OBJECTIVES: Previous studies have indicated that obsessive-compulsive disorder (OCD) is associated with high levels of impulsiveness. The aim of this study was to assess whether there are differences in clinical correlates with impulsiveness between OCD patients and healthy controls, and whether there is a significant relation between certain obsessive-compulsive symptomatic dimensions and impulsiveness. METHODS: A group of 45 OCD outpatients and 45 matched healthy controls were interviewed and diagnosed according to DSM-IV criteria. All subjects were assessed by means of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Barratt Impulsiveness Scale (BIS-11), the Hamilton Anxiety Scale (HAM-A), and the Montgomery-Asberg Depression Rating Scale (MADRS). RESULTS: Compared with healthy controls, OCD patients exhibited significantly higher BIS-11 scores except for with respect to non-planning impulsiveness. The MADRS scores and age at onset in patients with OCD were significantly correlated with BIS-11 total scores. Multiple regression analyses revealed that only age at onset showed an independent positive correlation with impulsiveness. Hoarding was the only dimension significantly associated with impulsiveness. CONCLUSION: These findings suggest that groups of patients with early onset OCD may show some association with impulsiveness, and that impulsiveness may be another distinct clinical feature of hoarding in OCD.
Anxiety ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Obsessive Hoarding ; Obsessive-Compulsive Disorder ; Outpatients

OBJECTIVES: This study aimed to evaluate preliminarily the clinical effects of cognitive-behavioral treatment in children with anxiety disorders. METHODS: Subjects were 11 children between 2nd and 6th grade with anxiety disorder. All subjects were diagnosed through Kiddie-Schedule for Affective Disorder and Schizophrenia Present and Lifetime Version (K-SADS-PL) interview. The CBT program consisted of sessions once a week (60min/session) for 14 weeks with parent education. RESULTS: Children and parents reported significantly improved social skills, social competence and decreased anxiety. However, there were no significant changes in children's negative thoughts and subjective depressive symptoms. CONCLUSION: Cognitive-behavioral treatment is expected to be effective in children with anxiety disorders such as generalized anxiety disorder, phobia, separation anxiety disorder, and obsessive-compulsive disorder.
Anxiety ; Anxiety Disorders ; Anxiety, Separation ; Child ; Humans ; Mental Competency ; Mood Disorders ; Parents ; Phobic Disorders ; Schizophrenia

OBJECTIVE: There are conflicting reports about whether individual anxiety disorders are independently associated with suicidal ideation and suicide attempts. We examined whether anxiety disorders are related to suicidal ideation and suicide attempts in a community sample of South Korean adults. METHODS: In-person interviews based on the South Korean version of the Composite International Diagnostic Interview were conducted to diagnose mental disorders. Multivariate logistic regression analysis was performed to examine whether anxiety disorders were associated with suicidal ideation and suicide attempts. Each regression model treated lifetime diagnosis of anxiety disorders as independent variables. Sociodemographic characteristics, cohabitation status, lifetime history of mood disorders, alcohol use disorders, and psychotic disorders were included as covariates. RESULTS: Nationally representative sample of 6,510 South Korean adults aged 18–64 years was recruited. Multivariate analysis adjusted for psychiatric comorbidity and sociodemographic variables revealed that generalized anxiety disorder (GAD) [2.34, 95% confidence interval (CI) (1.27, 4.33)], post-traumatic stress disorder (PTSD) (3.50, 95% CI: 2.16, 5.68), specific phobia (1.55, 95% CI: 1.14, 2.11), social phobia (2.97, 95% CI: 1.27, 6.94), and obsessive-compulsive disorder (OCD) (5.58, 95% CI: 2.70, 11.6) were associated with suicidal ideation, whereas only social phobia (3.78, 95% CI: 1.41, 10.1) and PTSD (5.13, 95% CI: 2.81, 9.37) were associated with suicide attempts. CONCLUSION: Individual anxiety disorders are independently associated with suicidal ideation and/or suicide attempts. The importance of the early detection of anxiety disorders and of assessing the suicide risk in individuals with anxiety disorders is emphasized.
Adult* ; Anxiety Disorders* ; Anxiety* ; Comorbidity ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders* ; Humans ; Logistic Models ; Mental Disorders ; Mood Disorders ; Multivariate Analysis ; Obsessive-Compulsive Disorder ; Panic Disorder ; Phobic Disorders ; Psychotic Disorders ; Stress Disorders, Post-Traumatic ; Suicidal Ideation ; Suicide

BACKGROUND: It is reported that many types of psychiatric disorders, including anxiety disorder, are related with abnormal brain wave activity, and neurofeedback is associated with clinical improvement in generalized anxiety, OCD, phobic disorder, and PTSD. But in panic disorder, previous studies with neurofeedback are very lacking. Therefore, in this study, the author applied neurofeedback to patients with panic disorder, refractory to cognitive-behavioral therapy and medication. METHODS: From March 2 to May 15 in 2005, six patients with a panic disorder had received 20 sessions of neurofeedback training. The author evaluated the treatment effect by using the alteration of K-APPQ score, the frequency of panic attack, medication and individual handicap. RESULTS: All 6 patients completed 20 sessions of neurofeedback training. At the end, the score of total APPQ, agoraphobia, and interoceptive fear was decreased (P= 0.028) and the frequency of panic attack, medication, and individual handicap was also decreased. CONCLUSION: Neurofeedback training was successful in reducing panic symptom severity, frequency and individual handicap. A controlled study on a larger population is strongly recommended.
Agoraphobia ; Anxiety ; Anxiety Disorders ; Brain Waves ; Humans ; Neurofeedback* ; Panic ; Panic Disorder* ; Phobic Disorders ; Stress Disorders, Post-Traumatic

OBJECTIVES: It is reported that panic disorder is frequently comorbid with other psychiatric illnesses. The aim of this study was to investigate differences of psychiatric comorbidity according to age of onset of panic disorder. METHODS: Three hundred-two patients participated in the study. All the patients were evaluated by clinical instruments for the assessment the presence of other comorbid psychiatric disorders and various clinical features; Korean version of Mini International Neuropsychiatric Interview, Self-report questionnaires(Beck Anxiety Inventory, Beck Depression Inventory, Anxiety Sensitivity Index and State-Trait Anxiety Inventory) and clinical rating scale (Hamilton Anxiety Scale, Hamilton Depression Scale and Global Assessment of Functional score). Chi-square test was used to determine the difference between early onset and late onset panic disorder. RESULTS: Forty percent of panic patients were found to have at least one comorbid psychiatric diagnosis. There were no differences among the groups divided by number of comorbidity in sex, agoraphobia comorbidity, duration of panic disorder, except onset age of panic disorder. Early onset group had more comorbidy with social phobia, agoraphobia, PTSD. We also found that Early onset panic disorder patients were more likely to experience derealization, nausea, parethesia than late onset panic disorder patients. CONCLUSION: The results of our study are in keeping with previous data from other parts of the world. Our finding suggest that earier onset of panic disorder related to more psychiatric comorbidity.
Age of Onset ; Agoraphobia ; Anxiety ; Comorbidity ; Depersonalization ; Depression ; Humans ; Mental Disorders ; Nausea ; Panic ; Panic Disorder ; Phobic Disorders ; Stress Disorders, Post-Traumatic

OBJECTIVES: We investigated the significance of interoceptive fear in assessment of panic disorder (PD) patients. METHODS: 102 patients affected by PDs with (n=68) or without (n=34) agoraphobia according to DSM-IV criteria completed self-report questionnaires, such as Albany Panic and Phobia Questionnaire (APPQ), The Expanded Anxiety Sensitivity Index (ASI-R), Agoraphobic Cognitions Questionnaire (ACQ), Body Sensation Questionnaire (BSQ), Beck Anxiety Inventory (BAI), and Panic Disorder Severity Scale (PDSS). Pearson correlation analysis, stepwise regression analysis, paired t-test and independent t-test were used. RESULTS: All variables except BSQ were significantly correlated with panic severity. In stepwise regression analysis, interoceptive fear and catastrophic cognition were the most significant predicting variables for panic severity. After 3-months medication, all variables significantly diminished, but interoceptive fear and catastrophic cognition of panic patients were still significantly higher than normal control. CONCLUSION: Interoceptive fear is the fear of automatic sensations that are similar to those of a panic attack and is the most significant variable in predicting panic severity. After 3-months medication, interoceptive fear significantly decreased, but still was higher than the control group.
Agoraphobia ; Anxiety ; Cognition ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Panic Disorder* ; Panic* ; Phobic Disorders ; Surveys and Questionnaires ; Sensation

OBJECTIVES: Psychiatric patients report higher rates of interpersonal trauma, and they present with more symptoms and behavioral problems. However, less is known about other anxiety disorders, except for posttraumatic stress disorder. In this study, we investigated symptomatic correlates of interpersonal trauma (i.e., physical or sexual assaults) in patients with heterogeneous anxiety disorders. METHODS: We surveyed a consecutive sample of 90 outpatients with DSM-IV anxiety disorders (panic disorder, generalized anxiety disorder, obsessive compulsive disorder, social phobia, anxiety disorder not otherwise specified) at the psychiatric department of a university-affiliated hospital. The questionnaire was comprised of the Symptom Checklist-90-Revised (SCL-90-R), Beck Depression Inventory, State and Trait Anxiety Inventory, and Impact of Events Scale-Revised. RESULTS: Patients with interpersonal trauma (n=51) demonstrated a significantly higher level of interpersonal sensitivity, paranoid ideation, and obsessive-compulsive subscale of the SCL-90-R. However, logistic regression analysis suggested that interpersonal sensitivity alone was suggested as the best fitting model. CONCLUSION: Anxiety disorder patients with interpersonal trauma demonstrated difficulty in domains of interpersonal relationship. Clinicians treating this population should consider this finding for better engagement and management.
Anxiety ; Anxiety Disorders ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Logistic Models ; Obsessive-Compulsive Disorder ; Outpatients ; Phobic Disorders ; Surveys and Questionnaires ; Stress Disorders, Post-Traumatic

OBJECTIVES: A great deal of attention has been paid to comorbid personality disorders in obsessive-compulsive disorder not only from the theoretical perspectives but also from the clinical aspects related to the prediction of the treatment response. The purpose of the current study was to investigate the relations of the symptoms dimensions in OCD to the comorbid personality pathology. METHODS: One-hundred thirty subjects with OCD completed Yale-Brown Obsessive Compulsive Scale (YBOCS) and Personality Disorder Questionnaire-4+ (PDQ-4+). Factor scores of symptom dimensions yielded from a factor analysis of 13 categories in YBOCS symptom checklist were inspected how to be related with the presence of any personality disorder and the PDQ scores for cluster A, B, and C personality pathology. RESULTS: The PDQ total score was significantly correlated with aggressive/sexual/religious obsessions, hoarding, and symmetry/ordering dimensions. The hoarding and repeating/counting dimensions were correlated with cluter A pathology, the symmetry/ordering dimension was with cluster B pathology, while the obsessions dimension was globally related to personality disorders of all the clusters. CONCLUSION: These findings add the evidence of the heterogeneity of OCD. The presence of pure obsessions, hoarding, and symmetry/ordering dimensions may need a close screening for comorbid personality disorders and individualized therapeutic strategies.
Checklist ; Mass Screening ; Obsessive Behavior ; Obsessive Hoarding ; Obsessive-Compulsive Disorder* ; Pathology* ; Personality Disorders ; Population Characteristics

OBJECTIVE: Serotonin-1A receptors (5-HTR1A) is suggested to be involved in the etiology of several psychiatric disorders including panic disorder (PD). A few imaging studies have suggested the alterations of the cingulum bundle in PD. The objective of this study is to examine the structural changes of cingulum related to the 5-HTR1A polymorphism rs6295 in the patients with PD. METHODS: Thirty-two right-handed patients with PD [11 men, 21 women; 40.34+/-13.17 (mean+/-SD) age] who met the diagnostic criteria in Structured Clinical Interview for DSM-IV were examined by means of MRI at 3 Tesla. We divided the patients with PD into CC genotype group and non CC genotype group (GG/CG genotype group) of the 5-HTR1A rs6295 polymorphism to compare the cingulum white matter connectivity. RESULTS: Tract-based spatial statistics showed significantly increased fractional anisotropy (FA) values in cingulate gyrus process of left cingulum in 5-HTR1A CC genotype compared to GG/CG genotype in PD. Significant positive correlations were shown between the Albany Panic and Phobia Questionnaire (APPQ) interoceptive fear subscale scores, the Anxiety Sensitivity Inventory-Revised fear of publicly observable anxiety reaction subscale scores and FA values of cingulate gyrus process of left cingulum in 5-HTR1A rs6295 GG/CG genotype group. In CC genotype group, APPQ total, APPQ agoraphobia subscale and APPQ social phobia subscale scores also showed significant positive correlations with FA values of hippocampal process of right cingulum. CONCLUSION: This preliminary study suggests that 5-HTR1A polymorphism may be associated with the cingulum white matter connectivity in PD.
Agoraphobia ; Anisotropy ; Anxiety ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Genotype ; Gyrus Cinguli ; Humans ; Magnetic Resonance Imaging ; Male ; Neuroimaging ; Panic Disorder* ; Panic* ; Phobic Disorders ; Surveys and Questionnaires

The anxiety disorders make up one of the most common groups of psychiatric disorders. Anxiety is an alerting signal ; it warns of impending danger and enables a person to take measures to deal with a threat. Three major schools of psychological theory-psychoanalytic, behavioral, and existential-have contributed theories about the causes of anxiety. Many drugs are effective in managing distressing signs and symptoms associated with anxiety disorders. As the symptoms are controlled by medication, patients are reassured and develop confidence that they will not be incapacitated by the disorder. Benzodiazepines are useful in panic disorder, phobias, and agitation. In general, benzodiazepines act as hypnotics at high doses and as anxiolytics or sedatives at low doses. The benzodiazepines have become the sedative-hypnotic drugs of first choice because they have a higher therapeutic index and significantly less abuse potential than do many of other sedative-hypnotics. The most common adverse effect of benzodiazepines is drowsiness. Some patients also experience dizziness and ataxia. The most serious adverse effects of benzodiazepines occur when other sedative substances are taken concurrently. When benzodiazepines are used for long periods, they usually cause significant tolerance, dependence, or withdrawal effects. Overdoses with benzodiazepines alone have a predictably favorable outcome. The benzodiazepines should be started at a low dosage, and the patient should be informed about the drug’s sedative properties and abuse potential. Serotonin-specific reuptake inhibitors (SSRIs) have a much more favorable profile of adverse effects and have significantly broadened the horizon for pharmacological treatment of anxiety disorder. Three fourths of patients experience no adverse effects at low starting doses, and doses may be increased relatively rapidly in these patients. In the remaining one fourth of patients, most of the SSRIs’ adverse effects appear within the first 1 to 2 weeks, and they generally subside or resolve spontaneously if the drugs are continued at the same dose.
Anti-Anxiety Agents ; Anxiety ; Anxiety Disorders ; Ataxia ; Benzodiazepines ; Dihydroergotamine ; Dizziness ; Humans ; Hypnotics and Sedatives ; Panic Disorder ; Phobic Disorders ; Sleep Stages