Alyssa Epstein

Panic disorder: a review of DSM-IV panic disorder and proposals for DSM-V†

This review covers the literature since the publication of DSM‐IV on the diagnostic criteria for panic attacks (PAs) and panic disorder (PD). Specific recommendations are made based on the evidence available. In particular, slight changes are proposed for the wording of the diagnostic criteria for PAs to ease the differentiation between panic and surrounding anxiety; simplification and clarification of the operationalization of types of PAs (expected vs. unexpected) is proposed; and consideration is given to the value of PAs as a specifier for all DSM diagnoses and to the cultural validity of certain symptom profiles. In addition, slight changes are proposed for the wording of the diagnostic criteria to increase clarity and parsimony of the criteria. Finally, based on the available evidence, no changes are proposed with regard to the developmental expression of PAs or PD. This review presents a number of options and preliminary recommendations to be considered for DSM‐V. Depression and Anxiety, 2010.

A Longitudinal Examination of Stress Generation in Depressive and Anxiety Disorders

The current study compared two competing theories of the stress generation model of depression (stress causation vs. stress continuation) using interview-based measures of episodic life stress, as well as interpersonal and noninterpersonal chronic life stress. We also expanded on past research by examining anxiety disorders as well as depressive disorders. In addition, we examined the role of neuroticism and extraversion in these relationships. Participants were 627 adolescents enrolled in a two-site, longitudinal study of risk factors for depressive and anxiety disorders. Baseline and follow-up assessments were approximately one year apart. Results supported the stress causation theory for episodic stress generation for anxiety disorders, with neuroticism partially accounting for this relationship. The stress causation theory was also supported for depression, but only for more moderate to severe stressors; neuroticism partially accounted for this relationship as well. Finally, we found evidence for interpersonal and noninterpersonal chronic life stress continuation in both depressive and anxiety disorders. The present findings have implications regarding the specificity of the stress generation model to depressive disorders, as well as variables involved in the stress generation process.

Naltrexone attenuates acute cigarette smoking behavior

This within-subjects, placebo-controlled laboratory study was designed to examine the effects of naltrexone on cigarette response in 44 chronic smokers (23 male, 21 female). Each participant received either 50-mg oral naltrexone or identical placebo during the morning of the session after maintaining overnight abstinence. Subsequently, the participant was administered a smoking cue (holding lit cigarette) to examine craving and associated features of smoking, and instructed to smoke a cigarette 1 h later. This was followed by a smoking interval in which participants could choose to smoke up to four more cigarettes over a 2-h period. Subjective measures (withdrawal, craving, affect, and side effects) and smoking behavior were assessed throughout the session. Naltrexone significantly reduced the total number of choice cigarettes smoked and expired carbon monoxide levels (Ps<.05). Naltrexone significantly increased total side effects, especially for sedation (P<.01). Further, naltrexone significantly increased overall negative affect, and decreased positive affect 1 h after smoking the first cigarette (Ps<.05). However, naltrexone did not affect acute withdrawal or smoking urges. Despite mixed findings, women reported more overall naltrexone-induced withdrawal (P<.05) and side effects (P<.08) compared to men. Although the exact mechanism is unknown, the findings support an opioid antagonist attenuation of smoking behavior.

Elevated Responding to Safe Conditions as a Specific Risk Factor for Anxiety Versus Depressive Disorders: Evidence From a Longitudinal Investigation

The current study evaluated the degree to which startle reflexes (SRs) in safe conditions versus danger conditions were predictive of the onset of anxiety disorders. Specificity of these effects to anxiety disorders was evaluated in comparison to unipolar depressive disorders and with consideration of level of neuroticism. A startle paradigm was administered at baseline to 132 nondisordered adolescents as part of a longitudinal study examining risk factors for emotional disorders. Participants underwent a repetition of eight safe-danger sequences and were told that delivery of an aversive stimulus leading to a muscle contraction of the arm would occur only in the late part of danger conditions. One aversive stimulus occurred midway in the safe-danger sequences. Participants were assessed for the onset of anxiety and unipolar depressive disorders annually over the next 3 to 4 years. Larger SR magnitude during safe conditions following delivery of the aversive stimulus predicted the subsequent first onset of anxiety disorders. Moreover, prediction of the onset of anxiety disorders remained significant above and beyond the effects of comorbid unipolar depression, neuroticism, and subjective ratings of intensity of the aversive stimulus. In sum, elevated responding to safe conditions following an aversive stimulus appears to be a specific, prospective risk factor for the first onset of anxiety disorders.

Testing a hierarchical model of anxiety and depression in adolescents: A tri-level model

The present study examined the structural relationships among anxiety and depressive symptoms in a sample of high school juniors. The best-fitting structural representation was a tri-level hierarchical arrangement with a broad general factor (general distress), two factors of intermediate breadth (anxious-misery and fears), and five conceptually meaningful, narrow group factors. In accord with the integrative hierarchical model of anxiety and depression, the results supported a structure with a symptom factor central to major depression, and other symptom factors specific to particular anxiety disorders. These group factors displayed significant, unique associations with clinician severity ratings (CSRs) for their respective DSM diagnoses. The hierarchical arrangement demonstrated temporal invariance over a one-year period and configural and partial metric invariance in females and males. Implications for DSM classification and arrangement of anxiety and depressive disorders are discussed as is how present findings help bridge existing research conducted at symptom and diagnostic levels.

Subtypes of panic attacks: a critical review of the empirical literature

Background: Panic disorder is a heterogeneous disorder, comprising a variety of somatic, physiological, and cognitive symptoms during repeated panic attacks. As a result, considerable data have examined whether panic attacks may be classified into distinct diagnostic or functional subtypes. The aim of this study is to evaluate the existing literature regarding the validity of panic attack subtypes. Methods: This review focuses on data published since 2000, with the publication of DSM‐IV‐TR, augmented by replicated data published since 1980, with the publication of DSM‐III and subsequently DSM‐IV. Published reports evaluating empirical evidence for the validity of panic attack subtypes are reviewed. Results: Five sets of panic symptoms (respiratory, nocturnal, nonfearful, cognitive, and vestibular) have been shown to cluster together at varying degrees of consistency. However, none of these potential subtypes have been associated with sufficient and reliable external validation criteria indicative of functional differences. This apparent lack of findings may be related to methodological inconsistencies or limitations across the reviewed studies. Conclusions: Although at present the data do not warrant the utility of subtyping, further research aimed at patent gaps in the literature, including clearer operationalization of symptom subtypes, greater use of biological challenge paradigms and physiological and other more objective measures of fear and anxiety, and exploration of subtyping based on biological factors such as genetics, may support the future designation of panic attack subtypes and their ultimate clinical utility. Depression and Anxiety, 2009.

The Impact of Depressive Symptoms on the Efficacy of Naltrexone in Smoking Cessation

Abstract In the current double-blind study, we examined the impact of depressive symptoms on the efficacy of naltrexone as an adjunct to smoking cessation treatment. Participants were 110 adult nicotine dependent smokers interested in quitting smoking. All subjects received behavioral counseling and nicotine patches. Subjects were randomly assigned to the naltrexone or placebo group. Naltrexone was administered daily starting three days prior to the quit date (25 mg daily) and continued for 8 weeks thereafter (50 mg daily). Smoking cessation status was assessed at the end of treatment and at 24 week follow-up. The efficacy of naltrexone was moderated by depressive symptoms such that naltrexone was related to better quit rates than placebo at higher levels of depressive symptoms. These findings suggest that individual differences in depressive symptoms may be important determinants of clinical response to naltrexone, and may help to clarify discrepancies in prior studies of naltrexone and smoking cessation.

EXPERIENCING CORE SYMPTOMS OF ANXIETY AND UNIPOLAR MOOD DISORDERS IN LATE ADOLESCENCE PREDICTS DISORDER ONSET IN EARLY ADULTHOOD

Identification of youth at risk for anxiety and unipolar mood disorders (UMDs) can improve public health by targeting those who may warrant early or preventive intervention. This study examined whether endorsing core features of anxiety and UMDs predicted onset of later anxiety and UMDs across the next 7–9 years, and whether having subthreshold or subclinical manifestations of these disorders similarly predicted onset.

Sex Differences in the Relationship Between Alcohol- Associated Smoking Urge and Behavior: A Pilot Study

This study examined sex differences in alcohol-associated smoking urge and smoking patterns to elucidate factors contributing to the co-use of alcohol and cigarettes. Participants were 39 (22M, 17F) binge-drinking tobacco chippers. Although men and women showed similar alcohol-smoking patterns and similar alcohol-induced smoking urges, a positive association between these factors was observed only in men. The lack of relationship in women suggests that co-use of these substances may be due to exteroceptive factors beyond the pharmacological effects of alcohol potentiating smoking urge.

The Relationship Between Anxiety Sensitivity and Latent Symptoms of Emotional Problems: A Structural Equation Modeling Approach

A large body of research suggests that common and specific psychopathology dimensions underlie the symptoms that occur within mood and anxiety disorders. As of yet, it is unclear precisely how the facets of Anxiety Sensitivity (AS), or fear of the symptoms of fear and anxiety, relate to these latent factors. Using data from 606 adolescents participating in the baseline phase of a longitudinal study on risk factors for emotional disorders, we modeled the facets of AS as measured by the Anxiety Sensitivity Index-Expanded Form (ASI-X) and related these facets to a hierarchical model of latent symptoms of psychological distress. Results suggest that one facet of AS is associated with a broad General Distress factor underlying symptoms of most emotional disorders while others relate to intermediate-level and conceptually-meaningful narrow factors representing aspects of psychological distress specific to particular emotional disorders.