevalence of this resilient capacity has surprised researchers and clinicians alike and refocused clinical practice. We review three key points about resilience: resilience is different from the process of recovery; resilience in the face of loss or potential trauma is common; and there are multiple and sometimes unexpected pathways to resilience. We then present six clinical practices informed by the study of resilience, illustrating key points with clinical vignettes.

Weissman MM. · College of Physicians and Surgeons, Columbia University, Department of Clinical and Genetic Epidemiology, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 24, New York, NY 10034, USA. · Epidemiol Psichiatr Soc. · Pubmed #16584099 No free full text.

Abstract: This Editorial presents recent research on the transmission of depression across three generations and discusses the implications for improving detection, treatment and prevention and for identifying important subgroups for biological studies. It reports a case-control study of three generations at high or low risk for major depression. The first two generations were followed longitudinally for 20 years and were assessed blind to the clinical status of the other generations. Depression is highly familial across three generations. Over 60% of grandchildren (average age 12 yrs.) with two generations affected with depression already have some psychopathology. Anxiety disorders are usually the first presentation before puberty with an increase in depression in adolescents, especially among girls. New opportunities for early detection and treatment exist. Families with three generations affected with depression present a potentially important group for biological, genetic and neuroimaging studies.

DiMaggio C, Galea S. · Mailman School of Public Health, Columbia University, New York, NY 10032, USA. · Acad Emerg Med. · Pubmed #16551774 No free full text.

Abstract: Effective postterrorism public health interventions require the recognition that behavioral consequences are, in fact, the intent of terrorists. The authors searched published and unpublished post-1980 studies that documented population-level behavioral and psychological consequences of terrorist incidents, focusing on posttraumatic stress disorder (PTSD). Results were tabulated, and random effects models were used to calculate overall effect sizes. The analysis indicates that in the year following terrorist incidents, the prevalence of PTSD in directly affected populations varies between 12% and 16%. The review also shows that this prevalence can be expected to decline 25% over the course of that year. These prevalence estimates mask great variability, depending on who is being studied, who is conducting the study, and where the event occurred. Higher rates of disease are reported for survivors and rescue workers, and higher overall rates are also reported from studies conducted in Western Europe compared with studies conducted in North America. Prior psychiatric diagnoses are strongly associated with subsequent PTSD and may be a useful triage factor, particularly when considered together with factors such as female gender and direct exposure to events as either a survivor or rescuer. The review indicates that these associations are consistent across study types and environments and represent important variables to consider when developing triage, outreach, and treatment programs.

Steinglass J, Walsh BT. · Department of Psychiatry, College of Physicians and Surgeons of Columbia University/New York State Psychiatric Institute, New York, New York 10032, USA. · Int J Eat Disord. · Pubmed #16523472 No free full text.

Abstract: OBJECTIVE: Anorexia nervosa (AN) is characterized by abnormal behaviors involving eating and weight that are impressively resistant to change. The persistence of these behaviors likely plays an important role in the high relapse rate after initial treatment. Persistent, stereotyped behaviors are also characteristic of obsessive-compulsive disorder (OCD). This article presents a neurocognitive model of AN, based on comparisons with OCD. METHOD: This article reviews clinical, neuropsychological, and neuroimaging findings in both OCD and AN relevant to a neurobiological understanding of a potential mechanism of the perpetuation of AN. RESULTS: The identification of specific neurocognitive disturbances in individuals with OCD has led to a compelling hypothesis of the neural mechanisms mediating this disorder. Evidence suggests that similar disturbances, involving neural circuits between the cortex and the basal ganglia, may be present in individuals with AN. CONCLUSION: Research on such neurocognitive disturbances has the potential both to inform understanding of neural mechanisms underlying AN and to lead to advances in treatment.

Sher L. · Division of Neuroscience, Department of Psychiatry, Columbia University, New York, NY 10032, USA. · Acta Psychiatr Scand. · Pubmed #16390364 No free full text.

Abstract: OBJECTIVE: The purpose of this paper was to provide a clinical review of the literature on the relation of alcoholism to suicidal behavior. METHOD: Studies of alcoholism and suicidal behavior available in MEDLINE, Institute for Scientific Information Databases (Science Citation Index Expanded, Social Sciences Citation Index, and Arts & Humanities Citation Index), EMBASE, and Cochrane Library were identified and reviewed. RESULTS: Alcoholism is associated with a considerable risk of suicidal behavior. Individuals with alcoholism who attempt or complete suicide are characterized by major depressive episodes, stressful life events, particularly interpersonal difficulties, poor social support, living alone, high aggression/impulsivity, negative affect, hopelessness, severe alcoholism, comorbid substance, especially cocaine abuse, serious medical illness, suicidal communication, and prior suicidal behavior. Partner-relationship disruptions are strongly associated with suicidal behavior in individuals with alcoholism. CONCLUSION: All individuals with alcoholism should receive a suicide risk assessment based on known risk factors.

Louis ED. · Department of Neurology, Columbia University, New York, New York, USA. · Adv Neurol. · Pubmed #16383227 No free full text.

Abstract: As the complexity and heterogeneity of ET emerge, greater interest has been taken in the nonmotor manifestations of this disease. The fact that the motor manifestations reflect widespread anatomic pathology (e.g., cerebellum, basal ganglia) suggests that the nonmotor aspects might be a manifestation of an illness that affects multiple areas of the nervous system. Therefore, nonmotor aspects of the disease might reflect the presence of disease pathology in a particular area of the brain. Alternatively, nonmotor aspects could be the result of the tremor itself and the effects that it has on disability, mood, and personality. Finally, some of the nonmotor aspects could reflect the possibility that individuals with these disorders have a shared predisposition for ET and that a common mechanism underlies both. Further work is needed to define the extent of the nonmotor manifestations, their presence or absence in the predisease state, and their progression over time. These studies will further our insights into the mechanisms and anatomic pathology of ET and help us to develop a broader understanding of issues that are important in treating the individuals with this disease.

Waslick B. · Department of Psychiatry, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA. · Child Adolesc Psychiatr Clin N Am. · Pubmed #16321725 No free full text.

Abstract: Pediatric anxiety disorders are commonly occurring mental health disorders of childhood and are associated with significant distress, impairment, and risk for ongoing morbidity. During the past decade, significant progress has been made in developing safe and effective therapeutic approaches to these disorders. This article focuses on the scientific literature supporting the use of a variety of medication approaches to the treatment of the various anxiety disorders of childhood and adolescence.

Leonardo ED, Hen R. · Center for Neurobiology and Behavior, Columbia University, New York, New York 10032, USA. · Annu Rev Psychol. · Pubmed #16318591 No free full text.

Abstract: The study of the genetics of complex behaviors has evolved dramatically from the days of the nature versus nurture debates that dominated much of the past century. Here we discuss advances in our understanding of the genetics of affective and anxiety disorders. In particular, we highlight our growing understanding of specific gene-environment interactions that occur during critical periods in development, setting the stage for later behavioral phenotypes. We review the recent literature in the field, focusing on recent advances in our understanding of the role of the serotonin system in establishing normal anxiety levels during development. We emphasize the importance of understanding the effect of genetic variation at the level of functional circuits and provide examples from the literature of how such an approach has been exploited to study novel genetic endpoints, including genetically based variation in response to medication, a potentially valuable phenotype that has not received much attention to date.

Skodol AE, Gunderson JG, Shea MT, McGlashan TH, Morey LC, Sanislow CA, Bender DS, Grilo CM, Zanarini MC, Yen S, Pagano ME, Stout RL. · New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, NY 10032, USA. · J Pers Disord. · Pubmed #16274278 No free full text.

Abstract: The Collaborative Longitudinal Personality Disorders Study (CLPS; Gunderson et al., 2000) was developed to fill gaps in our understanding of the nature, course, and impact of personality disorders (PDs). Here, we review published findings to date, discuss their implications for current conceptualizations of PDs, and raise questions that warrant future consideration. We have found that PDs are more stable than major depressive disorder, but that meaningful improvements are possible and not uncommon. We have confirmed also that PDs constitute a significant public health problem, with respect to associated functional impairment, extensive treatment utilization, negative prognostic impact on major depressive disorder, and suicide risk. At the same time, we have demonstrated that dimensional models of PDs have clinical validity that categories do not, especially greater temporal stability. Furthermore, dimensional personality traits appear to be the foundation of behaviors described by many PD criteria. Taken together, our results lead us to hypothesize that PDs may be reconceptualized as hybrids of stable personality traits and intermittently expressed symptomatic behaviors.

Haney M. · New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA. · Curr Psychiatry Rep. · Pubmed #16216154 No free full text.

Abstract: A subset of marijuana smokers develop a cannabis use disorder and seek treatment for their marijuana use on their own initiative. A less well-known consequence of daily, repeated marijuana use is a withdrawal syndrome, characterized by a time-dependent constellation of symptoms: irritability, anxiety, marijuana craving, decreased quality and quantity of sleep, and decreased food intake. Treatment studies show that rates of continuous abstinence are low (comparable to relapse rates for other abused drugs), and more treatment options are needed. The objective of this review is to update clinicians on the current state of marijuana research and to describe features of marijuana withdrawal to facilitate the diagnosis and treatment of cannabis use disorders.

Brown RP, Gerbarg PL. · Columbia College of Physicians and Surgeons, New York, NY, USA. · J Altern Complement Med. · Pubmed #16131297 No free full text.

Abstract: Yogic breathing is a unique method for balancing the autonomic nervous system and influencing psychologic and stress-related disorders. Part I of this series presented a neurophysiologic theory of the effects of Sudarshan Kriya Yoga (SKY). Part II will review clinical studies, our own clinical observations, and guidelines for the safe and effective use of yoga breath techniques in a wide range of clinical conditions. Although more clinical studies are needed to document the benefits of programs that combine pranayama (yogic breathing) asanas (yoga postures), and meditation, there is sufficient evidence to consider Sudarshan Kriya Yoga to be a beneficial, low-risk, low-cost adjunct to the treatment of stress, anxiety, post-traumatic stress disorder (PTSD), depression, stress-related medical illnesses, substance abuse, and rehabilitation of criminal offenders. SKY has been used as a public health intervention to alleviate PTSD in survivors of mass disasters. Yoga techniques enhance well-being, mood, attention, mental focus, and stress tolerance. Proper training by a skilled teacher and a 30-minute practice every day will maximize the benefits. Health care providers play a crucial role in encouraging patients to maintain their yoga practices.

Gilliam FG, Mendiratta A, Pack AM, Bazil CW. · Department of Neurology, Neurological Institute, Columbia University, New York, NY 10032, USA. · Epileptic Disord. · Pubmed #16120491 links to  free full text

Abstract: Epilepsy is a chronic disorder that has been associated with other specific health problems. Evidence from recent clinical and basic investigations indicates that aspects of cerebral dysfunction associated with a lowered seizure threshold may also predispose toward other disorders such as depression, cognitive impairment, sleep disorders, and migraine. Similarly, certain types of brain injury may also increase the risk of adverse antiepileptic drug (AED) effects. For example, a history of febrile seizures is associated with a three fold increase in the occurrence of negative psychiatric effects of two newer AEDs. Poor fitness and obesity are also reported at higher rates in epilepsy. Some comorbid conditions in epilepsy, such a depression and anxiety, may have a greater influence on subjective health status than does seizure rate. Management strategies employed in the outpatient clinic to maximize overall health outcomes should include screening and treatment for the commonly coexistent conditions in persons with epilepsy.

Hien D, Cohen L, Campbell A. · Columbia University, Social Intervention Group, New York, NY, USA. · Clin Psychol Rev. · Pubmed #15967556 No free full text.

Abstract: The primary goal of this paper is to review existing findings from trauma, addictions and developmental research in order to delineate salient and outstanding questions for future research in this field. Toward this aim, our manuscript will provide an overview of the extant body of knowledge of trauma/PTSD comorbidity with substance use disorders and draw attention to converging developmental and neurobiological literature on the consequences of trauma on self-regulation. We conclude with suggestions for future research in these areas.

Mariani JJ, Levin FR. · Department of Psychiatry, Division on Substance Abuse, Columbia University, College of Physicians and Surgeons, USA. · Harv Rev Psychiatry. · Pubmed #15764470 No free full text.

Abstract: Alcohol-related disorders are a major public health problem in the United States. Alcohol interacts with several neurotransmitter systems causing both acute and chronic effects in the brain. While the mainstay of treatment of alcohol-related disorders, with the exception of alcohol withdrawal, has historically been psychosocial, pharmacotherapy is increasingly being investigated and incorporated into standard clinical practice. Patients with alcohol use disorders and comorbid psychiatric conditions, most commonly depressive and anxiety disorders, can benefit from symptom-targeted pharmacotherapy, even if the patient fails to achieve abstinence from alcohol. Although benzodiazepines remain the treatment of choice to treat alcohol withdrawal, a variety of other agents is being investigated, particularly in the outpatient setting. Further randomized clinical trials of alcohol-related disorder pharmacotherapy, particularly of comorbid subpopulations, are needed to better inform clinical decision making. The routine exclusion of alcohol-dependent patients from pharmacotherapy trials of psychiatric disorders presents a barrier to gathering more data. Recommendations for future research are discussed.

Brown RP, Gerbarg PL. · Columbia College of Physicians and Surgeons, New York, NY, USA. · J Altern Complement Med. · Pubmed #15750381 No free full text.

Abstract: Mind-body interventions are beneficial in stress-related mental and physical disorders. Current research is finding associations between emotional disorders and vagal tone as indicated by heart rate variability. A neurophysiologic model of yogic breathing proposes to integrate research on yoga with polyvagal theory, vagal stimulation, hyperventilation, and clinical observations. Yogic breathing is a unique method for balancing the autonomic nervous system and influencing psychologic and stress-related disorders. Many studies demonstrate effects of yogic breathing on brain function and physiologic parameters, but the mechanisms have not been clarified. Sudarshan Kriya yoga (SKY), a sequence of specific breathing techniques (ujjayi, bhastrika, and Sudarshan Kriya) can alleviate anxiety, depression, everyday stress, post-traumatic stress, and stress-related medical illnesses. Mechanisms contributing to a state of calm alertness include increased parasympathetic drive, calming of stress response systems, neuroendocrine release of hormones, and thalamic generators. This model has heuristic value, research implications, and clinical applications.

Lessing JE. · Children's Hospital of New York, Columbia University, New York, NY 10032, USA. · J Pediatr Health Care. · Pubmed #15662358 No free full text.

Abstract: Acute sexual assault is a serious and underreported crime with the potential for causing grave physical and emotional harm to its victim. As a result of developmental and psychological factors, the adolescent victim may delay the disclosure of such an assault and therefore experience detrimental, acute, and long-term effects. By understanding the reasons for delayed disclosure and integrating this with currently established guidelines for acutely assaulted patients, primary care providers can better tailor the care they provide when faced with the delayed disclosure of adolescent sexual assault. Furthermore, based on this review, it becomes clear that standardized protocols are necessary to more efficiently care for these patients. Recommendations are provided to allow tailoring of primary care provider's interventions based on established protocols and new understandings when caring for adolescents who delay the disclosure of their sexual assault.

Sher L. · Division of Neuroscience, Department of Psychiatry, Columbia University, New York, NY 10032, USA. · Forsch Komplementarmed Klass Naturheilkd. · Pubmed #15604626 No free full text.

Abstract: The concept of the placebo effect has received a considerable attention over the past several decades. The placebo effect has been observed in different psychiatric disorders, including post-traumatic stress disorder (PTSD), a chronic and severe disorder precipitated by exposure to a psychologically distressing event. The placebo response rates in patients with PTSD range from 19% to 62%. A considerable number of research publications suggest that endogenous opioids are involved in the mechanisms of the placebo effect. Endogenous opioid peptides play an important role in stress response and in the pathophysiology of PTSD. Therefore, endogenous opioids may be involved in the neurobiology of the placebo effect in PTSD. Possibly, the endogenous opioid system mediates the effect of placebo on all 3 PTSD symptom clusters (re-experiencing symptoms, avoidance and numbing, and physiologic arousal). The placebo effect-related activation of the endogenous opioid system may result in an improvement in intrusive symptomatology and symptoms of increased arousal because the administration of exogenous opioids improve these symptoms. The placebo effect-related activation of the endogenous opioid system may have a mood-enhancing effect, and, consequently, diminish avoidance and numbing. Multiple neurotransmitter and neuroendocrine pathways may be involved in the mechanisms of the placebo effect in PTSD. Further studies of the neurobiology of the placebo effect on patients with PTSD and other psychiatric disorders may produce interesting and important results.