Mechanisms of comorbidity, continuity, and discontinuity in anxiety-related disorders

We discuss comorbidity, continuity, and discontinuity of anxiety-related disorders from the perspective of a two-dimensional neuropsychology of fear (threat avoidance) and anxiety (threat approach). Pharmacological dissection of the "neurotic" disorders justifies both a categorical division between fear and anxiety and a subdivision of each mapped to a hierarchy of neural modules that process different immediacies of threat. It is critical that each module can generate normal responses, symptoms of another syndrome, or syndromal responses. We discuss the resultant possibilities for comorbid dysfunction of these modules both with each other and with some disorders not usually classified as anxiety related. The simplest case is symptomatic fear/anxiety comorbidity, where dysfunction in one module results in excess activity in a second, otherwise normal, module to generate symptoms and apparent comorbidity. More complex is syndromal fear/anxiety comorbidity, where more than one module is concurrently dysfunctional. Yet more complex are syndromal comorbidities of anxiety that go beyond the two dimensional fear/anxiety systems: depression, substance use disorder, and attention-deficit/hyperactivity disorder. Our account of attention-deficit/hyperactivity disorder-anxiety comorbidity entails discussion of the neuropsychology of externalizing disorders to account for the lack of anxiety comorbidity in some of these. Finally, we link the neuropsychology of disorder to personality variation, and to the development of a biomarker of variation in the anxiety system among individuals that, if extreme, may provide a means of unambiguously identifying the first of a range of anxiety syndromes

SKYSURF-4: Panchromatic HST All-Sky Surface-Brightness Measurement Methods and Results

The diffuse, unresolved sky provides most of the photons that the Hubble Space Telescope (HST) receives, yet remains poorly understood. HST Archival Legacy program SKYSURF aims to measure the 0.2-1.6 $\mu$m sky surface brightness (sky-SB) from over 140,000 HST images. We describe a sky-SB measurement algorithm designed for SKYSURF that is able to recover the input sky-SB from simulated images to within 1% uncertainty. We present our sky-SB measurements estimated using this algorithm on the entire SKYSURF database. Comparing our sky-SB spectral energy distribution (SED) to measurements from the literature shows general agreements. Our SKYSURF SED also reveals a possible dependence on Sun angle, indicating either non-isotropic scattering of solar photons off interplanetary dust or an additional component to Zodiacal Light. Finally, we update Diffuse Light limits in the near-IR based on the methods from Carleton et al. (2022), with values of 0.009 MJy sr$^{-1}$ (22 nW m$^{-2}$ sr$^{-1}$) at 1.25 $\mu$m, 0.015 MJy sr$^{-1}$ (32 nW m$^{-2}$ sr$^{-1}$) at 1.4 $\mu$m, and 0.013 MJy sr$^{-1}$ (25 nW m$^{-2}$ sr$^{-1}$) at 1.6 $\mu$m. These estimates provide the most stringent all-sky constraints to date in this wavelength range. SKYSURF sky-SB measurements are made public on the official SKYSURF website and will be used to constrain Diffuse Light in future papers.Comment: Revised based on helpful comments from the reviewer, and accepted to AJ on April 12th, 2023. Main paper: 18 pages, 9 figures, 4 tables. Appendices: 16 pages, 10 figures, 1 table. Main results shown in Figure 7 and Table

Specific phobia predicts psychopathology in young women

Contains fulltext : 90255.pdf (publisher's version ) (Closed access)Although specific phobia is characterized by an early age at onset and by high rates of comorbidity, few studies have examined comorbid relationships prospectively. The present study investigated the association between specific phobia and the risk of a broad range of psychopathology among young women in the community. Data came from the Dresden Predictor Study in which 1,538 German women (18-25 years) completed a diagnostic interview at two time points. Women with specific phobia had a twofold increase in odds of developing any anxiety disorder, generalized anxiety disorder, depression, and any somatoform disorder during 17 months, compared to women without specific phobia. Except for depression, these associations persisted after adjustment for all comorbid mental disorders. Specific phobia thus appears to be a risk factor for a variety of problems. The result further underpins the necessity for early intervention for specific phobia to prevent later mental health problems

Cell phone-supported cognitive behavioural therapy for anxiety disorders: a protocol for effectiveness studies in frontline settings

The resulting protocol (NCT01205191 at clinicaltrials.gov) for use in frontline clinical practice in which effectiveness, adherence, and the role of the therapists are analyzed, provides evidence for what are truly valuable cell phone-supported CBT treatments and guidance for the broader introduction of CBT in health services.Original Publication:Joakim Ekberg, Toomas Timpka, Magnus Bång, Anders Fröberg, Karin Halje and Henrik Eriksson, Cell phone-supported cognitive behavioural therapy for anxiety disorders: a protocol for effectiveness studies in frontline settings., 2011, BMC medical research methodology, (11), 3.http://dx.doi.org/10.1186/1471-2288-11-3Copyright: BioMed Centralhttp://www.biomedcentral.com

Advancing the defensive explanation for anxiety disorders: lorazepam effects on human defense are systematically modulated by personality and threat-type

Clinically effective drugs against human anxiety and fear systematically alter the innate defensive behavior of rodents, suggesting that in humans these emotions reflect defensive adaptations. Compelling experimental human evidence for this theory is yet to be obtained. We report the clearest test to date by investigating the effects of 1 and 2mg of the anti-anxiety drug lorazepam on the intensity of threat-avoidance behavior in 40 healthy adult volunteers (20 females). We found lorazepam modulated the intensity of participants’ threat-avoidance behavior in a dose-dependent manner. However, the pattern of effects depended upon two factors: type of threat-avoidance behavior and theoretically relevant measures of personality. In the case of flight behavior (one-way active avoidance), lorazepam increased intensity in low scorers on the Fear Survey Schedule tissuedamage fear but reduced it in high scorers. Conversely, in the case of risk-assessment behavior (two-way active avoidance), lorazepam reduced intensity in low scorers on the Spielberger trait anxiety but increased it in high scorers. Anti-anxiety drugs do not systematically affect rodent flight behavior; therefore, we interpret this new finding as suggesting that lorazepam has a broader effect on defense in humans than in rodents, perhaps by modulating general perceptions of threat intensity. The different patterning of lorazepam effects on the two behaviors implies that human perceptions of threat intensity are nevertheless distributed across two different neural streams, which influence effects observed on one-way or two-way active avoidance demanded by the situation

SKYSURF: Constraints on Zodiacal Light and Extragalactic Background Light through Panchromatic HST All-Sky Surface-Brightness Measurements: I. Survey Overview and Methods

We give an overview and describe the rationale, methods, and testing of the Hubble Space Telescope (HST) Archival Legacy project "SKYSURF." SKYSURF uses HST's unique capability as an absolute photometer to measure the ~0.2-1.7 $\mu$m sky surface brightness (SB) from 249,861 WFPC2, ACS, and WFC3 exposures in ~1400 independent HST fields. SKYSURF's panchromatic dataset is designed to constrain the discrete and diffuse UV to near-IR sky components: Zodiacal Light (ZL; inner Solar System), Kuiper Belt Objects (KBOs; outer Solar System), Diffuse Galactic Light (DGL), and the discrete plus diffuse Extragalactic Background Light (EBL). We outline SKYSURF's methods to: (1) measure sky-SB levels between its detected objects; (2) measure the integrated discrete EBL, most of which comes from AB$\simeq$17-22 mag galaxies; and (3) estimate how much diffuse light may exist in addition to the extrapolated discrete galaxy counts. Simulations of HST WFC3/IR images with known sky-values and gradients, realistic cosmic ray (CR) distributions, and star plus galaxy counts were processed with nine different algorithms to measure the "Lowest Estimated Sky-SB" (LES) in each image between the discrete objects. The best algorithms recover the inserted LES values within 0.2% when there are no image gradients, and within 0.2-0.4% when there are 5-10% gradients. SKYSURF requires non-standard re-processing of these HST images that includes restoring the lowest sky-level from each visit into each drizzled image. We provide a proof of concept of our methods from the WFC3/IR F125W images, where any residual diffuse light that HST sees in excess of the Kelsall et al. (1998) Zodiacal model prediction does not depend on the total object flux that each image contains. This enables us to present our first SKYSURF results on diffuse light in Carleton et al. (2022).Comment: Accepted to AJ; see accompanying paper Carleton et al. 2022: arXiv:2205.06347. Comments welcome

Axis I and II disorders as long-term predictors of mental distress: a six-year prospective follow-up of substance-dependent patients

<p>Abstract</p> <p>Background</p> <p>A high prevalence of lifetime psychiatric disorders among help-seeking substance abusers has been clearly established. However, the long-term course of psychiatric disorders and mental distress among help-seeking substance abusers is still unclear. The aim of this research was to examine the course of mental distress using a six-year follow-up study of treatment-seeking substance-dependent patients, and to explore whether lifetime Axis I and II disorders measured at admission predict the level of mental distress at follow-up, when age, sex, and substance-use variables measured both at baseline and at follow-up are controlled for. </p> <p>Methods</p> <p>A consecutive sample of substance dependent in- and outpatients (n = 287) from two counties of Norway were assessed at baseline (T1) with the Composite International Diagnostic Interview (Axis I), Millon's Clinical Multiaxial Inventory (Axis II), and the Hopkins Symptom Checklist (HSCL-25 (mental distress)). At follow-up (T2), 48% (137/287 subjects, 29% women) were assessed with the HSCL-25, the Alcohol Use Disorders Identification Test, and the Drug Use Disorders Identification Test. </p> <p>Results</p> <p>The stability of mental distress is a main finding and the level of mental distress remained high after six years, but was significantly lower among abstainers at T2, especially among female abstainers. Both the number of and specific lifetime Axis I disorders (social anxiety disorder, generalized anxiety disorder, and somatization disorder), the number of and specific Axis II disorders (anxious and impulsive personality disorders), and the severity of substance-use disorder at the index admission were all independent predictors of a high level of mental distress at follow-up, even when we controlled for age, sex, and substance use at follow-up.</p> <p>Conclusion</p> <p>These results underscore the importance of diagnosing and treating both substance-use disorder and non-substance-use disorder Axis I and Axis II disorders in the same programme.</p

Internet-based cognitive behavior therapy for obsessive compulsive disorder: A pilot study

<p>Abstract</p> <p>Background</p> <p>Cognitive behavior therapy (CBT) is widely regarded as an effective treatment for obsessive compulsive disorder (OCD), but access to CBT therapists is limited. Internet-based CBT (ICBT) with therapist support is a way to increase access to CBT but has not been developed or tested for OCD. The aim of this study was to evaluate ICBT for OCD.</p> <p>Method</p> <p>An open trial where patients (N = 23) received a 15-week ICBT program with therapist support consisting of psychoeducation, cognitive restructuring and exposure with response prevention. The primary outcome was the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), which was assessed by a psychiatrist before and immediately after treatment. Secondary outcomes were self-rated measures of OCD symptoms, depressive symptoms, general functioning, anxiety and quality of life. All assessments were made at baseline and post-treatment.</p> <p>Results</p> <p>All participants completed the primary outcome measure at all assessment points. There were reductions in OCD symptoms with a large within-group effect size (Cohen's <it>d </it>= 1.56). At post-treatment, 61% of participants had a clinically significant improvement and 43% no longer fulfilled the diagnostic criteria of OCD. The treatment also resulted in statistically significant improvements in self-rated OCD symptoms, general functioning and depression.</p> <p>Conclusions</p> <p>ICBT with therapist support reduces OCD symptoms, depressive symptoms and improves general functioning. Randomized trials are needed to confirm the effectiveness of this new treatment format.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01348529">NCT01348529</a></p

What does a transdiagnostic approach have to offer the treatment of anxiety disorders?

Purpose: The purpose of this paper is to review the rationale for 'transdiagnostic' approaches to the understanding and treatment of anxiety disorders. Methods: Databases searches and examination of the reference lists of relevant studies were used to identify papers of relevance. Results: There is increasing recognition that diagnosis-specific interventions for single anxiety-disorders are of less value than might appear since a large proportion of patients have more than one co-existing anxiety disorder and the treatment of one anxiety disorder does not necessarily lead to the resolution of others. As transdiagnostic approaches have the potential to address multiple co-existing anxiety disorders they are potentially more clinically relevant than single anxiety disorder interventions. They may also have advantages in ease of dissemination and in treating anxiety disorder not otherwise specified. Conclusions: The merits of the various transdiagnostic cognitive-behavioral approaches that have been proposed are reviewed. Such approaches have potential benefits, particularly in striking the balance between completely idiosyncratic formulations and diagnosis-driven treatments of anxiety disorders. However, caution is needed to ensure that transdiagnostic theories and treatments benefit from progress made by research on diagnosis-specific treatments, and further empirical work is needed to identify the shared maintaining processes that need to be targeted in the treatment of anxiety disorders

The design and analysis of a complete entity-relationship interface for the Multi-Backend Database System

Interest in increasing programmer productivity has spawned new software tools . Some of these tools are statistical packages, program generators, and database management systems (DBMS). In the area of DBMS, research is ongoing to improve the efficiency of DBMS tools. One research effort to improve the efficiency of DBMS is the multi-lingual database system (MLDS). MLDS combines software and hardware technology to gain efficiency and versatility in DBMS. The MLDS design goals overcome the conventional limitation to develop a database system that supports a single data model and a corresponding model-based data language. Examples of data models are relational, hierarchical, network, and entity-relationship. Examples of corresponding model-based data languages are SQL, DL/I, CODASYL, and Daplex. These models and their data languages are supported conventionally by separate DBMS. Instead, MLDS as a single DBMS is capable of supporting multiple models and their respective database languages. In this theses we present a methodology for supporting entity-relationship database management on an attribute-based database system, since the heart of MLDS is the attribute-based system. Specifically, we provide the design specifications for transforming Daplex requests into equivalent attribute-based data language requests. During this design process, we describe the data structures, control structures, and the functions required to implement this transformation.http://archive.org/details/designanalysisof00goisMajor, United States ArmyApproved for public release; distribution is unlimited