This review summarizes findings on the epidemiology and etiology of anxiety disorders among children and adolescents including separation anxiety disorder, specific phobia, social phobia, agoraphobia, panic disorder, and generalized anxiety disorder, also highlighting critical aspects of diagnosis, assessment, and treatment. Childhood and adolescence is the core risk phase for the development of anxiety symptoms and syndromes, ranging from transient mild symptoms to full-blown anxiety disorders. This article critically reviews epidemiological evidence covering prevalence, incidence, course, and risk factors. The core challenge in this age span is the derivation of developmentally more sensitive assessment methods. Identification of characteristics that could serve as solid predictors for onset, course, and outcome will require prospective designs that assess a wide range of putative vulnerability and risk factors. This type of information is important for improved early recognition and differential diagnosis as well as prevention and treatment in this age span.

BACKGROUND: Panic disorder is a common and severe psychiatric disorder. The estimated current prevalence rate for panic disorder is 1% to 2% of the adult population. Panic disorder is commonly accompanied by major depression, substance use disorders, and other anxiety disorders. Female gender, low socioeconomic status, and anxious childhood temperament are common risk factors for panic disorder. Panic disorder can produce marked distress and impairment and is associated with significant suicide risk. Panic disorder appears to increase risk for all-cause mortality because it may increase risk for cardiovascular disease.

BACKGROUND: Generalized anxiety disorder (GAD) is generally considered to be a chronic condition, waxing and waning in severity; however prospective investigation of the course of GAD in community samples is lacking. This study seeks to fill that gap, by identifying the whole spectrum of generalized anxiety syndromes, sub-typing them according to their duration and frequency of occurrence, and evaluating their long-term course and outcome in the community. METHOD: The prospective Zurich Study assessed psychiatric and somatic syndromes in a community sample of young adults (N = 591)(aged 20 years at first interview) by six interviews over a period of 20 years (1979-1999). GAD syndromes were defined by DSM-III symptom criteria without applying any exclusion criteria. A spectrum of generalized anxiety was defined by duration: 6 months (DSM-IV), 1 month (DSM-III),</=2 weeks (with weekly occurrence over one year), and anxiety symptoms. From 1978 (screening) to 1999 the annual presence of symptoms and treatment was assessed. Persistence of anxiety was defined by the almost daily presence of symptoms over the previous 12 months. RESULTS: The annual incidence of DSM-III GAD increased considerably between the ages of 20 and 40. The average age of onset of symptoms was 15.6 years; in 75% of cases it occurred before the age of 20. 75 of 105 DSM-III GAD cases had at least one follow-up. At their individual last follow-up, 12 of those 75 subjects (16%) were re-diagnosed as having GAD, 22 (29%) manifested subthreshold syndromes or anxiety symptoms, while 39 cases, the majority,(52%) were symptom-free; 5 of the 12 re-diagnosed GAD cases were persistent (corresponding to 7% of all 75 initial GAD cases). In their twenties they were treated at some time in 6% of all years, but in their thirties this figure rose to 12%. At their individual last follow-up 26% of 6-month GAD subjects and 22% of 1-month GAD subjects were still being treated. Treated vs. non-treated subjects did not differ in terms of gender but did differ in severity, persistence and in comorbidity with bipolar-II disorder, social phobia, obsessive-compulsive syndromes and substance-use disorders. LIMITATIONS: Results are based on a relatively small sample and cannot be generalized to adults aged over 40 years. CONCLUSIONS: The course of DSM-III-defined GAD may not be chronic, as previously suggested, but mainly recurrent with intervening symptom-free periods of recovery in about half of cases. Over a period of 20 years there was more improvement than progression within the anxiety spectrum.

ObjectivesThe relationship of treatment preferences and experiences to outcome was explored in patients with generalized anxiety disorder (GAD).DesignPatients were randomly allocated to either affect-focused body psychotherapy (ABP)(N=26) or standard psychiatric out-patient treatment (N=17).MethodInitial preferences and subsequent experiences of treatment interventions were measured using a questionnaire focusing on support, inward reflection, concrete and directive problem solving, and affective expression. Outcome was assessed after 1 and 2 years in relation to symptom change.ResultsABP patients reported being helped by supportive and reflective treatment interventions to a greater extent than controls. ABP patients also had more positive experiences of supportive and emotionally expressive interventions than they had expected at initial assessment. When patients were divided into two groups on the basis of patterns of preferences and experiences using cluster analysis, it was found that differences in outcome were considerably more marked for clusters than treatment groups.ConclusionsIt is concluded that treatment preferences may have considerable interpersonal potential in therapy; how therapists utilize this potential may be important for improving outcome.

Generalized anxiety disorder is a highly prevalent and under-recognized public health problem associated with significant impairment and serious disability. Generalized anxiety disorder is the most common anxiety disorder among adults over the age of 60 years. This article discusses distinguishing features of generalized anxiety disorder, such as disorder-specific worry domains and associated features. The relation of the disorder to normal aging, major depression and health is also discussed. Current psychosocial treatment strategies are outlined, with a particular focus on cognitive behavior therapy.

OBJECTIVE: Childhood-onset psychiatric disorders can be persistent and impairing but often go untreated. Affected individuals' treatment utilization into adulthood is not well understood. A 15-year follow-up of depressed, anxious, and never mentally ill children (control group) examined need, predisposing, and enabling factors associated with use of outpatient mental health care into early adulthood. METHODS: Between 1977 and 1985, a total of 315 children and adolescents were ascertained. Their psychiatric status and treatment utilization into adulthood were reassessed between 1991 and 1997 by clinicians blind to their childhood diagnoses. RESULTS: Respondents ascertained for depression demonstrated 13-fold, and those ascertained for anxiety demonstrated six-fold, greater odds of any treatment compared with controls. Among utilizers, childhood depression conferred 14-fold, and childhood anxiety, 23-fold, increased odds of long-term treatment. Blacks were less likely than whites to obtain treatment. Utilizers older at follow-up reported longer treatment duration. Mood disorder episodes over follow-up and poorer global functioning were associated with both increased odds of any utilization and increased treatment duration among utilizers. CONCLUSIONS: This sample demonstrated high and persistent treatment utilization. Need indicated by childhood diagnosis was the strongest predictor of treatment; however, utilization also differed by race or ethnicity. Strategies to maximize the uptake of effective, culturally relevant treatment approaches should be investigated.

The nature of Generalized Anxiety Disorder (GAD) and worry across the lifespan remains incompletely understood. We investigated genetic and environmental influences on GAD and the proportion of genetic and environmental variation in GAD that is shared with neuroticism in older adult twins. Participants included 1618 monozygotic and 2291 same-sexed dizygotic twin pairs from the Swedish Twin Registry aged 55 to 74. Participants provided personality information in 1973 and also participated in a telephone screening between 1998 and 2002 that included an assessment for lifetime GAD. Univariate biometric models indicated that both GAD and neuroticism were moderately heritable (.27 and .47, respectively), while the balance of variation reflected environmental factors unique to the individual. Bivariate analyses indicated that approximately one third of the genetic influences on GAD were in common with genetic influences on neuroticism, while individual specific environmental influences were virtually unshared between GAD and neuroticism. Analyses of sex effects suggested that men and women differed in the frequency of lifetime GAD and level of neuroticism; however, no sex differences for genetic and environmental influences for either trait were identified.

OBJECTIVE: The authors sought to observe the long-term clinical course of anxiety disorders over 12 years and to examine the influence of comorbid psychiatric disorders on recovery from or recurrence of panic disorder, generalized anxiety disorder, and social phobia. METHOD: Data were drawn from the Harvard/Brown Anxiety Disorders Research Program, a prospective, naturalistic, longitudinal, multicenter study of adults with a current or past history of anxiety disorders. Probabilities of recovery and recurrence were calculated by using standard survival analysis methods. Proportional hazards regression analyses with time-varying covariates were conducted to determine risk ratios for possible comorbid psychiatric predictors of recovery and recurrence. RESULTS: Survival analyses revealed an overall chronic course for the majority of the anxiety disorders. Social phobia had the smallest probability of recovery after 12 years of follow-up. Moreover, patients who had prospectively observed recovery from their intake anxiety disorder had a high probability of recurrence over the follow-up period. The overall clinical course was worsened by several comorbid psychiatric conditions, including major depression and alcohol and other substance use disorders, and by comorbidity of generalized anxiety disorder and panic disorder with agoraphobia. CONCLUSIONS: These data depict the anxiety disorders as insidious, with a chronic clinical course, low rates of recovery, and relatively high probabilities of recurrence. The presence of particular comorbid psychiatric disorders significantly lowered the likelihood of recovery from anxiety disorders and increased the likelihood of their recurrence. The findings add to the understanding of the nosology and treatment of these disorders.

OBJECTIVE: To examine long-term outcome of late-life anxiety disorders and utilization of mental health care services. METHOD: A cohort of subjects (aged > or = 55 years) with an anxiety disorder (n = 112) was identified in the Longitudinal Aging Study Amsterdam (n = 3107). At 6 year follow-up, the rate of persistence and prognostic factors for persistence of anxiety were established. RESULTS: Six years after baseline 23% of our sample met the criteria for an anxiety disorder. Another 47% suffered from subclinical anxiety symptoms. Persistence of anxiety was associated with a high score on neuroticism at baseline. Use of benzodiazepines was high (43%), while use of mental health care facilities (14%) and anti-depressants (7%) remained low in those with persistent anxiety. CONCLUSION: Results indicate that those high in neuroticism are at greater risk for persistence of anxiety. Efforts to enhance appropriate referral of anxious older adults do not seem to have had the desired effect.

Eighty treatment-seeking adults age 60 or over with panic disorder, generalized anxiety disorder, and mixed anxiety states (generalized anxiety with panic attacks, panic disorder with secondary generalized anxiety) completed a clinical assessment and battery of self report measures. Several hypotheses were tested from the domains of distinguishing symptoms, associated features, and rates of comorbidity with other disorders. Greater between- than within-group variance was found on a subset of measures suggesting that the distinction between GAD and PD is generally valid in the older adult population. Higher scores on measures of sympathetic arousal, agoraphobic avoidance, and rates of comorbid somatization disorder and alcohol dependence distinguished those with PD from those with GAD. Higher scores on measures of depression and hostility, but not trait anxiety or worry, distinguished the GAD group. Results indicate that distinguishing features of GAD and PD in older treatment-seeking adults may be fewer and slightly different from those of younger adults.

Although irritable bowel syndrome (IBS) is a common disorder among gastrointestinal clinic outpatients, it continues to be a diagnosis of exclusion. In treatment-seeking populations, IBS has been frequently associated with psychiatric illness, and this co-occurrence has added to controversy about the validity of the IBS diagnosis. This study is a preliminary effort to examine the nature of this relationship by using the family study design. The probands consisted of 20 patients with IBS and 20 patients who had undergone laproscopic cholecystectomy. Their first-degree relatives were interviewed to obtain lifetime diagnoses of functional gastrointestinal and psychiatric syndromes. Significantly more IBS probands had lifetime psychiatric illness than the cholecystectomy probands. The lifetime prevalence of IBS as well as other functional gastrointestinal syndromes was not significantly different between the groups of relatives. However, significantly more relatives of the IBS probands had lifetime psychiatric illness than the relatives of the cholecystectomy probands. Among the relatives with functional gastrointestinal disorders, significantly more had psychiatric illness. This preliminary study provides support for a relationship between IBS and psychiatric illness by the finding of an increased prevalence of psychiatric disorders among the relatives of patients who have IBS.

OBJECTIVE: To examine the association between parental obsessive-compulsive disorder (OCD) and emotional and behavioural disorders in offspring. METHOD: Demographic, clinical, and diagnostic data were collected from parents with OCD, control subjects, and their respective offspring. Offspring were reassessed at a 2-year follow-up. RESULTS: Probands with OCD and controls were relatively well matched for age, gender, race, educational rating, and marital status. Offspring of OCD probands were at greater risk than offspring of controls for dimensionally measured anxiety, depression, somatization, and social problems. OCD offspring were significantly more likely than control offspring to have lifetime overanxious disorder, separation anxiety disorder, OCD, or 'any anxiety disorder'. Female gender in the parent with OCD, evidence of family dysfunction, and high symptom levels in offspring were predictive of broadly defined OCD at follow-up. CONCLUSION: Children having a parent with OCD are more likely than control offspring to have social, emotional, and behavioural disorders.

Clinical symptoms and self-reported health status in persons reporting multiple chemical sensitivities (MCS) are presented from a 9-year follow-up study. Eighteen (69%) subjects from a sample of 26 persons originally interviewed in 1988 were followed up in 1997 and given structured interviews and self-report questionnaires. In terms of psychiatric diagnosis, 15 (83%) met DSM-IV criteria for a lifetime mood disorder, 10 (56%) for a lifetime anxiety disorder, and 10 (56%) for a lifetime somatoform disorder. Seven (39%) of subjects met criteria for a personality disorder using the Personality Diagnostic Questionnaire-IV. Self-report data from the Illness Behavior Questionnaire and Symptom Checklist-90-Revised show little change from 1988. The 10 most frequent complaints attributed to MCS were headache, memory loss, forgetfulness, sore throat, joint aches, trouble thinking, shortness of breath, back pain, muscle aches, and nausea. Global assessment showed that 2 (11%) had "remitted", 8 (45%) were "much" or "very much" improved, 6 (33%) were "improved", and 2 (11%) were "unchanged/worse". Mean scores on the SF-36 health survey showed that, compared to U.S. population means, subjects reported worse physical functioning, more bodily pain, worse general health, worse social functioning, and more emotional-role impairment; self-reported mental health was better than the U.S. population mean. All subjects maintained a belief that they had MCS; 16 (89%) acknowledged that the diagnosis was controversial. It is concluded that the subjects remain strongly committed to their diagnosis of MCS. Most have improved since their original interview, but many remain symptomatic and continue to report ongoing lifestyle changes.

Nondepressed outpatients with a compulsive buying disorder were recruited by advertisement and word of mouth for inclusion in a controlled treatment trial. Following a 1-week single-blind placebo washout, subjects were randomly assigned to fluvoxamine (n = 12) or placebo (n = 11). Subjects received fluvoxamine (up to 300 mg daily) or placebo for 9 weeks. There were few dropouts. Outcome measures included the Yale-Brown Obsessive-Compulsive Scale--Shopping Version (YBOCS-SV), three Clinical Global Impressions (CGI) ratings, the Hamilton Rating Scale for Depression (HRSD), and the Maudsley Obsessive-compulsive Inventory (MOI). At the conclusion of the trial, 50% of fluvoxamine recipients and 63.6% of placebo recipients achieved CGI ratings of "much" or "very much" improvement, while 33% of fluvoxamine recipients were "very much" improved compared with 18% of placebo recipients (by endpoint analysis). Subjects in both treatment cells showed improvement as early as the second week of the trial, and for most, improvement continued during the 9-week study. There were no significant differences between fluvoxamine- and placebo-treated subjects on any of the outcome measures, with the exception that fluvoxamine recipients achieved greater improvement than placebo recipients on the MOI (p =.02). Adverse experiences were more frequent in the group receiving fluvoxamine, particularly nausea, insomnia, decreased motivation, and sedation. We conclude that in a short-term treatment trial of compulsive buying, subjects receiving fluvoxamine or placebo respond similarly.

The authors assessed self-reported health status and clinical symptoms in people reporting multiple chemical sensitivities (MCS) at a 9-year follow-up interview using structured and semistructured instruments and self-report questionnaires. Of the original sample, 18 people (69%) consented to an interview. By use of the best estimate diagnostic method, 15 subjects (83%) met DSM-IV criteria for a lifetime mood disorder, 10 (56%) for a lifetime anxiety disorder, and 10 (56%) for a lifetime somatoform disorder. None of the subjects met the criteria for a substance use disorder (current or lifetime). The Illness Behavior Questionnaire and the Symptom Check-list-90-Revised results showed little change from 1988 and remained significantly different from the control group on many subscales. The authors conclude that the subjects remain strongly committed to the diagnosis of MCS, and although improved since their original interview, many remain symptomatic and continue to report ongoing lifestyle changes.

OBJECTIVES: Because relatively little is known about illness fears, we sought to estimate the prevalence, risk factors, and morbidity associated with such fears in the community. METHODS: We conducted a brief telephone survey of persons aged 40 to 65 years from randomly selected households in the Johnson County, Iowa, area. Respondents were asked whether a series of illness and medical care items made them no more nervous, somewhat more nervous, or much more nervous than other people. Those who reported more discomfort were asked to what extent this interfered with medical care or caused impairment or distress. Information about demographic and health characteristics was also obtained. RESULTS: Five hundred persons, 62% of those contacted, responded to the survey. A factor analysis revealed four fear dimensions: illness/injury, medical care, blood/needle, and aging/death. Five percent of respondents reported much more nervousness in relation to at least four of six illness/injury items, 4% indicated that such fears interfered with their medical care, and 5% reported some negative effect on their life. Similarly, 5% of respondents reported much more nervousness in relation to at least two of four medical care items. Illness/injury fears were somewhat more common in persons with lower income and education and in those with medical conditions. CONCLUSIONS: This survey shows that fears of illness and medical care are common in the general population and indicates that lower socioeconomic status and experience with illness are associated with these fears. The findings also suggest that interference with care occurs among those with the strongest fears.

BACKGROUND: We sought to examine the demographic and clinical features and psychiatric comorbidity in persons reporting compulsive computer use. METHOD: Sixteen men and 5 women were recruited by advertisement and word-of-mouth. All reported excessive computer use that interfered with social or occupational functioning or caused personal distress. The subjects completed structured and semistructured assessments, including a computer version of the Diagnostic Interview Schedule (DIS), the Minnesota Impulsive Disorders Interview, the Personality Diagnostic Questionnaire-Revised (PDQ-R), and a brief version of the Medical Outcome Study Short Form-36 (SF-36). RESULTS: The typical subject was a 32-year-old single white man with a mean yearly income of $27,000; problem computer use began at age 29 and consumed 27 hours each week. Eleven subjects (52%) reported school or academic problems resulting from their computer use, and 12 (57%) reported that family members had confronted them about it. Thirteen subjects (62%) had tried to cut back on their computer usage. Nine subjects (43%) reported missing work or school owing to their computer use. According to DIS results, 7 subjects (33%) had a lifetime mood disorder, 8 subjects (38%) had a substance use disorder, and 4 subjects (19%) had a lifetime anxiety disorder. According to the PDQ-R results, 11 subjects (52%) met criteria for at least one personality disorder, the most frequent being the borderline, antisocial, and narcissistic types. Impulse-control disorders were also common, particularly compulsive buying. On the SF-36, subjects showed impaired mental health functioning compared with a normative sample. CONCLUSION: The results show that persons reporting compulsive computer use suffer substantial psychiatric comorbidity and show evidence of emotional distress. While the disorder appears to be increasing in prevalence, more work is needed to determine its relationship with other disorders and to determine its risk factors, family history, psychosocial complications, and natural history.

Because few community surveys of hypochondriasis have been completed, little is known about the epidemiology of this disorder outside of clinical populations. To address this deficiency, the authors obtained information about hypochondriasis and pertinent characteristics from a group of first-degree relatives of hypochondriacal and nonhypochondriacal probands who participated in a family study. In addition to psychiatric diagnoses, the authors elicited information on demographic variables, medical history, impairment in functioning, psychiatric comorbidity, psychiatric symptoms, personality traits, and childhood experiences. The authors identified hypochondriasis in 7.7% of the relatives. These relatives had a high rate of comorbid anxiety, depressive, and somatoform disorders. They also reported substantial physical and psychological impairment, including diminished work performance and disability. In addition, these relatives reported greater utilization of health care but less satisfaction with that care. These relatives showed most of the same characteristics found in earlier studies of hypochondriacal patients.

The multiple chemical sensitivities (MCS) syndrome is characterized by unexplained physical and psychiatric complaints attributed by patients and some of their physicians to low-level chemical exposures. In this study, we interviewed 15 subjects with MCS and 21 controls about their first-degree relatives using the Family History-Research Diagnostic Criteria (FH-RDC). Subjects with MCS were more likely than controls to report their relatives to have major depression, alcoholism, panic disorder, obsessive-compulsive disorder, and antisocial personality disorder. They were also likely to have past suicide attempts, and to have received some form of psychiatric treatment (hospitalization, medication or electroconvulsive therapy, or counseling). Nearly 30% of the relatives of subjects with MCS were reported to have MCS themselves. Possible reasons for the findings are discussed.

The generalized anxiety disorder (GAD) is often a debilitating chronic condition, characterized by long-lasting anxiety that is not focused on any object or situation. Besides being clearly linked to increased susceptibility to infectious diseases, anxiety is also known to contribute to the pathogenesis of many inflammatory/autoimmune disorders. The present work aimed to explore the T cell profile following in vitro activation in cultures obtained from a group of individuals with GAD, comparing them with healthy control individuals. Our results demonstrated that cell cultures from GAD group proliferated less following T cell activation as compared with the control group. The analysis of the cytokine profile revealed Th1 and Th2 cytokine deficiencies in the anxious group, as compared with the control subjects. On the other hand, this cellular and humoral immune damage was followed by enhanced production of Th17-derived cytokines. In particular, the levels of TNF-α and IL-17 were significantly higher in cell cultures containing activated T cells from GAD individuals. Therefore, besides a deficiency on Th1 phenotype, an elevated proinflammatory status of these individuals might be related to both glucocorticoid immune resistance and lower IL-10 levels produced by activated T cells. In conclusion, our results demonstrated a T cell functional dysregulation in individuals with GAD, and can help to explain the mechanisms of immune impairment in these subjects and their relationship with increased susceptibility to infections and autoimmune diseases.

The purpose of this study was to extend previous work examining publication rates for the anxiety disorders and publication topics for generalized anxiety disorder (GAD). Specifically, we examined anxiety disorder publication rates in MEDLINE and PsycINFO from 1998 to 2008. The results show:(1) that with the exception of panic disorder, there was a significant increase in the annual rate of publications for every anxiety disorder;(2) that GAD had the second lowest annual rate of publications in every year - with no more than 8% of anxiety disorder publications devoted to GAD in any given year; and (3) that GAD publications focused more often on treatment (44%) than on descriptive issues (26%), process issues (22%), and general reviews (8%). Given that citation analysis appears to be a valid indicator of research progress, the current findings suggest that research on GAD continues to lag behind research on most other anxiety disorders.

This study examines the impact of several of the most common comorbid psychiatric disorders (i.e., generalized anxiety disorder (GAD); major depressive disorder (MDD); social phobia, and panic disorder) on cognitive-behavioral therapy (CBT) response in adults with obsessive-compulsive disorder (OCD). One hundred and forty-three adults with OCD (range=18-79 years) received 14 sessions of weekly or intensive CBT. Assessments were conducted before and after treatment. Primary outcomes included scores on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), response rates, and remission status. Sixty-nine percent of participants met criteria for at least one comorbid diagnosis. Although baseline OCD severity was slightly higher among individuals with OCD+MDD and OCD+GAD (in comparison to those with OCD-only), neither the presence nor the number of pre-treatment comorbid disorders predicated symptom severity, treatment response, remission, or clinically significant change rates at post-treatment. These data suggest that CBT for OCD is robust to the presence of certain common Axis-I comorbidities.

BACKGROUND: Serotonergic dysfunction in schizophrenia, bipolar disorder, major depressive disorder, anxiety disorder, and healthy controls was evaluated by measuring the activity of the loudness dependence of the auditory evoked potential (LDAEP). METHODS: The 357 subjects who were evaluated comprised 55 normal controls, 123 patients with major depressive disorder, 37 with bipolar disorder, 46 with schizophrenia, 37 with panic disorder (PD), 31 with generalized anxiety disorder (GAD), and 28 with post-traumatic stress disorder (PTSD). RESULTS: LDAEP was significantly stronger in healthy controls than in patients with either bipolar disorder (p=0.025) or schizophrenia (p=0.008), and significantly stronger in patients with major depressive disorder than in those with bipolar disorder (p=0.01) or schizophrenia (p=0.03). LDAEP did not differ significantly between patients with major depressive disorder and healthy control subjects (p=0.667), or between healthy control subjects and patients with anxiety disorder, including PD (p=0.469), GAD (p=0.664), and PTSD (p=0.167). CONCLUSION: The findings of the present study reveal that patients with major psychiatric disorders exhibit different strengths of LDAEP according to their serotonin-related pathology. Studies controlled for psychotropic medication, menstruation cycle, and smoking are needed.

BACKGROUND: Uncontrollability and unpredictability are key concepts related to re-experiencing, avoidance, and hypervigilance symptoms of posttraumatic stress disorder (PTSD). However, little is known about the differential sensitivity of PTSD individuals to unpredictable stressors, relative to either healthy individuals or individuals with other anxiety disorders. This study tested the hypothesis that elevated anxious reactivity, specifically for unpredictable aversive events, is a psychophysiological correlate of PTSD. METHODS: Sixteen patients with PTSD (34.5 +/- 12.4 years) were compared with 18 patients with generalized anxiety disorder (GAD)(34.0 +/- 10.5 years) and 34 healthy control subjects (30.2 +/- 8.5 years). Participants were exposed to three conditions: one in which predictable aversive stimuli were signaled by a cue, a second in which aversive stimuli were administered unpredictably, and a third in which no aversive stimuli were anticipated. Startle magnitude was used to assess anxious responses to the threat cue and to contexts associated with each condition. RESULTS: Posttraumatic stress disorder and GAD patients showed normative enhancement of fear to the predictable threat cue, but the PTSD group displayed elevated anxiety during the unpredictable condition compared with participants with GAD and healthy control subjects. CONCLUSIONS: Anxious reactivity to unpredictable aversive events was heightened in PTSD but not in GAD and healthy subjects. Prior works also found signs of increased reactivity to unpredictable threat in panic disorder (PD), suggesting that PTSD and PD may involve shared vulnerability. As such, the current results inform understandings of classification, pathophysiology, and psychopharmacology of anxiety disorders, generally, and PTSD and panic disorder specifically.

Background: Generalized anxiety disorder (GAD) is a common and sometimes disabling condition often associated with stressful life events that involve significant loss or danger. The disorder appears moderately heritable. Polymorphisms in the RGS2 (regulator of G-protein signaling 2) gene were recently associated with anxious behavior in mice and panic disorder and trait anxiety in humans. We examined whether rs4606, a single nucleotide polymorphism (SNP) in the 3' UTR of RGS2, was associated with GAD in an epidemiologic sample of adults exposed to the 2004 Florida Hurricanes. Methods: The sample for the current study is 607 adults from the 2004 Florida Hurricane Study who returned buccal DNA samples via mail. Participants were selected via random digit dial procedures and interviewed via telephone about hurricane exposure, social support, and GAD symptoms. The outcome measure was DSM-IV diagnosis of GAD derived from structured interviews. Results: RGS2 SNP rs4606 was significantly associated with GAD in this sample. In logistic regression analyses, each C allele was associated with a 100%(P=.026) increased risk of GAD after controlling for age, sex, ancestry, hurricane exposure, and social support. Conclusions: These findings are consistent with a previously published study showing a higher prevalence of the C allele among panic disorder patients than controls. This study points toward a relevant polymorphism for GAD at the 3' end of the RGS2 gene; and suggests that studying a recently disaster-exposed sample is both feasible and may improve power to find gene-disorder associations. Depression and Anxiety 0:1-7, 2008. Published 2008 Wiley-Liss, Inc.

High rates of irritable bowel syndrome (IBS) symptoms have been reported in individuals diagnosed with anxiety and depressive disorders. However, most studies have investigated these relations in a single disorder, rather than a heterogeneous group of patients, thereby not allowing for comparisons across anxiety disorders and depression, or for considering the effects of comorbidity. Thus, the present study investigated the symptoms of IBS in a diverse group of patients (N=357) by administering questionnaires and a diagnostic interview. A high frequency of IBS symptoms was found in patients with panic disorder, generalized anxiety disorder, and major depressive disorder. However, the frequency of IBS symptoms in patients with social anxiety disorder, specific phobia, and obsessive-compulsive disorder was comparable to rates found in community samples. In addition, anxiety sensitivity and illness attitudes and intrusiveness were predictive of elevated IBS symptomatology. Together, these findings emphasize the role physiological symptoms of anxiety and worry in the co-occurrence of the anxiety disorders and IBS.

OBJECTIVE: To evaluate the prevalence and course of Axis I concurrent disorders in a population of patients who underwent cognitive-behavioural therapy (CBT) to treat their generalized anxiety disorder (GAD). METHOD: This study is a secondary analysis combining patients from 3 treatment studies done at Université Laval. A total of 90 patients with a DSM-IV consistent GAD diagnosis received from 12 to 16 CBT sessions to treat GAD. Symptomatology was assessed at pretest, posttest, and 6 months after treatment, with the Anxiety Disorders Interview Schedule, a structured diagnostic interview. RESULTS: Seventy-three per cent of patients had both GAD and a concurrent diagnosis. The most common diagnoses were simple phobia, social phobia, panic disorder, and major depression. CBT applied to GAD decreases the number of concurrent diagnoses. A panic disorder or a greater number of concurrent diagnoses at pretest is associated with a less efficient treatment at follow-up 6 months later. CONCLUSION: Patients with GAD have a high comorbidity rate with other Axis I disorders, but these significantly decrease after a short CBT aimed at GAD. Implications for GAD treatment and mechanisms that might explain these findings are discussed.

Muscle relaxation therapy (MRT) has continued to play an important role in the modern treatment of anxiety disorders. Abbreviations of the original progressive MRT protocol [Jacobson, E.(1938). Progressive relaxation (2nd ed.). Chicago: University of Chicago Press] have been found to be effective in panic disorder (PD) and generalized anxiety disorder (GAD). This review describes the most common MRT techniques, summarizes recent evidence of their effectiveness in treating anxiety, and explains their rationale and physiological basis. We conclude that although GAD and PD patients may exhibit elevated muscle tension and abnormal autonomic and respiratory measures during laboratory baseline assessments, the available evidence does not allow us to conclude that physiological activation decreases over the course of MRT in GAD and PD patients, even when patients report becoming less anxious. Better-designed studies will be required to identify the mechanisms of MRT and to advance clinical practice.

The current study examined the naturalistic course of generalized anxiety disorder (GAD) in a sample of 113 primary care patients across a 2-year period. Initial diagnoses were established using structured clinical interviews according to DSM-IV diagnostic criteria. Results indicated that the majority of patients meeting DSM-IV diagnostic criteria for GAD were still symptomatic to some degree after 2 years of follow-up. Rates of full and partial recovery from GAD, however, were found to be higher than those reported for previous studies of GAD in psychiatric patients. Diagnostic comorbidity, severity of psychosocial impairment, and gender were found to be significantly associated with achieving full or partial recovery from GAD. Psychiatric treatment was not found to be associated with time to full or partial recovery from GAD symptoms, likely due to a treatment-biasing effect. These results underscore that GAD is a chronic and persistent illness in primary care patients.