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Alcohol Dependence and Gender: An fMRI Pilot Study Examining Affective ProcessingPadula, Claudia B. 20 April 2011 (has links)
No description available.
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Fearful temperament moderates the association between positive parenting and children's social competence during early childhoodGrande, Jessica M 18 December 2015 (has links)
Social competence during kindergarten has been linked to adaptive teacher-child and peer relationships. The quality of parents’ interaction with their children during the toddler years may promote better social development placing children on a trajectory towards social competence. Quite possibly, children vary in how responsive they are to parenting efforts. This study evaluated the extent to which positive parenting predicted change in social competence from child age 3 to 4 among 137 parent-child dyads. Observational measures of positive parenting and fearful temperament were analyzed when children were 3-years of age. Teacher reports of social competence in the classroom were collected during children’s 4-year old assessment. Positive parenting was positively associated with children’s level of social competence. No evidence emerged of fearful temperament as a moderator for the association between positive parenting and social competence. Regardless of children’s temperament, all children benefit from positive parenting during early childhood.
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The interaction of parenting and the serotonin transporter gene on trajectories of fearfulness in early childhoodRiley, Moira R 18 December 2015 (has links)
Children who are more fearful and inhibited during early childhood are at greater risk for social problems (e.g., loneliness, social isolation) and clinically significant internalizing disorders during adolescence and adulthood (e.g., Rubin, Chen, McDougall, Bowker, & McKinnon, 1995; Williams et al., 2009). While the impact of fearful temperament on adjustment indices are regularly the focus of study, less well understood are biological and social processes that may affect the development of fearful temperament. The present study considered the role of the 5-HTTLPR polymorphism and parenting on change in fearful and inhibited temperamental characteristics during early childhood.
The s/s genotype was expected to be associated with elevated and sustained levels of fearful temperament. Moreover, supportive parenting was expected to be associated with less fearful temperament while more harsh parenting would be associated with more fearful temperamental characteristics, especially for children with the s/s 5-HTTLPR genotype. Study hypotheses were tested using 165 families (i.e., biological mothers and fathers, 3-5 year old children) who participated in the Family Transitions Project (FTP: R. D. Conger & K. J. Conger, 2002). Children were genotyped using cheek swabs. Parents reported on children’s temperamental characteristics at ages 3, 4, and 5. Independent observations of mothers and fathers completing a puzzle with their 3 and 4 year old children were used to measure parenting. Results were partially supportive of predictions. Parenting interacted with the 5-HTTLPR genotype to predict trajectories of shyness and soothability dimensions of fearful temperament, but the pattern of findings varied for mothers and fathers. Results are discussed in terms of differential susceptibility and the conceptualization of risk and resilience.
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Fearful Temperament Moderates the Effect of Harsh Parenting on Early Childhood Problem Behaviors within Dangerous Neighborhoods: A Multilevel AnalysisSapotichne, Brenna 18 December 2015 (has links)
No description available.
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Effects of a mutation on the TSHR gene on social and fear related behaviours in chickens.Axling, Johanna January 2011 (has links)
It has been shown that thyroid hormones are important in development and growth in birds and further that thyrotropin (TSH) signaling regulated photoinduced seasonal reproduction. In addition to controlling the development of certain physiological traits, TSH can affect a wide range of phenotypes related to domestication such as behaviour, growth rate, more frequent reproductive cycle’s, pigmentation and also behaviour. Studies indicate that thyroid hormone physiology could potentially be responsible for differences in individual stress response as well as differences in social dominance. This project investigated behaviours expressed in the different genotypes on the Thyroid stimulating hormone receptor (TSHR) gene in chickens. Standard test such as Fear of human, Aerial predator, Tonic immobility and Social hierarchy were carried out with White leghorn (WL) as a domesticated species and Red Junglefowl (Rjf) as their wild counterpart; these were considered to be the control group. There was no significant result on genotype effect for the TSHR animals observed in those variables tested. The TSHR mutants were expected to mirror the White leghorn behavioural response and the TSHR wildtype the behaviour of Rjf. This was however not confirmed. There were a significant interaction between genotype effect and sex effect for TSHR for stand alert in the Aerial predator test which mirrored the results seen in the control groups. The male wildtype followed the male Rjf pattern however the mutant did not mirror the WL male. This study would benefit from more individuals to be tested, for stronger statistical results, plus also to have all genotypes represented to fully investigate the affect the TSHR mutation have on domesticated chickens and potentially the domestication process in a range of species. / TSHR
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Fearful Temperament in Middle Childhood and Anxiety Symptoms in Adolescence: The Roles of Attention Biases, Effortful Control, and Frontal EEG AsymmetryLiu, Ran 01 December 2020 (has links)
Fearful temperament represents one of the robust predictors of the development of child and adolescent anxiety. Not all children with fearful temperament unvaryingly develop anxiety, however. Diverse processes resulting from the interplay among attention, cognitive control, and motivational system drive the trajectories toward more adaptive or maladaptive directions. In this study, I examined various factors that underlie the association between fearful temperament at age 9 and adolescent anxiety symptoms including attention biases, different components of effortful control, and frontal EEG asymmetry. 78 children participated in this study. Results indicate that fearful temperament at age 9 significantly predicted adolescent anxiety symptoms. This association, however, was moderated by children's effortful control and frontal EEG asymmetry at age 9. Specifically, fear at 9 years predicted adolescent anxiety only when children had low attentional control, low inhibitory control, low activation control, and exhibited greater right activation from baseline to task. The associations between AB and fearful temperament as well as anxiety were not significant. The association between fear at 9 years and sustained AB during adolescence, however, was moderated by children's attentional control, inhibitory control, and frontal EEG asymmetry at age 9. Specifically, fear predicted attention biases away from threat when children had high attentional control, high inhibitory control, and showed greater left activation. The findings will be discussed in terms of the roles of attention biases in the development of anxiety and how different components of effortful control and frontal EEG asymmetry contribute to the resilience process. / Doctor of Philosophy / Anxiety disorders represent one of the most commonly occurring mental health problems in childhood and adolescence. Children who tend to show wariness and distress to negative stimuli are more likely to have anxiety. Not all children with fearful temperament develop anxiety, however. Certain individual characteristics can protect fearful children from having anxiety symptoms. In this study, I examined the roles of attentional biases toward threat (AB), different components of self-regulation (EC), and the asymmetrical frontal brain activation (FA) in changing the relation between fearful temperament and anxiety. 78 children participated in this study. Results indicated that adolescents were at higher risk for anxiety if they showed high fearful temperament at age 9. However, the risk could be attenuated if children were better able to control their attention and behaviors, and exhibited greater left activation from resting to a mildly stressful situation at age 9. In addition, fearful children were better able to direct attention away from threat during adolescence if they were better able to control their attention and behaviors, and exhibited greater left activation from resting to a mildly stressful situation at age 9. The findings provide suggestions for early identification and intervention of children who are more vulnerable to anxiety during adolescence.
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The role of fearful spells as risk factors for panic pathology and other mental disordersAsselmann, Eva 15 January 2015 (has links) (PDF)
Background. Previous research suggests that individuals experiencing DSM-IV panic attacks (PA) are at increased risk for various forms of psychopathology, including anxiety, depressive and substance use disorders. However, little is known regarding whether the sole occurrence of fearful spells (FS-only; distressing spells of anxiety with less than four panic symptoms and/or lacking crescendo in symptom onset) similarly elevates the risk for subsequent psychopathology and could therefore be promising to identify high-risk groups for targeted preventive interventions. Thus, the current dissertation thesis aims to examine (a) whether FS-only predict incident mental disorders in addition to full-blown PA and whether their associations with subsequent psychopathology differ from those obtained for PA, (b) whether FS-only, PA, and panic disorder (PD) share similar etiologies, (c) which characteristics of initial FS/PA and other risk factors predict a progression to more severe panic pathology and other mental disorders, and (d) whether help-seeking/potential treatment in individuals with panic alters the risk for subsequent psychopathology.
Methods. A representative community sample of adolescents and young adults (N=3021, aged 14-24 at baseline) was prospectively followed up in up to three assessment waves over a time period of up to 10 years. FS-only, PA, PD, and other mental disorders were assessed at each assessment wave using the DSM-IV-M-CIDI. Additional modules/questionnaires were used to assess characteristics of initial FS/PA (T1/T2), potential risk factors, and help-seeking/potential treatment. Logistic regressions were applied to test associations (Odds Ratios, OR) of FS-only and PA at baseline with incident mental disorders at follow-up as well as respective interactive effects with help-seeking at baseline. Associations (Hazard Ratios, HR) of putative risk factors with the onset of panic pathology (FS-only, PA, and PD) or the onset of subsequent anxiety/depressive vs. substance use disorders in those with panic pathology (aggregated data across assessment waves) were estimated with Cox regressions. Multinomial logistic regressions were used to test associations of initial FS/PA characteristics (aggregated from T1 and T2) with PA and PD (lifetime incidences aggregated across assessment waves).
Results.
FS-only at baseline predicted incident anxiety and depressive disorders at follow-up (OR 1.59-4.36), while PA at baseline predicted incident anxiety, depressive, and substance use disorders at follow-up (OR 2.08-8.75; reference group: No FS/PA). Merely any anxiety disorder (OR=3.26) and alcohol abuse/dependence (OR=2.26) were significantly more strongly associated with PA than with FS-only. Female sex, parental anxiety disorders, parental depressive disorders, behavioral inhibition, harm avoidance, lower coping efficacy, and parental rejection predicted FS-only, PA, and PD (HR 1.2-3.0), whereas the associations with other risk factors partially differed for FS-only, PA, and PD and tended to be more pronounced for PA and PD than for FS-only.
Alcohol consumption, use of drugs/medication, and physical illness as perceived reasons for the initial FS/PA were associated with the occurrence of full-blown PA (without PD, OR 2.46-5.44), while feelings of anxiety/depression and having always been anxious/nervous as perceived reasons for the initial FS/PA, appraising the initial FS/PA as terrible and long-term irritating/burdensome, subsequent feelings of depression, avoidance of situations/places, and consumption of medication, alcohol, or drugs were associated with the development of PD (OR 2.64-4.15). A longer duration until “feeling okay again” was associated with both PA and PD (OR 1.29-1.63 per category). Moreover, partially different risk constellations in subjects with panic pathology (FS/PA/PD) predicted the onset of subsequent anxiety/depressive vs. substance use disorders. Panic pathology (FS/PA) and help-seeking/potential treatment at baseline interacted on predicting incident PD (OR=0.09) and depression (OR=0.22) at follow-up in a way that panic pathology only predicted these disorders in individuals not seeking help at baseline.
Conclusions. Findings suggest that individuals with FS-only are at similar risk of developing subsequent psychopathology compared to individuals with full-blown PA. Specific initial FS/PA characteristics and additional risk factors may be used to identify sub-groups of individuals with panic pathology, which are at particular risk of progressing to more severe panic pathology or other mental disorders and might therefore profit from supplemental outcome-related preventive interventions in addition to panic-specific treatment. Future research may replicate the current findings and test the efficacy of targeted preventive interventions in panickers at elevated risk for PD and other forms of psychopathology. / Theoretischer Hintergrund. Auf Grundlage früherer Forschungsbefunde ist anzunehmen, dass Personen mit DSM-IV-Panikattacken (PA) ein erhöhtes Risiko für zahlreiche psychische Störungen, einschließlich Angst-, depressiver und Substanzstörungen, aufweisen. Unklar ist jedoch, ob das alleinige Auftreten von Fearful Spells (FS-only, Angstanfälle mit weniger als vier Paniksymptomen und/oder fehlendem Crescendo in der Symptomentwicklung) das Risiko für Psychopathologie in ähnlicher Weise erhöht und hilfreich sein könnte, um Hochrisikogruppen für Präventivinterventionen zu identifizieren. Innerhalb der vorliegenden Dissertation wird daher untersucht, (a) ob FS-only zusätzlich zu PA inzidente psychische Störungen vorhersagen und ob sich Unterschiede in den Assoziationen von FS-only vs. PA mit nachfolgender Psychopathologie ergeben, (b) ob FS-only, PA und Panikstörung (PS) ähnliche Ätiologien teilen, (c) welche Merkmale initialer FS/PA und welche anderen Risikofaktoren die Entwicklung schwerer Panikpathologie und weiterer psychischer Störungen vorhersagen und (d) ob Hilfesuchverhalten/potenzielle Behandlung bei Personen mit Panik das Risiko für nachfolgende Psychopathologie verändert.
Methodik. Eine repräsentative Bevölkerungsstichprobe Jugendlicher und junger Erwachsener (N=3021, 14-24 Jahre zur Baseline-Erhebung) wurde in bis zu drei Erhebungswellen über einen Zeitraum von bis zu 10 Jahren untersucht. FS-only, PA, PS und andere psychische Störungen wurden zu jeder Erhebungswelle mithilfe des DSM-IV-M-CIDI erfasst. Merkmale initialer FS/PA (T1/T2), mögliche Risikofaktoren sowie Hilfesuchverhalten/potenzielle Behandlung wurden mit weiteren Modulen und Fragebögen erhoben. Mithilfe logistischer Regressionen wurden Assoziationen (Odds Ratios, OR) von FS-only und PA zu Baseline mit inzidenten psychischen Störungen zum Follow-Up sowie diesbezügliche Interaktionen mit Hilfesuchverhalten zu Baseline getestet.
Zusammenhänge zwischen möglichen Risikofaktoren und dem Auftreten von Panikpathologie (FS-only, PA und PS) bzw. nachfolgender Angst-/depressiver und Substanzstörungen bei Personen mit Panikpathologie (Verwendung von über die Erhebungswellen hinweg aggregierter Daten) wurden mithilfe von Cox-Regressionen geschätzt. Multinomiale logistische Regressionen wurden genutzt, um Assoziationen von Merkmalen initialer FS/PA (aggregiert über T1 und T2) mit PA und PS (über die Erhebungswellen hinweg aggregierte Lebenszeitinzidenzen) zu erfassen.
Ergebnisse. FS-only zu Baseline sagten inzidente Angst- und depressive Störungen zum Follow-Up vorher (OR 1.59-4.36), wohingegen PA zu Baseline inzidente Angst-, depressive und Substanzstörungen zum Follow-Up vorhersagten (OR 2.08-8.75; Referenzkategorie: Keine FS/PA). Lediglich irgendeine Angststörung (OR=3.26) und Alkoholmissbrauch/-abhängigkeit (OR=2.26) waren signifikant stärker mit PA als mit FS-only assoziiert. Weibliches Geschlecht, elterliche Angst- und depressive Störungen, Verhaltenshemmung, Schadensvermeidung, geringere Coping-Erwartung und elterliche Zurückweisung sagten FS-only, PA und PS vorher (HR 1.2-3.0), während sich teils unterschiedliche Assoziationen anderer Risikofaktoren mit FS-only, PA und PS ergaben, die tendenziell stärker für PA und PS als für FS-only waren.
Alkoholkonsum, Drogen-/Medikamentengebrauch und körperliche Erkrankungen als wahrgenommene Gründe für die initiale FS/PA waren mit dem Auftreten vollständiger PA assoziiert (ohne PS; OR 2.46-5.44), während Gefühle von Angst/Depression und die Einschätzung schon immer ängstlich/nervös gewesen zu sein als wahrgenommene Gründe für die initiale FS/PA, die Bewertung der initialen FS/PA als schrecklich und langfristig verunsichernd/belastend, nachfolgende Gefühle von Niedergeschlagenheit, Vermeidung von Situationen/Orten und Konsum von Medikamenten, Alkohol oder Drogen mit der Entwicklung von PS assoziiert waren (OR 2.64-4.15).
Eine längere Dauer bis sich die betroffene Person wieder vollständig in Ordnung fühlte war sowohl mit PA als auch mit PS assoziiert (OR 1.29-1.63 pro Kategorie). Weiterhin sagten teils unterschiedliche Risikokonstellationen bei Personen mit Panikpathologie (FS/PA/PS) die nachfolgende Entstehung von Angst-/depressiven und Substanzstörungen vorher. Panikpathologie (FS/PA) und Hilfesuchverhalten/potenzielle Behandlung zu Baseline interagierten bei der Vorhersage von inzidenter PS (OR=0.09) und Depression (OR=0.22) zum Follow-Up; d.h. das Vorhandensein von Panikpathologie sagte diese Störungen nur bei Personen ohne, nicht aber bei Personen mit Hilfesuchverhalten zu Baseline vorher.
Schlussfolgerungen. Die vorliegenden Ergebnisse implizieren, dass Personen mit FS-only im Vergleich zu Personen mit vollständigen PA ein ähnliches Risiko für die Entwicklung nachfolgender Psychopathologie aufweisen. Spezifische Merkmale initialer FS/PA und zusätzliche Risikofaktoren könnten zur Identifikation von Sub-Gruppen von Personen mit Panik genutzt werden, die sich durch ein besonderes Risiko für schwergradige Panikpathologie und andere psychische Störungen auszeichnen und demzufolge von Outcome-bezogenen Präventionen (ergänzend zu Panik-spezifischer Intervention) profitieren könnten. Zukünftige Studien sollten die vorliegenden Befunde replizieren und die Effektivität gezielter Präventivinterventionen bei Personen mit erhöhtem Risiko für PS und andere psychische Störungen testen.
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Fearful to Friendly (F2F): a Constructional Fear Treatment for Domestic Cats Using a Negative Reinforcement Shaping Procedure in a Home SettingRentfro, Angela Drake 08 1900 (has links)
Feral and fearful cats and kittens in animal shelters are not likely to be adopted as companion animals because they emit fearful or aggressive behaviors in the presence of humans. The purpose of the fearful to friendly (F2F) research was to investigate a shaping procedure to increase friendly behaviors of feral and fearful domestic cats and kittens with the goal of achieving animal shelters’ adoptability criteria. The results showed the F2F procedure was a safe and very effective procedure to quickly tame feral kittens deemed unadoptable. The day after implementing F2F, three out of four kittens approached me and accepted petting and holding without any additional training.
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The role of fearful spells as risk factors for panic pathology and other mental disorders: A prospective-longitudinal study among adolescents and young adults from the communityAsselmann, Eva 02 December 2014 (has links)
Background. Previous research suggests that individuals experiencing DSM-IV panic attacks (PA) are at increased risk for various forms of psychopathology, including anxiety, depressive and substance use disorders. However, little is known regarding whether the sole occurrence of fearful spells (FS-only; distressing spells of anxiety with less than four panic symptoms and/or lacking crescendo in symptom onset) similarly elevates the risk for subsequent psychopathology and could therefore be promising to identify high-risk groups for targeted preventive interventions. Thus, the current dissertation thesis aims to examine (a) whether FS-only predict incident mental disorders in addition to full-blown PA and whether their associations with subsequent psychopathology differ from those obtained for PA, (b) whether FS-only, PA, and panic disorder (PD) share similar etiologies, (c) which characteristics of initial FS/PA and other risk factors predict a progression to more severe panic pathology and other mental disorders, and (d) whether help-seeking/potential treatment in individuals with panic alters the risk for subsequent psychopathology.
Methods. A representative community sample of adolescents and young adults (N=3021, aged 14-24 at baseline) was prospectively followed up in up to three assessment waves over a time period of up to 10 years. FS-only, PA, PD, and other mental disorders were assessed at each assessment wave using the DSM-IV-M-CIDI. Additional modules/questionnaires were used to assess characteristics of initial FS/PA (T1/T2), potential risk factors, and help-seeking/potential treatment. Logistic regressions were applied to test associations (Odds Ratios, OR) of FS-only and PA at baseline with incident mental disorders at follow-up as well as respective interactive effects with help-seeking at baseline. Associations (Hazard Ratios, HR) of putative risk factors with the onset of panic pathology (FS-only, PA, and PD) or the onset of subsequent anxiety/depressive vs. substance use disorders in those with panic pathology (aggregated data across assessment waves) were estimated with Cox regressions. Multinomial logistic regressions were used to test associations of initial FS/PA characteristics (aggregated from T1 and T2) with PA and PD (lifetime incidences aggregated across assessment waves).
Results.
FS-only at baseline predicted incident anxiety and depressive disorders at follow-up (OR 1.59-4.36), while PA at baseline predicted incident anxiety, depressive, and substance use disorders at follow-up (OR 2.08-8.75; reference group: No FS/PA). Merely any anxiety disorder (OR=3.26) and alcohol abuse/dependence (OR=2.26) were significantly more strongly associated with PA than with FS-only. Female sex, parental anxiety disorders, parental depressive disorders, behavioral inhibition, harm avoidance, lower coping efficacy, and parental rejection predicted FS-only, PA, and PD (HR 1.2-3.0), whereas the associations with other risk factors partially differed for FS-only, PA, and PD and tended to be more pronounced for PA and PD than for FS-only.
Alcohol consumption, use of drugs/medication, and physical illness as perceived reasons for the initial FS/PA were associated with the occurrence of full-blown PA (without PD, OR 2.46-5.44), while feelings of anxiety/depression and having always been anxious/nervous as perceived reasons for the initial FS/PA, appraising the initial FS/PA as terrible and long-term irritating/burdensome, subsequent feelings of depression, avoidance of situations/places, and consumption of medication, alcohol, or drugs were associated with the development of PD (OR 2.64-4.15). A longer duration until “feeling okay again” was associated with both PA and PD (OR 1.29-1.63 per category). Moreover, partially different risk constellations in subjects with panic pathology (FS/PA/PD) predicted the onset of subsequent anxiety/depressive vs. substance use disorders. Panic pathology (FS/PA) and help-seeking/potential treatment at baseline interacted on predicting incident PD (OR=0.09) and depression (OR=0.22) at follow-up in a way that panic pathology only predicted these disorders in individuals not seeking help at baseline.
Conclusions. Findings suggest that individuals with FS-only are at similar risk of developing subsequent psychopathology compared to individuals with full-blown PA. Specific initial FS/PA characteristics and additional risk factors may be used to identify sub-groups of individuals with panic pathology, which are at particular risk of progressing to more severe panic pathology or other mental disorders and might therefore profit from supplemental outcome-related preventive interventions in addition to panic-specific treatment. Future research may replicate the current findings and test the efficacy of targeted preventive interventions in panickers at elevated risk for PD and other forms of psychopathology.:CONTENT
0 Synopsis 10
1 Introduction 13
1.1 Current challenges in clinical psychology 13
1.2 Psychological models of mental disorders 13
1.3 Diagnostic approaches to psychopathology 15
1.4 Methodological issues 16
1.5 Preventive and early treatment interventions 17
2 Panic pathology 18
2.1 Definitions 18
2.2 Epidemiology 19
2.3 Etiology 20
2.4 Physiological, neurobiological, and genetic findings 21
2.5 Unresolved issues 22
3 Aims 24
4 Methods 26
5 Study I: Associations of fearful spells and panic attacks with incident anxiety, depressive, and substance use disorders: A 10-year prospective-longitudinal community study of adolescents and young adults 27
5.1 Abstract 27
5.2 Introduction 27
5.3 Materials and methods 28
5.4 Results 30
5.5 Discussion 35
6 Study II: Characteristics of initial fearful spells and their associations with DSM-IV panic attacks and panic disorder in adolescents and young adults from the community 37
6.1 Abstract 37
6.2 Introduction 37
6.3 Materials and methods 38
6.4 Results 41
6.5 Discussion 43
7 Study III: Risk factors for fearful spells and panic: A 10-year prospective-longitudinal study among adolescents and young adults 47
7.1 Abstract 47
7.2 Introduction 47
7.3 Materials and methods 49
7.4 Results 52
7.5 Discussion 60
8 Study IV: Does help-seeking alter the risk for incident psychopathology in adolescents and young adults with and without fearful spells or panic attacks? Findings from a 10-year prospective-longitudinal community study 63
8.1 Abstract 63
8.2 Introduction 63
8.3 Materials and methods 64
8.4 Results 66
8.5 Discussion 70
9 General discussion 73
9.1 Summary and discussion of main findings 73
9.2 Preventive interventions among individuals with panic pathology 75
9.3 Research implications 77
10 Conclusions 78
11 References 79
12 Appendix 94
12.1 Acknowledgements 94
12.2 Erklärung zu den Eigenanteilen an einzelnen Publikationen 95
12.3 Eigenständigkeitserklärung 96 / Theoretischer Hintergrund. Auf Grundlage früherer Forschungsbefunde ist anzunehmen, dass Personen mit DSM-IV-Panikattacken (PA) ein erhöhtes Risiko für zahlreiche psychische Störungen, einschließlich Angst-, depressiver und Substanzstörungen, aufweisen. Unklar ist jedoch, ob das alleinige Auftreten von Fearful Spells (FS-only, Angstanfälle mit weniger als vier Paniksymptomen und/oder fehlendem Crescendo in der Symptomentwicklung) das Risiko für Psychopathologie in ähnlicher Weise erhöht und hilfreich sein könnte, um Hochrisikogruppen für Präventivinterventionen zu identifizieren. Innerhalb der vorliegenden Dissertation wird daher untersucht, (a) ob FS-only zusätzlich zu PA inzidente psychische Störungen vorhersagen und ob sich Unterschiede in den Assoziationen von FS-only vs. PA mit nachfolgender Psychopathologie ergeben, (b) ob FS-only, PA und Panikstörung (PS) ähnliche Ätiologien teilen, (c) welche Merkmale initialer FS/PA und welche anderen Risikofaktoren die Entwicklung schwerer Panikpathologie und weiterer psychischer Störungen vorhersagen und (d) ob Hilfesuchverhalten/potenzielle Behandlung bei Personen mit Panik das Risiko für nachfolgende Psychopathologie verändert.
Methodik. Eine repräsentative Bevölkerungsstichprobe Jugendlicher und junger Erwachsener (N=3021, 14-24 Jahre zur Baseline-Erhebung) wurde in bis zu drei Erhebungswellen über einen Zeitraum von bis zu 10 Jahren untersucht. FS-only, PA, PS und andere psychische Störungen wurden zu jeder Erhebungswelle mithilfe des DSM-IV-M-CIDI erfasst. Merkmale initialer FS/PA (T1/T2), mögliche Risikofaktoren sowie Hilfesuchverhalten/potenzielle Behandlung wurden mit weiteren Modulen und Fragebögen erhoben. Mithilfe logistischer Regressionen wurden Assoziationen (Odds Ratios, OR) von FS-only und PA zu Baseline mit inzidenten psychischen Störungen zum Follow-Up sowie diesbezügliche Interaktionen mit Hilfesuchverhalten zu Baseline getestet.
Zusammenhänge zwischen möglichen Risikofaktoren und dem Auftreten von Panikpathologie (FS-only, PA und PS) bzw. nachfolgender Angst-/depressiver und Substanzstörungen bei Personen mit Panikpathologie (Verwendung von über die Erhebungswellen hinweg aggregierter Daten) wurden mithilfe von Cox-Regressionen geschätzt. Multinomiale logistische Regressionen wurden genutzt, um Assoziationen von Merkmalen initialer FS/PA (aggregiert über T1 und T2) mit PA und PS (über die Erhebungswellen hinweg aggregierte Lebenszeitinzidenzen) zu erfassen.
Ergebnisse. FS-only zu Baseline sagten inzidente Angst- und depressive Störungen zum Follow-Up vorher (OR 1.59-4.36), wohingegen PA zu Baseline inzidente Angst-, depressive und Substanzstörungen zum Follow-Up vorhersagten (OR 2.08-8.75; Referenzkategorie: Keine FS/PA). Lediglich irgendeine Angststörung (OR=3.26) und Alkoholmissbrauch/-abhängigkeit (OR=2.26) waren signifikant stärker mit PA als mit FS-only assoziiert. Weibliches Geschlecht, elterliche Angst- und depressive Störungen, Verhaltenshemmung, Schadensvermeidung, geringere Coping-Erwartung und elterliche Zurückweisung sagten FS-only, PA und PS vorher (HR 1.2-3.0), während sich teils unterschiedliche Assoziationen anderer Risikofaktoren mit FS-only, PA und PS ergaben, die tendenziell stärker für PA und PS als für FS-only waren.
Alkoholkonsum, Drogen-/Medikamentengebrauch und körperliche Erkrankungen als wahrgenommene Gründe für die initiale FS/PA waren mit dem Auftreten vollständiger PA assoziiert (ohne PS; OR 2.46-5.44), während Gefühle von Angst/Depression und die Einschätzung schon immer ängstlich/nervös gewesen zu sein als wahrgenommene Gründe für die initiale FS/PA, die Bewertung der initialen FS/PA als schrecklich und langfristig verunsichernd/belastend, nachfolgende Gefühle von Niedergeschlagenheit, Vermeidung von Situationen/Orten und Konsum von Medikamenten, Alkohol oder Drogen mit der Entwicklung von PS assoziiert waren (OR 2.64-4.15).
Eine längere Dauer bis sich die betroffene Person wieder vollständig in Ordnung fühlte war sowohl mit PA als auch mit PS assoziiert (OR 1.29-1.63 pro Kategorie). Weiterhin sagten teils unterschiedliche Risikokonstellationen bei Personen mit Panikpathologie (FS/PA/PS) die nachfolgende Entstehung von Angst-/depressiven und Substanzstörungen vorher. Panikpathologie (FS/PA) und Hilfesuchverhalten/potenzielle Behandlung zu Baseline interagierten bei der Vorhersage von inzidenter PS (OR=0.09) und Depression (OR=0.22) zum Follow-Up; d.h. das Vorhandensein von Panikpathologie sagte diese Störungen nur bei Personen ohne, nicht aber bei Personen mit Hilfesuchverhalten zu Baseline vorher.
Schlussfolgerungen. Die vorliegenden Ergebnisse implizieren, dass Personen mit FS-only im Vergleich zu Personen mit vollständigen PA ein ähnliches Risiko für die Entwicklung nachfolgender Psychopathologie aufweisen. Spezifische Merkmale initialer FS/PA und zusätzliche Risikofaktoren könnten zur Identifikation von Sub-Gruppen von Personen mit Panik genutzt werden, die sich durch ein besonderes Risiko für schwergradige Panikpathologie und andere psychische Störungen auszeichnen und demzufolge von Outcome-bezogenen Präventionen (ergänzend zu Panik-spezifischer Intervention) profitieren könnten. Zukünftige Studien sollten die vorliegenden Befunde replizieren und die Effektivität gezielter Präventivinterventionen bei Personen mit erhöhtem Risiko für PS und andere psychische Störungen testen.:CONTENT
0 Synopsis 10
1 Introduction 13
1.1 Current challenges in clinical psychology 13
1.2 Psychological models of mental disorders 13
1.3 Diagnostic approaches to psychopathology 15
1.4 Methodological issues 16
1.5 Preventive and early treatment interventions 17
2 Panic pathology 18
2.1 Definitions 18
2.2 Epidemiology 19
2.3 Etiology 20
2.4 Physiological, neurobiological, and genetic findings 21
2.5 Unresolved issues 22
3 Aims 24
4 Methods 26
5 Study I: Associations of fearful spells and panic attacks with incident anxiety, depressive, and substance use disorders: A 10-year prospective-longitudinal community study of adolescents and young adults 27
5.1 Abstract 27
5.2 Introduction 27
5.3 Materials and methods 28
5.4 Results 30
5.5 Discussion 35
6 Study II: Characteristics of initial fearful spells and their associations with DSM-IV panic attacks and panic disorder in adolescents and young adults from the community 37
6.1 Abstract 37
6.2 Introduction 37
6.3 Materials and methods 38
6.4 Results 41
6.5 Discussion 43
7 Study III: Risk factors for fearful spells and panic: A 10-year prospective-longitudinal study among adolescents and young adults 47
7.1 Abstract 47
7.2 Introduction 47
7.3 Materials and methods 49
7.4 Results 52
7.5 Discussion 60
8 Study IV: Does help-seeking alter the risk for incident psychopathology in adolescents and young adults with and without fearful spells or panic attacks? Findings from a 10-year prospective-longitudinal community study 63
8.1 Abstract 63
8.2 Introduction 63
8.3 Materials and methods 64
8.4 Results 66
8.5 Discussion 70
9 General discussion 73
9.1 Summary and discussion of main findings 73
9.2 Preventive interventions among individuals with panic pathology 75
9.3 Research implications 77
10 Conclusions 78
11 References 79
12 Appendix 94
12.1 Acknowledgements 94
12.2 Erklärung zu den Eigenanteilen an einzelnen Publikationen 95
12.3 Eigenständigkeitserklärung 96
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