The relationship between fluoxetine use and suicidal behavior in 654 subjects with anxiety disorders

BACKGROUND: In the past few years, there has been controversy over the relationship between suicidal behavior and fluoxetine use. This report examines the relationship between fluoxetine use and suicidal behavior in the Harvard/Brown Anxiety Disorders Research Program (HARP). METHOD: HARP is a naturalistic, prospective, longitudinal anxiety disorders study. Probabilities of suicidal behavior for 654 subjects were examined using life table analysis for the study group as a whole and stratified by depression status at intake. RESULTS: Subjects not using fluoxetine during follow-up had almost twice the probability of making a suicide attempt or gesture during the follow-up than subjects who were using fluoxetine, although this difference was not statistically significant. Subjects having episodes of major depressive disorder (MDD) at intake were more likely than those not having an episode to receive fluoxetine during follow-up (74/166 [45%] vs. 118/488 [24%], chi squared= 24.85, df= 1, p < .0001). Among those subjects having episodes of MDD at intake, there was a statistically significantly lower probability of suicide attempts/gestures for those taking fluoxetine than for those not using fluoxetine during follow-up (log-rank chi squared= 5.10, df= 1, p= .02). CONCLUSION: We found no evidence that fluoxetine use is associated with increased risk of suicide attempts or gestures. However, we did find that subjects with more suicide risk factors at intake were more likely to use fluoxetine than those without these risk factors.     

Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents

We examine the lifetime comorbidity among anxiety disorders, and between anxiety disorders and other mental disorders, in a large (n = 1,507) community sample of high school students on whom extensive diagnostic data were available. Three diagnostic groups were formed: those with a lifetime anxiety disorder (n = 134); those with a nonanxiety disorder (n = 510); and those who had never met criteria for a mental disorder (n = 863). The intra-anxiety comorbidity rate was relatively low (18.7%), and was strongly associated with being female (92%). The lifetime comorbidity between anxiety and other mental disorders (primarily MDD) was substantial (73.1%) and was not associated with being female.     

The relationship between maladaptive cognitions and social anxiety.

Used the cognitive theories of A. Beck (see PA, Vol 56:8303) and A. Ellis (see PA, Vol 37:1437) to identify cognitive phenomena thought to be related to social anxiety. Their constructs, risk appraisal and irrational beliefs, were operationalized for the present study. Both discriminated between a clinical sample of 46 anxious men and a group of 18 competent daters (18–26 yrs). Together they accounted for 35% of the variance in social anxiety for a mixed sample of high, moderate, and low confident men. Ss were administered the Irrational Beliefs Test, Survey of Heterosexual Interactions, and Situational Expectancies Inventory. Results are discussed in terms of their clinical significance and implications for cognitive assessment of social anxiety. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between anxiety and oral word association performance.

To test the comparative validity of 2 theories of anxiety (Sarason's interfering response and Spence and Taylor's drive theory), associations to word stimuli were analyzed. According to drive theory, anxiety should interfere with the number of different associations to the same word. Words that stimulate few associations should result in short reaction times and few disturbance of responsiveness and rare responses. According to interference theory there should be an effect upon association without an interaction between the degree of association value of the word and anxiety level of S. The results were interpreted as supporting Sarason's theory. From Psyc Abstracts 36:04:4HK68G. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between advanced age and mental abilities.

Scores on primary mental abilities, speed, memory, and motor rigidity were obtained from 50 college graduates ranging in age from 70 to 84 years. A cross sectional study demonstrates a differential decline in these abilities with advancing age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The neurobiology of anxiety disorders

The use of pharmacologic challenges and the application of new brain imaging technologies in the study of patients with anxiety disorders have led to an improvement in the understanding of the neurobiologic basis of these disorders. Abnormal function of noradrenergic, serotonergic, GABAergic, and dopaminergic neural systems as well as abnormal chemoreceptor reactivity have all been implicated in the pathophysiology of anxiety. Functional imaging data have revealed abnormal patterns of cortical and subcortical activity in anxiety patients. These data have allowed significant improvements in the available anatomic models of the anxiety disorders. Further improvements in research technique and technology likely will lead in the near future to a significantly clearer image of the neurobiologic processes involved in anxiety disorders.     

The relationship between a measure of transitory anxiety and spontaneous autonomic activity.

The effects of stress (threat of shock) on GSR nonspecific responses were evaluated for Ss who differed in transitory anxiety as measured by the Affect Adjective Check List (AACL). 52 Ss were equally divided among 4 groups: Hi AACL Stress, Lo AACL Stress, Hi AACL Nonstress, and Lo AACL Nonstress. 1st, all Ss rested; then both Stress groups were threatened with shock, while both Nonstress groups continued resting; finally, all Ss rested again. During the 2nd period GSR nonspecifics increased for both stress groups; however, during the final period, after the cessation of stress, GSR nonspecifics decreased more for the Lo AACL Ss than for the Hi AACL Ss. It was concluded that the AACL may be related to "autonomic recovery rate." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between social connectedness and anxiety, self-esteem, and social identity.

Social connectedness and its relationship with anxiety, self-esteem, and social identity was explored in the lives of women. Social connectedness was negatively related to trait anxiety and made a larger unique contribution to trait anxiety than social support or collective self-esteem. Women with high connectedness also reported greater social identification in high, as compared with low, cohesion conditions. Women with low connectedness exhibited no difference in either condition. Social connectedness was also positively related to state self-esteem across both conditions but did not have an effect on state anxiety. Future research in gender and cultural differences, self-evaluation process, and intervention strategies are discussed in light of the findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between age and depressive symptoms in two national surveys.

There is inconsistency in the literature on the relationship between age and depressive symptoms. Although a careful review shows that some of this inconsistency can be reconciled by recognizing the nonlinear relationship (J. P. Newmann, 1989), 2 additional issues remain unclear. One is that most previous studies used depression screening scales that contain somatic items that could introduce an age bias. The other is that most previous studies combined samples of men and women even though there is evidence that the sex difference in depressive symptoms varies with age. These 2 issues are addressed in this article, using analyzed data from 2 large national surveys. There is a consistent, but quite modest, nonlinear association between age, somatic, and nonsomatic depressive symptoms in both surveys. There is no significant sex difference in the age curves. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between age and gender in workers' attitudes toward sexual harassment

The relationship between gender, age, and workers' attitudes toward sexual harassment as measured by the Sexual Harassment Attitudes Scale was examined. Participants were full-time workers employed at a local hardware-manufacturing company or a local utility company in New England. Results indicated that the women younger than 40 years old were significantly less tolerant of sexual harassment than older women were. In contrast, male workers' tolerance of sexual harassment decreased with age up until the age of 50 years, after which their tolerance level of sexual harassment increased significantly.     

Curvilinearity between dream content and death anxiety and the relationship of death anxiety to repression-sensitization.

Discusses the merits of a defense mechanism model in the research dealing with death anxiety. The prediction was made that both high and low scorers on the Death Anxiety Scale (DAS) would report more unpleasant and death dream themes than Ss who score in the middle ranges of DAS. The Repression-Sensitization (R-S) Scale was used as a companion predictive instrument to the DAS. Findings are reported for 43 and 36 undergraduates, with 1 yr. intervening between data collections. Curvilinearity between DAS and dream content was found in both Samples 1 and 2. The R-S scale failed to predict comparably to the DAS, and some possible reasons for this difference are discussed. (18 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"The relationship between advanced age and mental abilities": Erratum.

Reports an error in the original article by Charles R. Strother, K. Warner Schaie, and Paul Horst (Journal of Abnormal & Social Psychology, 1957[Sept], 55, 166-170. The cuts for Figs. 1 and 3 were erroneously transposed in printing. The graph labelled Fig. 1 is derived from the data shown in Table 4 and represents the corrected T-score values. The graph labelled Fig. 3 is derived from the data in Table 1 and shows the uncorrected values. (The following abstract of this article originally appeared in record 1959-03294-001). Scores on primary mental abilities, speed, memory, and motor rigidity were obtained from 50 college graduates ranging in age from 70 to 84 years. A cross sectional study demonstrates a differential decline in these abilities with advancing age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychoneuroendocrinology of anxiety disorders

This article focuses on neuroendocrine measures in anxiety disorders and their relationships to neurotransmitter and neuroendocrine function. In particular, the hypothalamic-pituitary-somatotropin and the hypothalamic-pituitary-adrenal (HPA) axes are emphasized, and a role for extrahypothalamic corticotropin releasing factor is proposed. Additional neuroactive hormones are also considered. A nonhuman primate model of anxiety is discussed in terms of its neuroendocrine relevance. And, throughout, a hypothetical functional-anatomic model for anxiety and panic is proposed using the findings of cognitive neuroscience fear research. Finally, an effort is made to synthesize existing psychoneuroendocrinologic data into a current conceptualization of the pathophysiology of anxiety disorders.     

The relationship between age and major league baseball performance: Implications for development.

Lifetime performance data of 388 baseball players active in 1965 were analyzed to determine the age of peak performance for skills required to play baseball, to derive age-performance curves for athletic productivity, and to assess the magnitude of individual differences among elite and less able players. Cross-sectional and longitudinal analyses show that athletic performance on key indicators rises relatively quickly from age 19 to a peak age of 27 and then declines. The primary difference between elite and less able players is that performance of the elite players remains high for a longer period of time and decays more gradually. The performance of the most elite players is superior to that of less able players even at very early ages. These results parallel findings reported for other achievement domains and can be explained in terms of basic developmental processes involving the interaction of experience, physiological capacity, and motivation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in anxiety disorders and anxiety symptoms in adolescents.

Gender differences in anxiety were examined in a large sample of adolescents that included 1,079 who had never met criteria for any disorder, 95 who had recovered from an anxiety disorder, and 47 who had a current anxiety disorder. Participants were examined on a wide array of psychosocial measures. There was a preponderance of females among current and recovered anxiety disorder cases, but not among those who had never experienced an anxiety disorder. The female preponderance emerges early in life, and retrospective data indicate that at age 6, females are already twice as likely to have experienced an anxiety disorder than are males. Psychosocial variables that were correlated with both anxiety and gender were identified. Statistically controlling for these variables did not eliminate the gender differences in prevalence or anxiety symptom means. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Overprediction of anxiety, and disconfirmatory processes, in anxiety disorders

The overprediction of anxiety phenomenon and its relationships with fear, dysfunctional and functional beliefs, and emotional experiences during confrontations with feared stimuli were investigated in two studies. Study 1 investigated exposure in vivo exercises executed by anxiety patients during treatment (n = 37). Study 2 investigated behavioural experiments executed by anxiety patients (n = 11) during cognitive treatment. In both studies patients rated various variables just before and immediately after their exercises. The results indicate that anxiety patients tend to overpredict the level of anxiety they are going to experience. There is no evidence that this phenomenon is a statistical artefact, caused for instance by a pre-test response style. There is also no evidence that the observed adjustment of incorrect anxiety predictions is a statistical artefact. A global negative emotional evaluation of the experience appears to have an adverse influence on the reduction of anxiety predictions and on the reduction of fear. Fear, and its reduction after exposure in vivo or after behavioural tests, appears to be influenced by both anxiety predictions and dysfunctional beliefs. Positive emotions and functional beliefs did not appear to play an important role. The interrelationships between these factors are comprised in a path-model which describes how emotional and cognitive information yielded by disconfirmatory experiences influences changes in anxiety predictions and changes in fear. Unexpectedly, change in dysfunctional belief did not relate directly to change in fear, but only indirectly, via change in anxiety predictions. Theoretical and therapeutical implications are discussed.     

The age of anxiety? The birth cohort change in anxiety and neuroticism, 1952–1993.

Two meta-analyses find that Americans have shifted toward substantially higher levels of anxiety and neuroticism during recent decades. Both college student (adult) and child samples increased almost a full standard deviation in anxiety between 1952 and 1993 (explaining about 20% of the variance in the trait). The average American child in the 1980s reported more anxiety than child psychiatric patients in the 1950s. Correlations with social indices (e.g., divorce rates, crime rates) suggest that decreases in social connectedness and increases in environmental dangers may be responsible for the rise in anxiety. Economic factors, however, seem to play little role. Birth cohort, as a proxy for broad social trends, may be an important influence on personality development, especially during childhood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A note on the relationship between age and sales effectiveness.

Manager's rankings of 539 salesmen converted into a stanine distribution and compared with chronological age showed that sales effectiveness increases until about 40 and then starts to decrease after that age. Even so, many older salesmen received high ratings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Medico-socioeconomic impact of anxiety disorders

Budgetary control policies implemented in order to cope with the increase in health costs in industrialized countries and with the desequilibrium of the national health insurance accounts, give rise to the problem of preserving the quality of care and quality of life of the patients. Only health economic studies evaluating the possible different therapeutic strategies, will enable us to reconcile the 2 terms of the equation whose contradiction might be only apparent. This is particularly true for the treatment of psychiatric diseases, and especially anxiety. Budgetary control cannot be reduced to a simple management of penury, since the cheapest treatments are not necessarily the most profitable. In this context, new strategies are proposed: it is suggested that thorough diagnosis (avoiding both the non acknowledgement of the illness and the overconsumption of anxiolytic drugs) and early optimal treatment, of adequate duration, of the anxiety disorders might be the most economic attitude in the management of this pathology. On the other hand, the impact of the treatment of anxiety on the quality of life of the patient has a direct effect on costs if one considers the supplement to medical consumption and the social deficit induced by therapeutic failure in particular anxiety disorders. It remains that the evaluation of the health economics of anxiety is difficult, because of the complexity of the parameters involved. Though rather well developed in the UK and in North America, this evaluation still has to be introduced in France.