Progrès récents dans le traitement des troubles anxieux.

[Correction Notice: An erratum for this article was reported in Vol 52(3) of Canadian Psychology/Psychologie canadienne (see record 2011-18506-009). In the CPA President’s Address article that appeared in the February issue of Canadian Psychology, “Recent advances in the treatment of anxiety disorders” by Martin M. Antony (Canadian Psychology, Vol. 52, No. 1, pp. 10–19), the heading for the article incorrectly printed as “Honourary President’s Address—2010.” It should have read “President’s Address—2010.” The publisher apologizes for this unfortunate production error. The online version has been corrected.] Over the past several decades, evidence-based treatments have emerged for each major anxiety disorder. These include primarily behavioural, cognitive, and pharmacological approaches. In addition, researchers continue to develop new ways of treating anxiety disorders and to improve on existing treatments. This article discusses several new and emerging treatments for anxiety disorders, including attentional training, virtual reality-based treatments, mindfulness and acceptance-based strategies, enhancement of exposure using d-cycloserine, and the application of motivational interviewing strategies in anxiety disorders. For each of these treatments, the current status and directions for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Correction à l'article de M. Antony (2011).

Reports an error in "Progrès récents dans le traitement des troubles anxieux" by Martin M. Antony (Canadian Psychology/Psychologie canadienne, 2011[Feb], Vol 52[1], 10-19). In the CPA President’s Address article that appeared in the February issue of Canadian Psychology, “Recent advances in the treatment of anxiety disorders” by Martin M. Antony (Canadian Psychology, Vol. 52, No. 1, pp. 10–19), the heading for the article incorrectly printed as “Honourary President’s Address—2010.” It should have read “President’s Address—2010.” The publisher apologizes for this unfortunate production error. The online version has been corrected. (The following abstract of the original article appeared in record 2011-04299-014.) Over the past several decades, evidence-based treatments have emerged for each major anxiety disorder. These include primarily behavioural, cognitive, and pharmacological approaches. In addition, researchers continue to develop new ways of treating anxiety disorders and to improve on existing treatments. This article discusses several new and emerging treatments for anxiety disorders, including attentional training, virtual reality-based treatments, mindfulness and acceptance-based strategies, enhancement of exposure using d-cycloserine, and the application of motivational interviewing strategies in anxiety disorders. For each of these treatments, the current status and directions for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Treatment of anxiety in older adults.

This article is a broad review of psychological literature that addresses the prevalence, consequences, and psychological treatment of anxiety in older adults. Psychological treatments, including relaxation, cognitive-behavioral therapy, psychodynamic therapy, and life review, are explored as alternatives to pharmacological approaches to treatment of anxiety. Several anxiety associated conditions are discussed: dementia, depression, phobias, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. Case histories illustrate the effectiveness of psychological intervention for treatment of anxiety in the elderly. Included is a comprehensive list of manuals for anxiety treatment procedures. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Recent advances in the treatment of anxiety disorders": Correction to Antony (2011).

Reports an error in "Recent advances in the treatment of anxiety disorders" by Martin M. Antony (Canadian Psychology/Psychologie canadienne, 2011[Feb], Vol 52[1], 1-9). The heading for the article was incorrectly printed. The corrected heading is provided in the erratum. (The following abstract of the original article appeared in record 2011-04299-001.) Over the past several decades, evidence-based treatments have emerged for each major anxiety disorder. These include primarily behavioural, cognitive, and pharmacological approaches. In addition, researchers continue to develop new ways of treating anxiety disorders and to improve on existing treatments. This article discusses several new and emerging treatments for anxiety disorders, including attentional training, virtual reality-based treatments, mindfulness and acceptance-based strategies, enhancement of exposure using d-cycloserine, and the application of motivational interviewing strategies in anxiety disorders. For each of these treatments, the current status and directions for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Pediatric Psychopharmacology for Prepubertal Internalizing Disorders.

Evidence-based studies of drug, psychosocial and combined treatments for prepubertal internalizing disorders (depression, obsessive-compulsive disorder [OCD], and non-OCD anxiety) were reviewed. No age effects were found. Although no combined studies met evidence-based criteria, efficacious and possibly efficacious psychosocial and pharmacological treatments were identified, along with safety concerns for drug treatments. Evidentiary support favored psychosocial treatment for non-OCD anxiety disorders and pharmacological treatments for OCD, with mixed results for depression. Cost-benefit considerations suggest psychosocial treatments should be considered the first choice for at least anxiety and depression, except in unusual cases where stabilization may require pharmacological intervention first. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Comorbidity among anxiety disorders: Implications for treatment and DSM-IV..

Research on comorbidity among psychological disorders is relatively new. Yet, comorbidity data have fundamental significance for classification and treatment. This significance is particularly apparent in the anxiety disorders, which, prior to Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R), were subsumed under disorders considered more significant (e.g., psychotic and depressive disorders). After considering definitional, methodological, and theoretical issues of comorbidity, data on comorbidity among the anxiety disorders are reviewed as well as data on comorbidity of anxiety disorders with the depressive, personality, and substance use disorders. Treatment implications are presented with preliminary data on the effects of psychosocial treatment of panic disorder on comorbid generalized anxiety disorder. Implications of comorbidity for research on the nature of psychopathology and the ultimate integration of dimensional and categorical features in the authors' nosology are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Panic and phobic anxiety: defining phenotypes for genetic studies

OBJECTIVE: With recent advances in molecular genetics, the rate-limiting step in identifying susceptibility genes for psychiatric disorders has become phenotype definition. The success of psychiatric genetics may require the development of a "genetic nosology" that can classify individuals in terms of the heritable aspects of psychopathology. The authors' aim is to begin to apply this analysis to the anxiety disorders, focusing on panic and phobic disorders. METHOD: Two parallel traditions of defining anxiety phenotypes are reviewed: the first, more closely identified with clinical psychiatry, has identified categorical diagnoses (e.g., panic disorder and social phobia). The other, more closely identified with psychological studies of personality development, has examined dimensional traits (e.g., neuroticism) and anxious temperament (e.g., behavioral inhibition). RESULTS: The authors suggest that a genetic nosology of panic and phobic disorders may incorporate features of both traditions and discuss strategies for optimizing genetic approaches to anxiety including 1) studying phenotypic extremes, 2) identifying biological trait markers, and 3) using animal models to identify candidate loci. CONCLUSIONS: An important dividend from the effort to define the boundaries of heritable phenotypes for genetic studies of anxiety may be a refinement of the nosology of anxiety disorders.     

Childhood history of anxiety in adults with panic disorder: association with anxiety sensitivity and comorbidity

Converging lines of evidence indicate a nonspecific link between childhood anxiety disorders and adult panic disorder. Anxiety sensitivity, defined as the fear of anxiety symptoms, was hypothesized to be a potential mediating variable in this link. This study examined the association among childhood history of anxiety disorders, current anxiety symptoms, and anxiety sensitivity in a sample of 100 patients with panic disorder undergoing treatment. Fifty-five percent of the patients had histories of one or more childhood anxiety disorders. Despite the heterogeneity of symptoms and treatment interventions among these patients, a childhood history of anxiety was associated with comorbid anxiety conditions, agoraphobic avoidance, and anxiety sensitivity scores. Anxiety sensitivity was itself a significant predictor of current severity of illness, but a childhood history of anxiety was not. These findings are consistent with the hypothesis that having an anxiety disorder during childhood is linked with patterns of anxiety and phobic avoidance in adulthood, including the level of anxiety sensitivity in patients with panic disorder.     

Anxiety sensitivity and the anxiety disorders: A meta-analytic review and synthesis.

There has been significant interest in the role of anxiety sensitivity (AS) in the anxiety disorders. In this meta-analysis, we empirically evaluate differences in AS between anxiety disorders, mood disorders, and nonclinical controls. A total of 38 published studies (N = 20,146) were included in the analysis. The results yielded a large effect size indicating greater AS among anxiety disorder patients versus nonclinical controls (d = 1.61). However, this effect was maintained only for panic disorder patients compared to mood disorder patients (d = 0.85). Panic disorder was also associated with greater AS compared to other anxiety disorders except for posttraumatic stress disorder (d = 0.04). Otherwise the anxiety disorders generally did not differ from each other in AS. Although these findings suggest that AS is central to the phenomenology of panic disorder and posttraumatic stress disorder, causal inferences regarding the role of AS in these anxiety disorders cannot be made. Moderator analyses showed that a greater proportion of female participants was associated with larger differences in AS between anxiety and nonclinical control groups. However, more female participants were associated with a smaller AS difference between anxiety and mood disorder groups. This finding suggests that AS is less robust in distinguishing anxiety from mood disorders among women. Age also moderated some observed effects such that AS was more strongly associated with anxiety disorders in adults compared to children. Type of AS measure used also moderated some effects. Implications of these findings for the conceptualization of AS in anxiety-related disorders are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Treating Health Anxiety: A Cognitive-Behavioral Approach.

Health anxiety had been somewhat neglected for years as it by nature evades clear diagnostic boundaries, wavering between a somatoform disorder, an anxiety disorder, and in some cases, a delusional disorder. Recently, the topic of health anxiety has received increasing attention, primarily from leaders in the anxiety disorders field, as reflected in the growing literature on the topic. The book "Treating Health Anxiety: A Cognitive-Behavioral Approach" (see record 2005-04429-000), reviewed in this article, is a timely and much needed addition to this area that will appeal to both clinicians and researchers alike. The book's authors have done a fine job producing a comprehensive book on health anxiety that is well written, interesting, and provides broad coverage of the nature, assessment, and treatment of health anxiety. The use of case examples throughout and the relatively short chapters certainly make this an interesting and quick read. This book will be especially useful for clinicians treating the full range of health anxiety, including hypochondriasis, disease phobia, somatic delusion, or any disorder characterized by excessive anxiety about one's health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based psychological treatments for late-life anxiety.

This project identified evidence-based psychotherapy treatments for anxiety disorders in older adults. The authors conducted a review of the geriatric anxiety treatment outcome literature by using specific coding criteria and identified 17 studies that met criteria for evidence-based treatments (EBTs). These studies reflected samples of adults with generalized anxiety disorder (GAD) or samples with mixed anxiety disorders or symptoms. Evidence was found for efficacy for 4 types of EBTs. Relaxation training, cognitive-behavioral therapy (CBT), and, to a lesser extent, supportive therapy and cognitive therapy have support for treating subjective anxiety symptoms and disorders. CBT for late-life GAD has garnered the most consistent support, and relaxation training represents an efficacious, relatively low-cost intervention. The authors provide a review of the strengths and limitations of this research literature, including a discussion of common assessment instruments. Continued investigation of EBTs is needed in clinical geriatric anxiety samples, given the small number of available studies. Future research should examine other therapy models and investigate the effects of psychotherapy on other anxiety disorders, such as phobias and posttraumatic stress disorder in older adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: Implications for assessment and treatment.

A wealth of evidence attests to the extensive current and lifetime diagnostic comorbidity of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM–IV) anxiety and mood disorders. Research has shown that the considerable cross-sectional covariation of DSM–IV emotional disorders is accounted for by common higher order dimensions such as neuroticism/behavioral inhibition (N/BI) and low positive affect/behavioral activation. Longitudinal studies indicate that the temporal covariation of these disorders can be explained by changes in N/BI and, in some cases, initial levels of N/BI are predictive of the temporal course of emotional disorders. The marked phenotypal overlap of the DSM–IV anxiety and mood disorders is a frequent source of diagnostic unreliability (e.g., temporal overlap in the shared features of generalized anxiety disorder and mood disorders, situation specificity of panic attacks in panic disorder and specific phobia). Although extant dimensional proposals may address some drawbacks associated with the DSM nosology (e.g., inadequate assessment of individual differences in disorder severity), these proposals do not reconcile key problems in current classification, such as modest reliability and high comorbidity. This article considers an alternative approach that emphasizes empirically supported common dimensions of emotional disorders over disorder-specific criteria sets. Selection and assessment of these dimensions are discussed along with how these methods could be implemented to promote more reliable and valid diagnosis, prognosis, and treatment planning. For instance, the advantages of this system are discussed in context of transdiagnostic treatment protocols that are efficaciously applied to a variety of disorders by targeting their shared features. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recent advances in the treatment of anxiety disorders.

[Correction Notice: An erratum for this article was reported in Vol 52(2) of Canadian Psychology/Psychologie canadienne (see record 2011-10782-004). The heading for the article was incorrectly printed. The corrected heading is provided in the erratum.] Over the past several decades, evidence-based treatments have emerged for each major anxiety disorder. These include primarily behavioural, cognitive, and pharmacological approaches. In addition, researchers continue to develop new ways of treating anxiety disorders and to improve on existing treatments. This article discusses several new and emerging treatments for anxiety disorders, including attentional training, virtual reality-based treatments, mindfulness and acceptance-based strategies, enhancement of exposure using d-cycloserine, and the application of motivational interviewing strategies in anxiety disorders. For each of these treatments, the current status and directions for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Pharmacologic treatments effective in both generalized anxiety disorder and major depressive disorder: clinical and theoretical implications

OBJECTIVE: To review the efficacy of anxiolytics (alprazolam and azapirones) in major depressive disorder (MDD) and that of antidepressants in generalized anxiety disorder (GAD), thereby exploring the possible theoretical and clinical implications of this efficacy. METHOD: A Medline literature search was performed for the period January 1980 to September 1997 of randomized, double-blind comparison studies between anxiolytics and antidepressants in the acute treatment of adult patients with either MDD or GAD. RESULTS: Alprazolam, at doses double those generally recommended for anxiety disorders, appears to be as effective as tricyclic antidepressants (TCAs) in the acute treatment of mild to moderate MDD. Alprazolam was also found to have a more rapid onset of action than to TCAs, particularly for the improvement of anxiety, somatization, and insomnia. Two azapirones (buspirone and gepirone) also have demonstrated a modest acute antidepressant effect in preliminary studies, albeit only in a depressed outpatient sample with considerable anxiety at baseline. Finally, various antidepressant drugs (imipramine, trazodone, paroxetine) were shown to have, at the least, comparable efficacy to benzodiazepines (BZDs) in the acute treatment of GAD. CONCLUSIONS: The nonspecificity of treatment response suggests that GAD and MDD are 1) different expressions of a similar disorder with a common neurobiological substrate, 2) discrete diagnostic entities that respond to independent pharmacological effects of the same drugs, or 3) a combination of the two (heterogeneity hypothesis). The most relevant clinical finding is the efficacy of antidepressants in the acute treatment of GAD.     

Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders

BACKGROUND: The co-occurrence of anxiety disorders with other mental, addictive, and physical disorders has important implications for treatment and for prediction of clinical course and associated morbidity. METHOD: Cross-sectional and prospective data on 20,291 individuals from the Epidemiologic Catchment Area (ECA) study were analysed to determine one-month, current disorders, one-year incidence, and one-year and lifetime prevalence of anxiety, mood, and addictive disorders, and to identify the onset and offset of disorders within the one-year prospective period. RESULTS: Nearly half (47.2%) of those meeting lifetime criteria for major depression also have met criteria for a comorbid anxiety disorder. The average age of onset of any lifetime anxiety disorder (16.4 years) and social phobia (11.6 years) among those with major depression was much younger than the onset age for major depression (23.2 years) and panic disorder. CONCLUSIONS: Anxiety disorders, especially social and simple phobias, appear to have an early onset in adolescence with potentially severe consequences, predisposing those affected to greater vulnerability to major depression and addictive disorders.     

Antidepressants as first-line agents in the current pharmacotherapy of anxiety disorders.

Over the last decade, there has been a shift in the order of medications considered as first-line treatments for anxiety disorders. This transition was largely initiated by the introduction and consolidation of the selective serotonin reuptake inhibitors (SSRIs)—fluoxetine, paroxetine, sertraline, fluvoxamine, and citalopram—in the treatment of depression, and by the subsequent extension of these agents beyond depression to various anxiety disorders, such as obsessive-compulsive disorder and panic disorder. This article reviews important clinical considerations for prescribing SSRIs for the treatment of panic disorder, obsessive-compulsive disorder, social phobia, posttraumatic stress disorder, and generalized anxiety disorder. The SSRIs and newer atypical antidepressants have established equal or superior efficacy and a more favorable side effect profile when compared to their predecessors. However, the newer agents are not without side effects, such as nausea, diarrhea, insomnia, headaches, sexual dysfunction, sedation, and weight gain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship of genetically transmitted alpha EEG traits to anxiety disorders and alcoholism

We tested the hypothesis that a heritable EEG trait, the low voltage alpha (LV), is associated with psychiatric disorders. Modest to moderate evidence for genetic linkage of both panic disorder and the low voltage alpha trait to the same region of chromosome 20q has recently been reported, raising the issue of whether there is a phenotypic correlation between these traits. A total of 124 subjects including 50 unrelated index subjects and 74 relatives were studied. Alpha EEG power was measured and EEG phenotypes were impressionistically classified. Subjects were psychiatrically interviewed using the SADS-L and blind-rated by RDC criteria. Alcoholics were four times more likely to be LV (including so-called borderline low voltage alpha) than were nonalcoholic, nonanxious subjects. Alcoholics with anxiety disorder are 10 times more likely to be LV. However, alcoholics without anxiety disorder were similar to nonalcoholics in alpha power. An anxiety disorder (panic disorder, phobia, or generalized anxiety) was found in 14/17 LV subjects as compared to 34/101 of the rest of the sample (P < 0.01). Support for these observations was found in the unrelated index subjects in whom no traits would be shared by familial clustering. Lower alpha power in anxiety disorders was not state-dependent, as indicated by the Spielberger Anxiety Scale. Familial covariance of alpha power was 0.25 (P < 0.01). These findings indicate there may be a shared factor underlying the transmissible low voltage alpha EEG variant and vulnerability to anxiety disorders with associated alcoholism. This factor is apparently not rare, because LV was found in approximately 10% of unrelated index subjects and 5% of subjects free of alcoholism and anxiety disorders.     

Predictive validity of automatic self-associations for the onset of anxiety disorders.

Negative self-cognitions are assumed to play an important role in the onset of anxiety disorders. Current dual-process models emphasize the relevance of differentiating between more automatic and more deliberate self-cognitions in this respect. Therefore, this study was designed to test the prognostic value of both deliberate and automatic self-anxious associations as a generic vulnerability factor for the onset of anxiety disorders between baseline and 2-year follow-up. To test the disorder specificity of negative self-associations, we also measured self-depressed associations. Self-report measures of depressive symptoms, anxiety symptoms, neuroticism, and fearful avoidance were included as covariates. Healthy controls (n = 593), individuals who had depression (n = 238), and individuals remitted from an anxiety disorder (n = 448) were tested as part of the Netherlands Study of Depression and Anxiety. Deliberate self-anxious associations predicted the onset of anxiety disorders in all groups. Automatic self-anxious associations showed predictive validity only in individuals remitted from an anxiety disorder or in currently depressed individuals. Although deliberate self-depressed associations were related to the onset of anxiety disorders as well, automatic self-depressed associations were not. In the (remitted) patient groups, only deliberate self-anxious associations showed independent predictive value for the onset of anxiety disorders together with self-reported fearful avoidance behavior. In the healthy controls, only a composite index of negative emotionality (depressive or anxiety symptoms and neuroticism) showed independent predictive validity. This study provides the first evidence that automatic and deliberate self-anxious associations have predictive value for the future onset of anxiety disorders. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Sommeil, insomnie et psychopathologie.

Sleep plays a critical role in psychological well-being and adaptation. Not surprisingly, sleep disturbance is a frequent problem among individuals facing situational psychological difficulties as well as among those with more chronic psychopathology. This article examines the relationship among sleep, insomnia, and psychopathology. In the first section, we address the issue of comorbidity by examining prevalence rates of sleep disturbances in the general population and among subgroups of individuals with selected psychopathologies and, conversely, rates of psychological symptoms/syndromes among individuals with and without sleep disturbances. The data indicate high rates of psychological syndromes (40%) associated with insomnia among community-based samples, and even higher rates (80%) of sleep disturbances among selected samples of patients with psychopathology. Comorbidity is particularly high among patients with insomnia, major depression, and generalized anxiety disorder. Although insomnia is often a symptom of an underlying psychopathology, longitudinal studies show that it can also be an important risk factor for a new onset major depressive disorder. The second section of this article summarizes the main subjective and EEG sleep impairments in selected anxiety disorders, mood disorders, and schizophrenia. Insomnia is a common clinical feature or even a diagnostic criterion of several of those disorders. Other related symptoms such as fatigue, low energy and poor concentration are shared across insomnia, major depression, and generalized anxiety disorder, suggesting some common mechanisms among those conditions. In addition to subjective sleep complaints, there is also evidence of EEG sleep abnormalities, such as impairment of sleep continuity, reduced slow wave sleep, and altered REM sleep patterns, with the latter two features being more specific to mood disorders. The third section of this article examines the effects of insomnia treatment on co-existing psychological symptoms or disorders and, conversely, the effects of treatment of selected anxiety and mood disorders on sleep. These results indicate that treatments of depression and anxiety may produce some sleep improvements but, in many cases, residual sleep disturbances persist and may actually increase the risk of subsequent relapse. The main implication is that treatment should directly target both co-existing conditions. Additional implications for the treatment and prevention of comorbid sleep disturbances and psychopathology and for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental disorders and disability among patients in a primary care group practice

OBJECTIVE: This article examines social and occupational disability associated with several DSM-IV mental disorders in a group of adult primary care outpatients. METHOD: The subjects were 1,001 primary care patients (aged 18-70 years) in a large health maintenance organization. Data on each patient's sociodemographic characteristics and functional disability, including scores on the Sheehan Disability Scale, were collected at the time of a medical visit. A structured diagnostic interview for current DSM-IV disorders was then completed by a mental health professional over the telephone within 4 days of the visit. RESULTS: The most prevalent disorders were phobias (7.7%), major depressive disorder (7.3%), alcohol use disorders (5.2%), generalized anxiety disorder (3.7%), and panic disorder (3.0%). A total of 8.3% of the patients met the criteria for more than one mental disorder. The proportion of patients with co-occurring mental disorders varied by index disorder from 50.0% (alcohol use disorder) to 89.2% (generalized anxiety disorder). Compared with patients who had a single mental disorder, patients with co-occurring disorders reported significantly more disability in social and occupational functioning. After adjustment for other mental disorders and demographic and general health factors, compared with patients with no mental disorder, only patients with major depressive disorder, bipolar disorder, phobias, and substance use disorders had significantly increased disability, as measured by the Sheehan Disability Scale. CONCLUSIONS: Primary care patients with more than one mental disorder are common and highly disabled. Individual mental disorders have distinct patterns of psychiatric comorbidity and disability.