Selective processing of masked and unmasked verbal threat material in anxiety: Influence of an immediate acute stressor

Attentional biases for threat were investigated using a computerised version of the emotional Stroop task. The study examined the influence of state and trait anxiety by employing a student sample assigned to high trait anxious (HTA; n = 32) or low trait anxious (LTA; n = 32) groups on the basis of questionnaire scores, and state anxiety was manipulated within participants through the threat of electric shock. Threatening words that were either unrelated (e.g., cancer, danger) or related to the threat of shock (e.g., electrocute, shock) were presented to participants both within and outside of awareness. In the latter condition a backward masking procedure was used to prevent awareness and exposure thresholds between the target and mask were individually set for each participant. For unmasked trials the HTA group showed significant interference in colour naming for all threat words relative to control words when performing under the threat of shock, but not in the shock safe condition. For the masked trials, despite chance performance in being able to identify the lexical status of the items, HTA participants showed facilitated colour naming for all threat words relative to control items when performing under threat of shock, but this effect was not evident in the shock safe condition. Neither valence of the items nor the threat of shock influenced colour naming latencies in either exposure mode for the LTA group.

Validation of the Quality of Life Inventory for patients with anxiety and depression

Background: In 1992, Frisch et al (Psychol Assess. 1992;4:92- 10 1) developed the Quality of Life Inventory (QOLI) to measure the concept of quality of life (QOL) because it has long been thought to be related to both physical and emotional well-being. However, the psychometric properties of the QOLI in clinical populations are still in debate. The present study examined the factor structure of QOLI and reported its validity and reliability in a clinical sample. Method: Two hundred seventeen patients with anxiety and depressive disorders completed the QOLI and additional questionnaires measuring symptoms (Zung Self-rating Depression Scale, Beck Anxiety Inventory, Fear Questionnaire, Depression Anxiety Stress Scale-Stress) and subjective well-being (Satisfaction With Life Scale) were also used. Results: Exploratory factor analysis via the principal components method, with oblique rotation, revealed a 2-factor structure that accounted for 42.73% of the total variance, and a subsequent confirmatory factor analysis suggested a moderate fit of the data to this model. The 2 factors appeared to describe self-oriented QOL and externally oriented QOL. The Cronbach alpha coefficients were 0.85 for the overall QOLI score, 0.81 for the first factor, and 0.75 for the second factor. Conclusion: Consistent evidence was also found to support the concurrent, discriminant, predictive, and criterion-related validity of the QOLI. (c) 2006 Elsevier Inc. All rights reserved.

Autonomic response in depersonalisation disorder

Background Emotional-processing inhibition has been suggested as a mechanism underlying some of the clinical features of depersonalization and/or derealization. In this study, we tested the prediction that autonomic response to emotional stimuli would be reduced in patients with depersonalization disorder. Methods The skin conductance responses of 15 patients with chronic depersonalization disorder according to DSM-IV, 15 controls, and 11 individuals with anxiety disorders according to DSM-IV, were recorded in response to nonspecific elicitors (an unexpected clap and taking a sigh) and in response to 15 randomized pictures with different emotional valences: 5 unpleasant, 5 pleasant, and 5 neutral. Results The skin conductance response to unpleasant pictures was significantly reduced in patients with depersonalization disorder (magnitude of 0.017 µsiemens in controls and 0.103 µsiemens in patients with anxiety disorders; P = .01). Also, the latency of response to these stimuli was significantly prolonged in the group with depersonalization disorder (3.01 seconds compared with 2.5 and 2.1 seconds in the control and anxiety groups, respectively; P = .02). In contrast, latency to nonspecific stimuli (clap and sigh) was significantly shorter in the depersonalization and anxiety groups (1.6 seconds) than in controls (2.3 seconds) (P = .03). Conclusions In depersonalization disorder, autonomic response to unpleasant stimuli is reduced. The fact that patients with depersonalization disorder respond earlier to a startling noise suggests that they are in a heightened state of alertness and that the reduced response to unpleasant stimuli is caused by a selective inhibitory mechanism on emotional processing.

Autonomic response in the perception of disgust and happiness in depersonalization disorder

Patients with depersonalization disorder have shown attenuated responses to emotional unpleasant stimuli, hence supporting the view that depersonalization is characterised by a selective inhibition on the processing of unpleasant emotions. It was the purpose of this study to establish if autonomic responses to facial emotional expressions also show the same blunting effect. The skin conductance responses (SCRs) of 16 patients with chronic DSM-IV depersonalization disorder, 15 normal controls and 15 clinical controls with DSM-IV anxiety disorders were recorded in response to facial expressions of happiness and disgust. Patients with anxiety disorders were found to have greater autonomic responses than patients with depersonalization, in spite of the fact that both groups had similarly high levels of subjective anxiety as measured by anxiety scales. SCR to happy faces did not vary across groups. The findings of this study provide further support to the idea that patients with depersonalization have a selective impairment in the processing of threatening or unpleasant emotional stimuli.

The impact of the Val158Met catechol-O-methyltransferase genotype on neural correlates of sad facial affect processing in patients with bipolar disorder and their relatives

Background - The Met allele of the catechol-O-methyltransferase (COMT) valine-to-methionine (Val158Met) polymorphism is known to affect dopamine-dependent affective regulation within amygdala-prefrontal cortical (PFC) networks. It is also thought to increase the risk of a number of disorders characterized by affective morbidity including bipolar disorder (BD), major depressive disorder (MDD) and anxiety disorders. The disease risk conferred is small, suggesting that this polymorphism represents a modifier locus. Therefore our aim was to investigate how the COMT Val158Met may contribute to phenotypic variation in clinical diagnosis using sad facial affect processing as a probe for its neural action. Method - We employed functional magnetic resonance imaging to measure activation in the amygdala, ventromedial PFC (vmPFC) and ventrolateral PFC (vlPFC) during sad facial affect processing in family members with BD (n=40), MDD and anxiety disorders (n=22) or no psychiatric diagnosis (n=25) and 50 healthy controls. Results - Irrespective of clinical phenotype, the Val158 allele was associated with greater amygdala activation and the Met allele with greater signal change in the vmPFC and vlPFC. Signal changes in the amygdala and vmPFC were not associated with disease expression. However, in the right vlPFC the Met158 allele was associated with greater activation in all family members with affective morbidity compared with relatives without a psychiatric diagnosis and healthy controls. Conclusions - Our results suggest that the COMT Val158Met polymorphism has a pleiotropic effect within the neural networks subserving emotional processing. Furthermore the Met158 allele further reduces cortical efficiency in the vlPFC in individuals with affective morbidity. © 2010 Cambridge University Press.

Influence of birth cohort on age of onset cluster analysis in bipolar I disorder

PURPOSE: Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database. METHODS: The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared. RESULTS: There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups. CONCLUSION: These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.

Social and individual influences on eating in preadolescents:the role of friends’ eating behaviours and individual anxiety and depression

Background: Friends are important role models for the formation of social norms and behaviour comparisons, particularly in children. This study examined the similarities between pre-adolescent children’s own eating behaviours with the eating behaviours of those in their friendship group. It also evaluated whether symptoms of anxiety and depression were related to eating behaviours in this age group. Methods: Three hundred and forty three children (mean age 8.75 years) completed questionnaires designed to measure dietary restraint, emotional eating and external eating, as well as general and social anxiety, and symptoms of depression. Children also provided details about their friendship groups. Results: Pre-adolescents’ dietary restraint was positively predicted by the dietary restraint of members of their friendship groups, and their individual levels of anxiety and depression. The levels of general anxiety exhibited by pre-adolescents predicted emotional and external eating behaviours. Younger children were significantly more likely to report higher levels of emotional and external eating than older children, and boys were more likely to report more external eating behaviours than girls. Conclusions: These results suggest that greater dieting behaviours in pre-adolescents are related to their friends’ reports of greater dieting behaviours. In contrast, greater levels of eating governed by emotions, and eating in response to external hunger cues, are related to greater symptoms of anxiety in pre-adolescent children. Such findings underline the importance of friends’ social influences on dieting behaviours in this age group and highlight the value of targeting healthy eating and eating disorder prevention interventions at pre-adolescents.

Anxiety sensitivity in children and the development of panic and anxiety in adolescents: A prospective study

Research with adult samples has identified a cognitive risk factor for the development of panic and other anxiety disorders in the concept of anxiety sensitivity. The research to date on anxiety sensitivity in children, using the Childhood Anxiety Sensitivity Index (CASI), suggests that the CASI may help to garner knowledge regarding the development of anxiety sensitivity and also help to understand the development of panic attacks, panic disorder and other anxiety disorders in youth. To examine the development of anxiety sensitivity and its relation to panic in youth, data were collected on 44 children in 1998 who were administered the CASI in 1991. Results indicated that children whose CASI scores increased from Time 1 to Time 2 were significantly more likely to report experiencing panic attacks than children whose CASI scores decreased from Time 1 to Time 2. Specifically, 64% (9/14) of children whose CASI scores increased from Time 1 to Time 2 reported having one or more panic attacks versus 36% (5/14) reported having none. Moreover, 72% (21/29) of children whose CASI scores decreased from Time 1 to Time 2 reported no panic attacks. These results suggest that childhood may be the time when anxiety sensitivity as a risk factor for panic and panic disorder is developing. Results are discussed in terms of their relevance for understanding the development of panic and the need for further research to determine the generalizability of these findings in larger samples of children followed over different time spans. ^

Online information seeking by patients with bipolar disorder:results from an international multisite survey

Background: Information seeking is an important coping mechanism for dealing with chronic illness. Despite a growing number of mental health websites, there is little understanding of how patients with bipolar disorder use the Internet to seek information. Methods: A 39 question, paper-based, anonymous survey, translated into 12 languages, was completed by 1222 patients in 17 countries as a convenience sample between March 2014 and January 2016. All patients had a diagnosis of bipolar disorder from a psychiatrist. Data were analyzed using descriptive statistics and generalized estimating equations to account for correlated data. Results: 976 (81 % of 1212 valid responses) of the patients used the Internet, and of these 750 (77 %) looked for information on bipolar disorder. When looking online for information, 89 % used a computer rather than a smartphone, and 79 % started with a general search engine. The primary reasons for searching were drug side effects (51 %), to learn anonymously (43 %), and for help coping (39 %). About 1/3 rated their search skills as expert, and 2/3 as basic or intermediate. 59 % preferred a website on mental illness and 33 % preferred Wikipedia. Only 20 % read or participated in online support groups. Most patients (62 %) searched a couple times a year. Online information seeking helped about 2/3 to cope (41 % of the entire sample). About 2/3 did not discuss Internet findings with their doctor. Conclusion: Online information seeking helps many patients to cope although alternative information sources remain important. Most patients do not discuss Internet findings with their doctor, and concern remains about the quality of online information especially related to prescription drugs. Patients may not rate search skills accurately, and may not understand limitations of online privacy. More patient education about online information searching is needed and physicians should recommend a few high quality websites.

Facial affect processing inbipolar disorder:a magnetoencephalography study

Background: Identifying biological markers to aid diagnosis of bipolar disorder (BD) is critically important. To be considered a possible biological marker, neural patterns in BD should be discriminant from those in healthy individuals (HI). We examined patterns of neuromagnetic responses revealed by magnetoencephalography (MEG) during implicit emotion-processing using emotional (happy, fearful, sad) and neutral facial expressions, in sixteen BD and sixteen age- and gender-matched healthy individuals. Methods: Neuromagnetic data were recorded using a 306-channel whole-head MEG ELEKTA Neuromag System, and preprocessed using Signal Space Separation as implemented in MaxFilter (ELEKTA). Custom Matlab programs removed EOG and ECG signals from filtered MEG data, and computed means of epoched data (0-250ms, 250-500ms, 500-750ms). A generalized linear model with three factors (individual, emotion intensity and time) compared BD and HI. A principal component analysis of normalized mean channel data in selected brain regions identified principal components that explained 95% of data variation. These components were used in a quadratic support vector machine (SVM) pattern classifier. SVM classifier performance was assessed using the leave-one-out approach. Results: BD and HI showed significantly different patterns of activation for 0-250ms within both left occipital and temporal regions, specifically for neutral facial expressions. PCA analysis revealed significant differences between BD and HI for mild fearful, happy, and sad facial expressions within 250-500ms. SVM quadratic classifier showed greatest accuracy (84%) and sensitivity (92%) for neutral faces, in left occipital regions within 500-750ms. Conclusions: MEG responses may be used in the search for disease specific neural markers.

A preliminary examination of the relationship between compulsive exercise and shame in individuals with an eating disorder: and clinical research portfolio

Objective: To explore the relationship between compulsive exercise and shame in a clinical sample of eating disorder patients. Method: In a cross-sectional study, individuals with an eating disorder (n=21) completed self-report measures of compulsive exercise, internal shame, external shame, bodily shame, anxiety and depression. Results: Internal shame was moderately associated with compulsive exercise (r=.496, p<.05). No further variables were significantly related to compulsive exercise. Individuals with Anorexia-Nervosa and Bulimia-Nervosa did not significantly differ on any of the study variables. Discussion: Hypotheses regarding the possible nature of the relationship between compulsive exercise and shame are suggested. For instance, that compulsive exercise may serve a role in the regulation of internal shame. That compulsive exercise may act as a compensatory behaviour and be a consequence of high levels of shame. Or that internal shame may result as a response to negative perceptions of one’s exercise habits. The results are discussed in line with current literature.

The relation between attachment, personality, internalizing, and externalizing dimensions in adolescents with borderline personality disorder

The relation between attachment and personality features is an important field to explore in adolescent borderline personality disorder (BPD), and previous research has shown that personality features may be conceptualized within latent internalizing and externalizing dimensions. This cross-sectional study used a structural equation model to examine the association between the BPD participants' perception of attachment and personality features, mediated by the underlying internalizing/externalizing personality dimensions. Data were analyzed for 60 adolescents, ages 15 to 18 years, diagnosed with BPD who completed attachment and personality self-report measures. The authors' results showed a good fit of the model, suggesting a significant association between attachment and the internalizing/externalizing dimensions, which simultaneously congregate and influence personality traits. The perception of attachment anxiety was positively related to the internalizing dimension and at the same time negatively related to the externalizing dimension. However, the perception of attachment avoidance was not related to internalizing or externalizing personality dimensions.

Behavioral traits predicting cocaine-conditioned place reference in mice: role of anxiety adn the basolateral amygdala

Aims. The individual susceptibility to cocaine addiction, a factor of interest in the understanding and prevention of this disorder, may be predicted by certain behavioral traits. However, these are not usually taken into account in research, making it difficult to identify whether they are a cause or a consequence of drug use. Methods. Male C57BL/6J mice underwent a battery of behavioral tests (elevated plus maze, hole-board, novelty preference in the Y maze, episodic-like object recognition memory and forced swimming test), followed by a cocaine-conditioned place preference (CPP) training to assess the reinforcing effect of the drug. In a second study, we aimed to determine the existence of neurobiological differences between the mice expressing high or low CPP by studying the number of neurons in certain addiction-related structures: the medial prefrontal cortex, the basolateral amygdala and the ventral tegmental area. Results. Anxiety-like behaviors in the elevated plus maze successfully predicted the cocaine-CPP behavior, so that the most anxious mice were also more likely to search for cocaine in a CPP paradigm. In addition, these mice exhibited an increased number of neurons in the basolateral amygdala, a key structure in emotional response including anxiety expression, without differences in the others regions analyzed. Conclusions. Our results suggest a relevant role of anxiety as a psychological risk factor for cocaine vulnerability, with the basolateral amygdala as potential common neural center for both anxiety and addiction.

The Effect of Stress Management Program Using Cognitive Behavior Approach on Mental Health of the Mothers of the Children With Attention Deficit Hyperactivity Disorder

Background: Attention deficit hyperactivity disorder is one of the most common psychiatric disorders in children. Objectives: The study aimed to evaluate the effectiveness of stress management program using cognitive behavior approach on mental health of the mothers of the children with attention deficit hyperactivity disorder. Patients and Methods: In this interventional study, 90 mothers of the children with attention deficit hyperactivity disorder were randomly allocated into three intervention, placebo, and control groups. The general health questionnaire was used to measure mental health. Besides, stress was assessed through the depression-anxiety-stress scale. The two instruments were completed at baseline, immediately after, and one month after the intervention by the mothers. Afterwards, within group comparisons were made using one-sample repeated measurement ANOVA. One-way ANOVA was used for inter group comparisons. Mothers in the placebo group only participated in meetings to talk and express feelings without receiving any interventions. Results: At the baseline, no significant difference was found among the three groups regarding the means of stress, anxiety, depression, and mental health. However, a significant difference was observed in the mean score of stress immediately after the intervention (P = 0.033). The results also showed a significant difference among the three groups regarding the mean score of mental health (P < 0.001). One month after the intervention, the mean difference of mental health score remained significant only in the intervention group (P < 0.001). Conclusions: The study findings confirmed the effectiveness of stress management program utilizing cognitive behavior approach in mental health of the mothers of the children with attention deficit hyperactivity disorder.