Is anxiety sensitivity a predictor of PTSD in children and adolescents?
ABSTRACT Anxiety sensitivity (AS) is the fear of the physical symptoms of anxiety and related symptoms. Longitudinal studies support AS as a vulnerability factor for development of anxiety disorders. This study aimed to investigate AS as a vulnerability factor in the development of childhood posttraumatic stress disorder (PTSD) following traumatic experiences.
The study included 81 children 8-15 years of age who experienced the 1999 earthquake in Bolu, Turkey. The earthquake survivors were compared to a randomized group of age- and sex-matched controls 5 years after the earthquake. Both the subject and control groups were administered the Childhood Anxiety Sensitivity Index (CASI), State and Trait Anxiety Inventory for Children (STAI-C), and Child Depression Inventory (CDI), while the PTSD symptoms of the subjects were assessed using the Child Posttraumatic Stress Reaction Index (CPTS-RI).
Subjects and controls did not differ significantly in CASI, STAI-C, or CDI scores. Multiple regression analysis showed that both trait anxiety and CASI scores predicted CPTS-RI scores of the subjects; the prediction by CASI scores was over and above the effect of trait anxiety.
The results of this study support the hypothesis that AS may be a constitutional factor, which might increase the risk of PTSD following traumatic experiences.
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ABSTRACT: Psychometric studies indicate that anxiety sensitivity (AS) is a risk factor for anxiety disorders such as panic disorder (PD). To better understand the psychophysiological basis of AS and its relation to clinical anxiety, we examined whether high-AS individuals show similarly elevated reactivity to inhalations of carbon dioxide (CO2) as previously reported for PD and social phobia in this task. Healthy individuals with high and low AS were exposed to eight standardized inhalations of 20% CO2-enriched air, preceded and followed by inhalations of room air. Anxiety and dyspnea, in addition to autonomic and respiratory responses were measured every 15s. Throughout the task, high AS participants showed a respiratory pattern of faster, shallower breathing and reduced inhalation of CO2 indicative of anticipatory or contextual anxiety. In addition, they showed elevated dyspnea responses to the second set of air inhalations accompanied by elevated heart rate, which could be due to sensitization or conditioning. Respiratory abnormalities seem to be common to high AS individuals and PD patients when considering previous findings with this task. Similarly, sensitization or conditioning of anxious and dyspneic symptoms might be common to high AS and clinical anxiety. Respiratory conditionability deserves greater attention in anxiety disorder research.Psychiatry Research 03/2013; · 2.68 Impact Factor
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ABSTRACT: We aimed to investigate the efficacy of 20 Hz repetitive transcranial magnetic stimulation (rTMS) of either right or left dorsolateral prefrontal cortex (DLPFC) as compared to sham rTMS for the relief of posttraumatic stress disorder (PTSD)-associated symptoms. In this double-blind, placebo-controlled phase II trial conducted between October 2005 and July 2008, 30 patients with DSM-IV-diagnosed PTSD were randomly assigned to receive 1 of the following treatments: active 20 Hz rTMS of the right DLPFC, active 20 Hz rTMS of the left DLPFC, or sham rTMS. Treatments were administered in 10 daily sessions over 2 weeks. A blinded rater assessed severity of core PTSD symptoms, depression, and anxiety before, during, and after completion of the treatment protocol. In addition, a battery of neuropsychological tests was measured before and after treatment. Results show that both active conditions-20 Hz rTMS of left and right DLPFC-induced a significant decrease in PTSD symptoms as indexed by the PTSD Checklist and Treatment Outcome PTSD Scale; however, right rTMS induced a larger effect as compared to left rTMS. In addition, there was a significant improvement of mood after left rTMS and a significant reduction of anxiety following right rTMS. Improvements in PTSD symptoms were long lasting; effects were still significant at the 3-month follow-up. Finally, neuropsychological evaluation showed that active 20 Hz rTMS is not associated with cognitive worsening and is safe for use in patients with PTSD. These results support the notion that modulation of prefrontal cortex can alleviate the core symptoms of PTSD and suggest that high-frequency rTMS of right DLPFC might be the optimal treatment strategy.The Journal of Clinical Psychiatry 08/2010; 71(8):992-9. · 5.81 Impact Factor
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ABSTRACT: Background Stressful life events in adolescents have been found to be longitudinally associated with higher anxiety sensitivity (AS). A question that has not been addressed is whether AS in adolescence is associated with different childhood adversity exposures. Methods School attending adolescents (n=1149) completed measures of anxiety sensitivity (CASI), trait anxiety (STAI-T), childhood trauma (CTQ), depression (CES-DC), alcohol (AUDIT) and drug use (DUDIT), and resilience (CD-RISC) and coping orientation (A-COPE). Results There was no significant gender difference in childhood trauma exposure, resilience levels or coping orientation. Gender differences were evident in terms of AS, trait anxiety, depression, alcohol and drug use. Depression, trait anxiety and alcohol use mediated the relationship between the amount of childhood trauma and AS and played a role in the relationship between certain childhood trauma types and AS. Neither resilience nor coping orientation had a moderating effect on the relationship between the amount of childhood trauma and AS. Limitations Cross-sectional study, over- or under-reporting of data due to use of self-report instruments, and use of a retrospective measure of childhood trauma (CTQ) that is subject to recall bias. Conclusions Girls are at greater risk than boys for early onset anxiety disorders as girls have higher rates of AS, trait anxiety and depression despite the same rates of childhood trauma, coping orientation and resilience. Our findings, in the context of childhood trauma, underscore the influence of depression, trait anxiety and alcohol use as risk factors for the development of AS in youth.Journal of Affective Disorders. 01/2014; 168:5–12.