Das aktuelle Modell zur Pathophysiologie der Zwangserkrankung (OCD) geht von fronto-striatalen Dysfunktionen aus. Damit werden Beeinträchtigungen im prozeduralen Lernen, das anhand der Serial Reaction Time Task (SRTT) erfasst werden kann, in Verbindung gebracht. Die Befunde zu Defiziten von OCD-Patienten in der SRTT sind widersprüchlich, was auf Unterschiede im methodischen Vorgehen sowie die zusätzliche Auslastung des Arbeitsgedächtnisses durch die Vorgabe einer Gedächtnisaufgabe zurückgeführt wird. Weiterhin ist unklar, ob die vermutete fronto-striatale Dysfunktion und die Defizite im prozeduralen Lernen kennzeichnend für OCD sind oder auch bei anderen Störungsbildern auftreten. Die prozedurale Lernleistung von OCD-Patienten wurde mit der Lernleistung von gesunden Probanden, Patienten mit einer Angststörung und Patienten mit einer Depression verglichen. Weiterhin wurde die prozedurale Lernleistung unter der Vorgabe der SRTT alleine (single-task) und bei gleichzeitiger Vorgabe einer Gedächtnisaufgabe (dual-task) untersucht. OCD-Patienten zeigten im Vergleich zu gesunden Probanden Defizite im prozeduralen Lernen – sowohl unter der single-task als auch unter der dual-task Bedingung. Im Vergleich zu Patienten mit einer Angststörung zeigte sich lediglich in der dual-task Bedingung eine tendenzielle Beeinträchtigung der OCD-Patienten. Keine Unterschiede ergaben sich in der prozeduralen Lernleistung zwischen OCD-Patienten und Patienten mit einer Depression. Die stärkste Beeinträchtigung der prozeduralen Lernleistung in den verschiedenen Symptomdimensionen (Kontrolle, Waschen, Symmetrie, Horten) der OCD zeigte sich in der Dimension Horten. Außerdem waren die Defizite im prozeduralen Lernen stärker bei Patienten mit einem früheren Beginn der Zwangsstörung ausgeprägt. Die Befunde stehen im Einklang mit bisherigen Ergebnissen, wonach bei OCD eine Beeinträchtigung im prozeduralen Lernen vorliegt, was für die Annahme einer fronto-striatalen Dysfunktion bei OCD spricht. / Obsessive-compulsive disorder (OCD) is seen as a disease that implicates fronto-striatal dysfunctions. These dysfunctions are hypothesized to be related to neuropsychological deficits. One of the putative deficits regards procedural learning, which can be assessed by using the serial reaction time task (SRTT). So far, the results regarding procedural learning in OCD patients are inconsistent, which is attributed to differences in methods, like the implementation of a secondary task (dual-task condition) using a concurrent working memory load. Moreover, it is still uncertain whether the fronto-striatal dysfunctions and the deficits in procedural learning are specific to OCD or if they can also be found in other mental illnesses. Procedural learning performance as measured with the SRTT was compared in OCD patients, healthy subjects, patients with anxiety disorder and depression. Additionally, procedural learning was examined under single- (SRTT) and dual-task (SRTT plus a secondary task) conditions. In comparison with healthy subjects, procedural learning was impaired in OCD patients – both in the single- and in the dual-task condition. Yet in the dual task condition, procedural learning was diminished in both groups. Compared to patients with anxiety disorder, OCD patients were impaired in procedural learning only in the dual-task condition, while there was no difference between OCD and depression in procedural learning. Regarding the different symptom dimensions of OCD (checking, washing, symmetry, hoarding), patients high on the dimension hoarding exhibited the most distinct impairment. Moreover, deficits in procedural learning were more pronounced in OCD patients with an earlier age at illness onset. The results confirm previous findings and add supportive evidence for performance deficits in procedural learning and the fronto-striatal dysfunction model of OCD.

Background Lack of coordination between screening studies for common mental disorders in primary care and community epidemiological samples impedes progress in clinical epidemiology. Short screening scales based on the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI), the diagnostic interview used in community epidemiological surveys throughout the world, were developed to address this problem. Method Expert reviews and cognitive interviews generated CIDI screening scale (CIDI-SC) item pools for 30-day DSM-IV-TR major depressive episode (MDE), generalized anxiety disorder (GAD), panic disorder (PD) and bipolar disorder (BPD). These items were administered to 3058 unselected patients in 29 US primary care offices. Blinded SCID clinical reinterviews were administered to 206 of these patients, oversampling screened positives. Results Stepwise regression selected optimal screening items to predict clinical diagnoses. Excellent concordance [area under the receiver operating characteristic curve (AUC)] was found between continuous CIDI-SC and DSM-IV/SCID diagnoses of 30-day MDE (0.93), GAD (0.88), PD (0.90) and BPD (0.97), with only 9–38 questions needed to administer all scales. CIDI-SC versus SCID prevalence differences are insignificant at the optimal CIDI-SC diagnostic thresholds (χ2 1 = 0.0–2.9, p = 0.09–0.94). Individual-level diagnostic concordance at these thresholds is substantial (AUC 0.81–0.86, sensitivity 68.0–80.2%, specificity 90.1–98.8%). Likelihood ratio positive (LR+) exceeds 10 and LR− is 0.1 or less at informative thresholds for all diagnoses. Conclusions CIDI-SC operating characteristics are equivalent (MDE, GAD) or superior (PD, BPD) to those of the best alternative screening scales. CIDI-SC results can be compared directly to general population CIDI survey results or used to target and streamline second-stage CIDIs.

Pathologische Sorgen sind ungenau definiert. Für die Behandlungsplanung bleiben wichtige Fragen offen: Welche Merkmale sind für die Unterscheidung zwischen behandlungsbedürftigen und nicht behandlungsbedürftigen Sorgen relevant? Welche Art von Sorgen muss wie behandelt werden? Und: Welche Art von Sorgen gilt es eher zu akzeptieren? Wir machen praxisnahe Vorschläge dafür, wie Sorgen mittels einer einfachen Heuristik auch vom Patienten selbst als «pathologisch» identifiziert werden können. Im Sinne eines therapeutischen Arbeitsmodells ergeben sich differentielle Bearbeitungsstrategien, je nachdem, ob es sich um wichtige oder weniger wichtige, auf lösbare oder unlösbare Probleme bezogene sowie angemessene oder überzogene Sorgen handelt. Das vorgestellte Arbeitsblatt zu den Sorgen soll vor allem die wahrgenommene Kontrolle des Patienten stärken und die Psychoedukation zur Generalisierten Angststörung erleichtern. / Pathological worries have not yet been clearly defined. As a consequence, practically relevant questions remain open: Which characteristics distinguish worries relevant for treatment from those which are not? What kind of worries has to be treated in which way? And: What kind of worries is rather to be accepted? We propose a simple rationale which helps the therapist and the patient to identify pathological worries. According to this working model, different treatment strategies result depending on whether worries are central or not, whether they relate to a problem which can be solved or not, and whether they seem proportionate or exaggerated. The presented worksheet is meant to strengthen the perceived control of the patient and to help facilitate psychoeducation for generalised anxiety disorder. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Background: Worry exposure (WE) is a core element of cognitive-behavioral treatment for generalized anxiety disorder (GAD). Its efficacy as a stand-alone treatment method (without further cognitive-behavioral therapy interventions) has never been tested.We aimed to examine whether WE alone is as efficacious as the empirically supported stand-alone treatment for GAD, applied relaxation (AR). Methods: In a randomized controlled study, 73 outpatients meeting DSM-IV criteria for GAD as primary diagnosis were allocated to either WE or AR or a waiting list control group; in a 2nd randomization procedure the waiting list subjects were reallocated to WE or AR. The treatment was manualized (15 sessions with WE or AR), included 6-month and 1-year follow-ups, as well as last observation carried forward and completer analyses, and was controlled for allegiance effects.The Hamilton Anxiety Rating Scale and the State-Trait Anxiety Scale were used as primary outcome measures. Self-report scales of anxiety, worrying and depression including negative metacognition about worrying and thought suppression served as secondary outcome measures. Results: The dropout rate was moderate. The pre-/posttreatment effects were high for the Hamilton Anxiety Rating Scale (standardized mean difference >1) and for the State-Trait Anxiety Inventory (standardized mean difference >0.87). The proportion of patients reaching high end state functioning was 48% (WE) and 56% (AR). WE and AR did not differ with regard to dropout rate or treatment effects. The treatment effects were stable at 6 month and 1 year follow-up. Conclusion: This is the first study to show that a stand-alone exposure in sensu technique – WE – is efficacious in the treatment of GAD. Both AR and WE seem to represent effective principles of change in GAD. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Clinicians frequently treat patients suffering from more than one mental disorder. As they have to choose which disorder to treat first, knowledge on generalization effects or even comorbidity-associated obstacles should guide the clinician’s decision. Patients with panic disorder (PD) and agoraphobia (AG) often suffer from other mental disorders, e.g. social anxiety disorder (SAD) [1]. Nevertheless, evidence is missing whether cognitive-behavioral therapy (CBT) for PD/AG generalizes to SAD or whether comorbid SAD impedes the treatment of primary PD/AG.

The objective was to examine duloxetine 60–120mg/day treatment for relapse prevention in adults with generalized anxiety disorder (GAD). Adult patients (N=887; mean age=43.3 years; 61.0% female) with DSM-IV-TR-defined GAD diagnosis were treated with duloxetine for 26 weeks. Patients who completed open-label phase and were treatment responders (≥50% reduction in Hamilton Anxiety Rating Scale total score to ≤11 and “much”/“very much improved” ratings for the last 2 visits of open-label phase) were randomly assigned to receive duloxetine or placebo for a 26-week double-blind continuation phase. Relapse was defined as ≥2-point increase in illness severity ratings or by discontinuation due to lack of efficacy. During the double-blind phase, placebo-treated patients (N=201) relapsed more frequently (41.8%) than duloxetine-treated patients (13.7%, N=204, P≤0.001) and worsened on each outcome measure (P≤0.001, all comparisons). Duloxetine 60–120 mg/day treatment was efficacious and reduced risk of relapse in patients with GAD.

Parmi les diagnostics de troubles anxieux auprès de la population ayant une déficience intellectuelle (DI), le trouble d’anxiété de séparation figure parmi les plus fréquents. Près de 30 à 50 % des personnes avec une déficience intellectuelle (DI) présentent également un trouble de santé mentale en comorbidité, dont les troubles anxieux. Sachant que la prévalence de la DI est de 1,0 % à 2,6 % de la population du Québec, il semble pertinent d’offrir des services adaptés à leurs besoins particuliers. Pourtant, la grande majorité des recherches portant sur des interventions pour réduire les symptômes anxieux auprès d’une population ayant un trouble neurodéveloppemental, tel que le trouble du spectre de l’autisme (TSA), exclut les participants ayant une DI. Pour répondre à ce besoin, ce projet de recherche visait à évaluer l’efficacité d’un programme d’intervention auprès d’un parent d’un enfant âgé de 8 ans ayant une DI et un trouble d’anxiété de séparation. Dans le cadre d’un devis à cas unique de type AB, nous avons mesuré les comportements anxieux tout au long du programme d’intervention mis en place. Les résultats montrent que certains symptômes anxieux ont diminué suivant l’implantation par le parent de stratégies cognitivo-comportementales. D’autres études devront être effectuées afin d’explorer davantage l’efficacité de ce programme. / Among the diagnoses of anxiety disorders in the population with intellectual disabilities (ID), separation anxiety disorder is the most common. About 30 to 50% of people with intellectual disabilities (ID) also have a comorbid mental health problem, including anxiety disorders. Knowing that the prevalence of the disease is from 1.0% to 2.6% of the population of Quebec, it seems relevant to offer services tailored to their specific needs. Yet, the vast majority of research has been done on interventions to reduce the symptoms of the population with a neurodevelopmental disorder, such as the autism spectrum disorder (ASD), excludes participants with an ID. To address this need, this research project was designed to evaluate the effectiveness of an intervention program with a parent of an 8-year-old child with ID and separation anxiety disorder. As part of a single-case AB type design, we measured anxiety behaviors throughout the intervention program set up. The results show that some anxiety symptoms have decreased following the parent's implementation of cognitive-behavioral strategies. Other studies should be done to explore the effectiveness of the program.

No description available.

Nights in The City Beautiful is a collection of confessional, free verse poems that explores sexual trauma, mental health, the exigencies of marriage, and the complexities of human desire. These interconnected poems are grounded with a braided narrative and tackle taboo themes. In Part 1: Monogamy, the reader journeys into the world of Vincent and Victoria, their profound love, and their anxiety disorders. In Part 2: Polyamory, Victoria gets caught in a love triangle when she meets her publishing coworker, Peter Langley. The book evokes the movement of Romanticism and first-and-second-generation Romantic poets such as William Blake and Lord Byron. Contemporary influences on this collection include Aaron Smith’s Primer, Stacey Waite’s Butch Geography, and Tracy K. Smith’s The Body's Question. Nights in The City Beautiful merges lyricism with narrative, the ethereal with the physical. It is a novella in verse that delves into the boundaries of sexuality, love, and intimacy.

Hintergrund. In klinischen und epidemiologischen Untersuchungen wurden retrospektiv Assoziationen zwischen Angst- und Alkoholstörungen bestätigt. Bei Personen, die von beiden Störungen betroffen waren, fand man restrospektiv meist einen früheren Beginn der Angststörungen im Vergleich zu den Alkoholstörungen, was kausal im Sinne der Selbstmedikationshypothese interpretiert wurde. Diese konnte bisher nicht eindeutig bestätigt werden. Zur Aufklärung notwendige prospektive Untersuchungen, die Angststörungen auf diagnostischer Ebene erfassen, zwischen verschiedenen Angststörungen unterscheiden und sich auf Jugendliche beziehen, fehlen bisher. Fragestellung. Die Bedeutung von Angststörungen für die Entwicklung von erhöhtem Alkoholkonsum und Alkoholstörungen bei Jugendlichen und jungen Erwachsenen. Methodik. Die Analysen basieren auf den Daten der prospektiv-longitudinalen EDSP-Studie (Follow-Up: insg. 4 Jahre) mit einer epidemiologischen, repräsentativen Stichprobe von 3021 Personen im Alter zwischen 14 und 24 Jahre zu T0 aus München und Umland. Zur Erhebung von DSM-IV-Diagnosen wurde das M-CIDI verwendet. Ergebnisse. Primäre Panikstörungen, Panikattacken und Soziale Phobie erwiesen sich prospektiv als spezifische Prädiktoren für Beginn und Aufrechterhaltung von Alkoholproblemen. Umgekehrt waren Alkoholprobleme mit einem erhöhten Risiko für den Beginn von Sozialer Phobie und GAS assoziiert. Bezüglich DSM-IV Diagnosekriterien fanden sich phobische Ängste sowie Episoden intensiver Angst als Risikofaktoren für den Beginn von Alkoholproblemen. Vermeidungsverhalten war mit einem verminderten Risiko für nachfolgende Alkoholprobleme verbunden. Schlussfolgerungen. Maßnahmen zur Prävention von Alkoholproblemen können sich zielgruppenorientiert an Jugendliche mit Sozialer Phobie und Paniksymptomatik richten. Bei Patienten, die sich wegen Alkoholproblemen in Behandlung begeben, ist eine umfassende Diagnostik zur Identifikation zusätzlicher Angststörungen ratsam. / Background. Many clinical and epidemiological studies have documented significant cross-sectional comorbidities between anxiety disorders and alcohol use disorders. Analysis of retrospective age-of-onset reports suggests that the anxiety disorders often start earlier than the alcohol disorders. These data have often been interpreted in terms of a self-medication-model implying a causal mechanism. Overall, in former studies this model couldn't definitely be proofed. Prospective studies that follow a sample of adolescents into adulthood assessing different anxiety disorders on an diagnostic level are needed to confirm these associations. Methods. Baseline and four-year-follow-up data from the EDSP-Study, a prospective community survey of 3021 (2548 at follow-up) adolescents and young adults aged 14 to 24 years at baseline carried out in Munich, were used. DSM-IV anxiety disorders, alcohol use and alcohol use disorders were assessed with the M-CIDI. Results. While in retrospective analyses strong associations between nearly all anxiety disorders and alcohol problems, especially harmful use and dependence, were found, prospective analyses showed that only primary panic disorder, panic attack and social phobia are specific predictors of subsequent onset and persistence of alcohol problems. Contrary, primary alcohol problems were related to subsequent onset of social phobia and GAD. Considering the different DSM-IV-criteria, phobic anxiety as well as episodes of intensive anxiety were found to be risk factors for the following onset of alcohol problems. Avoidance behavior was associated with a lower risk for subsequent alcohol problems. Conclusions. Alcohol prevention programs could be directed to target groups with social phobia and panic. Patients with alcohol problems should carefully be screened for comorbid anxiety disorders. In order to prevent relapses the treating of social phobia and panic should be part of the therapy with comorbid alcohol patients.