Background: Apathy, a complex neuropsychiatric syndrome, commonly affects patients with Alzheimer's disease. Prevalence estimates for apathy range widely and are based on cross-sectional data and/or clinic samples. This study examines the relationships between apathy and cognitive and functional declines in non-depressed community-based older adults.

Methods: Data on 1,136 community-dwelling adults aged 50 years and older from the Baltimore Epidemiologic Catchment Area (ECA) study, with 1 and 13 years of follow-up, were used. Apathy was assessed with a subscale of items from the General Health Questionnaire. Logistic regression, t-tests, χ2 and Generalized Estimating Equations were used to accomplish the study's objectives.

Results: The prevalence of apathy at Wave 1 was 23.7%. Compared to those without, individuals with apathy were on average older, more likely to be female, and have lower Mini-mental State Examination (MMSE) scores and impairments in basic and instrumental functioning at baseline. Apathy was significantly associated with cognitive decline (OR = 1.65, 95% CI = 1.06, 2.60) and declines in instrumental (OR = 4.42; 95% CI = 2.65, 7.38) and basic (OR = 2.74; 95%CI = 1.35, 5.57) function at 1-year follow-up, even after adjustment for baseline age, level of education, race, and depression at follow-up. At 13 years of follow-up, apathetic individuals were not at greater risk for cognitive decline but were twice as likely to have functional decline. Incidence of apathy at 1-year follow up and 13-year follow-up was 22.6% and 29.4%, respectively.

Conclusions: These results underline the public health importance of apathy and the need for further population-based studies in this area.

Background. This study questions the 6-month duration criterion for generalized anxiety disorder (GAD) used in DSM-III-R and DSM-IV.

Method. In adults from age 20/21 to 40/41 in the prospective Zurich Cohort Study, four groups of generalized anxiety syndromes defined by varying duration (2 weeks, 1 month, 3 months and 6 months) were compared.

Results. Applying DSM-III (1979–1999) and DSM-III-R (1986–1999) criteria, there were no significant differences between the four groups in terms of family history of anxiety, work impairment, distress, treatment rates or co-morbidity with major depressive episodes (MDEs), bipolar disorder or suicide attempts. Only social impairment related to the length of episodes. The 6-month criterion of DSM-III-R and DSM-IV GAD would preclude this diagnosis in about half of the subjects treated for generalized anxiety syndromes.

Conclusions. In this epidemiological sample, the 6-month duration criterion for GAD could not be confirmed as clinically meaningful. GAD syndromes of varying duration form a continuum with comparable clinical relevance.

Background. Little is known about the long-term outcome of personality disorder traits. The purpose of this study was to investigate, in a community-residing population, the longitudinal relationship between psychiatrist-assessed personality disorder scores and global functioning 13–18 years later.

Method. A stratified random sample of residents of east Baltimore were examined by psychiatrists in 1981 and asssessed for DSM-III personality disorders using a semi-structured instrument, the Standardized Psychiatric Examination. A total of 292 persons were re-examined by different psychiatrists during 1994–1999 using the Schedules for the Assessment of Neuropsychiatry (SCAN). After completion of the SCAN, the subjects' functional status was evaluated using the Global Assessment of Functioning (GAF). The relationships between personality dimensions and follow-up GAF scores were evaluated using linear regression models.

Results. All of the personality disorder scales measured in 1981 were inversely related to functioning 13–18 years later, with the exception of narcissistic and compulsive scales. After controlling for Axis I disorders diagnosed contemporaneously with GAF assessment, schizoid, antisocial, borderline, histrionic, and avoidant personality disorder scores significantly predicted GAF scores.

Conclusions. Most dimensions of DSM-III personality disorder traits were significantly associated with global functioning after an interval of 15 years. However, only schizoid, antisocial, borderline, histrionic, and avoidant personality disorder traits had long-term effects on functioning when Axis I disorders at follow-up were controlled. This suggests that the functional effect of the other personality disorder traits may be mediated through their relationship with Axis I disorders. Future research is needed using more specific and sensitive outcome measures.

Objective. The study was designed to determine the association between self-reported asthma and the risk, persistence and severity of panic attacks among adults in the community.

Method. Data were drawn from waves 1 and 2 of the Baltimore site of the Epidemiologic Catchment Area (ECA) Study (N=2768), which included self-report information on asthma, treatment for asthma and panic attacks in 1981 and 1982. Multiple logistic regression analyses were used to calculate odds ratios comparing the prevalence of panic attack at baseline and follow-up by asthma status at baseline. Linear regression analyses were used to examine the relationship between self-reported asthma status and the number of panic symptoms during a panic attack.

Results. Self-report asthma was associated with significantly increased likelihood of having panic attacks at baseline (1981) (12·1% v. 7·3%, P<0·05) and of having panic attacks at both baseline and follow-up (15·9% v. 7·3%, P<0·05), compared to those without asthma at baseline. Adults receiving treatment for asthma at baseline had an increased risk of incident panic attacks at follow-up (OR=2·65 (1·11, 6·34)) and at baseline and follow-up (OR=5.88 (2·21, 15.62)), though untreated asthma did not appear to increase risk of incident panic at follow-up. Similarly, the risk of panic at follow-up was not increased among those with asthma at baseline who did not report asthma at follow-up, compared with those without asthma at baseline. Treated asthma was associated with having more panic symptoms during panic attacks, compared to those without asthma (P<0·001).

Conclusion. These findings are consistent with and extend previous results suggesting that self-reported asthma is associated with an increased risk of panic attacks among adults in the general population, and that there is a consistent relation between severity and persistence of asthma and panic attacks. The lack of association between remitted asthma and panic attack may reveal a need for further research to determine whether asthma may be a causal risk factor for panic attacks, or whether a third factor (genetic or environmental) may be associated with increased risk of the co-occurrence of asthma and panic attacks. Replication of these results using alternative methodology with corroborative data on asthma and panic attacks is needed next.

Background. This study examines the effects of distress and three types of social relationships (family, friends, and confidantes) on the use of out-patient health services in an adult sample from a community survey of 3481 persons in Baltimore, Maryland.

Methods. Independent effects of predisposing (age, education, marital status, race and sex), enabling (employment, income and insurance) and need (physical health) factors are adjusted for in estimating the odds of using health care services.

Results. Illness, being female, and having insurance were positively related to use of services, while being aged was inversely related. After adjustment for the above factors, social support interacted with psychological distress to effect the use of medical care: the combination of high distress and low social support by a confidante results in a fourfold increase of medical utilization.

Conclusions. Our findings support the inclusion of psychological distress and social network variables in addition to physical health status in models attempting to explain the use of health services. Despite an inability to analyse change over time, our data suggest an understanding of the interrelationship between psychosocial factors, distress and health care use would benefit health providers and their patients.

Background. We report the prevalence, clinical characteristics, frequency of mental health treatment, demographic correlates, frequency of co-morbid psychiatric conditions, and general health ramifications of DSM-IV blood-injection-injury phobia in the general population.

Method. The Diagnostic Interview Schedule (version III-R), which included questions on blood-injection-injury phobia, was administered to 1920 subjects in the Baltimore ECA Follow-up Study.

Results. The estimated unweighted lifetime prevalence of blood-injection-injury phobia was 3·5%. The median age of onset was 5·5 years; 78% had had symptoms within the last 6 months. Subjects with blood-injection-injury phobia (cases) had higher lifetime histories of fainting and seizures than those without (non-cases). None reported seeking mental health treatment specifically for phobia. Prevalences were lower in the elderly and higher in females and persons with less education. Cases had significantly higher than expected lifetime prevalences of other psychiatric conditions, including marijuana abuse/dependence, major depression, obsessive–compulsive disorder, panic disorder, agoraphobia, social phobia and other simple phobia. Cases and non-cases did not differ with regard to usual health-care settings, regular care for specific medical conditions, numbers of out-patient visits or hospitalizations, or previous general anaesthesia or live births. However, diabetics with blood-injection-injury phobia had higher than expected rates of macrovascular complications.

Conclusion. Blood-injection-injury phobia is common, especially in females and those with less education, and it is associated with several co-morbid psychiatric conditions. No strong, broad general health ramifications of this phobia are apparent. However, diabetics with this phobia appear at particular risk for complications; this deserves further study.