Anxiety Disorders: University of Washington

Roy-Byrne PP. · Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98104, USA. · J Clin Psychiatry. · Pubmed #15762815 No free full text.

Abstract: Benzodiazepines bind to a specific site on the gamma-aminobutyric acid (GABA)-benzodiazepine receptor complex. This complex has been implicated in the pathophysiology of anxiety by numerous pre-clinical and clinical studies. Preclinical studies have shown that there are multiple molecular forms of this receptor complex, that these genetically coded variations are linked to specific actions of the benzodiazepines, and that receptors are located in neuroanatomical areas known to mediate the anxiety response in animals and humans. Human studies have shown that patients with pathologic anxiety have anomalous responses to drugs that specifically bind to these receptors and have reduced numbers of benzodiazepine receptors in key brain areas that regulate anxiety responses. More recent preclinical studies suggest that molecular alterations in this receptor complex may produce findings in animals similar to those observed in anxious humans. Finally, chronic treatment with benzodiazepines causes the development of tolerance, which may be associated with molecular changes and a pharmacologic response profile similar to that observed in pathologically anxious humans.

Ai AL, Park CL. · University of Washington, USA. · J Interpers Violence. · Pubmed #15601799 No free full text.

Abstract: The effects of trauma and violence may be better understood by taking a broader perspective that includes resilience and recovery as well as damage and symptomatology. Based on this broader view, this article describes three interrelated, cutting-edge trends in mental health research: (a) the positive psychology movement, (b) the recognition of the role of spirituality and religion in health and well-being, and (c) stress-related growth. The integration of these trends into mainstream studies of trauma and violence will provide a counterbalance to the predominant orientation of victimization and pathology currently evidenced in the literature. All three have important implications for survivors of violence and trauma.

Roy-Byrne PP, Wagner A. · Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Medical Center, Seattle, WA 98104, USA. · J Clin Psychiatry. · Pubmed #15384933 No free full text.

Abstract: Recently, there has been increased interest in the impact and treatment of anxiety disorders. However, one type of anxiety disorder, generalized anxiety disorder (GAD), has received less attention than other disorders, such as panic disorder, despite the prevalence and amenability of this disorder to treatment in the primary care setting. Rates of GAD have been found to be between 2.8% and 8.5%, with a median prevalence of 5.8%-at least twice the rate reported in the National Comorbidity Survey. Up to one third of patients presenting to primary care clinics with somatic complaints had a mood or anxiety disorder. Generalized anxiety disorder is linked to the overuse of medical services: emergency department visits, hospitalizations, diagnostic and laboratory tests, pharmacy costs, and so on. Recognition of anxiety and depression in primary care is poor, with only 23% of pure anxiety cases being recognized compared with 56% of depression cases. The various stakeholders (patients, family members, employers, and insurers) in a patient's outcome often complicate treatment of anxiety. Barriers to effective treatment include time constraints, acute disease orientation of most care systems, lack of planned follow-up and monitoring, and relative unavailability of specialist access. The collaborative care approach is designed to overcome these barriers. With this approach, the patient is provided with additional educational materials, physicians are supported by physician extenders (nurses, social workers, or expert consultants) who provide case-based feedback, follow-up, extra visits, and telephone calls to patients. Providing efficacious treatment to primary care for GAD will require improving knowledge of providers and increasing patient engagement.

Dunner DL. · Center for Anxiety and Depression and the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98105-6099, USA. · J Clin Psychiatry. · Pubmed #15242326 No free full text.

Abstract: Individuals with bipolar and major depressive disorders have considerably higher suicide rates than the general population. However, estimating the risk of suicide is complicated, and there exists a general lack of consensus among researchers regarding whether suicide rates are higher in patients with unipolar, bipolar I, or bipolar II depressive disorders. Isolating the specific factors that contribute to the high risk of suicide in patients with affective disorders can be challenging as well; substance and alcohol abuse, family history of suicide, differences in allele distributions, comorbid anxiety, depression recurrence, seasonal effects, rapid cycling, and a history of hospitalizations for depression all appear to contribute to the likelihood that these patients will engage in suicidal behavior. Research does tend to agree that lithium is efficacious in decreasing suicidal behavior in patients with affective disorders.

Bond EF. · Department of Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, 1959 NE Pacific Street, Box 357266, Seattle WA 98195, USA. · Nurs Clin North Am. · Pubmed #15062727 No free full text.

Abstract: An increasing percentage of the US Armed Forces are women. Although barred from ground combat job titles, women are serving in ever-broader military occupations. Combat activity is widely dispersed in contemporary wars. involving rear echelon personnel and escalating the involvement of women in hostile action. War is associated with psychological trauma, deprivations, and toxic exposures, each potentially evoking profound long-lasting mental and physical health effects on soldiers. There is some evidence that the mental and physical health sequellae are different in women, although there remain many large gaps in our knowledge. These differences may be due to differing exposures and experiences or they may reflect different vulnerabilities. Health care providers caring for soldiers and veterans require accurate data regarding risks borne by the men and women who have experienced war. Needed are continued comprehensive studies of the health status of former war soldiers. These studies must be designed so that men and women can be compared in the context of specific roles and exposures. Debriefing activities are critical to providing early clues to soldiers' health problems. It is reasonable to anticipate that treatment responses may differ for men and women. Needed are broad follow-up studies in women and men to guide clinical care.Nursing education changes are needed. Because the violence and terror that characterize a war zone are not limited to that venue, there is need for systematic preparation of health care providers to care for patients during disaster and mass casualty situations. Health care providers, such as nurses,could benefit from learning strategies to protect their own health, as well,when confronted with mass casualties. Because the United States continues to send large numbers of its citizens to war, it is critical that nurses appreciate the long-term impact of war on the men and women who serve and explore strategies effective in restoring the war veteran's mental and physical health.

Chun BJ, Dunner DL. · Department of Psychiatry and Behavioral Science, Center for Anxiety and Depression, University of Washington, Seattle, WA 98105, USA. · Bipolar Disord. · Pubmed #14996139 No free full text.

Abstract: OBJECTIVES: To determine if the classification of 'antidepressant-induced hypomania' in DSM-IV is supported by available data. METHODS: We reviewed the available scientific literature to examine the incidence of mania and hypomania in non-bipolar patients who were treated with antidepressants. RESULTS: Eighty-nine per cent of studies of antidepressants in major depressive disorder patients reported no cases of treatment-induced hypomania. No instances of treatment-induced hypomania were reported in three large studies of patients with chronic forms of depression. CONCLUSIONS: The rate of antidepressant-induced hypomania in major depressive disorder is within the rate of misdiagnosis of bipolar depression as unipolar. Depressed patients who experience antidepressant-associated hypomania are truly bipolar.

MacDonald CM. · Psychosocial Nursing Graduate Program, University of Washington, Seattle, WA 98105, USA. · Mil Med. · Pubmed #14719618 No free full text.

Abstract: Military members are frequently exposed to traumatic events. In an attempt to mitigate the psychological impact of traumatic events, formal interventions, such as Critical Incident Stress Debriefing and Process Debriefing, have been developed and implemented. Through a literature review of psychological debriefing interventions in the military, several anecdotal and research-based observations are discussed. Suggestions for clinical application and programmatic research are made based on these empirical findings.

Kaysen D, Resick PA, Wise D. · University of Missouri-St Louis, USA. · Trauma Violence Abuse. · Pubmed #14697125 No free full text.

Abstract: In this article on the effects of chronic traumatization, research is reviewed regarding the association between chronicity of traumatization and posttraumatic stress disorder (PTSD) symptomatology. The contribution of the broader traumatic context to PTSD symptomatology is also examined. This review focuses on three populations: combat veterans, child sexual abuse survivors, and survivors of domestic violence. The challenges of defining chronicity of a traumatic event and traumatic context are addressed. Finally, suggestions for future directions are provided.

Dunner DL. · Department of Psychiatry and Behavioral Sciences, Center for Anxiety and Depression, University of Washington School of Medicine, Seattle, WA 98105, USA. · Bipolar Disord. · Pubmed #14636371 No free full text.

Abstract: The prevalence of bipolar disorder is higher than previously believed, especially when bipolar spectrum disorders (BSD) are taken into account, and may approach rates as high as 5%. Difficulties in diagnosing bipolar II and BSD arise from complexities associated with defining and diagnosing hypomania. Additionally, bipolar disorder and BSD are often misdiagnosed because of symptoms that overlap with other psychiatric disorders, particularly unipolar depression. Recognition of the broader spectrum of bipolar disorders and their adequate treatment is paramount because bipolar disorder exacts such a high personal and societal toll, with high rates of suicide and interpersonal problems and a substantial economic burden. Recognition can be improved with active screening, and screening tools such as the Mood Disorders Questionnaire can be easily included in the initial assessment of patients who present with depressive symptoms. Depressive episodes are common in patients who experience BSDs, and increasingly treatment approaches designed specifically for bipolar depression are being studied.

McClellan JM, Werry JS. · Child Psychiatry, 6F-1, Children's Hospital, 4800 Sand Point Way, N.E., Seattle, WA 98125, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #14627873 No free full text.

Abstract: OBJECTIVE: To provide a list of evidence-based psychopharmacology and psychotherapy treatments for child psychiatry. METHOD: Published reviews and Medline searches were examined to generate a list of treatments supported by randomized controlled trials. RESULTS: For psychopharmacology, the best evidence to date supports the use of stimulant medications for attention-deficit/hyperactivity disorder and selective serotonin reuptake inhibitors (SSRIs) for obsessive-compulsive disorder. There is also reasonable evidence addressing SSRIs for anxiety disorders and moderate to severe major depressive disorder, and risperidone for autism. The psychosocial interventions best supported by well-designed studies are cognitive-behavioral and behavioral interventions, especially for mood, anxiety, and behavioral disorders. Family-based and systems of care interventions also have been found effective. CONCLUSIONS: Although the number of evidence-based treatments for child psychiatry is growing, much of clinical practice remains based on the adult literature and traditional models of care. Challenges toward adopting evidence-based practices are discussed.

Beauchaine TP. · Department of Psychology, University of Washington, Seattle 98195-1525, USA. · Dev Psychopathol. · Pubmed #14582930 No free full text.

Abstract: Developmental psychopathologists have criticized categorical classification systems for their inability to account for within-group heterogeneity in biological, etiological. developmental, and cultural influences on behavior. Dichotomizing continuous scores of symptom severity is also inadvisable statistically. Perhaps because of a resulting wariness of categorizing, few explorations into the ontological status of traits or disorders as dimensional versus discrete have been conducted. It is argued here that the limitations of categorizing have little to do with the ontological status of traits and that developmental psychopathologists should be concerned with identifying discrete behavioral syndromes. Common taxometric methods for resolving discrete traits are described, and questions of concern to developmental psychopathologists are outlined that can be addressed through taxometrics studies. These include (a) identifying children who are at risk for future psychopathology, (b) identifying discrete subtypes within current diagnostic classes, (c) locating sensitive periods in the development of discrete pathological traits, (d) discovering moderators of treatment outcome, and (e) elucidating mechanisms of equifinality and multifinality. Although most behavioral traits probably are distributed continuously, identifying those that are discrete will advance the science of developmental psychopathology. Disorders for which taxometric analyses might be applied include anxiety, attention deficit hyperactivity disorder, autism spectrum disorders, conduct problems, depression, and schizophrenia.

Varley CK, Smith CJ. · Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98177, USA. · Pediatr Clin North Am. · Pubmed #14558683 No free full text.

Abstract: Several disorders have been reviewed (Table 1). Based upon review of the literature, an algorithm has been developed, supporting the initial use of cognitive behavioral therapy, followed by a psychopharmacology algorithm if treatment is not successful. In this algorithm, severely anxious patients initially may require psychopharmacologic treatment to be able to participate in cognitive behavioral treatment. Nonspecific measures of parent education, general support, and illness education to parents and patients are overarching principles. In this algorithm, the SSRIs are perceived to be first-line interventions, with tricyclic antidepressants and venlafaxine as second-line agents. Buspirone is considered a second- or third-line agent, as are the benzodiazepines. Table 2 reviews psychopharmacologic agents shown to be useful in the management of anxiety disorders in youth. Although much research remains to be done, there is evidence of efficacy of several interventions for anxiety disorders in children and adolescents. There is a need for a holistic and comprehensive management plan. Particular attention must be given to specific psychopharmacologic and psychotherapy needs, family matters, abuse issues, freedom from substance abuse, the use of peer support groups, and the encouragement of healthier lifestyle choices such as exercise. A rising number of well-done, large, placebo-controlled studies are providing increased support for medication and psychotherapy to inform evidence-based treatment. There is a need for teamwork and effective communication among team members in addressing pediatric and adolescent anxiety disorders.

Labyak SE, Bourguignon C, Docherty S. · Department of Family and Child Nursing, School of Nursing, University of Washington, Seattle 98195-7262, USA. · Holist Nurs Pract. · Pubmed #12889547 No free full text.

Abstract: Children with juvenile rheumatoid arthritis (JRA) report poor sleep quality, daytime sleepiness, fatigue, anxiety, and altered mood. Sleep disturbances in school-aged children are an issue of serious concern. Children are at an age when sleep is of primary importance to physical and intellectual growth, and sleep disturbances that begin in childhood may persist into adulthood. In this article we will review what is currently known about sleep in children with JRA, the influence of medications on sleep quality, the potential impact of poor sleep quality on daily life issues, and complementary/alternative modalities that may be effective in reducing sleep disturbances.

Wagner AW. · Department of Psychiatry & Behavioral Sciences, University of Washington Medical Center, Seattle, Washington, USA. · Semin Clin Neuropsychiatry. · Pubmed #12874738 No free full text.

Abstract: This article discusses the applicability of cognitive-behavioral therapy (CBT) to the treatment of injured trauma survivors, with special consideration of treatment delivery within the trauma care system. The theoretical underpinnings and major treatment components of CBT for posttraumatic stress disorder (PTSD) are presented, followed by a review of the treatment outcome research to date. As few studies have evaluated CBT for injured trauma survivors, specifically, circumstances and comorbidities of this population, that might impact treatment delivery and outcome are discussed within a cognitive-behavioral framework. The article concludes with recommendations for research and treatment of PTSD among injured trauma survivors that draw from cognitive-behavioral theory and empirically supported principles of change.

Zatzick D, Roy-Byrne P. · Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, WA, USA. · Semin Clin Neuropsychiatry. · Pubmed #12874737 No free full text.

Abstract: This pharmacotherapy chapter outlines a series of recommendations regarding the delivery of medications for patients who present with posttraumatic stress disorders (PTSD) and related behavioral and emotional disturbances in the acute care medical setting. These recommendations integrate information previously articulated in PTSD treatment guidelines with clinical experiences derived from real world effectiveness trials. Information from clinical trials suggests that there are patient, provider, and system level considerations that serve to influence the delivery of pharmacotherapeutic interventions targeting PTSD in acute care. The current pharmacotherapy recommendations also integrate considerations regarding the delivery of psychotherapeutic interventions targeting PTSD among injured trauma survivors.

Zatzick D, Roy-Byrne P. · Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, Seattle, Washington, USA. · Semin Clin Neuropsychiatry. · Pubmed #12874736 No free full text.

Abstract: The secondary prevention of posttraumatic stress disorder (PTSD) and related comorbidities among injured trauma survivors constitutes an important public health problem. This article outlines quality-of-care criteria that are intended to guide intervention development for PTSD in the acute care medical setting. The multiple demographic, injury, and service delivery system factors that characterize the acute care setting's clinical heterogeneity are discussed. A model of intervention development that begins with population-based descriptive studies and small pilots of efficacious PTSD treatments and evolves to the development of larger-scale multifaceted collaborative interventions is introduced. Collaborative interventions hold promise for injured trauma survivors treated in acute care settings because they combine evidence-based PTSD interventions and patient-centered supportive care.

Zatzick D. · Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA. · Semin Clin Neuropsychiatry. · Pubmed #12874735 No free full text.

Abstract: Each year in the United States approximately 2.5 million Americans incur injuries so severe that they require inpatient admissions to acute care medical settings. This article reviews the development of posttraumatic stress disorder (PTSD) and related comorbid medical conditions among injured trauma survivors. Between 10% and 40% of injured trauma survivors appear to develop PTSD in the weeks and months after their injury. The symptoms of PTSD are clearly linked to a broad spectrum of functional impairment and diminished well-being in injured patients. Although PTSD, depression, somatic amplification, and recurrent substance use are common disturbances after injury, it appears that few symptomatic trauma survivors receive formal mental health evaluation or treatment. Substantial perceived and structural barriers to accessing care exist for injured trauma survivors. The public health significance of these findings is discussed and implications for future intervention development are explored in the following chapters.

Lee GK, Beaton RD, Ensign J. · Department of Psychosocial and Community Health, University of Washington, School of Nursing, Seattle, Washington, USA. · J Psychosoc Nurs Ment Health Serv. · Pubmed #12812002 No free full text.

Abstract: 1. Eye movement desensitization and reprocessing (EMDR) is an integrative therapy that "unlocks" disturbing memories or beliefs and reprocessess them, in some way, so they are no longer as disabling. 2. EMDR can be used for any experientially based psychological problems and has proven especially effective for traumatic imagery associated with posttraumatic stress disorder. 3. A primary benefit of EMDR is its time efficiency, requiring as few as 3 to 5 hours of treatment. 4. Many potential mechanisms (i.e., cognitive, hypnotic, self-disclosure, biological) may account for the effectiveness of EMDR.

Clark MS, Kaiyala KJ. · Department of Psychiatry and Behavioral Science and Harborview Medical Center, University of Washington, Seattle, WA, USA. · Semin Clin Neuropsychiatry. · Pubmed #12728411 No free full text.

Abstract: Corticotropin-releasing factor (CRF) and related neuropeptides such as urocortin are key mediators of stress in the central nervous system. Through two types of G-protein-linked receptors, they play important roles in stress and its relationship to a variety of psychiatric illnesses. CRF appears to play an important role in regulating key neural systems involved in controlling mood, anxiety, feeding behavior, and the interactions between stress and drug addiction. Our improved understanding of the actions of CRF and related peptides reveals not only mechanisms by which stress affects behavior, but also new opportunities to intervene in psychiatric disorders related to stress exposure.

Turk DC. · Department of Anesthesiology, University of Washington, Seattle 98195, USA. · Pain Res Manag. · Pubmed #12717478 links to  free full text

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Berlant J. · Department of Psychiatry, University of Washington, Seattle, WA 98195, USA. · Curr Opin Investig Drugs. · Pubmed #12625026 No free full text.

Abstract: US FDA approval of two serotonin-selective reuptake inhibitor (SSRI) agents for post-traumatic stress disorder (PTSD) has created new opportunities for drug development. This follows many years of exploring the potential utility of several classes of psychotropic agents for this very common, yet under-recognized and under-treated disorder. This review examines some of the basic neurobiological abnormalities observed in PTSD and summarizes open and controlled drug trials for major classes of medications, including SSRIs, other antidepressants, atypical neuroleptics, noradrenergic modulators and anticonvulsants, while critically evaluating the extent of effectiveness of these agents and reviewing unmet gaps in therapeutic need.

Berry D. · University of Washington, Seattle, Washington, USA. · Int J Psychiatr Nurs Res. · Pubmed #12448875 No free full text.

Abstract: Nurses in mental health settings are expected to provide insightful, wholistic, and effective care. Many patients in mental health settings have concerns or needs related to spiritual or religious dimensions. Unfortunately, many of these concerns are not addressed. Religious psychotherapy (RPT) is an approach to therapy that attempts to recognize and utilize the religious beliefs of clients in treatment for the purposes of reducing mental health difficulties. The purpose of this paper is to review the current randomized and controlled research (RCT) on the utilization of RPT in adult populations with anxiety and depressive disorders and to make recommendations for practice and future research. A search of the literature yielded four studies. A critical review of the studies yielded the following findings: (1) The findings across studies consistently demonstrate that RPT is as effective as standard treatment; (2) the results in each study were statistically significant and appeared to qualify as being clinically significant; and 3) the studies reviewed, although varying in quality, were true experiments marked by intervention, randomization, and control groups or comparison with standard treatment groups. There is warrant for greater consideration of the religious beliefs of depressed and anxious clients in outpatient settings. Nurses should be aware of the potential for the reduction of distressing symptomology through the consideration of clients' belief systems as they effect clients' perceptions of their own mental health.

Clark MS, Neumaier JF. · Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, Seattle, USA. · Psychopharmacol Bull. · Pubmed #12397864 links to  free full text

Abstract: 5-HT1B receptors are expressed throughout the mammalian central nervous system. These receptors are located in the axon terminals of both serotonergic and nonserotonergic neurons, where they act as inhibitory autoreceptors or heteroreceptors, respectively. 5-HT1B receptors inhibit the release of a range of neurotransmitters, including serotonin, GABA, acetylcholine, and glutamate. These receptors have been difficult to study because of the diversity of their cellular localization and the absence of highly selective agonists and antagonists. There has been accumulating evidence, however, that 5-HT1B receptors modulate drug reinforcement, stress sensitivity, mood, anxiety, and aggression. The general results of a number of studies suggest that reduced 5-HT1B heteroreceptor activity may increase impulsive behaviors, whereas reduced 5-HT1B autoreceptor activity may have an antidepressant-like effect. This review focuses on the evidence from animal studies and human genetics that suggest that 5-HT1B receptors may be involved in the mechanism of action of antidepressants and may become important targets of drug therapy in the future.

Fann JR. · Department of Psychiatry, University of Washington, Seattle, WA, USA. · Semin Clin Neuropsychiatry. · Pubmed #12111675 No free full text.

This publication has no abstract.

Myers K, Winters NC. · University of Washington School of Medicine, and Children's Hospital and Regional Medical Center, Seattle 98105, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #12049439 No free full text.

Abstract: OBJECTIVE: This article, the second in the Journal's series of 10-year updates on rating scales, summarizes scales assessing internalizing disorders. METHOD: The authors sampled articles on mood and anxiety disorders over the past 25 years, selected scales with multiple citations over many years, and reviewed their properties. Those with adequate psychometric properties, plus continued wide literature citations or a current special niche, are presented here. RESULTS: Rating scales for depression were developed and/or examined in the 1980s. Despite generally strong properties, they lack clear construct validity. Most have parent-report forms that broaden their suitability with youths. Anxiety scales were developed bimodally. Those developed in the 1960s to 1970s were downward modifications of adult scales. They have been criticized for unclear constructs and unsuitability for youths. Newer scales developed in the 1990s have addressed these problems and have parent-report forms. However, their utility is still being determined. CONCLUSIONS: Rating scales can reliably, validly, and efficiently measure youths' internalizing psychopathology. They have great utility in research, treatment planning, and accountability in practice. However, the user must define the goals of measurement, consider the construct the scale measures, and use the scale within its defined capabilities. The use of more than one scale for a task is recommended.