Faculty Bibliography

In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, World J Biol Psychiatry 3:171), recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo- or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines

Evidence suggests a relationship between parental depression and phobias in offspring as well as links between childhood fears and risk for major depression. This study examines the relationship between major depressive disorder (MDD) and anxiety disorders in parents and specific fears and phobias in offspring. Three hundred and eighteen children of parents with lifetime MDD, anxiety disorder, MDD+anxiety disorder, or neither were psychiatrically assessed via parent interview. Rates of specific phobias in offspring did not differ significantly across parental groups. Specific fears were significantly elevated in offspring of parents with MDD+anxiety disorder relative to the other groups (MDD, anxiety disorder, and controls, which did not differ). We failed to find increased phobias in offspring of parents with MDD without anxiety disorder. Elevated rates of specific fears in offspring of parents with MDD+anxiety disorder may be a function of more severe parental psychopathology, increased genetic loading, or unmeasured environmental influences

Reports an error in "Amygdala and nucleus accumbens activation to emotional facial expressions in children and adolescents at risk for major depression" by Christopher S. Monk, Rachel G. Klein, Eva H. Telzer, Elizabeth A. Schroth, Salvatore Mannuzza, John L. Moulton III, Mary Guardino, Carrie L. Masten, McClure-Tone, Stephen Fromm, R. James Blair, Daniel S. Pine and Monique Ernst (American Journal of Psychiatry, 2008[Jan], Vol 165[1], 90-98). In this article, the figure titles and footnotes accompany the wrong images. In the version that was published online in advance of print, the figures appeared as they were intended. In the print edition, the title and footnote text for Figure 1 should accompany Figure 3. The title and footnote text for Figure 2 should accompany Figure 1. The title for Figure 3 should accompany Figure 2. The footnote text for what should have accompanied Figure 1 should have read "Figures 1 and 2 display group-level data..." Production problems at the time the article was being prepared for inclusion in the January issue caused an older draft version to be used. The PDF version that now appears online has been corrected and it indicates that it differs from what appears in print because the figure titles and footnotes have been corrected. The full-text HTML has also been corrected. (The following abstract of the original article appeared in record 2008-00613-018.) Objective: Offspring of parents with major depressive disorder face a threefold higher risk for major depression than offspring without such family histories. Although major depression is a significant cause of morbidity and mortality, neural correlates of risk for major depression remain poorly understood. This study compares amygdala and nucleus accumbens activation in children and adolescents at high and low risk for major depression under varying attentional and emotional conditions. Method: Thirty-nine juveniles, 17 offspring of parents with major depression (high-risk group) and 22 offspring of parents without histories of major depression, anxiety, or psychotic disorders (low-risk group) completed a functional magnetic resonance imaging study. During imaging, subjects viewed faces that varied in intensity of emotional expressions across blocks of trials while attention was unconstrained (passive viewing) and constrained (rate nose width on face, rate subjective fear while viewing face). Results: When attention was unconstrained, high-risk subjects showed greater amygdala and nucleus accumbens activation to fearful faces and lower nucleus accumbens activation to happy faces (small volume corrected for the amygdala and nucleus accumbens). No group differences emerged in amygdala or nucleus accumbens activation during constrained attention. Exploratory analysis showed that constraining attention was associated with greater medial prefrontal cortex activation in the high-risk than in the low-risk group. Conclusions: Amygdala and nucleus accumbens responses to affective stimuli may reflect vulnerability for major depression. Constraining attention may normalize emotion-related neural function possibly by engagement of the medial prefrontal cortex; face-viewing with unconstrained attention may engage aberrant processes associated with risk for major depression.

BACKGROUND: Spontaneous very low frequency oscillations (VLFO: <0.2 Hz) in functional magnetic-resonance imaging are proposed to identify a default-mode network of resting brain activity. Activity in this network has been related to lapses of attention during goal-directed tasks and may provide a basis for ADHD. This study assessed the relation between scalp-recorded EEG VLFO at rest and ADHD. METHODS: 13 young adults with high- and 11 with low self-ratings of ADHD participated. Direct current EEG was recorded during a five minute rest session and was retested after approximately 1 week. RESULTS: A consistent and temporally stable pattern of VLFOs was observed across specific scalp regions in low-ADHD participants. High-ADHD participants had less VLFO power across these locations, especially where inattention self-ratings were high. Inattention was not related to VLFO power in other locations. DISCUSSION: Initial evidence is provided for a pattern of VLFOs at rest which is associated with inattention symptoms

BACKGROUND: The relationship of panic attacks (PA), panic disorder (PD) and agoraphobia (AG) is controversial. The aim of the current study is to prospectively examine the 10-year natural course of PA, PD and AG in the first three decades of life, their stability and their reciprocal transitions. METHODS: DSM-IV syndromes were assessed via Composite International Diagnostic Interview - Munich version in a 10-year prospective-longitudinal community study of 3,021 subjects aged 14-24 years at baseline. RESULTS: (1) Incidence patterns for PA (9.4%), PD (with and without AG: 3.4%) and AG (5.3%) revealed differences in age of onset, incidence risk and gender differentiation. (2) Temporally primary PA and PD revealed only a moderately increased risk for subsequent onset of AG, and primary AG had an even lower risk for subsequent PA and PD. (3) In strictly prospective analyses, all baseline groups (PA, PD, AG) had low remission rates (0-23%). Baseline PD with AG or AG with PA were more likely to have follow-up AG, PA and other anxiety disorders and more frequent complications (impairment, disability, help-seeking, comorbidity) as compared to PD without AG and AG without PA. CONCLUSIONS: Differences in incidence patterns, syndrome progression and outcome, and syndrome stability over time indicate that AG exists as a clinically significant phobic condition independent of PD. The majority of agoraphobic subjects in this community sample never experienced PA, calling into question the current pathogenic assumptions underlying the classification of AG as merely a consequence of panic. The findings point to the necessity of rethinking diagnostic concepts and DSM diagnostic hierarchies.

This study explored the relationship between personal resources and previous adverse life events such as homelessness and depression. Participants were recruited from two church sponsored multisite social service centers in Anne Arundel County, Maryland. The interview included demographics and several standardized scales to assess history of homelessness, medical history, personal resources, and depressive symptoms. A hierarchical multiple regression analysis revealed that participants with higher levels of depressive symptoms were older, had a history of homelessness, had more health problems, had a history of mental illness, and had lower self-esteem, mastery, and mattering. A subanalysis indicated that individuals who had experienced homelessness at or before age 21 had higher levels of depressive symptoms than those who were first homeless as an adult. Previous history of homelessness, especially before age 21, and lack of personal resources may place individuals at risk for psychological distress, including higher levels of depressive symptoms.