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Based upon epidemiological surveys, adverse childhood events are proposed to be risk factors for adult depressive and anxiety disorders. However, the extent to which these events are seen in clinical patient populations is less clear. We examined the prevalence of a number of proposed risk factors for depression in 650 patients with mood and anxiety disorders at the time of presentation for treatment in an outpatient subspecialty clinic. Emotional abuse, physical abuse, or sexual abuse (childhood adversity) was found in approximately 35% of patients with major depression and panic disorder, was more common in women than men, and was associated with an earlier onset of symptoms. Childhood adversity was also strongly associated with marital discord/divorce, and psychopathology in a parent, suggesting family discord predisposes to childhood abuse. Furthermore, the association of childhood abuse with parental mental illness suggests that genetic and environmental factors are difficult to separate as etiological factors in vulnerability. Depression and Anxiety 5:66-72, 1997. © 1997 Wiley-Liss, Inc

Previous research has demonstrated that individualized behavioral exposure and response prevention therapy is an effective treatment for Obsessive-Compulsive Disorder. In our prior preliminary report, 7-week group exposure and response prevention therapy was also found effective in reducing obsessions and compulsions. The present report describes a larger sample (N=113) of treatment seeking obsessive-compulsives who received group behavioral therapy. As before, group exposure and response prevention significantly improved ratings of obsessions, compulsions, and depression. These improvements were maintained at 3-month and long-term follow-up. A sub-sample of patients who received 12 weeks of treatment had outcomes at the end of the group and at follow-up that did not significantly differ from those who received 7 weeks of treatment. These results confirm the efficacy of a 7-week behavioral treatment program administered in a group format. Depression and Anxiety 13:161-165, 2001. © 2001 Wiley-Liss, Inc.

This paper provides an overview of the conceptualization and methods used in the National Survey of American Life (NSAL). The objectives of the NSAL are to investigate the nature, severity, and impairment of mental disorders among national samples of the black and non-Hispanic white (n = 1,006) populations in the US, including African American (N = 3,570), and Afro-Caribbean (N = 1,623) immigrant and second and older generation, populations. National multi-stage probability methods were used in generating the samples and race/ethnic matching of interviewers and respondents were employed in the largely face-to-face interview, lasting on average 2 hours and 20 minutes. Two methodological approaches are described for addressing sampling coverage of individuals attached to, but not residing in, selected households at the time of the study. The paper also describes two approaches used to address concerns about the interpretations of standard symptom probe information in assessing serious mental disorders. This included a clinical reappraisal study designed to ascertain differences in symptom responding and ascertainment of cases (N = 677) in a subset of the same NSAL respondents. Finally, an abbreviated, novel method for estimating the prevalence of mental disorders in first-degree family members is described and the preliminary results from this new approach are reported. Copyright © 2004 Whurr Publishers Ltd.

Cholecystokinin (CCK) may mediate human anxiety and animal data suggest that cholecystokinin antagonists could provide an important advance in the treatment of anxiety disorders. The study of CCK receptor systems in psychiatric patients has, however, been severely limited by the lack of available probes. We utilized intravenous infusions of pentagastrin, a selective CCK-B receptor agonist, and studied behavioral and cardiovascular responses in 10 patients with panic disorder and 10 normal controls. Pentagastrin produced substantial symptomatology, including anxiety, and increases in heart rate and blood pressure, in both patients and controls. Patients were more sensitive to the panicogenic effects of the pentagastrin. Panic attacks occurred in 70% of patients and 0% of controls. Patients' symptom responses were very similar to their "typical" panic attacks and to symptoms produced by CCK4. Pentagastrin provides a readily available alternative to CCK4 for studying the CCK receptor system and exploring its involvement in human anxiety.

Cholecystokinin (CCK) has well-documented anxiogenic effects in animals and normal people, and panicogenic effects in patients with panic disorder, but little is known about its neuroendocrine profile. We examined neuroendocrine responses to intravenous infusions of pentagastrin, a selective CCK-B receptor agonist, in 10 patients with panic disorder and 10 normal control subjects. Pentagastrin potently activated the hypothalamic-pituitary-adrenal (HPA) axis, but did not release growth hormone or any of several vasoactive peptides (neurokinin A, substance P, vasoactive intestinal peptide). The HPA axis response was unrelated to increases in symptoms. Panic patients did not differ from controls in neuroendocrine responses to the CCK agonist. Differential sensitivity to novelty stress accounted for the only patient-control differences in neuroendocrine profiles. The data suggest that CCK may help modulate normal HPA axis activity, but its anxiogenic effects are unrelated to its stimulatory effects on the HPA axis. Pentagastrin provides a safe and readily available probe for further study of CCK receptor systems in humans.

Axelrod and Hamilton (Science 211:1390, 1981) suggested that trisomies may result from an end-game strategy between chromosomes competing to get on the gamete as the mother approaches menopause. We tested this hypothesis by reviewing studies of the parental origin of the extra chromosome in trisomy 21 births. These data show that there is no significant rise in trisomy 21 conceptions as the mother ages. The increase in trisomies with maternal age results not from an increase in nondisjunctions, but from a decrease in rejection of trisomy zygotes, which may be adaptive for the mother towards the end of her reproductive life. This decreasing rate of rejection may result from the changing inclusive benefits of two maternal strategies as menopause approaches.

This paper provides outcome data about the efficacy of a behavioral group therapy program for obsessive-compulsive disorder (OCD). Thirty-six patients completed a 7-week outpatient treatment program which provides: (1) education about OCD and its treatment, (2) instruction in a cognitive and behavioral approach to the self-treatment of OCD and (3) guided behavioral treatment. Significant improvement in obsession, compulsion, and depression scores were observed at completion of the group and at 3 month follow-up. Significant improvement in obsessions and compulsions was observed for both patients taking anti-obsessional medications and those who did not.

The effects of fluoxetine, phenelzine, and tranylcypromine in obsessive-compulsive disorder (OCD) were compared in an open-label pilot study involving sequential treatment with these agents in six patients. Despite full (or maximally tolerated) trials on these medications, there was no improvement in OC symptoms referable to the pharmacotherapy. Three patients, however, subsequently showed major improvement in symptoms following application of behavioral therapy techniques. Despite the small sample size, this study suggests that there may be many patients with OCD for whom these medications might be poorly tolerated or ineffective, and emphasizes that behavioral-therapeutic techniques can be effective in patients for whom medications prove ineffective or intolerable. Of note, one patient displayed simultaneous manic and OC symptoms, thus undermining previous suggestions that the coexistence of these symptoms may not be possible.

Of 156 patients meeting DSM-III criteria for either agoraphobia with panic attacks, panic disorder, simple or social phobia, or generalized anxiety disorder, 27 (17.3%) were found to score in the alcoholic range ([ges] 5) on the Michigan Alcoholism Screening Test. This pattern of alcohol abuse was primarily associated with the diagnosis of agoraphobia. Agoraphobic patients with a concurrent affective disorder were especially prone to abuse alcohol.

It is commonly accepted that early traumatic separation experiences predispose to the development of agoraphobia in adults. This separation anxiety hypothesis has been incorporated into the diagnostic criteria of the DSM-III, despite the absence of substantial empirical support. In the present study, 14 objective questions pertaining to childhood separation anxiety experiences were answered by 44 agoraphobics and a comparison group of 83 simple phobics. In no instance did the agoraphobics report significantly greater separation trauma in childhood than the simple phobics. This suggests that better evidence is needed before acceptance of the separation anxiety hypothesis of agoraphobia. Psychological explanations regarding the etiology of the disorder may need to be discarded in favor of biological factors which are receiving increasing empirical support.

The Diagnostic and Statistical Manual (DSM-III) contains little specific information pertaining to the ages of onset of anxiety disorders. Such information is of clinical and research value in understanding the natural history of mental illnesses, in determining which of several possible etiologies for a given diagnosis may be relevant for a particular patient, and in testing theories of psychopathology or pathophysiology. Age-of-onset data is presented for 423 psychiatric outpatients seen at a University Hospital--based anxiety disorders program. All adult anxiety disorders are represented except posttraumatic stress disorder. The relevance of this information is discussed in terms of past research on ages of onset of the anxiety disorders, and in its bearing on the psychiatric diagnosis of these conditions.

(1) The effect of anxiety on plasma levels of thyroid stimulating hormone (TSH) is not clear, despite a number of relevant studies. (2) Nine human subjects with severe phobias had blood samples taken for TSH assay every 20 min during five sessions of 3-hr duration each. (3) Severe anxiety, induced by treating the subject's phobia with in vivo flooding, did not influence plasma TSH levels in any consistent way, nor could a specific TSH response to anxiety be identified in any individual subject.