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1. 2. 3. 4. 5. Generalized Anxiety Disorder (GAD) Obsessive-Compulsive Disorder (OCD) Panic Disorder Post-Traumatic Stress Disorder (PTSD) Social Phobia (or Social Anxiety Disorder) Characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it Can't seem to shake their concerns Worries are accompanied by physical symptoms, especially fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, and hot flashes Diagnosed when a person worries excessively about a variety of everyday problems for at least 6 months GAD affects about 6.8 million American adults, including twice as many women as men. The disorder develops gradually and can begin at any point in the life cycle, although the years of highest risk are between childhood and middle age. There is evidence that genes play a modest role in GAD. Other anxiety disorders, depression, or substance abuse often accompany GAD, which rarely occurs alone. Characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these "rituals" only temporary relief, and not performing them increases anxiety. OCD affects about 2.2 million American adults and can be accompanied by eating disorders, other anxiety disorders, or depression. It strikes men and women in roughly equal numbers and usually appears in childhood, adolescence, or early adulthood. One-third of adults with OCD develop symptoms as children, and may run in families. Panic disorder is an anxiety disorder and is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress. Feelings of terror that strike suddenly and repeatedly with no warning. During a panic attack, most likely your heart will pound and you may feel sweaty, weak, faint, or dizzy. Your hands may tingle or feel numb, and you might feel flushed or chilled. You may have nausea, chest pain or smothering sensations, a sense of unreality, or fear of impending doom or loss of control. Often accompanied by other serious problems, such as depression, drug abuse, or alcoholism. Can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat. People with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb, especially with people they were once close to. They may experience sleep problems, feel detached or numb, or be easily startled. Anyone can get PTSD at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events. Some people get PTSD after a friend or family member experiences danger or is harmed. The sudden, unexpected death of a loved one can also cause PTSD. Characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. Social phobia can be limited to only one type of situation, such as a fear of speaking in formal or informal situations, or eating or drinking in front of others or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people. People with social phobia have a persistent, intense, and chronic fear of being watched and judged by others and being embarrassed or humiliated by their own actions. Their fear may be so severe that it interferes with work or school, and other ordinary activities. Physical symptoms often accompany the intense anxiety of social phobia and include blushing, profuse sweating, trembling, nausea, and difficulty talking. Social phobia affects about 15 million American adults. Women and men are equally likely to develop the disorder. Usually begins in childhood or early adolescence. There is some evidence that genetic factors are involved. Often accompanied by other anxiety disorders or depression, and substance abuse may develop if people try to self-medicate their anxiety. This term encompasses both dependence on and abuse of drugs usually taken voluntarily for the purpose of their effect on the central nervous system (usually referred to as intoxication or "high") or to prevent or reduce withdrawal symptoms. These mental disorders form a subcategory of the substance-related disorders. Trait Anxiety Depression Withdrawal Somatic complaints State Attention problems Aggressive behavior Rule-breaking actions Children of depressed mothers had significantly higher rates of lifetime depressive, separation anxiety, oppositional defiant, and any psychiatric disorders Children of depressed mothers also reported significantly lower psychosocial functioning and had higher rates of psychiatric treatment Association between lower socioeconomic status and higher rates of psychiatric disorders (including MDD) Higher prevalence of lifetime MDD in families with yearly incomes below $10,000 and in poor mothers with low income Results indicate a significant relationship between maternal depression and behavioral and emotional problems in the children Higher prevalence of depressive, anxiety, and disruptive behavior disorders as well as lower psychosocial functioning in children of mothers with lifetime depression compared to children of never depressed mothers Predominately Hispanic immigrants from the Caribbean Islands and Central America and speak primarily Spanish 2 bilingual trained clinical interviewers administered the Structured Clinical Interview for the DSM-IV Depressed mothers who had at least one lifetime episode of DSM-IV MDD of at least 4 weeks in duration Never depressed mothers with no lifetime history of MDD Up to 3 children per family 8-17 years old 58 children › 26 children of 16 depressed mothers › 32 children of 19 never-depressed mothers Mothers were administered the clinical interviews in Spanish and children in English Significantly higher lifetime prevalence of depressive disorders, separation anxiety disorder, oppositional defiant disorder, any psychiatric disorder, and suicidal ideation compared to children of never depressed mothers Lower psychosocial functioning across several areas, including lower general competence, overall home functioning, more problems with peers and parents, and lower quality relationships with their mother and siblings These findings in low-income minority population parallel the findings in studies of children from more affluent Caucasian populations Children of depressed parents social and school problems are not due to lower scores on intelligence measures, however other studies have reported lower scores on intelligence measures and academic performance Results indicate that the overall lifetime prevalence of psychiatric disorders in children of low-income depressed mothers Combination of socioeconomic factors and maternal depression might place children at particularly high risk for emotional and behavioral problems Poor people are less likely to seek mental health treatment, less likely to receive treatment from mental health specialists, and more likely to rely on primary-care physicians for their mental health needs Studies have reported that treatment of maternal depression can improve outcomes in children including symptoms and function 1. 2. 3. 4. Samle size Recruited a sample of convience - may not be representative Information on 6 children was obtained solely from the mothers Only on low-income families so doesn’t allow for direct comparison across socioeconomic groups Risk for psychiatric disorders may be particularly high in children of lowincome depressed mothers Multiple risk factors often coalesce in poor children and early detection and intervention become especially important Examined prevalence of anxiety, mood, and SUD in parents of children with anxiety disorders and with no psychological disorders. Investigated the relationship between parent and child anxiety disorders. Anxiety disorders aggregate in families Concordance between child and parent anxiety is thought to result from a combination of genetics, environment, and parenting (including discouragement of social interaction, modeling of cautious or fearful responses, increased levels of parental control and emotional involvement, and less granting of autonomy) Parents with anxiety disorders may model or communicate through anxious self-talk their specific anxieties to their children and place them at greater risk for anxiety disorders Family members have a greatest influence on one another when offspring are in childhood or adolescence it seems likely that children and their parents would exhibit levels of diagnostic specificity similar to adult first-degree relatives Parent-child association for OCD and a significant mother-child but not father-child association for SP Theory that PD is a the adult manifestation of SAD A relationship between child SAD and maternal lifetime SAD has been documented Twin pair study support relationship between maternal depression in the first 5 years of the twins lives and behavioral problems displayed at 7 years of age in a dose-response relationship Relationship between anxiety and depressive disorders in children and parent substance use problems may be accounted for by a positive history of anxiety or depressive disorders in parents 1. 2. 3. 4. Small samples Lack of blind evaluators and/or structured interviewers which may influence diagnoses No or low father participation Findings that predate changes to childhood anxiety disorders in the DSMIV Lifetime rates of anxiety, mood, and SUD in mothers and fathers of AD (anxiety disordered) children compared to mothers and fathers of NPD (no psychological disorder) Relationship between specific anxiety disorders in children and their mothers and fathers in AD children Predicted that mothers and fathers of AD children would exhibit greater lifetime rates of anxiety, mood, and SUD as well as anxious and depressive self-talk and self-reported symptoms than mothers and fathers of NPD children Parents of AD children would demonstrate similar diagnostic pattern of anxiety diagnoses as their AD children (ex children with social phobia would have parents with social phobia, mothers of panic disorder would have children with SAD) 230 children total presenting to the Child and Adolescent Anxiety Disorders Clinic (CAADC) and their parents 178 AD; 52 NPD Children had an IQ > 80 English speaking Not taking any anti-anxiety or anti-depressant medication › All participants were administered the anxiety disorders interview schedule-parent and child versions for DSM-IV to asses for child diagnoses › › › › NPD (No Psychological Disorder) Children AD (Anxiety Disordered) Children 178 children total 7-14 years old 53.4% males 85.8% Caucasian 14.2% Ethnic minority 57% diagnosed with more than 1 anxiety disorder › › › › › 12% mood disorder 23% ADHD 7% ODD 6% selective mutism 4% functional enuresis Percentage of children meeting criteria for specific child anxiety disorder and mood disorder diagnoses (Table 1) 52 children total 8-14 years old From same communities as AD youth, responded to notices for families to participate in research Did not met criteria for any disorder 48.1% males 76.9% Caucasian 17.3% African-American 5.7% ethnic minority 165 mothers 23-67 years old 87.1% Caucasian 12.9% ethnic minority 15% some graduate school training 31.2% college graduates 25.3% some college training 25.3% high school graduates or (GED) 2.4% less than a high school education 73.5% employed 157 fathers 26-63 years old 87.1% Caucasian 12.9% ethnic minority 23% some graduate school training 23.8% college graduates 20.0% some college training 29.4% high school graduates or (GED) 4.3% less than a high school education 93.8% employed 4.2% below $20,000 11.5% between $20,000-$40,000 23.0% between $40,000-$60,000 25.5% between $60,000-$80,000 35.8% above $80,000 52 mothers 28-52 years old 80.4% Caucasian 17.6% African-American 5.7% ethnic minority 20.0% some graduate school training 40.0% college graduates 30.0% some college training 10.0% high school graduates or (GED) 82.0% employed 50 fathers 33-56 years old 75.5% Caucasian 22.4% African-American 2.0% Hispanic 14.0% some graduate school training 30.6% college graduates 30.6% some college training 20.4% high school graduates or (GED) 4.0% less than a high school education 95.9% employed 4.2% below $20,000 14.6% between $20,000-$40,000 25.0% between $40,000-$60,000 35.4% between $60,000-$80,000 20.8% above $80,000 AD (Anxiety Disordered) 78.7% married 7.7% divorced 5.3% separated 7.1% never married 1.2% widowed NPD (No Psychological Disorder) 78.0% married 6.0% divorced 4.0% separated 12.0% never married Anxiety disorders interview schedule-parent and child versions for the DSM-IV (parent (ADIS-P) and child version (ADIS-C)) Semi-structured diagnostic interviews administered to parents and children independently to assess for DSM-IV anxiety disorders ADIS-C – assessed symptomatology and severity of anxiety, mood, and externalizing disorders in youth Anxiety Disorders Interview Schedule-IV Lifetime Version (ADIS-IV-L) › assesses for the lifetime presence of DSM-IV disorders in adults › Administered by interviewer blind to reason for interview › Diagnoses coded as absent or present, included: PD with or without agoraphobia, SP, GAD, OCD, specific phobias, mood disorders (MDD, dysthymia, and bipolar disorder), and SUD Anxious self-statements questionnaire (ASSQ) › 32 item self-report measure that assesses the frequency of self-talk associated with anxiety › 1-5 pt scale › Distinguishes between depressive and anxious self-talk Automatic Thoughts Questionanaire (ATQ-R) › 40 item adult self-report questionnaire › 30 negative self-statements and 10 positive self- statements › Rated on 1-5 pt scale to indicate the frequency of thought in the last 2 months Beck Depression Inventory, Second Ed (BDI-II) › 21 self-report measure of depressive symptoms › Rated on a 0-4 pt scale State-Trait Anxiety Inventory (STAI) › 20-item measure used to assess state (STAI-S) and trait (STAI-T) If child met initial criteria and parents agreed then the children and parents were scheduled for a diagnostic evaluation If child met criteria for an anxiety disorder then parents were scheduled for a second assessment to complete diagnostic interviews Separate diagnosticians blind to child diagnoses and reason for evaluation administered the ADIS-IV-L to each parent Diagnosticians completed and passed a 2-phase training process before conducting interviews Required to met 85% agreement with experienced diagnosticians MANOVA conducted to examine variance between AD and NPD youth on parental self-reports of anxiety, depression, and anxious and depressive self-talk Significant difference with mothers of AD youth reporting higher levels of trait and state anxiety compared to mothers of NPD Fathers of AD youth compared to fathers of NPD youth showed significant group differences in state anxiety but not trait anxiety Both mothers and fathers of AD youth reported more depressive symptoms than mothers and fathers of NPD youth Mothers, not fathers, of AD youth reported more anxious and depressive self-talk than mothers of NPD youth Odds of any paternal lifetime anxiety disorder were 2.33x higher in AD compared to NPD youth No significant associations between lifetime paternal SP with or without agoraphobia, GAD, OCD, or specific phobias Significant association between AD youth and lifetime SUD, odds of paternal SUD were 2.52x higher in AD relative to NPD youth Combined SAD and PD as one group, significant association between child SAD/PD and maternal lifetime PD Maternal lifetime PD was 2.53x higher in youth with SAD/PD Maternal lifetime SP was 2.09x higher in youth with SP relative to youth without Odds of having OCD was 7.61x higher in mothers of youth with OCD compared to those without Odds of a lifetime diagnosis of a specific phobia was 2.55x higher in mothers of youth with the diagnosis compared to those without Anxiety disorders aggregate in families Increased rates of anxiety disorders were found in the parents of AD youth compared to parents of NPD Mothers of AD youth were over 3x as likely to meet criteria for SP in particular compared to mothers of NPD youth Fathers of AD youth were over 2x as likely to meet criteria for any anxiety disorder Associations between mother and child psychopathology may be stronger than those between father and child Parental modeling of catastrophic thinking and anxious avoidance are related to the etiology and maintenance of anxiety disorders in youth In this study maternal modeling may contribute to the similarity between mother and child anxiety diagnoses Presence of an AD child may be a stressor for parents and may affect parents mental health Women may be more likely than men to experience psychological distress in response to familial stress Fathers of AD youth had increased risk for lifetime SUD Parents of AD youth were not found to be at increased risk for a lifetime mood disorder, however both reported higher levels of depressive symptomatology and mothers of AD youth reported more frequent depressive self-talk compared to NPD parents Rates of parental mood disorders were high in both AD and NPD especially mothers (32% AD and 27% NPD met the criteria for lifetime mood disorder) Many AD youth met the criteria for multiple anxiety disorders or comorbid mood and externalizing disorders Sample was predominantly Caucasian families with children between the ages of 7-14 and it is unclear whether these findings will generalize to other ethnicities or older children High levels of parental anxiety may be associated with poorer treatment response Anxiety disorders aggregate in families and place individuals at greater risk for developing mood and SUD Similarity in the diagnoses of AD children and their mothers but not fathers suggest the psychopathology between mother and child may be stronger than father and child Increased rates of anxiety disorders in parents of youth with anxiety disorders compared to parents of non-disordered youth › Child-mother relationship between SAD, PD, SP, OCD, and specific phobias › Child-father- fathers of AD children had an increased risk for lifetime SUD and when the presence of a paternal lifetime anxiety disorder was controlled the association disappeared suggesting the SUD was secondary to increased rates of paternal anxiety 905,000 children were abused or neglected in 2006 in the US. › 64.2% were neglected. › 16% were physically abused. › 8.8% were sexually abused. › 6.6% were emotionally or psychologically mistreated. High rates of major depression, PTSD, and other behavioral disorders have been reported in maltreated children and these disorders are frequent in adults with a history of childhood abuse. According to the National Center of Child Abuse and Neglect C. Heim and C. B. Nemeroff. The role of childhood trauma in the neurobiology of mood and anxiety disorders: preclinical and clinical studies. Biol.Psychiatry 49 (12):1023-1039, 2001.