Christopher D. Hornig

The validity of major depression with atypical features based on a community study

This article reports on evidence for the validity of major depression (MDD) with atypical features (defined as overeating and oversleeping) as a distinct subtype based on cross-sectional and 1-year prospective data from the Epidemiologic Catchment Area study. MDD with atypical features, when compared to MDD without atypical features, was associated with a younger age of onset, more psychomotor slowing, and more comorbid panic disorder, drug abuse or dependence, and somatization disorder. These differences could not be explained by differences in demographic characteristics or by symptom severity. This study, based on a community sample, found that major depression with atypical features may constitute a distinct subtype.

Anxiety sensitivity and cognitive biases for threat

Patients with panic disorder are characterized by elevated scores on the Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986 ) and by interpretive, attentional, and memory biases favoring the processing of threatening information ( McNally, 1994, pp. 123–132). Although longitudinal research indicates that elevated ASI scores predict the occurrence of spontaneous panic ( Schmidt, Lerew, & Jackson, 1997 ), it is unclear whether high anxiety sensitivity is premorbidly associated with information-processing biases that may themselves reflect cognitive risk for panic. To address this issue, we had 63 individuals who reported no history of spontaneous panic perform interpretive, attentional, and memory tasks similar to those revealing threat-related cognitive biases in panic disorder patients. Subjects completed the ASI as well as other potential predictors of cognitive bias (e.g., measures of state and trait anxiety). The results indicated that ASI scores predicted one measure of interpretive bias, but little else. Although elevated ASI scores appear to reflect cognitive risk for panic attacks, cognitive bias variables rarely correlate strongly with this risk factor.

Snake Fear and the Pictorial Emotional Stroop Paradigm

The purpose of this study was to test a novel pictorial emotional Stroop paradigm that required participants to name the colors of filtered images on a computer screen. High (n = 20) and low (n = 20) snake-fearful participants color-named filters covering images of snakes (threat), cows (neutral), bunnies (positive), and blank screens. Each image appeared as if viewed through tinted sunglasses. The results revealed that both groups took longer to name the colors of filters covering bunnies as well as snakes relative to filters covering cows. Intensely snake-fearful individuals (n = 5), however, exhibited additional interference for snake pictures beyond that evoked by bunny pictures. Thus, pictorial cues having positive as well as negative emotional valence disproportionately captured attention. This paradigm shows promise as a nonlexical, ecologically valid approach to evaluating selective processing of emotional cues.

Clinical versus nonclinical panic: A test of suffocation false alarm theory

Kleins suffocation false alarm theory of panic implies that suffocation sensations should distinguish clinical from nonclinical panic attacks better than should other symptoms. To test this theory, we conducted phenomenologic comparisons between attack patterns of patients with panic disorder and community subjects who had experienced unexpected panic. Effect size and multivariate analyses revealed that three cognitive symptoms best discriminated clinical from nonclinical panic (fears of dying, heart attack, and loss of control). These findings are consistent with cognitive theories of panic. Although lacking the discriminative power of cognitive symptoms, suffocation sensations had the largest effect size of any physiological symptom. Accordingly, suffocation sensations may be especially likely to give rise to the catastrophic thoughts that best discriminate clinical from nonclinical panic.

Uncomplicated and Comorbid Obsessive-Compulsive Disorder in an Epidemiologic Sample

This study investigates lifetime prevalence rates, demographic characteristics, childhood conduct disorder and adult antisocial features, suicide attempts, and cognitive impairment in individuals with obsessive-compulsive disorder (OCD) uncomplicated by or comorbid with any other psychiatric disorder. The data are from the NIMH Epidemiological Catchment Area (ECA) study, and the current analyses compared subjects with uncomplicated OCD (no history of any other lifetime psychiatric disorder) comorbid OCD (with any other lifetime disorder), other lifetime psychiatric disorders, and no lifetime psychiatric disorders across these variables. OCD in its uncomplicated and comorbid form had significantly higher rates of childhood conduct symptoms, adult antisocial personality disorder problems, and of suicide attempts than did no or other disorders. Comorbid OCD subjects had higher rates of mild cognitive impairment on the Mini-Mental Status Exam than did subjects with other disorders. These findings suggest that a subgroup of OCD patients may have impulsive features, including childhood conduct disorder symptoms and an increased rate of suicide attempts; wider clinical attention to these outcomes is needed.

Selective encoding of threat in panic disorder: Application of a dual priming paradigm

Patients with panic disorder and psychiatrically healthy control subjects performed a dual priming task whereby they viewed either lexical or non-lexical prime pairs before naming a target that had either threatening (e.g. collapse) or positive (e.g. cheerful) meaning. Lexical prime pairs comprised a threat word and a positive word, and non-lexical prime pairs comprised two rows of asterisks. Suggestive of a bias for encoding threat cues, panic disorder patients (under some conditions) were faster to name lexically primed threat targets than lexically primed positive targets. These data are consistent with the hypothesis that panic disorder is linked to an encoding bias for threatening relative positive information. A cognitive bias for selectively encoding threat cues may figure in the maintenance of anxiety states, such as panic disorder.

The voice of emotional memory: content-filtered speech in panic disorder, social phobia, and major depressive disorder

We asked patients with either panic disorder, social phobia, or major depressive disorder and healthy control participants to describe their most frightening experience and to describe an emotionally neutral experience. Both fear and neutral autobiographical memories were audiotaped and processed through a low-pass filter that eliminated frequencies above 400 Hz, thereby abolishing semantic content but leaving paralinguistic aspects like rate, pitch, and loudness intact, and these convey emotional cues. Raters blind to content and diagnosis rated the content-filtered speech clips on emotional dimensions. The results revealed that content-filtered fear memories received significantly higher ratings on anxious, aroused, and dominant (but not sad or negative) scales than did content-filtered neutral memories, irrespective of the diagnostic status of the speaker. Content-filtered speech appears promising as an on-line probe of emotional processing during accessing of autobiographical memories.

Cognitive bias in panic disorder : A process dissociation approach to automaticity

We applied a variant of Jacobys (1991) process dissociation procedure to parse the relative contributions of automatic and controlled processes to word-stem completion performance involving threatening, positive, and neutral material in patients with panic disorder and healthy control participants. Contrary to prediction, processing of threatening (relative to nonthreatening) information in panic disorder was not disproportionately influenced by automatic processing. We found limited evidence, however, that panic patients exhibit a baseline bias for completing stems relevant to threat relative to nonthreat stems, perhaps indicating a proneness to engage in self-generated priming of threat material.