Longitudinal trajectories of depression and anxiety in a prospective community study: the Zurich Cohort Study.
ABSTRACT The dearth of long-term follow-up studies of community-based samples and differences in methodology in existing studies highlight the need for research designed to examine the stability, comorbidity, and diagnostic thresholds of depression and anxiety in the community.
Prospective study of a community-based cohort aged 19 and 20 years from the canton of Zurich, Switzerland. Semistructured diagnostic interviews were administered by clinically experienced interviewers at 5 assessment points during a 15-year period. The format of the interview permitted assessment of major mental disorders at both the diagnostic and subthreshold levels.
Comorbid anxiety and depression tended to be far more persistent than either syndrome alone. Individuals with anxiety states alone tended to develop either depression alone or comorbid anxiety and depression as they progressed through adulthood. In contrast, depression alone and depression comorbid with anxiety tended to be more stable than anxiety alone over time. The patterns of stability were similar for subthreshold- and threshold-level disorders.
These findings have important implications for classification and treatment of affective disorders. The greater stability of comorbid anxiety and depression than either disorder alone illustrates the importance of further investigation of comorbid states compared with noncomorbid states in etiologic and treatment research. The persistence of subthreshold-level depression and anxiety from early to mid adulthood also suggests the importance of characterizing the continuum of expression of depression and anxiety rather than adhering to strict diagnostic thresholds.
SourceAvailable from: Katie A Mclaughlin[Show abstract] [Hide abstract]
ABSTRACT: Adolescence is a period of heightened vulnerability for the onset of internalizing psychopathology. Characterizing developmental patterns of symptom stability, progression, and co-occurrence is important in order to identify adolescents most at risk for persistent problems. We use latent growth curve modeling to characterize developmental trajectories of depressive symptoms and four classes of anxiety symptoms (GAD, physical symptoms, separation anxiety, and social anxiety) across early adolescence, prospective associations of depression and anxiety trajectories with one another, and variation in trajectories by gender. A diverse sample of early adolescents (N = 1 065) was assessed at three time points across a one-year period. All classes of anxiety symptoms declined across the study period and depressive symptoms remained stable. In between-individual analysis, adolescents with high levels of depressive symptoms experienced less decline over time in symptoms of physical, social, and separation anxiety. Consistent associations were observed between depression and anxiety symptom trajectories within-individuals over time, such that adolescents who experienced a higher level of a specific symptom type than would be expected given their overall symptom trajectory were more likely to experience a later deflection from their average trajectory in other symptoms. Within-individual deflections in GAD, physical, and social symptoms predicted later deflections in depressive symptoms, and deflections in depressive symptoms predicted later deflections in GAD and separation anxiety symptoms. Females had higher levels of symptoms than males, but no evidence was found for variation in symptom trajectories or their associations with one another by gender or by age.Journal of Abnormal Child Psychology 02/2015; 43(2). DOI:10.1007/s10802-014-9898-1 · 3.09 Impact Factor
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ABSTRACT: This review summarizes studies on neurobiological effects of psychotherapy or neurobiological predictors of treatment response in anxiety disorders and obsessive-compulsive disorders (OCD). In anxiety disorders, psychotherapy reduced activation in amygdala and prefrontal cortex, which were hyperactive compared to healthy participants. Psychotherapy thus normalized brain activity. In OCD psychotherapy rather influenced orbitofrontal cortex and anterior cingulate as well as in striatal regions, also corresponding to normalization. The here reviewed studies indicated no new, compensatory mechanisms after psychotherapy. The main mechanisms were a normalization of hyper(re)active circuits focusing on the amygdala in anxiety disorders and focusing on orbitofronto-striatal loops in OCD. This reflects the differential neurobiological models underlying these diagnostic groups. These findings could be a basis for future treatments using neurofeedback-supported training as augmentation of psychotherapy in anxiety disorders and OCD. [In dieser Übersicht werden Studien zusammengefasst, die neurobiologische Effekte der Psychotherapie oder neurobiologische Prädiktoren der Therapieresponse bei Angststörungen und Zwangsstörungen untersucht haben. Die Haupteffekte therapeutischer Interventionen bestanden in einer Aktivitäts-Normalisierung von zuvor meist überaktiven Hirnregionen. Bei den Angststörungen reduzierte bzw. normalisierte Psychotherapie die zunächst erhöhte Aktivität in der Amygdala sowie in präfrontalen Regionen. Bei der Zwangsstörung reduzierte bzw. normalisierte Psychotherapie eher die Aktivität im orbitofrontalen Cortex und anterioren Cingulum sowie in den Basalganglien (Striatum). Zusammenfassend scheint ein neurobiologischer Effekt von Psychotherapie bei Angst- und Zwangsstörungen darin zu bestehen, dass sich die im Vergleich zu Gesunden gesteigerte Aktivität spezifischer Netzwerke normalisiert. Es gibt hingegen keine deutlichen Hinweise auf kompensatorische Mechanismen. Dabei zeigen sich Unterschiede zwischen den Angststörungen (Fokus Amygdala) und der Zwangsstörung (Fokus orbitofrontal/striatal). Zukünftig könnten solche Befunde auch eine Basis für Neurofeedback-Training als Ergänzung zur Psychotherapie sein.]Zeitschrift für Psychiatrie Psychologie und Psychotherapie 04/2015; 63(2):109-116. DOI:10.1024/1661-4747/a000229 · 1.99 Impact Factor
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ABSTRACT: Opioid maintenance therapy is a well-established first-line treatment approach in opioid dependence. Buprenorphine, a partial opioid agonist, has been found by numerous studies to be an effective and safe medication in the treatment of opioid dependence. At present, buprenorphine is available as a monodrug or in a fixed 4:1 ratio combination with naloxone. A diminished risk of diversion and abuse for the buprenorphine-naloxone combination is likely but not firmly established. Conventional formulations are given sublingually to avoid the hepatic first-pass effect. A novel film tablet is available only in the US and Australia. Other novel, sustained-release formulations (implant, depot) are currently being developed and tested. Recent studies, including a Cochrane meta-analysis, suggest that the retention with buprenorphine is lower than for methadone, but that buprenorphine may be associated with less drug use. Higher doses of buprenorphine are associated with better retention rates. Buprenorphine has a ceiling effect at the opioid receptor with regard to respiratory depression, and may cause fewer fatal intoxications than methadone. Possible antidepressant effects of buprenorphine and its use in comorbid psychiatric patients has not been studied in much detail. Clinical implications are discussed.01/2015; 6:1-14. DOI:10.2147/SAR.S45585