Introdução: A neurobiologia dos transtornos de ansiedade (TA) é complexa e envolve interações ambientais e genéticas ainda não conhecidas. Esses transtornos, comumente, iniciam durante a infância e adolescência, persistindo ao longo da vida. O comprometimento da resposta biológica frente ao estímulo estressor, encontrado em muitos pacientes com TA, sugere a influência do eixo hipotálamo-hipófise-adrenal (HHA) nestes transtornos e, portanto, os polimorfismos associados ao eixo HHA poderiam ser estudados em genes candidatos. Os estudos que almejam entender a etiologia dos TA devem, também, explorar as alterações epigenéticas (incluindo a metilação do DNA) decorrentes das influências ambientais. Objetivos: Estudar, em adolescentes, polimorfismos genéticos funcionais do eixo HHA, interações Gene x Ambiente (G x A) e metiloma do DNA, considerando as diferentes trajetórias dos TA. Métodos: Foi realizada a extração de DNA das células do epitélio bucal de 228 adolescentes (131 casos e 97 controles para os TA) e foram genotipados, por PCR em tempo real, polimorfismos funcionais envolvidos com o eixo HHA (FKBP5: rs3800373, rs9296158, 3800373, rs9296158, 3800373, rs9296158, rs1360780, rs9470080 rs1360780, rs9470080 e rs4713916; NR3C1NR3C1 : rs6198;: rs6198;: rs6198; NR3C2NR3C2 : rs2070951;: rs2070951;: rs2070951; CRHR1CRHR1 CRHR1 : rs878886 : rs878886 e SERPINA6 SERPINA6 : rs746530) : rs746530) . Os participantes responderam à escala auto-aplicativa SCARED (Screen for Children Anxiety Related Emotional Disorder – Children rated) e realizaram entrevistas semiestruturadas para avaliação diagnóstica utilizando o K-SADS-PL (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime). O questionário CTQ (Childhood Trauma Questionnaire) foi aplicado em 90 adolescentes (54 casos e 36 controles para os TA) para avaliar a interação entre o trauma emocional e o polimorfismo do gene NR3C2 nos níveis séricos de BDNF. Uma subamostra de adolescentes (n=47) foi reavaliada, cinco anos após a primeira coleta, através das mesmas entrevistas psiquiátricas e nova extração de DNA salivar. Alguns participantes, na última avaliação, responderam ao MINI (Mini International Neuropsychiatric Interview) apropriado para a idade atual. A amostra foi organizada em 4 grupos, conforme o diagnóstico dos TA e o ano da coleta de saliva (anos de 2008 e 2013): (1) Desenvolvimento típico da adolescência (Controle; n=14); (2) Incidentes para os TA (ITA; n=11); (3) Persistentes para os TA (Caso; n=14) e (4) Remitentes para os TA (RTA; n=08). O metiloma do DNA foi analisado com o Infinium HumanMethylation 450 BeadChip da Illumina. Resultados: Não foi encontrada associação entre os polimorfismos estudados e os TA. Em relação à interação G x A, sugere-se que o polimorfismo rs2070951 do gene NR3C2 modera a associação entre negligência física e os níveis séricos de BDNF. Do ponto de vista epigenético, foi observada, nos grupos ITA e RTA, vias biológicas com padrão homogêneo e relacionadas ao sistema nervoso. Já nos grupos casos e controles para os TA, foram evidenciadas vias biológicas com padrão mais heterogêneo. Um perfil de hipometilação do DNA foi predominante nas vias encontradas. Na análise transversal, nós encontramos padrões opostos de metilação do DNA, conforme o período desenvolvimental avaliado: hipometilação no início da adolescência e hipermetilação em jovens adultos. Conclusão: Esse estudo abordou, em uma amostra de adolescentes, aspectos genéticos (genes candidatos envolvidos com o eixo HHA), ambientais (trauma emocional) e epigenéticos (metiloma do DNA) dos TA. Os achados sugerem que, embora sem associações entre os TA e genes envolvidos no eixo HHA, existe uma interação entre a presença de trauma emocional, polimorfismo genético do eixo HHA e marcadores biológicos. Os achados do metiloma do DNA sugerem, também, influências epigenéticas no curso dos TA. Novos estudos devem ser delineados para corroborar as influências genéticas e ambientais neste transtorno. / Background: The neurobiology of Anxiety Disorders (AD) is complex and involves environmental and genetic interactions understood. These disorders may have their onset during childhood and adolescence, persisting throughout life. The impairment of biological response against the stressor stimulus, described in many patients with AD, suggests a possible role of genetic polymorphisms of the hypothalamic-pituitary-adrenal (HPA) axis in these individuals. Studies that aim to understand the etiology of AD should also explore the epigenetic changes (including DNA methylation) arising from environmental influences. Objective: To study, in adolescents, functional genetic polymorphisms of HPA axis, Gene x Environment (G x E) interactions and DNA methylome, considering different AD outcomes. Methods: Saliva DNA was extracted from 228 adolescents (131 cases and 97 controls to AD) and we genotyped, by real time PCR, the functional polymorphisms involved with HPA axis (FKBP5: rs3800373, rs9296158, rs1360780, rs9470080 and rs4713916; 3800373, rs9296158, rs1360780, rs9470080 and rs4713916; 3800373, rs9296158, rs1360780, rs9470080 and rs4713916; 3800373, rs9296158, rs1360780, rs9470080 and rs4713916; 3800373, rs9296158, rs1360780, rs9470080 and rs4713916; 3800373, rs9296158, rs1360780, rs9470080 and rs4713916; 3800373, rs9296158, rs1360780, rs9470080 and rs4713916; NR3C1NR3C1 : rs6198; : rs6198; : rs6198; NR3C2NR3C2 : rs2070951; : rs2070951; CRHR1CRHR1CRHR1 CRHR1: rs878886 and : rs878886 and : rs878886 and : rs878886 and SERPINA6 SERPINA6 SERPINA6SERPINA6 : rs746530) : rs746530) . Participants responded to the scale self-applied Screen for Children Anxiety Related Emotional Disorder – Children rated (SCARED) and were diagnosed according to the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL). The Childhood Trauma Questionnaire (CTQ) was applied in 90 adolescents (54 cases e 36 controls to AD) to evaluate the interaction between emotional trauma and the NR3C2 polymorphism in the serum levels of BDNF. A sub-sample of adolescents (n = 47) was reassessed five years after the first evaluation by the same psychiatric semi-structured interviews and new extraction salivary DNA was performed. Some participants in the last evaluation responded to Mini International Neuropsychiatric Interview (MINI), which is a semi structure interview appropriate for the present age. The sample was organized in four groups according to the diagnosis of AD and the year of saliva collection (2008 and 2013): (1) Typically Developing Controls (TDC; n = 14); (2) Incident Anxiety Disorder (IAD; n = 11); (3) Persistent Anxiety Disorder (PAD; n = 14); (4) Remittent Anxiety Disorder (RAD; n = 8). DNA methylome was evaluated with Infinium HumanMethylation450 BeadChip. Results: We did not find any association between the genetic polymorphisms and AD. Considering the G x E interaction we suggest that rs2070951 polymorphism of NR3C2 gene moderates the association between physical neglect and serum BDNF levels. When we evaluated the DNA methylome, we observed more homogeneous biological pathways and mostly related with nervous system in individuals from IAD and RAD groups. On the other hand, in the TDC and PAD groups, we found biological pathways with a more heterogeneous pattern. A DNA hypomethylation profile was found predominant in the pathways. In a cross-sectional analysis, we found opposite patterns of DNA methylation, as the developmental period assessed: hypomethylation at the beginning of adolescence and hypermethylation in young adults. Conclusion: This study addressed, in an adolescent sample, genetics (candidate genes linked to HPA axis), environmental (emotional trauma) and epigenetic (DNA methylome) aspects of AD. The findings suggest that although there are no associations between AD and genes involved in HPA axis, there is an interaction between the presence of trauma, genetic polymorphism involved in this axis and biomarkers. The DNA methylome findings also suggest epigenetic influences on the course of TA. Further studies should be designed to corroborate the genetic influences in this disorder.

O Transtorno de Ansiedade Social (TAS) caracteriza-se pelo medo acentuado e persistente de situações sociais ou de desempenho, mostrando-se associado a prejuízos funcionais . Objetiva-se avaliar a associação do TAS a prejuízos funcionais nas atividades cotidianas, por meio da validação de duas escalas de auto e de hetero-avaliação, aplicadas a universitários brasileiros. Realizou-se dois estudos, um de comparação entre grupos TAS e Não TAS e outro de estudos de casos. Procedeu-se à tradução e adaptação da Escala de Liebowitz para auto-avaliação dos prejuízos funcionais (ELAPF) e da Escala de Liebowitz para hetero-avaliação dos prejuízos funcionais (ELHPF). Participaram do estudo de comparação entre grupos 173 universitários (TAS = 84 e Não TAS = 89), de ambos os sexos, com idade entre 17 e 35 anos. Procedeu-se a aplicação da Entrevista clínica semi-estruturada para o DSM-IV, para a confirmação diagnóstica e dos instrumentos: ELAPF, ELHPF, Questionário de Saúde Geral -12 (QSG-12), Inventário de Fobia Social (SPIN). Para os estudos de casos, selecionou-se três participantes do grupo TAS e procedeu-se a uma entrevista semi-estruturada sobre o impacto do transtorno nas atividades cotidianas, nos relacionamentos e na saúde geral. Os dados das escalas foram codificados e os grupos comparados por teste estatísticos não paramétricos (p 0,05) e para os estudos de casos foram integrados e analisados qualitativamente os dados das escalas e da entrevista,. Os grupos não apresentaram diferenças significativas quanto as variáveis demográficas. O grupo TAS apresentou no QSG-12 mais dificuldades quanto ao bem estar geral, e na ELAPF e na ELHPF apresentou, com significância estatística, mais dificuldades nas últimas semanas e no curso da vida. Observou-se para o grupo TAS: a) para a ELHPF, consistência interna de 0,68 no curso da vida e 0,67 nas duas últimas semanas, o coeficiente de correlação Kappa entre os avaliadores, variou de 0,75 a 0,93, caracterizando nível de concordância satisfatória e na análise dos componentes principais extrairam-se dois fatores para os dois parâmetros temporais; a validade concorrente realizada com o SPIN, mostrou valores que variaram entre 0,11 e 0,33 para o parâmetro no curso da vida e 0,17 a 0,39 nas duas últimas semanas, e b) para a ELAPF, a consistência interna foi de 0,85 para o parâmetro no curso da vida e 0,83 nas duas últimas semanas e na análise dos componentes principais extrairam-se três fatores, para o parâmetro temporal no curso da vida e dois fatores no parâmetro nas duas últimas semanas; a validade concorrente realizada em relação ao SPIN, mostrou valores no curso da vida de -0,14 a 0,25 e nas duas últimas semanas, a correlação variou de 0 a 0,38. Os estudos de casos evidenciaram que os prejuízos funcionais associados ao TAS têm impacto negativo para os relacionamentos, as atividades cotidianas, o bem estar e a percepção de saúde. As escalas , mostraram-se válidas para a avaliação dos prejuízos funcionais associados ao TAS, o que contribui para as práticas de saúde mental, em especial as de terapia ocupacional, que tem como foco as intervenções voltadas para a vida cotidiana. / Social Anxiety Disorder (SAD) is characterized by marked and persistent fear of social or performance situations and is associated with functional impairment. The objective of the present study was to assess the association of SAD with functional impairment in daily activities by means of the validation of two scales (auto and hetero-evaluation) applied to Brazilian university students. Two studies were conducted, one of them comparing SAD and Non SAD groups and the other consisting of cases studies. The Liebowitz Disability Self Rating Scale (LDSRS) and the Disability Profile /Clinician- Rated (DP) were translated and adapted. A total of 173 university students (SAD = 84 and Non-SAD = 89) of both genders, aged 17 to 35 years participated in the study of group comparison. A semi-structured clinical interview for DSM-IV was applied for confirmation of the diagnosis and the following instruments were applied: LDSRS, DP, General Health Questionnaire-12 (GHQ-12), and Social Phobia Inventory (SPIN). Three participants of the SAD group were selected for the case studies and submitted to a semi-structured interview about the impact of the disorder on daily activities, relationships, and general health. The scale data were coded and the groups were compared by a non-parametric test (p 0.05), and for the case studies the scale and interview data were integrated and analyzed qualitatively. The groups did not differ significantly in terms of demographic variables. For the SAD group, application of the GHQ-12 revealed more difficulties regarding general well-being, and application of the LDSRS and DP revealed significantly more lifetime difficulties and difficulties in the last weeks. The following observations were made for the SAD group: a) for the DP, the internal consistency was 0.68 during the life course and 0.67 during the last two weeks; the Kappa correlation coefficient for the two raters ranged from 0.75 to 0.93, characterizing a satisfactory level of concordance, and two factors for the two temporal parameters were extracted in the analysis of the principal components; concurrent validity performed with the SPIN showed values ranging from 0.11 to 0.33 for the lifetime parameter and from 0.17 to 0.39 for the last two weeks, and b) for the LDSRS, the internal consistency was 0.85 for the lifetime parameter and 0.83 for the last two weeks; concurrent validity performed with the SPIN showed lifetime values ranging from 0.14 to 0.25 and values ranging from 0 to 0.38 in the last two weeks. The case studies demonstrated that the functional impairment associated with SAD has a negative impact on relationships, daily activities, well-being, and health perception. The scales proved to be valid for the assessment of the functional impairment associated with SAD, a fact that contributes to mental health practices, especially those of occupational therapy, that focus on interventions in daily life.

Social anxiety disorder (SAD) is one of the most common anxiety disorders and understanding its symptoms and risk factors is vital for developing treatments and prevention strategies. Atypical physiological responses have been observed in anxious individuals and their consequences present a human and economic burden. This dissertation includes two studies that explore the subjective and physiological responses to an acute stress in the context of treatment and risk factors for SAD. The goal of the first study was to examine whether cognitive behavioural group therapy (CBGT) and a mindfulness-based stress reduction (MBSR) program differentially influenced the subjective and physiological response to a speech task. Participants in the treatment groups performed two speech tasks, before and after treatment, while a healthy control group completed it only once. Results indicated significant differences for the subjective, but not the physiological measures of stress. Patients with SAD reported higher subjective anxiety than the healthy control group and these scores were significantly reduced following treatment. Greater improvements were noted in the CBGT group; nonetheless, the study did indicate promising results for MBSR. The second study aimed to explore the effects of behavioural inhibition (BI), parental bonding variables and their interaction on the subjective and physiological responses to a similar speech task in healthy children. BI was related to subjective anxiety in a predictive manner, but was generally unrelated to the physiological measures. Parental bonding variables were not related to any of the stress responses and no interaction between BI and parental bonding was observed. These studies contribute to the literature by demonstrating treatment differences and their subjective and physiological consequences on stress reactions and exploring the extent to which risk factors for SAD affect the stress response in healthy children.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-28T14:23:24Z No. of bitstreams: 1 danielalexandregouveagomes.pdf: 1397863 bytes, checksum: c8dd2724000b5ba816907d9cb9b77578 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-28T14:25:16Z (GMT) No. of bitstreams: 1 danielalexandregouveagomes.pdf: 1397863 bytes, checksum: c8dd2724000b5ba816907d9cb9b77578 (MD5) / Made available in DSpace on 2016-01-28T14:25:16Z (GMT). No. of bitstreams: 1 danielalexandregouveagomes.pdf: 1397863 bytes, checksum: c8dd2724000b5ba816907d9cb9b77578 (MD5) Previous issue date: 2014-01-31 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O Transtorno de Ansiedade Social (TAS) é uma patologia muito comum nos dias atuais, figurando como o principal transtorno de ansiedade e uma das doenças mentais mais prevalentes na população mundial. É caracterizada por medo ou ansiedade excessiva e constante diante de situações sociais, que podem ser de desempenho, de interação ou de observação, em que o indivíduo apresenta temor em ser avaliado negativamente por outras pessoas, podendo ser exposto a humilhações e ao escrutínio. O objetivo do trabalho foi o desenvolvimento de um instrumento de rastreio dos sintomas do TAS, capaz de identificar os sujeitos com maior probabilidade de desenvolvimento da doença. O estudo dividiu-se em duas fases: primeiro tivemos a construção do instrumento, e segundo, a aplicação do mesmo em 297 pessoas. Foram aplicados um questionário sócio-demográfico, a Escala de Ansiedade Social de Liebowitz, o Mini Inventário de Fobia Social e a escala desenvolvida pelos autores. Os resultados preliminares mostraram excelentes índices de consistência interna e a análise fatorial foi considerada satisfatória. Houve associação entre a pontuação da escala e alguns indicadores sócio-demográficos, de acordo com a literatura científica da área. / The Social Anxiety Disorder (SAD) is a very common condition presently, appearing as the primary anxiety disorder and one of the most prevalent mental diseases worldwide. It is characterized by constant and excessive fear or anxiety about social situations, which can be of performance, interaction or observation, in which a person has fear of being negatively evaluated by others, and may be exposed to humiliation and scrutiny. The objective of this work is the development of a screening instrument of the symptoms of SAD, which is able to identify as well subjects with greater likelihood of developing the disease. The study was divided into two phases: the first refers to the construction of the instrument and the second consists on the application of the test to 297 subjects. One socio-demographic questionnaire, the Liebowitz Social Anxiety Scale, the Mini Social Phobia Inventory and the scale developed by the authors. Preliminary results showed excellent internal consistency and factor analysis was considered satisfactory. There was an association between the scale score and some socio-demographic indicators, according to scientific literature in the area.

O Transtorno de Ansiedade Social (TAS) tem sido considerado um grave problema de saúde mental pela sua alta prevalência em pessoas jovens e pelas incapacidades decorrentes no desempenho e interações sociais. É fundamental que se disponha de instrumentos validados e abrangentes que avaliem tanto os recursos e déficits comportamentais quanto os prejuízos sociais e funcionais destas pessoas. Objetivou-se, neste trabalho, verificar as associações entre as manifestações comportamentais e clínicas do TAS por meio de dois estudos, um psicométrico e outro empírico, visando: (a) aferir as propriedades psicométricas do Inventário de Habilidades Sociais (IHS-Del-Prette), enquanto medida do repertório comportamental de habilidades sociais, em relação à avaliação das manifestações clínicas próprias do TAS, medidas pelo Inventário da Fobia Social (SPIN); e (b) comparar e caracterizar o repertório de habilidades sociais apresentado por universitários brasileiros portadores de TAS e não portadores frente a uma situação experimental estruturada, o Teste de Simulação de Falar em Público (TSFP). Do estudo psicométrico, participaram 1006 universitários, na faixa etária entre 17 e 35 anos, de ambos os gêneros, provindos de duas instituições de ensino superior. Posteriormente, 86 participantes foram randomicamente selecionados desta amostra inicial e agrupados como casos e não-casos de TAS a partir de avaliação clínica sistemática por meio da Entrevista Clínica Estruturada para o DSM-IV. Do delineamento empírico, participaram 26 universitários, sendo 13 com diagnóstico de TAS e 13 não portadores de transtornos psiquiátricos. Quanto aos resultados, o IHS apresentou boa consistência interna para o escore total, reforçando a sua validade de construto. Observou-se boa validade concorrente entre o IHS e o SPIN, com um coeficiente altamente significativo de correlação negativa entre eles, indicando que quanto mais elaborado for o repertório de habilidades sociais de um indivíduo, menor é a sua probabilidade de satisfazer os critérios de rastreamento de indicadores para o TAS. O IHS demonstrou distinguir significativamente indivíduos com e sem TAS, atestando sua validade discriminativa e preditiva para esse diagnóstico, evidenciando-se assim a sua validade clínica e a possibilidade do seu uso em estudos empíricos que testem a eficácia terapêutica de programas de intervenção. No TSFP, os grupos caso e não-caso de TAS não demonstraram diferenças significativas, em termos de freqüência, para a maioria dos marcadores comportamentais de ansiedade avaliados. Um número maior de sujeitos do grupo não-caso foi avaliado como apresentando um nível de habilidades sociais apropriadas para falar em público, que variou de moderado a alto, em comparação ao grupo caso. Ao longo do TSFP, a freqüência de emissão dos marcadores comportamentais de ansiedade pelos sujeitos de ambos os grupos manteve-se estável. Os grupos diferiram significativamente na maioria dos itens indicativos da habilidade de falar em público do IHS e quanto ao escore geral desta habilidade. A análise dos resultados do estudo empírico aponta para a necessidade de novos estudos com amostras clínicas de indivíduos com TAS dos subtipos generalizado e circunscrito, e não-clínica, com maior número de sujeitos, previamente avaliados quanto ao medo de falar em público, e também para a possibilidade de uso do TSFP em programas de Treinamento em Habilidades Sociais. / Social Anxiety Disorder (SAD) has been considered a serious mental health problem for its high prevalence in young people and for the resulting disabilities in the performance and social interactions. It stands out, thus, as being fundamental to have comprehensive and validated instruments which evaluate both the resources and the social and functional impairments of these people. In this work, we aimed at verifying the associations between the behavioral and clinical manifestations of SAD by means of two studies, a psychometric study and an empirical one, in order to: (a) check the psychometric properties of the Social Skills Inventory (HIS-Del-Prette), as a measure of the social skills behavioral repertoire in relation to the evaluation of the typical clinical manifestations of SAD, measured by the Social Phobia Inventory (SPIN); (b) compare and characterize the social skills repertoire shown by Brazilian undergraduates with and without SAD in a structured experimental situation, the Simulated Public Speaking Test (SPST). A total of 1006 undergraduates of both genders participated in the psychometric study, with ages between 17 and 35, from two universities. Subsequently, 86 participants were randomly selected from this initial sample and grouped as SAD case and non-case from the systematic clinical evaluation. In the empirical outline, 26 undergraduates participated, 13 with a SAD diagnosis and 13 without the disorder. According to the results, IHS showed good internal consistency for the total score, reinforcing its construct validity. Good concurrent validity was demonstrated between IHS and SPIN, with a highly significant negative correlation coefficient between them, indicating that the more elaborate the social skills repertoire of an individual is, the smaller the probability that he or she will meet the screening criteria for the indicators of SAD. IHS proved to significantly distinguish individuals with and without SAD, attesting thus, discriminative and predictive validity for this diagnosis, showing its clinical validity for the diagnosis of this disorder and yet the possibility of using it in empirical studies testing the therapeutical efficacy in programs of intervention. In the SPST, the case and non-case groups of SAD did not show significant differences in terms of frequency for most of the social anxiety markers, except in relation to facial movements of discomfort, and the class of non-verbal markers, in which the non-case group presented higher values. A higher number of individuals from this group were evaluated as showing a level of appropriate social skills for speaking in public which varied from moderate to high, in comparison with the other group. Throughout SPST, the frequency of emission of anxiety behavioral markers by the participants of both groups was stable. The groups differed significantly in most items of IHS indicative of abilities to speak in public, as well as in the general score of this ability. The analysis of the results of the empirical study points to the necessity of new studies with clinical samples of individuals with SAD of the generalized and circumscribed subtypes and non-clinical, with a larger number of participants, previously evaluated as to the fear of speaking in public, and also to the possibility of using SPST in Social Skills Training.

Author: Bc. Marie Zasadilová Title: Incidence of Joint Hypermobility Syndrome in Anxienty Patients Objectives: The aim of this study is to find out what ist he incidence of Joint hypermobility syndrome in the research group of probands with anxiety disorder, on the base of collected theoretical knowledge. Methods: The group of patients with diagnosis of anxiety disorder was examined on presence of joint hypermobility syndrome. For the examination was used standardised test scale Beighton score. The data was statistically processed, prevalence of hypermobility in the research group was compared with prevalece in common population. Results: Prevalence of joint hypermobility syndrome in the research group was 44,88%, that is about 31,88% more, than in common population. Hypermobility was found in 65% of female part oft he research group, that is about 25% more, than in common female population. Prevalence in male part of research group was 16,67%, about 5,17% more than in common male population. The hypotesis, that prevalence of joint hypermobility syndrome will be hihger in the research group than in common population, was affirmed. Average result of Beighton score in group of probands was 4,38 points, the most common result was 2 points. Skewness and krtosis of the histogram curve corresponds with...

Theoretischer Hintergrund: Die diagnostischen Kriterien der Generalisierten Angststörung (GAS) und ihr Status als eigenständige psychische Störung waren lange umstritten. Inzwischen liegen neuere epidemiologische Daten vor, die ein präziseres Bild dieser Störung und ihrer Besonderheiten ermöglichen. Methode: Es wird ein systematischer Überblick zu Prävalenz, Verlauf und Komorbidität, zur Beeinträchtigung und zum Inanspruchnahmeverhalten sowie zur Spezifität des Kernsymptoms (Sorgen) erstellt. Ergebnisse: GAS ist eine häufige Störung, die im jungen Erwachsenenalter einsetzt, jedoch auch – anders als andere Angststörungen – hohe Inzidenzraten im mittleren Lebensalter aufweist. Der Verlauf ist eher chronisch. Trotz hoher Komorbidität lässt sich die Störung valide abgrenzen. Klinisch relevante Sorgen erweisen sich als störungsspezifisch. Die Beeinträchtigungen sind auch bei GAS-Patienten ohne Komorbidität beträchtlich. Schlussfolgerung: Der Forschungsstand spricht für die Bedeutung und Eigenständigkeit der Diagnose sowie für die stärkere Beachtung offener Forschungsfragen. / Background: The diagnostic criteria for generalized anxiety disorder (GAD) and its status as an independent mental disorder have been controversial. More recent epidemiological data provide a more precise picture of this disorder and its specific features. Methods: A systematic overview is given in regard to prevalence, course and comorbidity, impairment, and help-seeking behavior as well as to specificity of the core symptom (worries). Results: GAD is a frequent disorder with high incidence rates in middle-age groups, which are not seen in other anxiety disorders. Despite the high comorbidity GAD can be validly distinguished. Clinically relevant worries have been proven as specific for the disorder. The impairments are also considerable for patients without comorbid disorders. Conclusions: Research supports the independent status of GAD and the importance of this diagnosis. Unsolved questions are to be analyzed in future research.

Background. The proposed revisions of the ICD and DSM diagnostic systems have led to increased interest in evaluation of diagnostic criteria. This report focuses on the DSM-IV requirement that episodes of generalized anxiety disorder (GAD) must persist for at least 6 months. Community epidemiological data are used to study the implications of changing this requirement in the range 1–12 months for estimates of prevalence, onset, course, impairment, co-morbidity, associations with parental GAD, and sociodemographic correlates. Method. Data come from the US National Comorbidity Survey Replication (NCS-R), a US household survey carried out during 2001–2003. Version 3.0 of the WHO Composite International Diagnostic Interview (WMH-CIDI) was used to assess DSM-IV anxiety disorders, mood disorders, substance disorders, and impulse-control disorders. Results. Lifetime, 12-month, and 30-day prevalence estimates of DSM-IV GAD changed from 6·1%, 2·9%, and 1·8% to 4·2–12·7%, 2·2–5·5%, and 1·6–2·6% when the duration requirement was changed from 6 months to 1–12 months. Cases with episodes of 1–5 months did not differ greatly from those with episodes of [gt-or-equal, slanted]6 months in onset, persistence, impairment, co-morbidity, parental GAD, or sociodemographic correlates. Conclusions. A large number of people suffer from a GAD-like syndrome with episodes of <6 months duration. Little basis for excluding these people from a diagnosis is found in the associations examined here.

Objective: To examine in a nationally representative sample (a) the differential association of specific anxiety and depressive disorders defined according to DSM-IV with pain disorder (PD) and pain symptoms, and (b) whether pain-associated anxiety and depressive disorders and their comorbidity have different implications in terms of impairment, disability, health care utilization, and substance use. Method: A nationally representative community study was conducted in Germany. Symptoms, syndromes and diagnoses of mental disorders, and pain were assessed in N = 4,181 participants aged 18–65 years using the DSM-IV/M-CIDI. Results: Logistic regressions revealed that pain is associated with both specific anxiety and depressive disorders, with increasing significant odds ratios (OR) for medically explained pain symptoms (EPS; OR range: 1.9–2.0), to unexplained pain symptoms (UPS; OR range: 2.4–7.3), to PD (OR range: 3.3–14.8). PD and UPS persistently showed associations after adjusting for comorbid other anxiety and depressive disorders and physical illnesses. All types of pain, particularly PD/UPS, are associated with decreased quality of life, greater impairment in role functioning, disability, health care utilization, and substance use. Depressive disorders, even more so anxiety disorders and their comorbidity account for a substantial proportion of variance in these functional correlates. Conclusions: Pain is strongly associated with specific anxiety and depressive disorders. In light of the individual and societal burden due to pain, and the demonstrated role of comorbid anxiety or/and depression, our results call for further investigation of the underlying mechanisms for this association as well as targeted treatments for these comorbidities.

Concerns have been raised that the DSM-IV requirements of 6-month duration, excessive worry, and three associated symptoms exclude a substantial number of people with clinically significant anxiety from a diagnosis of generalized anxiety disorder (GAD). We examined the implications of relaxing these three criteria for the estimated prevalence and predictive validity of GAD using nationally representative data from the US National Comorbidity Survey Replication. Relaxing all three criteria more than doubles the estimated prevalence of GAD. Broadly defined GAD significantly predicts the subsequent first onset of a wide range of temporally secondary disorders. The odds of secondary disorders are somewhat smaller for broadly defined than DSM-IV GAD, though few of these differences are statistically significant. Results suggest that subthreshold manifestations of GAD are significantly related to elevated risk of subsequent psychopathology. Further research is needed to determine whether broadening the current diagnostic criteria results in a more valid characterization of GAD.