Comorbid anxiety and mood disorders among persons with social anxiety disorder.

Axis I comorbidity is associated with greater severity of social anxiety disorder. However, the differential effects of comorbid mood and anxiety disorders on symptom severity or treatment outcome have not been investigated. We evaluated 69 persons with uncomplicated social anxiety disorder, 39 persons with an additional anxiety disorder, and 33 persons with an additional mood disorder (with or without additional anxiety disorders). Those with comorbid mood disorders reported greater duration of social anxiety than those with uncomplicated social anxiety disorder. They were also judged, before and after 12 weeks of cognitive-behavioral group treatment and at follow-up, to be more severely impaired than those with no comorbid diagnosis. In contrast, persons with comorbid anxiety disorders were rated as more impaired than those with no comorbid diagnosis on only a single measure. Type of comorbid diagnosis did not result in differential rates of improvement of social anxiety disorder.     

The suicidal risk in severe personality disorders: differential diagnosis and treatment.

This article describes the clinical approach to patients with severe personality disorders who present suicidal intention and behavior, developed at the Personality Disorders Institute of the Department of Psychiatry at Cornell University Medical College and the Westchester Division of the New York Presbyterian Hospital. It describes the diagnostic evaluation of patients' suicidal potential, personality disorder, and the presence or absence of a spectrum of regressive illness. The analysis of the combined features in these three symptomatic domains determines alternative strategies of psychotherapeutic and psychopharmacological interventions. Within these strategies, transference-focused psychotherapy is described as a specific psychodynamic psychotherapy geared to treat characterologically based suicidal and parasuicidal tendencies in the context of the treatment of the patient's personality disorder.     

Childhood-onset multiple sclerosis and mood disorders: a case study.

Multiple Sclerosis (MS) is rare in children. Little research exists regarding emotional and behavioral disorders in childhood-onset MS, despite the occurrence of such problems in adults with MS. This paper describes the cognitive and behavioral characteristics of a boy diagnosed with MS at age 9 and mood disorder at age 10. He displayed no cognitive or behavioral problems prior to the onset of physical symptoms of MS. Three years after diagnosis, this child showed persistent problems with speed of processing, visual-motor skills, and parent and teacher-reported executive functioning. In addition, he had difficulties with emotional lability, behavioral disinhibition, depression, and social interaction. As with adults, children with MS may be at increased risk for mood disorder compared to their peers. Mood disorders in children with MS are likely to be multiply determined, although the specific causal mechanisms are unknown.     

The SCL-90-R as a screening instrument for severe personality disturbance among outpatients with mood and anxiety disorders

Our objective was to examine whether the SCL-90-R, a widely used self-report measure of distress and psychopathology, could screen for personality disorders in general and for severe personality disturbance (SPD) in particular, at the time when patients seek treatment for a state (mood or anxiety) disorder. The SCL-90-R was administered to 112 consecutive outpatients with various mood and anxiety disorders. The personality severity index (PSI) score, defined as the mean value of the scores on the SCL-90-R subscales of interpersonal sensitivity, hostility, and paranoid ideation, was compared with the current symptom index (CSI) score, defined as the mean value of the scores on the remaining six SCL-90-R subscales. A positive screen was considered if PSI > CSI. SPD was defined as the presence of any DSM-III-R Cluster A and/or Cluster B personality disorder. The accuracy of the screen was verified by means of the Structured Clinical Interview for DSM-III-R Personality Disorders. The sensitivity of the PSI > CSI criterion to screen for SPD was 89.4%, while its sensitivity to screen for any DSM-III-R personality disorder was 72.9%. The SCL-90-R subscales that contributed the most to the screening discriminability of this SCL-90-R-derived screening measure were hostility, paranoid ideation, somatization, and obsessive-compulsive behavior. The SCL-90-R may be used to screen for SPD in routine work with outpatients with mood and anxiety disorders, but the results of the screening need to be verified because of the possibility of false negatives and false positives, although that possibility is apparently low. These findings may have important prognostic and treatment implications.     

The effects of mood on managerial risk perceptions: exploring affect and the dimensions of risk.

The effects of managerial mood on situational risk perceptions were tested among 85 managers from a variety of organizations, industries, and positions in Singapore. A risk-assessment scenario was developed that systematically varied the risk dimensions of outcome uncertainty, potential gains and losses, situational framing, and personal expectations. Negative, neutral, and positive moods were induced by having managers recall and describe work events. As affective state became more positive, managers perceived situational framing as more positive, and their beliefs that they could influence risky outcomes increased. Additionally, positive affect increased the likelihood that people who perceived situations as risky would select riskier courses of action.     

Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample.

The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with the highest comorbidity rates were mood disorders, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). A high rate of lifetime comorbidity was found between the anxiety and mood disorders; the lifetime association with mood disorders was particularly strong for PTSD, GAD, obsessive-compulsive disorder, and social phobia. The findings are discussed in regard to their implications for the classification of emotional disorders.     

Co-occurrence of personality disorders with mood, anxiety, and substance use disorders in a young adult population

The purpose of this study was to determine the co-occurrence of DSM- III-R personality disorders (PDs) with mood, anxiety, and substance use disorders in a young adult population. The members of the Northern Finland 1966 Birth Cohort Project, living in the city of Oulu with an age of 31 years (N = 1,609) were invited to participate in a two-phase field study. The SCID I and II were used as diagnostic instruments. One hundred and seventy-seven out of 321 interviewed subjects met the criteria for mood, anxiety, or substance use disorders. Altogether 72 (41%) of the subjects with an Axis I disorder met the criteria for at least one PD. The weighted co-occurrence rate of any PD varied from 28% for mood disorders to 47% for anxiety disorders. PDs, especially those in Cluster C, are highly associated with Axis I psychiatric disorders in population.     

Transdiagnostic processes in emotional disorders and insomnia: results from a sample of adult outpatients with anxiety and mood disorders

Conceptual similarities between recent models of insomnia and emotional disorders suggest there may be common factors that underlie or maintain these difficulties. Maladaptive cognitive and behavioral processes similar to those described in connection with emotional disorders have been cited as key mechanisms in the maintenance of primary insomnia. Unfortunately, research on this potential overlap is lacking. The present study examined the relationship among anxiety sensitivity (AS), dysfunctional beliefs, fatigue, safety behaviors, and insomnia severity in 59 outpatients with anxiety and mood disorders. Key insomnia processes (dysfunctional beliefs, fatigue, safety behaviors) were all related to insomnia severity in the comorbid sample, although AS was not. However, as hypothesized, AS did moderate the relationship of both dysfunctional beliefs and fatigue with insomnia severity. The relationships between key insomnia processes and insomnia severity was strongest among individuals high in AS. Results support the hypothesis that common mechanisms are involved for insomnia and emotional disorders. AS might function as a mechanism for the maintenance of sleep disturbance in the context of anxiety and mood disorders, suggesting a promising avenue for future research.     

The use of mood stabilizers and atypical antipsychotics in children and adolescents with bipolar disorders

The clinical use of mood stabilizers and antipsychotics in children and adolescents with bipolar disorders has increased significantly over the past few years. These agents have multiple effects and interactions. This articles reviews the studies that support the use of mood stabilizers and atypical antipsychotics in children and adolescents with bipolar disorders and presents information on these agent's pharmacokinetics, dosing, and drug interactions.     

Women and anxiety disorders: implications for diagnosis and treatment. Proceedings of a conference, November 19-21, 2003, Chantilly, Virginia, USA

Community studies indicate that 19% of men and 31% of women will develop some type of anxiety disorder during their lifetime. The impact of gender is profound in that it increases the likelihood of developing an anxiety disorder by 85% in women compared to men. Sex difference in prevalence rates are apparent as early as age 6, when girls are twice as likely as boys to have an anxiety disorder. In the National Comorbidity Survey, the prevalence rates for panic disorder in women and men were 5% and 2%, respectively. Agoraphobia, which often coexists with panic disorder, has a lifetime prevalence rate of 7% in women and 3.5% in men. Prevalence of trauma is increased in young women as well, and is experienced earlier in life; 62% of sexual assaults are inflicted on females < or = 18 years of age, and 29% occur in children < 11 years of age. Comorbidity of anxiety in women complicates other medical conditions as well. For example, panic disorder is highly comorbid with CHD, which remains the leading cause of death in women in developed countries. Fluctuations in reproductive hormone levels during the female life cycle is thought to be responsible for modulating anxiety. This is often implicated in the later age of onset, the more sudden and acute symptom emergence, and the more episodic course of OCD in women, and in the high prevalence(47.4%) of PMDD. Pregnancy appears to be a protective period for some anxiety disorders, including panic, while for others, such as OCD, it may be associated with onset. Hormonal changes during pregnancy, such as increased prolactin, oxytocin, and cortisol, may contribute to the suppression of stress response that occurs during this period. Despite a large and growing body of literature on anxiety disorders in general, the available data relating to women and girls falls short of informing aspects of diagnosis, treatment, and prevention that may entail sex differences. Additional work is required to understand the biological and psychosocial causes of these differences.     

Prevalence and correlates of self-reported depressive mood among seriously emotionally disturbed adolescents.

This study examined self-reported depression on the Reynolds Adolescent Depression Scale among 45 seriously emotionally disturbed adolescents. Scores of one-third of the sample exceeded the cut-off score, which indicated the need for further diagnostic study to assess the possible presence of depression. Significant positive correlations included an association with school attendance, a relationship with scores on the Revised Children's Manifest Anxiety Scale, and an association with teachers' ratings on two subscales of the Revised Behavior Problem Checklist. Also, the Depression scale's negative association with the Lie subscale of the Manifest Anxiety Scale is interpreted as indicative of seriously emotionally disturbed adolescents' response style on self-reported measures of depression.     

Suicidal behavior and prophylactic lithium treatment of major mood disorders: a review of reviews

This paper briefly summarizes and discusses at length two recent reviews. Their main findings were the following: (1) During prophylactic lithium treatment the overall mortality of patients with major mood disorders was much lower than in such patients in general. (2) The frequency of suicidal acts was many times lower in patients on lithium than in patients not on lithium. The limitations of the studies reviewed and the difficulty of interpreting their findings are discussed. It is concluded that prophylactic lithium treatment is indicated in patients with major mood disorders who are at high risk of committing suicide, that is, those with severe depressions or depressions with persistent suicidal thoughts or with suicide attempts in the past.     

The application of mindfulness-based cognitive interventions in the treatment of co-occurring addictive and mood disorders

This article reviews the theory, clinical application, and empirical findings on mindfulness-based cognitive therapy (MBCT) for mental health and addictive disorders. Expanding upon the research demonstrating the efficacy of cognitive-behavioral therapy (CBT) for addiction, this article develops and explores the rationale for combining mindfulness-based interventions with evidence-based CBTs in treating addictive disorders, with an emphasis on substance use disorders with co-occurring mood disorders. This article proposes that deficits in affect--regulation related to the behavioral and emotional effects of neurobiological changes that occur with long-term substance abuse--pose a unique set of challenges in early recovery. Prolonged use of addictive substances impairs the brain pathways that mediate certain affect regulation functions. These functions involve attention and inhibitory control, the saliency of and response to addictive versus natural reward stimuli, and the ability to detach or maintain perspective in response to strong emotional states. In treating this affective dysregulation, which can contribute to the vulnerability to relapse in the early stages of recovery, the affect-regulation-specific focus of MBCT adds a valuable element to augment CBT for addiction. Summarizing magnetic resonance imaging and positron emission tomography findings on the effects of MBCT and the neurobiology of drug addiction, this article outlines directions for further research on potential benefits of MBCT for the recovering individual. Finally, this article describes a structured protocol, developed at the Mount Sinai School of Medicine in New York City, which combines CBT with mindfulness-based intervention, for the treatment of affect-regulation issues specific to co-occurring addictive and mood disorders.     

Positive mood + action = negative mood + inaction: effects of general action and inaction concepts on decisions and performance as a function of affect

General action and inaction concepts have been shown to produce broad, goal-mediated effects on cognitive and motor activity irrespective of the type of activity. The current research tested a model in which action and inaction goals interact with the valence of incidental moods to guide behavior. Over four experiments, participants' moods were manipulated to be positive (happy), neutral, or negative (angry or sad), and then general action, inaction, and neutral concepts were primed. In Experiment 1, action primes increased intellectual performance when participants experienced a positive (happy) or neutral mood, whereas inaction primes increased performance when participants experienced a negative (angry) mood. Including a control-prime condition, Experiments 2 and 3 replicated these results measuring the number of general interest articles participants were willing to read and participants' memory for pictures of celebrities. Experiment 4 replicated the results comparing happiness with sadness and suggested that the effect of the prime's adoption was automatic. Overall, the findings supported an interactive model by which action concepts and positive affect produce the same increases in active behavior as inaction concepts and negative affect.     

Comparison of positive and negative intrusive thoughts and experimental investigation of the differential effects of mood.

The similarity between positive and negative intrusive thoughts is considered for both recently occurring, personally relevant intrusions and for the same intrusions occurring during an experimental task involving self-monitoring. The results indicate that positive and negative intrusions differ in most respects. There was evidence that increasing the frequency of negative thinking is associated with a deterioration of mood. In a subsequent experiment, induced happy and sad moods were shown to differentially affect frequency of intrusions in a fashion consistent with mood congruency effects previously found in experiments on the effect of mood on memory. The implications of these findings for disorders involving the experience of intrusive thoughts such as OCD and depression are discussed.     

Discriminant validity of the ZKPQ in a sample meeting BPD diagnosis vs. normal-range controls

Widiger and Simonsen (2005) state that given the limitations of the categorical model of Personality Disorders classification proposals are to be expected for dimensional classifications. The purpose of this paper is to test the alternative five factorial model (AFFM) of personality in a sample with PDs. Subjects were administered the ZKPQ to test the discriminant capacity of the AFFM in classifying subjects diagnosed with BPD (n = 74) vs normal-range controls (n = 148) paired by age and sex, and identifying sensitive and/or specific dimensions that can be of help in diagnosing BPD. The results showed that high scores on N-Anx and Imp-SS, and low scores on Act are prognostic factors for being diagnosed with BPD. Likewise, this model correctly classified 88% of subjects with a kappa index of 0.73. The AFFM of personality appears to have a substantial power for predicting SCID-II interview-based BPD diagnosis.     

Risky driving among young male drivers: The effects of mood and passengers

Young male drivers are at greater risk of automobile crashes than other drivers. Efforts to reduce risky driving in this population have met with mixed success. The present research was designed to examine the effects of induced mood and the presence or absence of passengers on risky driving in young male drivers. Male drivers (n = 204) aged 16–18 were tested in a driving simulator. This study employed a 2 (happy/sad mood) by 2 (passenger present/absent) between-subjects factorial design, and examined driving behavior in a simulator. Measures of risky driving were combined into two factors representing speed (e.g., exceeding the speed limit) and carelessness (e.g., crossing the center line). Findings indicated that driving with a passenger resulted in faster driving than driving alone. Although there was no significant main effect of induced mood on driving, results revealed a significant interaction of mood and passenger conditions: when in a happy mood, driving with a passenger significantly increased driving speed. There were no significant effects of passenger or mood on careless driving. In conclusion, both mood and passenger presence are important factors in fast driving among young male drivers. Results are discussed in the context of developing more effective countermeasures for this at-risk population.     

Intrusive and non-intrusive memories in a non-clinical sample: the effects of mood and affect on imagery vividness

We studied the number, valence, and vividness of intrusive and non-intrusive memories in two groups (N = 20) of pre-screened non-depressed mood and depressed mood undergraduate participants. They were asked to generate as many intrusive memories (IMs) as possible from the prior 2 weeks, together with pleasant and unpleasant non-intrusive memories from the same period. They subsequently formed images of these memories and rated them on measures of vividness, valence, arousal, and overall affect, while having their heart rate, skin conductance, and electromyogram monitored. IMs were common, with participants generating a mean of 1.15 pleasant IMs and 1.60 unpleasant IMs, and there was some evidence that they were mood-congruent. IMs were more vivid than non-intrusive memories, a difference not due to either valence or arousal. We conclude that IMs are a general feature of human memory rather than just a symptom of certain clinical disorders.     

The epidemiology of alcohol, drug, and mental disorders among homeless persons.

This article describes recent research on the prevalence of alcohol, drug, and mental (ADM) disorders and the characteristics of homeless substance abusers and persons with mental illness. Methodological problems in homelessness research are reviewed, particularly in relation to definitions of homelessness and sampling- and case-ascertainment methods. Prevalence rates of ADM disorders are much higher in homeless groups than in the general population. As is true of homeless people in general, homeless substance abusers and mentally ill persons are characterized by extreme poverty; underutilization of public entitlements; isolation from family, friends, and other support networks; frequent contact with correctional agencies; and poor general health. Knowledge of these disadvantages should be used to advocate for better services to prevent homelessness and support homeless people.     

The effects of unemployment on the mood,self-esteem,locus of control,and depressive affect of school-leavers

The purpose of this study was to investigate some psychological effects of unemployment in school-leavers using a longitudinal research design. Questionnaires which included mood questions and scales measuring self-esteem, locus of control and depressive affect, were administered twice to 761 students, once while they were at school, and then again one year later. Comparisons between the unemployed and employed groups revealed that the unemployed were generally less well-adjusted than their employed counterparts. Specifically they reported greater negative mood and had higher depression scores, and the unemployed girls also displayed lower self-esteem. These differences, however, resulted largely from an improvement in outlook on the part of the employed, rather than from the unemployed becoming more depressed and losing self-esteem.