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American Family Physician Dec 2022Anxiety disorders are the most common psychiatric conditions in children and adolescents, affecting nearly 1 in 12 children and 1 in 4 adolescents. Anxiety disorders...
Anxiety disorders are the most common psychiatric conditions in children and adolescents, affecting nearly 1 in 12 children and 1 in 4 adolescents. Anxiety disorders include specific phobias, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and generalized anxiety disorder. Risk factors include parental history of anxiety disorders, socioeconomic stressors, exposure to violence, and trauma. The U.S. Preventive Services Task Force recommends screening for anxiety disorders in children eight years and older; there is insufficient evidence to support screening in children younger than eight years. Symptoms of anxiety disorders in children and adolescents are similar to those in adults and can include physical and behavioral symptoms such as diaphoresis, palpitations, and tantrums. Care should be taken to distinguish symptoms of a disorder from normal developmental fears and behaviors, such as separation anxiety in infants and toddlers. Several validated screening measures are useful for initial assessment and ongoing monitoring. Cognitive behavior therapy and selective serotonin reuptake inhibitors are the mainstay of treatment and may be used as monotherapies or in combination. Prognosis is improved with early intervention, caretaker support, and professional collaboration.
Topics: Adult; Humans; Adolescent; Anxiety Disorders; Phobic Disorders; Cognitive Behavioral Therapy; Panic Disorder; Selective Serotonin Reuptake Inhibitors
PubMed: 36521463
DOI: No ID Found -
Expert Opinion on Emerging Drugs Sep 2015Anxiety disorders are among the most prevalent and disabling psychiatric disorders in the United States and worldwide. Basic research has provided critical insights into... (Review)
Review
INTRODUCTION
Anxiety disorders are among the most prevalent and disabling psychiatric disorders in the United States and worldwide. Basic research has provided critical insights into the mechanism regulating fear behavior in animals and a host of animal models have been developed in order to screen compounds for anxiolytic properties. Despite this progress, no mechanistically novel agents for the treatment of anxiety have come to market in more than two decades.
AREAS COVERED
The current review will provide a critical summary of current pharmacological approaches to the treatment of anxiety and will examine the pharmacotherapeutic pipeline for treatments in development. Anxiety and related disorders considered herein include panic disorder, social anxiety disorder, generalized anxiety disorder and post-traumatic stress disorder. The glutamate, neuropeptide and endocannabinoid systems show particular promise as future targets for novel drug development.
EXPERT OPINION
In the face of an ever-growing understanding of fear-related behavior, the field awaits the translation of this research into mechanistically novel treatments. Obstacles will be overcome through close collaboration between basic and clinical researchers with the goal of aligning valid endophenotypes of human anxiety disorders with improved animal models. Novel approaches are needed to move basic discoveries into new, more effective treatments for our patients.
Topics: Animals; Anti-Anxiety Agents; Anxiety; Anxiety Disorders; Disease Models, Animal; Drug Design; Humans; Molecular Targeted Therapy
PubMed: 26012843
DOI: 10.1517/14728214.2015.1049996 -
The New England Journal of Medicine Nov 2015
Review
Topics: Antidepressive Agents; Anxiety Disorders; Depressive Disorder, Major; Diagnosis, Differential; Female; Humans; Life Style; Middle Aged; Prevalence; Risk Factors; Selective Serotonin Reuptake Inhibitors; Serotonin and Noradrenaline Reuptake Inhibitors; Sleep Initiation and Maintenance Disorders
PubMed: 26580998
DOI: 10.1056/NEJMcp1502514 -
Psychiatria Polska Aug 2019Due to the co-occurrence of symptoms of anxiety disorders and obsessive-compulsive disorders, and the hypothesis about common etiopathological factors, we performed a... (Comparative Study)
Comparative Study
OBJECTIVES
Due to the co-occurrence of symptoms of anxiety disorders and obsessive-compulsive disorders, and the hypothesis about common etiopathological factors, we performed a research addressing the occurrence and severity of anxiety symptoms, the severity of groups of neurotic symptoms, and conducted factor analyses in two groups of patients: diagnosed with obsessive compulsive disorder (OCD) and with generalized anxiety disorder (GAD).
MATERIAL AND METHODS
A retrospective study was conducted on two groups of patients: 76 - diagnosed with OCD, and 186 - diagnosed with GAD. The source of information about the presence and severity of symptoms was the Symptom Checklist "O" (KO"O"). The impact of sex and the presence or absence of cognitive impairments (Bender's and Benton's tests) on the investigated associations were accounted for.
RESULTS
No significant differences in the severity of most anxiety symptoms were found between the groups of patients diagnosed with OCD or GAD. Patients with GAD were characterized by a significantly higher intensity of phobic disorders, conversion disorders, cardiac autonomic dysfunctions, and hypochondria, when compared to patients with OCD. Factor analyses identified the existence of three similar factors in the OCD and the GAD groups: 'anxiety/depressiveness', 'obsessions' and 'compulsions'. Additional factors were, among others, 'depressiveness' in OCD and separation anxiety in GAD.
CONCLUSIONS
The research indicates that anxiety plays a significant role in the clinical picture of OCD and may reach a severity similar to that observed in GAD. The presence and severity of anxiety and somatization symptoms can be associated with the presence of cognitive impairments, which requires further investigation.
Topics: Adult; Anxiety; Anxiety Disorders; Female; Humans; Male; Middle Aged; Obsessive-Compulsive Disorder; Psychiatric Status Rating Scales; Retrospective Studies; Severity of Illness Index
PubMed: 31760413
DOI: 10.12740/PP/105378 -
Clinical Child and Family Psychology... Jun 2021In current classification systems, selective mutism (SM) is included in the broad anxiety disorders category. Indeed, there is abundant evidence showing that anxiety,... (Review)
Review
In current classification systems, selective mutism (SM) is included in the broad anxiety disorders category. Indeed, there is abundant evidence showing that anxiety, and social anxiety in particular, is a prominent feature of SM. In this article, we point out that autism spectrum problems in addition to anxiety problems are sometimes also implicated in SM. To build our case, we summarize evidence showing that SM, social anxiety disorder (SAD), and autism spectrum disorder (ASD) are allied clinical conditions and share communalities in the realm of social difficulties. Following this, we address the role of a prototypical class of ASD symptoms, restricted and repetitive behaviors and interests (RRBIs), which are hypothesized to play a special role in the preservation and exacerbation of social difficulties. We then substantiate our point that SM is sometimes more than an anxiety disorder by addressing its special link with ASD in more detail. Finally, we close by noting that the possible involvement of ASD in SM has a number of consequences for clinical practice with regard to its classification, assessment, and treatment of children with SM and highlight a number of directions for future research.
Topics: Anxiety; Anxiety Disorders; Autism Spectrum Disorder; Child; Child Behavior Disorders; Humans; Mutism; Phobia, Social
PubMed: 33462750
DOI: 10.1007/s10567-020-00342-0 -
Dialogues in Clinical Neuroscience Jun 2017From the 19th century into the 20th century, the terms used to diagnose generalized anxiety included "pantophobia" and "anxiety neurosis." Such terms designated... (Review)
Review
From the 19th century into the 20th century, the terms used to diagnose generalized anxiety included "pantophobia" and "anxiety neurosis." Such terms designated paroxysmal manifestations (panic attacks) as well as interparoxysmal phenomenology (the apprehensive mental state). Also, generalized anxiety was considered one of numerous symptoms of neurasthenia, a vaguely defined illness. Generalized anxiety disorder (GAD) appeared as a diagnostic category in the third edition of the () in 1980, when anxiety neurosis was split into GAD and panic disorder. The distinct responses these two disorders had to imipramine therapy was one reason to distinguish between the two. Since the revised (), worry about a number of life circumstances has been gradually emphasized as the distinctive symptom of GAD. Thus, a cognitive aspect of anxiety has become the core criterion of GAD. The validity of GAD as an independent category has been questioned from up to preparation of . Areas of concern have included the difficulty to establish clear boundaries between GAD and (i) personality dimensions, (ii) other anxiety-spectrum disorders, and (iii) nonbipolar depression. The National Institute of Mental Health has recently proposed the Research Domain Criteria (RDoC), a framework destined to facilitate biological research into the etiology of mental symptoms. Within the RDoC framework, generalized anxiety might be studied as a dimension denominated "anxious apprehension" that would typically fit into the research domain called "negative valence systems" and the more specific construct termed "potential threat."
Topics: Anxiety; Anxiety Disorders; Depression; Diagnostic and Statistical Manual of Mental Disorders; History, 19th Century; History, 20th Century; Humans; Terminology as Topic
PubMed: 28867935
DOI: 10.31887/DCNS.2017.19.2/macrocq -
Advances in Experimental Medicine and... 2020Anxiety disorders are an enormous societal burden given their high lifetime prevalence among adult populations worldwide. A variety of anxiety disorders can be... (Review)
Review
Cognitive Behavioral Therapy, Mindfulness-Based Cognitive Therapy and Acceptance Commitment Therapy for Anxiety Disorders: Integrating Traditional with Digital Treatment Approaches.
Anxiety disorders are an enormous societal burden given their high lifetime prevalence among adult populations worldwide. A variety of anxiety disorders can be successfully treated with psychological treatments such as cognitive behavioral therapy (CBT), mindfulness-based cognitive therapy (MBCT), and acceptance and commitment therapy (ACT), either as stand-alone individual or group treatment or as adjunctive treatment to pharmacotherapy. Furthermore, a growing body of evidence suggests that therapist-guided Internet-delivered CBT (iCBT) and, to some degree, digitalized mindfulness- and acceptance-based interventions may be an efficacious complement to traditional face-to-face therapy. In view of the current advances regarding the integration of traditional and innovative treatment approaches, this chapter provides an overview on the theory and evidence base for different delivery modes of CBT-related interventions for specific phobia, panic disorder, agoraphobia, social anxiety disorder, and generalized anxiety disorder in adults. Finally, implications for clinical practice and research will be derived, and future directions for the psychological treatment of anxiety disorders will be outlined.
Topics: Acceptance and Commitment Therapy; Anxiety Disorders; Cognitive Behavioral Therapy; Humans; Mindfulness; Phobic Disorders; Treatment Outcome
PubMed: 32002935
DOI: 10.1007/978-981-32-9705-0_17 -
Journal of Affective Disorders Dec 2016There is a lack of clarity regarding specific risk factors discriminating generalized anxiety disorder (GAD) from panic disorder (PD).
BACKGROUND
There is a lack of clarity regarding specific risk factors discriminating generalized anxiety disorder (GAD) from panic disorder (PD).
GOAL
This study investigated whether GAD and PD could be discriminated through differences in developmental etiological factors including childhood parental loss/separation, psychological disorders, and maternal and paternal attachment.
METHOD
Twenty people with adult generalized anxiety disorder (GAD), 20 with adult panic disorder (PD), 11 with adult comorbid GAD and PD, and 21 adult non-anxious controls completed diagnostic interviews to assess symptoms of mental disorders in adulthood and childhood. Participants also reported on parental attachment, loss and separation.
RESULTS
Childhood diagnoses of GAD and PD differentiated clinical groups from controls as well as from each other, suggesting greater likelihood for homotypic over heterotypic continuity. Compared to controls, specific phobia was associated with all three clinical groups, and childhood depression, social phobia, and PTSD were uniquely associated with adult GAD. Both maternal and paternal attachment also differentiated clinical groups from controls. However, higher levels of subscales reflecting maternal insecure avoidant attachment (e.g., no memory of early childhood experiences and balancing/forgiving current state of mind) emerged as more predictive of GAD relative to PD. There were no group differences in parental loss or separation.
CONCLUSIONS
These results support differentiation of GAD and PD based on developmental risk factors. Recommendations for future research and implications of the findings for understanding the etiology and symptomatology of GAD and PD are discussed.
Topics: Adolescent; Adult; Anxiety Disorders; Comorbidity; Female; Humans; Male; Panic Disorder; Parenting; Phobia, Social; Phobic Disorders; Risk Factors; Young Adult
PubMed: 27466747
DOI: 10.1016/j.jad.2016.07.008 -
Current Psychiatry Reports Feb 2022With a focus on reviewing adequately powered randomized controlled trials, we present recent research on the potential of cognitive behavioral therapy for insomnia... (Review)
Review
PURPOSE OF REVIEW
With a focus on reviewing adequately powered randomized controlled trials, we present recent research on the potential of cognitive behavioral therapy for insomnia (CBT-I) to improve depression and anxiety outcomes among patients with insomnia and one of the following comorbid psychiatric disorders: major depressive disorder (MDD), generalized anxiety disorder (GAD), or posttraumatic stress disorder (PTSD). We also examine potential moderators of CBT-I on depression and anxiety outcomes in this population.
RECENT FINDINGS
Despite high comorbidity rates, current behavioral and pharmacological treatments for MDD, GAD, and PTSD do not substantially target or improve insomnia symptoms; residual insomnia is exceedingly common even among patients who experience remission. Insomnia plays a critical role in the onset and maintenance of depression and anxiety, and treating insomnia with CBT-I may improve global outcomes for patients with MDD, GAD, and PTSD. CBT-I is superior to traditional depression/anxiety treatment in improving insomnia symptoms among patients with comorbid psychiatric disorders. Results are mixed on whether CBT-I (either alone or augmented with depression/anxiety treatment) is effective in improving overall MDD, GAD, and PTSD outcomes. Evening circadian preference and depression/anxiety symptom severity may moderate the effect of CBT-I on depression and anxiety outcomes.
Topics: Anxiety; Anxiety Disorders; Cognition; Cognitive Behavioral Therapy; Depression; Depressive Disorder, Major; Humans; Sleep Initiation and Maintenance Disorders; Treatment Outcome
PubMed: 35061137
DOI: 10.1007/s11920-022-01326-3 -
Psychiatry Research Mar 2020Anxiety disorders are highly prevalent in the general population and associated with high rates of impairment and disability. This burden highlights the need to identify...
Anxiety disorders are highly prevalent in the general population and associated with high rates of impairment and disability. This burden highlights the need to identify risk factors that individuals can modify without professional intervention. A systematic review was conducted to identify studies that examined modifiable risk and protective factors for anxiety disorders among adults in the general population. Searches were conducted in PubMed, PsycINFO and MEDLINE using medical subject headings and text words related to risk factors, protective factors, and each anxiety disorder. Screening, data extraction, and quality assessment were performed by three study authors. Modifiable risk and protective factors from 19 studies across seven countries were identified. Risk factors identified included cigarette smoking, alcohol use, cannabis use, negative appraisals of life events, avoidance, and occupational factors. Protective factors included social support, coping, and physical activity. Cigarette smoking was the most studied risk factor. Support was found for cigarette smoking as a risk factor for agoraphobia and panic disorder. Mixed results were found for generalized anxiety disorder and specific phobia. Across disorders, smoking frequency was associated with greater risk. Results indicate an important gap in the literature in that few studies have examined modifiable risk factors for anxiety disorders.
Topics: Adult; Agoraphobia; Anxiety Disorders; Avoidance Learning; Cigarette Smoking; Cross-Sectional Studies; Female; Humans; Male; Occupational Health; Panic Disorder; Prevalence; Protective Factors; Retrospective Studies; Risk Factors; Substance-Related Disorders
PubMed: 31839417
DOI: 10.1016/j.psychres.2019.112705