Around 9–20% of bereaved individuals experience symptoms of complicated grief (CG) associated with significant distress and impairment. Increasing research has been focused on identifying the distinctive set of psychiatric symptoms that characterize this condition with respect to major depression, corroborating the need to include this syndrome in the forthcoming DSM-V as a distinctive diagnosis. Vulnerability to CG has been rooted in attachment disturbances and authors reported that symptoms of separation anxiety in childhood should be considered as predictors of CG onset in adulthood.

To date no study explored symptoms of adult separation anxiety among patients with CG with respect to healthy control subjects (HC).

To explore adult separation anxiety and mood spectrum symptoms in patients with CG with respect to HC.

53 patients with CG and 50 control subjects were recruited, Department of Psychiatry, University of Pisa. Assessments: SCID-I/P, the Inventory of Complicated Grief (ICG), the Adult Separation Anxiety Questionnaire (ASA-27), the Work and Social Adjustment Scale (WSAS), the Impact of Event Scale (IES) and the Mood Spectrum-Self Report (MOODS-SR) lifetime version.

Patients with CG reported significantly higher scores on the MOODS-SR, ASA_27, IES and WSAS with respect to controls. The scores on the ASA_27 were more strongly associated with IES scores with respect to other scales.

Our results suggest a correlation between adult separation anxiety and CG onset after the loss of a loved one in adulthood, with a possible correlation to a post-traumatic stress symptomatology. Further studies are needed.

A link between anxiety and disfunctions of the Hypotalamic-pituitary-adrenal (HPA) axis has been widely reported in both normal and pathological anxiety, but research findings are controversial.

To explore gender differences in the relationships between cortisol and neurosteroids and subthreshold anxiety dimensions.

To investigate the possible correlations between serum cortisol and dehydroepiandrosterone sulphate (DHEA-S) levels, or DHEA-S/cortisol ratio, and the subthreshold panic dimensions in a sample of healthy subjects.

Forty-two Italian civilians, without current or lifetime psychiatry disorders, were recruited and assessed by means of the Structured Clinical Interview for DSM-IV (SCID-I/P) and a specific questionnaire, the so-called Panic Agoraphobic Spectrum-Self Report lifetime version (PAS-SR), for assessing subthreshold panic-agoraphobic dimensions.

The results showed the presence of significant negative correlations between the cortisol levels and the total scores of the PAS-SR and of the following domains: separation sensitivity, panic like symptoms and medication/substance sensitivity. The PAS-SR total and the panic-like symptoms domain scores were related positively to the DHEAS/cortisol ratio. When the sample was distinguished in women and men, it turned out that this correlations were present only in women.

This findings would indicate that cortisol levels are related to subthreshold panic-agoraphobic symptoms, with a gender specificity. Therefore, further studies are needed to investigate those subthreshold conditions in order to indentify possible gender differences that may account for phenotypes at higher risk for psychiatric disorders.

A panic attack is an explosion of high anxiety. It is strongly associated with a sense of losing control or predicting that the very worst will happen. It is not a mental disorder, more than one in five people experience one or more panic attacks in their lifetime, but few go on to develop panic disorder or agoraphobia. There are different types of panic attacks: Cued Panic Attacks, Situational Predisposed Panic Attacks and Spontaneous Panic Attacks.

To discuss three case reports with one year follow-up, each one of a different type of panic attack.

1 Female, 25-years-old. First panic attack at age 20, since there several spontaneous episodes with a mean of 4 a week, not related to any specific situation, event, or place, without any warning.

2 Male, 28-years-old. Has always been afraid of airplanes but it was only 3 years ago that riding on an airplane has started to trigger panic attack. He don’t experience panic attacks in any other situation.

3 Male, 31-years-old. First episode 4 years ago while driving alone and since there driving, traveling alone, enclosed spaces and crowds are more likely to trigger a panic attack but not always. They don’t have a specific fear or phobia tied to that situation or place; they simply tend to experience panic attacks when there.

Understanding the different types of panic attacks can help you and your doctor determine the cause of your attacks and the best way to go about treating them.

Both anxiety sensitivity (AS) and negative affect (NA) are significant general predictors of anxiety disorders, including the obsessive-compulsive disorder (OCD; Taylor, 1999). Recently, our group reported preliminary findings suggesting that disgust sensitivity was able to predict OCD symptoms, particularly contamination obsessions and washing compulsions, when controlling for AS and NA (Sandín et al., 2008). The present study examines whether disgust domains of the Cuestionario de Sensibilidad al Asco (CSA) [Disgust Sensitivity Questionnaire] predict obsessive-compulsive symptoms above and beyond AS and NA.

A sample of undergraduates completed the CSA (see Valiente et al.), the Padua Inventory-Whasington State University Revision (Burns et al., 1996), the Anxiety Sensitivity Index-3 (Taylor et al., 2007; Sandín et al., 2007), and the Positive and Negative Affect Schedule (Watson et al., 1988, Sandín et al., 1999).

Hierarchic regression analysis revealed that CSA was a better predictor of contamination obsessions and washing compulsions than anxiety sensitivity and negative affect. Also, CSA domains predicted differentially each obsessive-compulsive dimension.

Contamination-based OCD symptoms appears to be particularly associated to disgust sensitivity, specially with the CSA dimension of hygiene (it includes items such as “Seeing someone spit”, Touching the clothes of a beggar or homeless”). Assuming that contamination-based OCD is a very prevalent type of OCD, future studies on implication of this dimension in its development and/or maintenance is warranted.

Graves’ disease is an autoimmune disease characterized by goitre with hyperthyroidism, Graves ophthalmopathy and pretibial myxedema The patients with Graves’ disease frequent develop a psychiatric manifestations such as mood and anxiety disorders and, cognitive dysfunction. The aims of the study is to estimate the prevalence of anxiety in patients with Graves’ disease.

66 patients with Graves’ disease (46 women and 20 men) were recruited to this study. The subjects were between 32 and 61 years. The Hamilton Anxiety Scale (HAM-A) is a used interview scale that measures the severity of a patient’s anxiety, based on 14 items, including anxious mood, tension, fears, insomnia, somatic complaints and behaviour at the interview. The HAM-A was completed prior and after the treatment. Results were compared with measurements of HAM-A in 24 subjects without Graves’ disease.

Mild anxiety was present in 24 patients with Graves’ disease (36.66%-16 women and 8 men) moderate anxiety in 13 patients (19.69% - 7 women and 6 men) and severe anxiety in 3 patients (4.54%- 2 women and 1 men) prior to treatment of hyperthyroidism. After treatment of hyperthyroidism 12 patients presented mild anxiety, 6 moderate anxiety and 3 severe anxiety. The prevalence of mild anxiety was present in 2 subjects(8.33%-2 women) without Graves’ disease.

A significant proportion of patients with Graves’ disease shows an altered mental state after treatment of hyperthyroidism. When psychiatric disorders persists after restoration of euthyroidism specific treatment for the psychiatric symptoms may be needed.

We assessed heart rate variability in 19 patients with panic disorder before and after 6-weeks treatment with antidepressants combined with CBT and 18 healthy controls. They were regularly assessed on the CGI, BAI and BDI. Heart rate variability was assessed during 5 min standing, 5 min supine and 5 min standing positions before and after the treatment. Power spectra were computed using a fast Fourier transformation for very low frequency - VLF (0.0033 - 0.04 Hz), low-frequency - LF (0.04-0.15 Hz) and high frequency - HF (0.15-0.40 Hz) powers.

19 panic disorder patients entered a 6-week open-label treatment study with combination of SSRI and cognitive behavioral therapy. A combination of CBT and pharmacotherapy proved to be the effective treatment of patients. They significantly improved in all rating scales. There were highly statistical significant differences between panic patients and control group in all components of power spectral analysis in 2nd and in two component of 3rd (LF and HF in standing) positions. There was also statistically significant difference between these two groups in LF/HF ratio in supine position (2nd). During therapy there was tendency to increasing values in all three positions in components of HRV power spectra, but there was only statistically significant increasing in HF1 component.

Supported by project IGA MZ ČR NS 10301-3/2009

Small size of convenience sample undergoing varying treatments within a single specialist tertiary referral centre. Early recognition and treatment of SAD, may ameliorate the occurrence of depression. Follow up studies are needed to investigate the risk factors that may lead to depression in SAD.

Some authors suggest that Anorexia Nervosa (AN) could be considered as part of the Obsessive Compulsive Spectrum. Obsessive-compulsive disorder (OCD) might be best characterized in terms of failures in cognitive and behavioral inhibitory functions. Impairments in intentionally inhibiting simple motor actions (Response Inhibition) have been demonstrated in these patients but no studies were conducted in AN patients.

The aim of this study was to evaluate Response Inhibition (RI) in patients with Obsessive Compulsive Disorder (OCD), patients with Anorexia Nervosa (AN) and Healthy Controls (HC).

29 HC, 17 patients with OCD and 15 patients with AN were recruited. Stop Signal Task (SST) selected from Cambridge Neuropsychological Test Automated Battery (CANTAB) was administered to all participants. SST is based on the Logan's theory and it gives an index of Response Inhibition, called Stop Signal Reaction Time (SSRT).

A significant difference in SSRT between HC and the clinical groups was found. No differences in SSRT and number of “Direction Errors” were found between OCD and AN groups. No gender influence on the SST performance was found.OCD group showed slower reaction times to the main task than AN and HC.

Results from neuropsychological assessment have shown a deficit in the Response Inhibition in OCD and AN patients, in line with our hypothesis. Findings supports evidences in literature about OCD patients, but it represents a pioneer result in the contest of AN patients.

Some authors suggested that Anorexia Nervosa (AN) could be part of Obsessive-Compulsive Spectrum. Evidences suggested that Obsessive-Compulsive Disorder (OCD) could be characterized by an impaired neuropsychological profile, referring particularly to cognitive flexibility, decision making and planning. It's possible that these deficits could represent possible endophenotypes that characterizes OCD spectrum.

The aim of this study was compared, cognitive flexibility, decision making and planning in 38 patients with OCD, in 21 patients with AN and in their first degree unaffected relatives (OCD relatives: 46; AN relatives: 21). Results have been also compared to a sample of 41 healthy controls (HC) and their unaffected first degree relatives (43).

All participants have been assessed by a neuropsychological battery composed by the Iowa Gambling Task (IGT), the Wisconsin Sorting Card Test (WISC) and the Hanoi Tower (TH).

Results showed an impaired cognitive flexibility only in OCD patients and their relatives. Patients with AN and their relatives didn’t seem to be characterized by a deficit in this area. Results obtained from the TH scores showed an impaired planning ability both in OCD and AN patients. The same deficit has been also observed in OCD relatives. Impaired decision making seemed to characterize both AN and OCD patients, compared HC. Moreover, OCD and AN relatives showed a deficit performance, suggesting an impairment in this function.

Results regarding planning and decision making seem to be in line with the hypothesis that this two domains could represent possible endophenotypes of obsessive compulsive spectrum.

In the past decades different evidences suggested a relationship between Panic Disorder (PD) and respiration, among which the presence of different respiratory irregularities at rest in PD patients. It has been hypothesized that PD could be characterized by a dysfunction of those areas involved in the central control of respiration. The aim of this study was to unravel possible differences in the respiratory patterns at rest between PD patients and healthy controls (HC). Moreover we investigate possible mechanisms linking smoking to respiration.

Respiratory physiology has been assessed in 32 PD patients with Agoraphobia and 24 HC, for 15 consecutive minutes. Mean and standard deviation of respiratory rate (RR), tidal volume (TV), minute ventilation (VE), and end-tidal CO2 (pCO2) have been assessed.

No significant difference between the two groups in all physiological indexes has been found. A significant diagnosis-by-smoking interaction has been found for RR and VT mean value (p < 0,05), that were significantly higher in non-smokers PD patients compared to non-smokers HC.

Results seem to suggest the existence of a peculiar equilibrium condition in PD patients. Respiratory system in PD responds to nicotine assumption differently from that of the HC. These data seem to be consistent with the hypothesis of a central homeostatic dysfunction in PD.

Further studies are needed, that take in account age of onset of smoking and number of cigarettes smoked daily. Moreover investigation on the Homeostatic Brain’ functioning should need a more integrated consideration of the cardiac, respiratory and balance systems together.

Various neurocognitive deficits have been identified across several domains in Obsessive-Compulsive Disorder (OCD), including memory, response inhibition attentional processing and cognitive flexibility.

The aim of this study was to evaluate Set Shifting in patients with Obsessive-Compulsive Disorder compared with Healthy Controls (HC).

44 OCD patients, according to DSM-IV criteria (APA, 1994) and 32 healthy controls (HC) were recruited. Information Sampling Task (IST) selected from Cambridge Neuropsychological Test Automated Battery (CANTAB) was administered to all participants to assess cognitive flexibility. The two IST versions were counterbalanced in the samples. Delta index has been calculated as the difference between the number of the boxes opened in the fixed condition and the number of boxes opened in the decrease condition.

Group differences in Delta IST were assessed within an analysis of covariance (ANCOVA) model including Groups (control vs. OCD) as between-subject factor and age as a covariate. Results show a no significant main effect for group on IST Delta index (p = 0.26). A significant effect of the covariates (age) on Delta IST(p = 0.027) was found.

Results suggests that cognitive flexibility, assessed by Information Sampling Task, was not impaired in OCD patients. Future research should evaluate this evidence, taking in account for OCD clinical subtypes.

Acute involuntary hospitalization is perceived as a threatening event for most of patients. Acute involuntary hospitalization of psychiatric patients is probably a major source of anxiety and may be related to anxiety disorders. Further knowledge on the anxiety disorders secondary to involuntary hospitalization may limit traumatic experience and is, indeed, of considerable importance.

Bibliographic review of the existing literature was conducted using MEDLINE/PubMed (1969-2010). The following key words were used “involuntary hospitalization”; “coercion”; “patient admission”; “stress disorder” “anxiety” and “posttraumatic stress disorder”. All papers in English and French were considered in this review.

Although the impact of diverse stressful or traumatic events has been the subject of numerous publications, we found only one study in the literature dealing with PTSD symptoms related to acute involuntary hospitalization. In this article involuntarily admitted patients were not more traumatized than voluntarily admitted ones. Although coercive measures can be traumatizing, but forced medication, seclusion, or application of any coercive measure were not significantly associated with traumatizing. Reviews on involuntary hospital admission’ demonstrated negative and positive consequences on various outcome domains. Findings highlight the predominantly negative impact of physical restraint on the person restrained and their family. These findings support minimal use of restraint in health care to a relatively vulnerable group of people. But coercion can also lead to positive outcomes.

Specific studies concerning the impact of involuntary hospitalization, coercitive measures and forced treatment causing anxiety disorders are still needed. Discussion about its methodology and ethical aspects remains necessary.

The aim of our study was the correlation of regional brain activity with intensity of psychopathology and the correlation of treatment effect of CBT in patients suffering from panic disorder.

Five patients suffering from panic disorder and five healthy controls were studied in fMRI during the exposition of threat-related words compared with neutral words and emotional faces compared with fixation points. Inpatients were treated with CBT (Cognitive Behavioral Therapy) and existing pharmacotherapy for 6 weeks. Patients were studied in fMRI scanner before and after the treatment. Psychopathology was assessed using Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI), The Clinical Global Impression rating scales (CGI), Panic Disorder Severity Scale (PDSS), Dissociative Experiences Scale (DES). Data were analyzed using software for functional magnetic analysis (AFNI) and compared with psychopathology rating scales.

Hyperactivity of cerebellum in patient treated with CBT compared with healthy controls was observed after activation by anxiety words and faces. The scores of psychopathology rating scales decreased in patient treated with CBT and correlates with decrease of hyperactivity in cerebellum.

Changes of brain activity in fMRI after the CBT treatment were observed in patient suffering from panic disorder. Threat-related words and emotional faces showed cerebellum hyperactivity in patients compared with healthy controls. Decrease of cerebellum hyperactivity was observed after treatment with CBT, compared with healthy controls. Predictor of therapeutic response in fMRI was not find. Cerebellum play an important role in panic disorder.

Supported with project IGA NS 10301-3/2009

The ways of coping with problems and emotions are particularly important in anxiety disorders. It is also likely that subjective functional styles help identify the mode of presentation of these disorders, regardless of diagnosis psychopathology.

Clinical and functional investigation of outpatients attending a third-level Anxiety Disorders Unit.

To identify the most employed coping strategies and investigate whether different coping styles are linked to specific expressions of psychopathology by means of a cross-correlation analysis between dimensional measures of coping and characteristics of psychopathology.

We administered a set of instruments including SCL-90-R and Brief-COPE to 172 patients; categorical diagnoses according to DSM-IV-TR were as follows: GAD 80 (46.5%), 33 PD (19.2%), other miscellaneous 59 (34.3%). The statistical analyses of correlation between COPE and SCL scores were performed by means of Spearman's Rho.

The most represented (mean score >5) coping strategies include: active coping, planning, self-blame, instrumental support, emotional support, self-distraction, acceptance, venting. Venting, denial, behavioural disengagement, and use of emotional support, show positive correlations (p ≤ 0.04) with anxiety, phobic anxiety and GSI; self-blame with anxiety and GSI. Conversely, humour correlates (p ≤ 0.04) negatively with anxiety and GSI.

Correlations between high scores of GSI and specific coping strategies suggest possible mechanisms of interaction between functioning styles and expressions of psychopathology. The interpretation of these findings requires further investigation of interactive mechanisms, taking into account phases of activity or remission of the clinical syndrome.

There is a limitation of data about factors associated with treatment response in panic disorder (PD) patients at long-term follow-up period. The aim of this study was to evaluate the long-term treatment response of pharmacotherapy-resistant patients with PD after 5 years of cognitive-behavior group therapy (CBGT) and to identify factors that predict this outcome.

Sixty-four patients who completed 12 sessions of CBGT were followed for 5-year. Outcome measures were evaluated by the Clinical Global Impression (CGI) and quality of life (QoL) using WHOQOL-bref. Demographic and clinical features, stressful life events were the variables investigated as predictors of CBGT response across follow-up period.

Treatment was associated with significant reduction in symptoms severity (agoraphobia, anticipatory anxiety and panic attacks) with maintenance of gains at 5-year of follow-up (p < 0.05). Twenty-four (40%) of the sample remained in remission after 5 years, 12 (20%) relapsed during the follow-up period and 24 (40%) were non-responder to CBGT. The poor CBGT response had an important negative impact in QoL. Regression analyzes showed that comorbidity with dysthymia (p = 0.017) and stressful life events (p = 0.012) as the most important predictors to worse response.

The improvement in all evaluations suggested that brief CBGT for pharmacotherapy-resistant patients could be an alternative as next-step strategy for residual symptoms with maintenance of the gains after 5 years as assessed across follow-up period. New strategies should be tried for resistant patients, such as those with dysthymia comorbidity, and some specific tool in order to cope with adverse events.

Alzheimer disease (AD) is one of the most common neurodegenerative disorders (prevalence boosts from 0.2% in patients aged 55-65 up to 27% in patients aged 85+ years. Clinical manifestations of psychiatric disorders accompanying hypo- and hyper-thyroid function can mimic cognitive impairment.

Our study aimed at studying the relationship between thyroid pathology, anxiety disorder and Alzheimer disease (AD).

Our longitudinal, prospective research followed 49 patients with thyroid disorders (aged 50-85 years, 93.5 females); 63.3% (n = 31) had coexisting dementia and thyroid disease while 36.7% (n = 18) were dementia-cleared (10 had mild cognitive impairment (MCI) and 8 - anxiety and/or depression); we cross/analyzed control (n = 18) and target (n = 31) groups.

In the target group, 64.5% (n = 20) had hypothyroidism, 22.6% (n = 7) had euthyroid function and 12.9% (n = 4) had hyperthyroidism. The prevalence of anxiety and depression was higher in the hypothyroidism + dementia group (55.5%, n = 11) than in the hypothyroidism-only group (44.4%, n = 8). Most controls (77.8%, n = 14) had hypothyroidism while 22% (n = 4) had normal thyroid function.

Anxiety disorder had a greater prevalence both in the group with dementia + thyroid disease and in the MCI group. Hypothyroidism was the dominant thyroid disorder in both groups. The early diagnostic and treatment of thyroid disease is expected to improve prognosis and evolution of future cognitive disorders (MCI & AD).

In this study, we aimed to elucidate the demographic and psychological characteristics of maladaptive soldiers in the Republic of Korea Army.

Study participants were 110 male conscripts who participated in the Green camp, a kind of group psychotherapy for maladaptive soldiers. All the participants were interviewed and diagnosed by a psychiatrist, and classified into two groups according to whether they left or rejoin the army. We analyzed the difference between these two groups in terms of demographic features, psychiatric diagnosis, and the Minnesota Multiphasic Personality Inventory (MMPI) subscores.

Compared with soldiers who rejoined their units, those who left military service exhibited significantly lower educational level (p = 0.041) and higher rate in psychiatric treatment prior to enlistment (p = 0.011). Among the 106 study subjects, 63 (59.4%) and 23(21.7%) were diagnosed as personality disorder and adjustment disorder, respectively. Soldiers who left military service were diagnosed more frequently as mood disorder (p = 0.001) and schizophrenia (p = 0.014), respectively, than those who rejoined their units. The MMPI scores of soldiers who left military service were significantly higher on the psychasthenia (p = 0.028) and schizophrenia (p = 0.039) scales than those of soldiers who rejoined their units.

Most of the maladaptive soldiers were diagnosed as mental disorder. The results of this study suggest that systematic, consistent psychiatric evaluation and intervention for maladaptive male conscripts is crucial in the army.