W. Simpson

Adult attention deficit hyperactivity disorder in an anxiety disorders population.

Adult Attention Deficit Hyperactivity Disorder (ADHD) is a life‐long, chronic disorder, which has its onset in childhood and is associated with significant functional impairment. ADHD appears to be highly comorbid with other psychiatric disorders, however, literature is lacking concerning ADHD/anxiety comorbidity. To that end, we examined the prevalence of ADHD in an anxiety disorder sample. Consecutive patients referred to an anxiety disorders clinic completed a variety of anxiety disorder self‐report measures as well as the Adult ADHD self‐report scale and were clinically assessed using the Structured Clinical Interview for DSM‐IV, and the ADHD module of the Mini International Neuropsychiatric Interview. Of the 129 patients assessed, the rate of adult ADHD was 27.9%. The mean age of the sample was 33.1 ± 12.5 years, and the mean baseline CGI‐S was 4.6 ± 1.1 (moderate to marked severity). The majority of the sample was female (63.6%) and single (49.5%). The most common comorbid disorders associated with ADHD were major depressive disorder (53.8%), social phobia (38.5%), generalized anxiety disorder (23.1%), and impulse control disorders (30.8%). Individuals with ADHD had higher symptom severity scores for obsessive‐compulsive disorder, (P≤ 0.05) and for GAD (P≤ 0.05) and reported a significantly earlier age of onset for depression as compared to those without (P≤ 0.05). The prevalence of adult ADHD was higher in our anxiety disorders clinic sample than found in the general population. Clinical implications of these findings are discussed.

Potential use of Internet-based screening for anxiety disorders: a pilot study.

Background: The Internet is a widely used resource for obtaining health information. Internet users are able to obtain anonymous information on diagnoses and treatment, seek confirmatory information, and are able to self‐diagnose. We posted a self‐report diagnostic screening questionnaire for DSM‐IV anxiety and mood disorders (MACSCREEN) on our clinic website. Method: Three hundred and two individuals completed the MACSREEN. For those who qualified for a DSM‐IV disorder, self‐report symptom severity measures were completed for the specified disorder: Quick Inventory of Depressive Symptomatology, self‐report, Social Phobia Inventory, GAD‐7, Davidson Trauma Scale, Panic and Agoraphobia Scale, and Yale/Brown Obsessive Compulsive Scale, self‐report. Cutoff scores for each self‐report measure were used to evaluate clinically significant symptom severity. Respondents were also asked to complete a series of questions regarding their use of the Internet for health information. Results: The mean age of the MACSCREEN sample was 35.2 years (±13.9), where the majority (67.2%) were female. The most frequently diagnosed conditions were social phobia (51.0%), major depressive disorder (32.4%), and generalized anxiety disorder (25.5%). Sixty‐five percent of the sample met criteria for at least one disorder. Most respondents reported completing the MACSCREEN, as they were concerned they had an anxiety problem (62.3%). The majority of respondents reported seeking health information concerning specific symptoms they were experiencing (54.6%) and were planning to use the information to seek further assessment (60.3%). Conclusion: Individuals with clinically significant disorder appear to be using the Internet to self‐diagnose and seek additional information. Depression and Anxiety, 2010.  © 2010 Wiley‐Liss, Inc.

Trichotillomania in youth: a retrospective case series.

Background: The purpose of this study was to investigate the outcome of the naturalistic treatment of youth with Trichotillomania (TTM) in an anxiety disorders clinic sample. Methods: A retrospective chart review was conducted on 11 treated patients between the ages of 6 and 17, with DSM‐IV TTM. Results: Ten patients were initially treated with a serotonin reuptake inhibitor (SRI), whereas one patient was initially treated with an antipsychotic. Three of the 10 patients who started with an SRI had a response (Clinical Global Impression‐Improvement Scale (CGI‐I)≥2) in TTM symptoms. Nine patients of the 11 patients were treated with an antipsychotic medication (in 8 patients the antipsychotic was added after an initial trial with an SRI, in 1 patient the antipsychotic was the first line agent), 2 patients remained on an SRI; 8/9 were responders to antipsychotic treatment and 2 patients remitted (complete cessation of hair pulling). Adverse events to the SRI or antipsychotic were experienced by 7/11 patients but did not lead to treatment discontinuation. Conclusions: This retrospective case series suggests that youth with TTM maybe responsive to pharmacological interventions with SRIs and/or antipsychotic agents, although the response seemed to be more robust with antipsychotics. These preliminary findings will need to be replicated in a larger scale controlled design. Depression and Anxiety, 2009.

INTERNET ADDICTION OR PSYCHOPATHOLOGY IN DISGUISE? RESULTS FROM A SURVEY OF COLLEGE-AGED INTERNET USERS

Purpose Internet addiction, is a term describing pathological, compulsive internet use and has an estimated prevalence of 6% among the general population and higher in students[1]. Extreme internet use may have significant public health importance as it has been attributed to several cardio-pulmonary deaths and at least one murder. While the pathological use of alcohol or drugs has been historically accepted as an addiction, questions remain concerning whether extreme internet use should be conceptualized as an addiction. The Internet Addiction Test (IAT) was developed in 1998, prior to the wide-spread use of Smartphone and other mobile devices, to detect internet addiction [2]. It is unclear whether this instrument is capable of capturing problematic modern internet use. The purpose of this study was to examine the construct of “internet addiction” in a sample of college aged internet users. Method A survey was administered to first year undergraduate students at McMaster University and posted to our centre website www.macanxiety.com . Following acknowledgment of a disclosure statement, participants completed several self-report scales detailing internet usage, symptoms of depression and anxiety, impulsiveness and executive functioning. Measures included: a short demographics questionnaire as well as a survey containing the IAT, sections from the Mini International Neuropsychiatric Interview for OCD, GAD, SAD, the Barkley Adult ADHD Rating Scale, the Barratt Impulsiveness Scale, the Depression, Anxiety and Stress Scale (DASS-21), the Barkley Deficits in Executive Functioning Scale (BDEFS) and the Sheehan Disability Scale (SDS). Individuals were also asked to complete the Dimensions of Problematic Internet Use (DPIU); a scale based on DSM-5 addiction criteria. Once the survey was complete, respondents were informed of their score and interpretation on the IAT. Results Two hundred and fifty-four participants completed all assessments. They had a mean age of 18.5±1.6 years and 74.5% were female. In total 12.5% (n = 33) met screening criteria for internet addition according to the IAT, while 107 (42%) met addiction criteria according to the DPIU. The most frequently reported dimensions of internet use where respondents had difficulty controlling their use were: video streaming services (55.8%), social networking (47.9%) and instant messaging tools (28.5%). Those screening positive on the IAT and on the DPIU had significantly higher levels of functional impairment (p  Conclusion A high proportion of the sample met criteria for internet addiction. Participants meeting criteria for internet addiction had greater levels of psychopathology and functional impairment. With the exception of instant messaging tools, none of the dimensions of internet use differed between individuals who did and did not meet internet addiction criteria on the IAT. This study highlights that problematic internet use may be more widespread than once thought. Further studies are needed to understand the relationship between problematic internet use and psychopathology.