Marianna de Abreu Costa

The multidimensional evaluation and treatment of anxiety in children and adolescents: rationale, design, methods and preliminary findings

OBJECTIVE This study aims to describe the design, methods and sample characteristics of the Multidimensional Evaluation and Treatment of Anxiety in Children and Adolescents - the PROTAIA Project. METHOD Students between 10 and 17 years old from all six schools belonging to the catchment area of the Primary Care Unit of Hospital de Clínicas de Porto Alegre were included in the project. It comprises five phases: (1) a community screening phase; (2) a psychiatric diagnostic phase; (3) a multidimensional assessment phase evaluating environmental, neuropsychological, nutritional, and biological factors; (4) a treatment phase, and (5) a translational phase. RESULTS A total of 2,457 subjects from the community were screened for anxiety disorders. From those who attended the diagnostic interview, we identified 138 individuals with at least one anxiety disorder (apart from specific phobia) and 102 individuals without any anxiety disorder. Among the anxiety cases, generalized anxiety disorder (n = 95; 68.8%), social anxiety disorder (n = 57; 41.3%) and separation anxiety disorder (n = 49; 35.5%) were the most frequent disorders. CONCLUSION The PROTAIA Project is a promising research project that can contribute to the knowledge of the relationship between anxiety disorders and anxiety-related phenotypes with several genetic and environmental risk factors.

Anxiety disorders in adolescence are associated with impaired facial expression recognition to negative valence

OBJECTIVE The aim of the present study was to test the ability of adolescents with a current anxiety diagnosis to recognize facial affective expressions, compared to those without an anxiety disorder. METHODS Forty cases and 27 controls were selected from a larger cross sectional community sample of adolescents, aged from 10 to 17 years old. Adolescents facial recognition of six human emotions (sadness, anger, disgust, happy, surprise and fear) and neutral faces was assessed through a facial labeling test using Ekmans Pictures of Facial Affect (POFA). RESULTS Adolescents with anxiety disorders had a higher mean number of errors in angry faces as compared to controls: 3.1 (SD=1.13) vs. 2.5 (SD=2.5), OR=1.72 (CI95% 1.02 to 2.89; p=0.040). However, they named neutral faces more accurately than adolescents without anxiety diagnosis: 15% of cases vs. 37.1% of controls presented at least one error in neutral faces, OR=3.46 (CI95% 1.02 to 11.7; p=0.047). No differences were found considering other human emotions or on the distribution of errors in each emotional face between the groups. CONCLUSION Our findings support an anxiety-mediated influence on the recognition of facial expressions in adolescence. These difficulty in recognizing angry faces and more accuracy in naming neutral faces may lead to misinterpretation of social clues and can explain some aspects of the impairment in social interactions in adolescents with anxiety disorders.

Somatic, but not cognitive, symptoms of anxiety predict lower levels of physical activity in panic disorder patients

BACKGROUND Anxiety disorders have gathered much attention as possible risk factors for the development of cardiovascular disease (CVD), possibly mediated by an unhealthy lifestyle (e.g. low physical activity). However, prospective studies on anxiety disorders and CVD show conflicting results. A possible explanation is that somatic symptoms of anxiety may have a more specific cardiovascular effect than cognitive symptoms across different anxiety disorders. The present study investigated the association between cognitive and somatic symptoms of anxiety and physical activity (PA) in a sample of panic disorder (PD) outpatients. METHODS One-hundred and two outpatients with a lifetime diagnosis of PD from a previously studied cohort were contacted. Patients were evaluated throughout the MINI, the Beck Anxiety Inventory (BAI) and the International Physical Activity Questionnaire (IPAQ). After performing a multivariate regression analysis, groups were divided into high and low somatic anxiety. RESULTS Patients with high somatic anxiety showed a significantly higher prevalence of low level of PA as compared to those with low somatic anxiety (62.5 versus 34.3%; χ²= 5.33; df=1; P=.021). Somatic symptoms of anxiety remained the only important predictors of low level of PA (odds ratio [OR] 2.81; 95% CI 1.00-7.90; p=.050) in the multivariate model. LIMITATIONS The main limitations of the present study are the cross-sectional design and the small sample size. CONCLUSIONS Results support specific effects of somatic symptoms of anxiety on risk for low level of PA, which might explain inconsistent results regarding CVD risk in the literature.

Association between anxiety symptoms and problematic alcohol use in adolescents.

BACKGROUND Anxiety disorders are highly prevalent, affecting approximately 10% of individuals throughout life; its onset can be detected since early childhood or adolescence. Studies in adults have shown that anxiety disorders are associated with alcohol abuse, but few studies have investigated the association between anxiety symptoms and problematic alcohol use in early ages. OBJECTIVE To evaluate if anxiety symptoms are associated with problematic alcohol use in young subjects. METHODS A total of 239 individuals aged 10-17 years were randomly selected from schools located in the catchment area of Hospital de Clínicas de Porto Alegre. The Screen for Child Anxiety-Related Emotional Disorders (SCARED) was used to evaluate the presence of anxiety symptoms, and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), to evaluate alcohol use. RESULTS One hundred twenty-seven individuals (53.1% ) reported having already used alcohol. Of these, 14 individuals showed problematic alcohol use (5.8% ). There was no association between lifetime use of alcohol and anxiety symptoms, but mean SCARED scores in individuals with problematic alcohol use was higher if compared to those without problematic use, even after adjustment for age and gender (29.9±8.5 vs. 23.7±11.8, p < 0.001). CONCLUSIONS Despite the limitation of a cross-sectional design, our study suggests that anxiety symptoms are associated with problematic alcohol use early in life.

From brain to heart: a (not so) long way to go

Anxiety disorders are among the most prevalent and disabling psychiatric conditions [1]. Recent studies have linked these disorders to cardiovascular risk factors and chronic diseases [2], possibly mediated by a range of factors, including inflammation [3]. These important associations have been extensively investigated in patients with major depression. Albeit, depression and anxiety are highly comorbid and respond to similar pharmacological treatment, it remains unclear what their shared risk factors are and to what extent the underlying inflammatory mechanisms could play a causal role. Moreover, the influence of stress in inflammatory response and in the hypothalamic–pituitary–adrenal axis functioning is associated with both depressive and anxiety disorders. The previous being said, the interplay amidst anxiety, inflammation and cardiovascular outcomes should be of interest and are discussed in the present study.

Inflammation and internalizing disorders in adolescents

ABSTRACT Serum inflammatory markers have been studied in adults with anxiety and depression, but little is known about cytokine levels in young adolescents with emotional disorders. The objective of this study is to compare serum levels of interleukin‐6 (IL‐6) and interleukin‐10 (IL‐10) between adolescents with internalizing disorders and adolescents from the same community without internalizing disorders. A total of 134 non‐medicated subjects (n = 76 with internalizing disorders) were recruited from a larger sample of 2457 individuals. Serum levels of IL‐6 and IL‐10 were quantified and psychiatric diagnosis was evaluated using structured clinical interviews. Adolescents with internalizing disorders presented significantly higher levels of IL‐6 as compared to youngsters without internalizing disorders. Differences between groups in IL‐10 levels were not statistically significant. This study points out that IL‐6 levels may be associated with internalizing disorders in youths and suggests that inflammation might be an early biomarker of emotional distress. High levels of cytokines may adversely affect general health in the long‐term, which raise broader issues in terms of public health if results are replicated. HIGHLIGHTSHigher IL‐6 levels were found in adolescents with internalizing disorders.No significant differences were found for IL‐10 levels.Inflammation might be an early biomarker of internalizing disorders.