Abstract Generalized anxiety disorder (GAD) is a mental health problem, which is characterized by excessive anxiety and worry, problems that are difficult to control. In the general population, the 12-month prevalence of GAD is 2-3%, with the lifetime prevalence being about 5%. However, GAD is more prevalent among primary care utilizers i.e. approximately 5-8% of them suffer from this disorder. Earlier studies have revealed GAD to be associated with a high utilization of health care resources. There were four goals of the present study; i) to investigate the prevalence of GAD among Finnish health care high utilizers, ii) to examine the association between GAD and utilization of different health care services at the population level, iii) to determine whether there would be any association between frequent utilization of health care services, GAD and somatic symptoms and iv) to compare the costs associated with GAD in secondary care in Finland with those attributable to major depressive disorder (MDD). In addition, the Finnish translation of the 7-item GAD scale (GAD-7) was validated. In a sample (n=150) of health care high utilizers in northern Finland, the prevalence of GAD was found to be 4%; GAD-7 was a valid instrument for detecting GAD in these subjects. In Northern Finland 1966 Birth Cohort, there was a significant association between GAD and health care utilization. Those subjects who screened positive for GAD with GAD-7 made 112% more total health care visits than other individuals. The results were statistically significant when controlled for potential confounders. Both GAD symptoms and physical symptoms were risk factors for frequent attendance of health care services, and the individuals who tested positive for GAD exhibited a higher rate of physical symptoms. Secondary care costs of all patients with a new diagnosis of GAD or MDD were calculated 2 years before and after the diagnosis date using the information from the Finnish Hospital Discharge Registers and National Hospital Benchmarking Database. Patients with a history of earlier depression or anxiety disorder had markedly higher costs compared with patients without psychiatric comorbidities. The highest mean individual costs (€19,538) during the 4-year follow-up were observed among patients with new onset of GAD but with a history of other anxiety disorders or MDD. / Tiivistelmä Yleistynyt ahdistuneisuushäiriö on mielenterveyden häiriö, jolle on ominaista ylenmääräinen ahdistuneisuus ja huolestuneisuus, joita on vaikea kontrolloida. Väestöstä noin 2 % on kärsinyt siitä vuoden aikana ja 5 % elinaikanaan. Perusterveydenhuoltoon hakeutuvilla potilailla sen on todettu olevan muuta väestöä yleisempi n. 5-8 %:n täyttäessä diagnostiset kriteerit. Aiemmat tutkimukset ovat viitanneet yleistyneestä ahdistuneisuushäiriöstä kärsivien käyttävän usein runsaasti terveyspalveluita. Tämän tutkimuksen tarkoituksena oli selvittää yleistyneen ahdistuneisuushäiriön esiintyvyyttä terveyspalveluita paljon käyttävillä suomalaisilla henkilöillä, yleistyneen ahdistuneisuushäiriön yhteyttä erilaisten terveyspalveluiden käyttöön väestötasolla, yleistyneen ahdistuneisuushäiriön ja somaattisten oireiden yhteyttä terveyspalveluiden suurkäyttöön ja yleistyneeseen ahdistuneisuushäiriöön erikoissairaanhoidossa liittyviä kustannuksia vertaillen niitä masennukseen liittyviin kustannuksiin. Samalla validoitiin yleistyneen ahdistuneisuushäiriön seulontaan kehitetyn GAD-7 seulan suomenkielinen käännös. Joukossa pohjoissuomalaisia (n=150) terveyspalveluita paljon käyttäviä henkilöitä 4 %:lla todettiin yleistynyt ahdistuneisuushäiriö. Heillä GAD-7-kysely osoittautui toimivaksi seulontatyökaluksi. Pohjois-Suomen 1966 syntymäkohortissa väestötasolla tutkittaessa todettiin yleistyneeseen ahdistuneisuushäiriöön liittyvän runsasta terveyspalveluiden käyttöä. GAD-7-kyselyssä positiivisen testituloksen saaneilla oli kokonaisuudessaan 112 % enemmän terveyspalveluiden käyttöä. Tulokset olivat tilastollisesti merkitseviä myös huomioitaessa mahdolliset sekoittavat tekijät. Lisäksi sekä yleistynyt ahdistuneisuushäiriö että somaattiset oireet liittyivät terveyspalveluiden suurkäyttöön. Sairaaloiden poistoilmoitusrekisteriä ja kansallista sairaaloiden vertailutietokantaa hyödyntäen laskettiin uusien yleistyneen ahdistuneisuushäiriön ja masennuksen diagnoosin saaneiden potilaiden erikoissairaanhoidon kokonaiskustannukset 2 vuotta ennen ja jälkeen diagnoosin. Erityisen suuret kustannukset olivat niillä uuden diagnoosin saaneilla, joilla oli historiassa aiempi masennus tai ahdistuneisuushäiriö. Suurimmat keskimääräiset erikoissairaanhoidon kustannukset (19 538 €) todettiin niillä yliestyneen ahdistuneisuushäiriön diagnoosin saaneilla, joilla aiemmin oli todettu jokin muu ahdistuneisuushäiriö tai masennus.

Hintergrund: Angststörungen sind häufig, oft chronifizierend, jedoch auch gut behandelbar. Leitlinienbehandlung ist die auf Exposition fokussierende Verhaltenstherapie. In der ambulanten Versorgungspraxis finden Expositionen jedoch selten statt. Die Angst-Tagesklinik am Universitätsklinikum Dresden realisiert die evidenzbasierte Behandlung von Angststörungen. In einer 5-wöchigen Kurzzeitbehandlung werden wöchentlich 4 begleitete und zeitoffene Expositionssitzungen durchgeführt. Untersucht wurden die Symptomverläufe und die Responder-Raten. Methoden: Zu Therapieaufnahme und -ende sowie zur Katamnese nach 3 Monaten und 1 Jahr wurde die Entwicklung der Symptombelastung bei n = 332 PatientInnen untersucht, die von 2009 bis 2015 behandelt wurden. Etwa zwei Drittel waren psychotherapeutisch vorbehandelt. Eingesetzt wurden spezifische etablierte Fragebögen. Berechnet wurden Mixed Models, Effektstärken und Responder-Raten. Ergebnisse: 90% der PatientInnen schlossen die Behandlung regulär ab. Es zeigten sich signifikante Linderungen bei Belastungen durch Angst- und depressive Symptome. Die höchsten Effektstärken um 0,9 ergaben sich bei verhaltensbezogenen Skalen und besonders bei den Agoraphobien und Panikstörungen, die die größte Störungsgruppe ausmachen. Die Responseraten lagen bei 60%. Zu den Katamnesezeitpunkten waren die Symptomverbesserungen stabil und bei den kognitiven Symptomen weiter steigend. Schlussfolgerungen: Die Behandlung in spezialisierten (teil)stationären Versorgungssettings mit Fokus auf hochfrequente Exposition, wie hier beispielhaft vorgestellt, zeigt eine gute Akzeptanz und gute bis sehr gute und längerfristig stabile Veränderungen der Symptombelastung. Diese Settings erfordern eine besondere strukturelle Ausstattung und Ressourcen. / Intensive Exposure-Based Treatment of Anxiety Disorders in a Specialized Patient-Centered Day Hospital Background: Anxiety disorders are highly prevalent, often chronic, but effectively treatable by cognitive-behavioral therapy, especially by exposure therapy. However, exposure treatments rarely occur in outpatient healthcare. The day hospital for anxiety disorders at the University Hospital Dresden implemented an evidence-based treatment. Every week, 4 guided time-open exposure sessions, not timelimited, are conducted during the 5-week treatment period. Improvements in symptomatology and response rates were examined. Methods: The symptomatology of n = 332 patients, treated from 2009 till 2015, was assessed at pretreatment and posttreatment, and at the follow-ups after 3 months and 1 year. Two-thirds had previously had other psycho therapy treatments. Established questionnaires were used. Data was analyzed by calculating mixed models, effect sizes, and response rates. Results: 90% of the patients finished the treatment regularly. Significant improvements occurred in anxiety and depressive symptoms. The strongest effect sizes of about 0.9 were achieved for behavioral scales, especially for symptoms of agoraphobia and panic disorder, the most frequent disorders in the sample. The response rates were 60%. Improvements remained stable at the follow-ups and even increased further for cognitive symptoms. Conclusions: Specialized day hospital healthcare settings, like the one presented here, are associated with good to very good and stable improvements and also with good acceptance. These therapeutic settings require specific structural equipment and resources.

Die vorliegende Arbeit beschäftigt sich mit der Diagnostik unerwünschter Gedanken sowie der Spezifität von Gedankenunterdrückung bei phobischen Patienten. Zwei Fragebogenverfahren zum Thema Sorgen sowie ein Instrument zur Erfassung von Strategien im Umgang mit intrusiven Gedanken wurden bezüglich der Gütekriterien der deutschen Übersetzung in einer klinischen Stichprobe evaluiert. Dabei handelt es sich um den Worry Domains Questionnaire (WDQ), der Sorgeninhalte erhebt, den Penn State Worry Questionnaire (PSWQ), der die Intensität von Sorgen erfasst, und den Thought Control Questionnaire (TCQ) zur Erfassung der Gedankenkontrollstrategien. Die Verfahren wurden bei 440 Psychotherapie-Patienten zu drei Meßzeitpunkten eingesetzt. Hinsichtlich der inneren Konsistenz und der Retest-Reliabilität ergeben sich für alle Instrumente zufriedenstellende bis gute Kennwerte. Die Validität ist nur für den PSWQ als gut zu bezeichnen. Beim WDQ zeigen sich Probleme hinsichtlich der Trennung von Sorgen und sozialer Ängstlichkeit, während der TCQ wohl eher Aspekte allgemeiner Psychopathologie als spezifische Strategien erfasst. Eine zweite Studie befasste sich mit intentionaler Gedankenunterdrückung. Die paradoxen Effekte dieser Bemühungen wurden wiederholt mit psychischen Störungen, vor allem mit Angststörungen, in Verbindung gebracht. Dabei ist ein wichtiges Thema, ob die Gedankenkontrollfähigkeit nur für störungsspezifische Inhalte oder generell beeinträchtigt ist. Die vorliegende Studie verglich Patienten mit Agoraphobie und Patienten mit Sozialphobie mit einer gesunden Kontrollgruppe. Alle Personen mussten Gedanken an ein neutrales Kontrollthema sowie zwei störungsspezifische Themen unterdrücken. Es zeigte sich ein störungsspezifischer Effekt bei den Agoraphobikern. Sozialphobiker scheinen hingegen ein generelles Defizit ihrer mentalen Kontrolle aufzuweisen. Zusätzlich erwies sich soziale Ängstlickeit innerhalb einer Reihe psychopathologischer Variablen als stärkster Prädikator für Schwierigkeiten bei der Gedankenunterdrückung. Ingesamt weisen einige Ergebnisse dieser Arbeit darauf hin, dass Gedankenunterdrückung ein wichtiges Merkmal der Sozialphobie sein könnte. / The work conducted aimed at evaluating instruments investigating unwanted thoughts as well as determining the specifity of thought suppression in phobia. German translations of two questionnaires measuring worry as well as an instrument, measuring strategies used in dealing with unwanted thoughts, were evaluated in a clinical sample. We used the Worry Domains Questionnaire (WDQ), measuring contents of worry, the Penn State Worry Questionnaire (PSWQ), measuring the intensity of worry, and the Thought Control Questionnaire (TCQ), investigating strategies in thought control. The instruments were administered at three points in a sample of 440 patients receiving psychological treatment. Concerning internal consistency and retest-reliability all questionnaires showed acceptable to good results. Validity is only good concerning PSWQ. WDQ has problems in differentiating worry and social anxiety, where as TCQ seems to measure general psychopathology more than specific strategies. The second study investigated intended thought suppression. Its paradoxical effects have been linked to psychological disorders, namely anxiety disorders. One important issue is if thought suppression is impaired only for thoughts related to the disorder or if the ability for mental control is generally impaired in anxiety patients. This study compared groups of agoraphobics and social phobics with healthy controls. All subjects had to suppress a neutral topic and two topics related to the central fear of the two disorders. We found a rather specific deficit in thought suppression for the agoraphobics. Social phobics seem to be characterized by a general impairment of mental control. In addition, among several psychopathological variables, social anxiety proved to be the strongest predictor for problems with thought suppression. Taken together, there are several indicators that thought suppression may be an important feature of social phobia.

Background: Chronic cough is a common health problem with variable success rates to standardized treatment. Psychologic symptoms of depression, anxiety, and stress have been reported in association with chronic cough. The purpose of this study was to examine changes in the psychologic symptoms of depression, anxiety, and stress in adults with chronic cough 3 months after management using the ACCP cough treatment guidelines. Methods: This study used a descriptive longitudinal observation design. The major tenets associated with the Theory of Unpleasant Symptoms were examined. Intervention fidelity to the study components was measured. Results: A sample of 80 consecutive patients with chronic cough of greater than 8 weeks duration was recruited from one cough specialty clinic. Mean age of subjects was 58.54 years; 68.7% were female; 98.7% were white, and 97.5% were non-smokers. Mean cough duration was 85.99 months and mean cough severity was 6.11 (possible 0 –10; higher scores equal greater cough severity). Cough severity improved post treatment (n=65, M=2.32, (SE =.291), t (64) =7.98, p=.000); cough-specific quality-of-life also improved (n=65, M=9.17, (SE=1.30), t (64) =7.02, p=.000). Physiologic (urge-to-cough r=.360, ability to speak r=.469) and psychologic factors (depression r=.512, anxiety r=.507, stress r=.484) were significantly related to cough-specific quality-of-life and to cough severity (urge-to-cough r=.643, ability to speak r=.674 and depression r=.356, anxiety r=.419, stress r=.323) (all r, p=.01); social support and number of diagnoses were not related to either variable. Those experiencing greater financial strain had worse cough severity. Women, those experiencing financial strain, and those taking self-prescribed therapy had worse cough-specific quality-of-life. Intervention fidelity to the study plan was rated as high according to observation, participant receipt, and patient/physician concordance. Qualitative review identified potential areas of variability with intervention fidelity. Conclusions: By measuring the factors related to the major tenets of the Theory of Unpleasant Symptoms, this theory has helped to explain why those with chronic cough may have symptoms of depression, anxiety, and stress and why these symptoms improve as cough severity and cough-specific quality-of-life improve. Moreover, by measuring intervention fidelity, it may be possible to determine why cough guidelines may not be yielding consistently favorable results.

Hintergrund. Angst- und depressive Störungen treten sehr häufig auf. Die Komorbidität zwischen beiden Störungsgruppen ist hoch. Quer- und Längsschnittstudien legen nahe, dass vorausgehende Angststörungen das Risiko sekundärer Depression erhöhen, wobei wenig zur Rolle klinischer Charakteristika von Angststörungen in diesem Zusammenhang bekannt ist. Es liegen eine Fülle von Befunden zu Risikofaktoren für Angst- und depressive Störungen vor, die bei genauerer Betrachtung allerdings eine Reihe methodischer Limitationen und offener Forschungsfragen aufweisen (z.B. viele Querschnittserhebungen, klinische Stichproben, keine vergleichenden Analysen der Risikofaktoren von Angststörungen versus Depression). Eine reliable Bewertung der diagnostischen Spezifität vs. Unspezifität von Vulnerabilitäts- und Risikofaktoren von Angst- und depressiven Störungen mit den bislang vorliegenden Ergebnissen schwer möglich ist. Fragestellungen. Es wurden Gemeinsamkeiten und Unterschieden hinsichtlich der Korrelate und Risikofaktoren von reinen Angst- versus reinen depressiven Störungen untersucht. Durch einen Vergleich reiner Angst- mit reinen depressiven Störungen sollte eine reliablere Einschätzung der Spezifität versus Unspezifität der untersuchten Vulnerabilitäts- und Risikofaktoren erfolgen. Der zweite Fokus lag in der Analyse der Rolle von primären Angststörungen und der mit ihnen assoziierten klinischen Merkmale bei der Entwicklung sekundärer Depressionen. Methoden. Die „Early Developmental Stages of Psychopathology (EDSP)“- Studie ist eine prospektive, longitudinale Studie. Eine repräsentative Bevölkerungsstichprobe von ursprünglich 3021 Jugendlichen und jungen Erwachsenen (zu Baseline 14-24 Jahre alt) wurde dreimal befragt (eine Baseline-Erhebung sowie zwei Folgebefragungen). Zusätzlich wurden die Eltern der Probanden, die am ersten Follow-Up teilgenommen hatten, in einem Elterninterview direkt interviewt. Von 2548 Probanden lagen diagnostische Informationen von der Basisbefragung und des Follow-Up-Zeitraumes vor. Psychische Störungen wurden mit Hilfe des M-CIDI nach DSM-IV Kriterien erfasst. Darüber hinaus wurden eine Vielzahl potenzieller Risikofaktoren (z.B. Behavioral Inhibition, kritische Lebensereignisse) erhoben. Ergebnisse. Die drei wichtigsten Ergebnisse dieser Arbeit waren: a)Es konnten gemeinsame, aber auch einige spezifische Risikofaktoren für Angststörungen versus depressive Störungen nachgewiesen werden. b)Die Angststörungen stellen eine heterogene Gruppe dar: Auch innerhalb der Gruppe der Angststörungen zeichnen sich spezifische Risikofaktoren für spezifische Angststörungen ab (d.h. es fanden sich Unterschiede zwischen Spezifischer und Sozialer Phobie). c)Es wurden starke Assoziationen zwischen Angststörungen sowie der mit ihnen assoziierten Merkmale (Beeinträchtigung, Komorbidität, Panikattacken) und der Entwicklung sekundärer depressiver Störungen gefunden. Im multiplen Modell, das alle klinischen Merkmale beinhaltete, stellte sich der Faktor schwere Beeinträchtigung als bedeutendster Prädiktor heraus. Diskussion und Schlussfolgerungen. Insgesamt befürworten die Befunde dieser Arbeit eher die sog. Splitters-Perspektive von zumindest teilweise unterschiedlichen Risikofaktoren für Angst- und depressive Störungen. Einer der potentesten Risikofaktoren für depressive Störungen scheinen vorausgehende Angststörungen zu sein, der Schweregrad der Beeinträchtigung durch die Angststörung spielt dabei eine entscheidende Rolle. Eine rechtzeitige, effektive Behandlung dieser Angststörungen könnte eine sehr erfolgversprechende Strategie in der Prävention depressiver Störungen sein. Der Beeinträchtigungsgrad durch die Angststörung kann dabei zur Identifizierung von sog. Hoch-Risiko-Personen genutzt werden. / Background. Anxiety disorders and depression are frequent mental disorders; comorbidity is high. Although cross-sectional and longitudinal studies suggest that anxiety disorders increase the risk of subsequent depression, little is known about the role of clinical characteristics of anxiety disorder in this association. Furthermore, there are a lot of studies investigating risk factors of anxiety disorders and depression. Most of these studies, however, have some substantial limitations (e.g., cross-sectional design, clinical samples, lack of analyses comparing risk factors of anxiety disorders versus depression) preventing a reliable assessment of the specificity of vulnerability and risk factors for anxiety disorders and depression. Aims. The first aim of the study was to examine common and specific correlates and risk factors of pure anxiety disorders versus pure depression. The second aim was to analyse the association between anxiety disorders and subsequent depression and the role of clinical characteristics of anxiety disorders in this associations. Methods. The data are from the Munich Early Developmental Stages of Psychopathology (EDSP) study. The EDSP study is a 4-year prospective-longitudinal community study, which includes both baseline and follow-up data on 2548 adolescents and young adults 14 to 24 years of age at baseline. Parents of those probands participated at the first follow-up of the study were also interviewed. DSM-IV diagnoses were made using the Munich-Composite International Diagnostic Interview (M-CIDI). A range of risk factors were assessed (e.g., behavioral inhibition, life events). Results. There were both common and specific risk factors of anxiety disorders and depression. Furthermore, specific risk factors for specific anxiety disorders could be identified (i.e. different risk factors of specific phobia versus social phobia were found). Anxiety disorders and their clinical characteristics (impairment, comorbidity, panic attacks) were significantly associated with the development of subsequent depression. In the final model, which included all clinical characteristics, severe impairment remained the only clinical feature that was an independent predictor of subsequent depression. Discussion and conclusions. The findings suggest that there are specific risk factors of anxiety disorders and depression. Anxiety disorders are a very powerful risk factor for subsequent depression whereas severe impairment seems to play a major role in this association. Effective treatment of anxiety disorders, specifically those associated with extreme disability, might be important for targeted primary prevention of depression. The degree of impairment of anxiety disorders could be used for the identification of individuals at highest risk for onset of depression.

Background and Objectives: To describe patterns of healthcare utilization among patients with generalized anxiety disorder (GAD) in general practitioner (GP) settings in Germany. Methods: Using a large computerized database with information from GP practices across Germany, we identified all patients, aged > 18 years, with diagnoses of, or prescriptions for, GAD (ICD-10 diagnosis code F41.1) between October 1, 2003 and September 30, 2004 ("GAD patients"). We also constituted an age- and sex-matched comparison group, consisting of randomly selected patients without any GP encounters or prescriptions for anxiety or depression (a common comorbidity in GAD) during the same period. GAD patients were then compared to those in the matched comparison group over the one-year study period. Results: The study sample consisted of 3340 GAD patients and an equal number of matched comparators. Mean age was 53.2 years; 66.3% were women. Over the 12-month study period, GAD patients were more likely than matched comparators to have encounters for various comorbidities, including sleep disorders (odds ratio [OR] = 6.75 [95% CI = 5.31, 8.57]), substance abuse disorders (3.91 [2.89, 5.28]), and digestive system disorders (2.62 [2.36, 2.91]) (all p < 0.01). GAD patients averaged 5.6 more GP encounters (10.5 [SD = 8.8] vs 4.9 [5.7] for comparison group) and 1.4 more specialist referrals (2.3 [2.9] vs 0.9 [1.7]) (both p < 0.01). Only 58.3% of GAD patients received some type of psychotropic medication (i.e., benzodiazepines, antidepressants, and/or sedatives/hypnotics). Conclusions: Patients with GAD in GP practices in Germany have more clinically recognized comorbidities and higher levels of healthcare utilization than patients without anxiety or depression.

Der folgende Beitrag schildert erste Ergebnisse einer Evaluationsstudie des Fortbildungsprogramms «Patientenseminar Angst» für Ärzte. 109 Teilnehmer der Veranstaltung I und 104 Teilnehmer der Veranstaltung II wurden vor und im Anschluβ an die Veranstaltungen sowie 3 Monate später bezüglich ihrer Beurteilung des Fortbildungsprogramms sowie zu ihren Einstellungen, Erfahrungen und Kenntnissen zu Angstpatienten befragt und mit einer Kontrollgruppe verglichen. Es zeigte sich, daβ Angstpatienten in der Allgemeinarztpraxis viel Zeitaufwand beanspruchen und sowohl die diagnostischen als auch die therapeutischen Kenntnisse nicht zufriedenstellend sind. Das Fortbildungsprogramm wurde von den Teilnehmern sehr gut beurteilt. Durch die Teilnahme wurde in Teilgruppen eine Verbesserung vor allem der Kenntnisse im Bereich «Angststörungen erkennen/Diagnostik» erreicht. Das Patientenseminar wurde vom Groβteil der Teilnehmer sowohl in Gruppen als auch bei einzelnen Patienten in der Praxis durchgeführt. Es wird deutlich, daβ trotz des hohen Aufwandes eine groβe Akzeptanz für den Einsatz solcher Patienten-seminare vorhanden ist und daβ insgesamt die bisher untersuchten Variablen für eine überraschend hohe Effektivität der Fortbildungsmaβnahmen sprechen. / This artide describes preliminary results of an evaluation study of the patientseminar 'anxiety', an educational programme for physicians. Before and after the two seminar meetings, 109 participants of part land 104 participants of part II filled in a questionnaire about their opinion on the programme as weil as their attitudes, experience, and knowledge about anxiety patients. They were compared with a control group, which did not take part in the programme. It is found that anxiety patients call for a lot of attention at general practitioners' and that the physicians' diagnostic and therapeutic knowledge is not sufficient. The educational programme was highly rated by participants. The patientseminar was conducted, for the greater part of participants, by the physicians both in groups and for single patients. It became evident that in spite of high expenses there is a wide acceptance of such patientseminars and that the variables so far examined up to now indicate surprisingly high efficiency of the educational programme.

„Comorbidity“ among mental disorders is commonly observed in both clinical and epidemiological samples. The robustness of this observation is rarely questioned; however, what is at issue is its meaning. Is comorbidity „noise“ – nuisance covariance that researchers should eliminate by seeking „pure“ cases for their studies – or a „signal“ – an indication that current diagnostic systems are lacking in parsimony and are not „carving nature at its joints?“ (Krueger, p. 921). With these words, Krueger started a discussion on the structure of mental disorders, which suggested that a 3-factor model of common mental disorders existed in the community. These common factors were labeled „anxious-misery,“ „fear“ (constituting facets of a higher-order internalizing factor), and „externalizing.“ Along with similar evidence from personality research and psychometric explorations and selective evidence from genetic and psychopharmacologic studies, Krueger suggested that this model might not only be phenotypically relevant, but might actually improve our understanding of core processes underlying psychopathology. Since then, this suggestion has become an influential, yet also controversial topic in the scientific community, and has received attention particularly in the context of the current revision process of the Manual of Mental Disorders (Fifth Edition) (DSM-V) and the International Classification of Diseases, 11th Revision (ICD-11). Focusing on anxiety disorders, this article critically discusses the methods and findings of this work, calls into question the model’s developmental stability and utility for clinical use and clinical research, and challenges the wide-ranging implications that have been linked to the findings of this type of exploration. This critical appraisal is intended to flag several significant concerns about the method. In particular, the concerns center around the tendency to attach wide-ranging implications (eg, in terms of clinical research, clinical practice, public health, diagnostic nomenclature) to the undoubtedly interesting statistical explorations.

Although functional magnetic resonance imaging (fMRI) has gained increasing importance in investigating neural substrates of anxiety disorders, less is known about the stress eliciting properties of the scanner environment itself. The aim of the study was to investigate feasibility, self-reported distress and anxiety management strategies during an fMRI experiment in a comprehensive sample of patients with panic disorder and agoraphobia (PD/AG). Within the national research network PANIC-NET, n = 89 patients and n = 90 controls participated in a multicenter fMRI study. Subjects completed a retrospective questionnaire on self-reported distress, including a habituation profile and exploratory questions about helpful strategies. Drop-out rates and fMRI quality parameters were employed as markers of study feasibility. Different anxiety measures were used to identify patients particularly vulnerable to increased scanner anxiety and impaired data quality. Three (3.5%) patients terminated the session prematurely. While drop-out rates were comparable for patients and controls, data quality was moderately impaired in patients. Distress was significantly elevated in patients compared to controls; claustrophobic anxiety was furthermore associated with pronounced distress and lower fMRI data quality in patients. Patients reported helpful strategies, including motivational factors and cognitive coping strategies. The feasibility of large-scale fMRI studies on PD/AG patients could be proved. Study designs should nevertheless acknowledge that the MRI setting may enhance stress reactions. Future studies are needed to investigate the relationship between self-reported distress and fMRI data in patient groups that are subject to neuroimaging research.

Anxiety disorders are among the most commonly diagnosed class of mental illness in the United States, and often involve abnormally high levels of stress and social fear. Despite high lifetime prevalence rates, social anxiety disorder (SAD) has remarkably low diagnosis and treatment rates. Furthermore, while individuals with other specific psychiatric disorders tend to exhibit significant neuropsychological deficits, neuropsychological functioning in individuals with SAD remains largely untested. A majority of the few existing studies concerning neuropsychological performance in SAD samples focus on specific functions, and their limited results are highly mixed. The primary objective of this investigation was to provide a more thorough, broad assessment of both auditory and visual working memory as related to psychometrically-defined social anxiety disorder. In addition, this study aimed to help clarify as to whether such deficits are related to the construct of social anxiety, or whether any potential deficits are better explained by generalized state and/or trait (in-the-moment) anxiety. The implications of a deficit in the visual and/or auditory working memory domains are multifaceted. For example, such a deficit may lead to the inability to detect visual cues in social situations. The inability to process these social cues has the potential to exacerbate some SAD- related symptoms, such as fear of humiliation and judgment. Twenty-nine college students completed both phases of this study, including an assessment of state and trait anxiety as well as social phobia and a four-part working memory battery. An analysis of the Phase II data indicates that individual scores on the four measures of both visual and auditory working memory did not relate to trait and/or state anxiety or psychometrically-defined social anxiety.; Thus, it appears that social, generalized trait, and generalized state anxiety do not relate to a neuropsychological deficit in either type of working memory in this sample population. However, we did find a statistical trend suggesting that as social anxiety increased, there was a relative decrease in visual vs. auditory working memory. This statistical trend remained after covarying for state and trait anxiety respectively. Therefore, future research in this area should examine the discrepancy in performance between the auditory and visual working memory domains as it relates to both diagnosed social phobia and psychometrically-defined social anxiety.