Professor - University Medical Line, Psychiatry and Behavioral Sciences
Residency Training Director, Psychiatry (2010 - Present)
Chief of the Division of Adult Psychiatry, Psychiatry (2006 - 2022)
Associate Chair, Psychiatry (2011 - Present)
Honors & Awards
Teacher of the Year, Department of Psychiatry, Stanford University School of Medicine (1994)
Faculty Scholars Award, William T. Grant (1995)
Selected as Educators for C.A.R.E. Program Faculty Member, Stanford University School of Medicine (2008)
Leadership in Education Award, Stanford University School of Medicine (2008)
Leadership in Education Award, Stanford University School of Medicine (2009)
Golden Apple Award for Professor of the Year, Stanford University/Palo Alto University Consortium (2010)
Residency: Stanford University Adult Psychiatry Residency (1986) CA
Fellowship: Stanford University Psychiatry and Behavioral Sciences (1988) CA
Medical Education: University of California at San Francisco School of Medicine (1984) CA
Board Certification: American Board of Psychiatry and Neurology, Psychiatry (1993)
MPH, Univ of California Berkeley, Epidemiology (1982)
BS, University of San Francisco (1977)
Current Research and Scholarly Interests
Dr. Haywards research has focused on the emergence of internalizing disorders during adolescence. His interests are in epidemiology of adolescent psychopathology in school-based studies and the role of puberty in determining onset of internalizing disorders in young adolescent girls in particular. He studies risk factors for the onset of adolescent panic disorder and social anxiety disorder. Dr. Hayward is also active in medical education and in 2008 was selected as one of the "Educators-for-Care" physicians in the Medical School. Dr. Hayward has also been the recipient of the teacher of the year award by graduating residents.
Attentional Biases for Threat in At-Risk Daughters and Mothers With Lifetime Panic Disorder
JOURNAL OF ABNORMAL PSYCHOLOGY
2012; 121 (4): 852-862
Children of parents with panic disorder (PD) have high risk for developing anxiety disorders. However, the mechanisms involved in transmission of risk are uncertain. Cognitive models of anxiety propose that information-processing biases underlie anxiety vulnerability; in particular, attentional biases for threat. Consequently, this study examined attentional biases in mothers with lifetime PD and their daughters (aged 9-14 years). Sixty mother-daughter dyads (n = 120) were recruited to the study; half the mothers had lifetime PD (i.e., either a current or past history of PD), and half had no psychiatric history. Attentional biases were assessed using a visual-probe task with pictorial and word stimuli related to physical-health threat. Stimulus duration was varied to examine the time-course of attentional biases (initial orienting and maintained attention). Results showed an attentional bias for threat in daughters of mothers with lifetime PD, compared with daughters of mothers with no PD history. Specifically, at-risk daughters had an attentional bias for physical-health threat cues (words and pictures) at the longer stimulus duration of 1250 ms (but not at 500 ms). In addition, attentional bias for threat in girls was associated with increased physical-health threat worries. Mothers with lifetime PD did not significantly differ from mothers with no PD history on the indices of attentional bias. The findings are discussed in terms of an attentional threat-monitoring strategy in at-risk girls and argue against the view that there is simple transmission of an anxiety-related attentional processing style across generations.
View details for DOI 10.1037/a0028052
View details for Web of Science ID 000311527700006
View details for PubMedID 22612199
Does Gender Moderate the Relationship Between Childhood Maltreatment and Adult Depression?
2011; 16 (3): 175-183
Although considerable evidence demonstrates that adults who report childhood maltreatment are at increased risk of depression in adulthood, little is known about whether gender moderates risk. In a sample of 5,673 adult Health Maintenance Organization (HMO) patients, the authors employed the Patient Health Questionnaire-8 (PHQ-8) to assess major depressive disorder (MDD) and the Childhood Trauma Questionnaire (CTQ) to assess five different types of childhood maltreatment: emotional, physical, and sexual abuse, as well as emotional and physical neglect. Logistic regression models tested the main and interactive effects of gender and childhood maltreatment. Consistent with previous studies, men and women with histories of each type of childhood adversity were significantly more likely to meet criteria for MDD. However, the authors found no evidence that gender moderates the risk of depression. These findings suggest that men and women reporting history of childhood maltreatment are equally likely to suffer major depression in adulthood.
View details for DOI 10.1177/1077559511412067
View details for PubMedID 21727161
Life stress and first onset of psychiatric disorders in daughters of depressed mothers
JOURNAL OF PSYCHIATRIC RESEARCH
2011; 45 (7): 855-862
This study used a comprehensive, interview-based measure of life stress to assess the role of different types of stress in predicting first onset of psychiatric disorders among daughters of depressed (n = 22) mothers and healthy (n = 22) mothers. Several types of stress were assessed: Chronic interpersonal stress, chronic non-interpersonal stress, episodic dependent (i.e., self-generated) interpersonal stress, episodic dependent non-interpersonal stress, episodic independent interpersonal stress, and episodic independent non-interpersonal stress. Daughters (ages 9-14) were recruited to have no clinically significant symptoms upon entry (T1). By a 30-month follow-up assessment (T2), 45% of the daughters of depressed mothers, but none of the daughters of healthy mothers, had developed a psychiatric disorder. Overall, daughters of depressed mothers were exposed to more severe chronic interpersonal and non-interpersonal stress than were daughters of healthy mothers. Further, daughters of depressed mothers who developed a psychiatric disorder by T2 were exposed to more severe chronic non-interpersonal stress and episodic dependent stress than were daughters of depressed mothers who remained healthy. We discuss the implications of these findings in the context of a stress-generation model for the intergenerational transmission of psychiatric risk among children of depressed mothers.
View details for DOI 10.1016/j.jpsychires.2011.03.016
View details for Web of Science ID 000292667900001
View details for PubMedID 21524424
View details for PubMedCentralID PMC3115484
Catastrophizing, depression and pain-related disability
GENERAL HOSPITAL PSYCHIATRY
2011; 33 (2): 150-156
The objective of the study was to examine catastrophizing, depression and their interactive effects in predicting disability in patients with chronic pain.A battery of questionnaires was mailed to primary care patients in a large integrated health care delivery system. The Patient Health Questionnaire was used to assess major depression, the Coping Strategies Questionnaire assessed catastrophizing and the Graded Chronic Pain Scale was used to assess pain intensity and two measures of disability, including self-report of pain interference and days missed from usual activities. Patient medical records were used to assess severe medical illness. Of the 5808 respondents, 2618 met criteria for chronic pain. Multiple regression analyses, covarying for age, gender, severe medical illness and pain intensity, estimated the main and interactive effects of catastrophic thinking and depression on two measures of pain-related disability.Both catastrophic thinking and depression were statistically significant predictors of both measures of pain-related disability, with larger effect sizes observed for catastrophic thinking.Routine assessment of both catastrophic thinking and depression is important in the treatment of chronic pain patients, and modification of these factors may reduce disability and increase the ability of chronic pain patients to participate in daily life activity.
View details for DOI 10.1016/j.genhosppsych.2010.12.008
View details for PubMedID 21596208
- Life stress and first onset of psychiatric disorders in daughters of depressed mothers Journal of Psychiatric Research 2011; 45: 855-862
- Catastrophizing Depression and Pain-Related Disability. General Hospital Psychiatry 2011; 33 (2): 150-156
Failure to improve cigarette smoking abstinence with transdermal selegiline plus cognitive behavior therapy
2010; 105 (9): 1660-1668
To examine the effectiveness of transdermal selegiline for producing cigarette smoking abstinence.Adult smokers were randomly assigned to receive selegiline transdermal system (STS) or placebo given for 8 weeks. All participants received cognitive behavior therapy (CBT). Follow-ups were conducted at 25 and 52 weeks.Community smoking cessation clinic.243 adult smokers (> or =18 years of age; > or =10 cigarettes/day).Expired-air carbon monoxide confirmed 7-day point prevalence abstinence.STS was not superior to placebo. More women than men were abstinent at 52 week follow-up (28% vs 16%, P < 0.05). Behavioral activation (BAS) moderated treatment response (P = 0.01). The survival rate through week 52 for those with high 'drive' scores on the BAS was 47% if assigned to selegiline and 34% if assigned to placebo. The survival rate for those with low 'drive scores' on the BAS was 35% if assigned to selegiline compared to 53% if assigned to placebo.Transdermal selegiline does not appear generally effective in aiding smoking cessation though there may be a selective effect in those smokers with low 'behavioral activation'.
View details for DOI 10.1111/j.1360-0443.2010.03020.x
View details for Web of Science ID 000280668200027
View details for PubMedID 20707784
- Failure to Improve Cigarette Smoking Abstinence With Transdermal Selegiline + Cognitive Behavioral Therapy. Addiction 2010; 105: 1660-1668
- The Interactive Effects of Puberty and Peer Victimization on Weight Concerns and Depression Symptoms Among Early Adolescent Girls JOURNAL OF EARLY ADOLESCENCE 2009; 29 (3): 357-375
Relationships Among Depression, Chronic Pain, Chronic Disabling Pain, and Medical Costs
2009; 60 (3): 344-350
Although evidence suggests that patients with depression use more medical services than those without depression, few studies have examined whether specific subgroups of patients with depression have higher utilization than others. The study compared costs for general medical care with and without psychiatric care for patients with major depression and disabling chronic pain (reference group) with costs for five other groups: those with depression and nondisabling chronic pain, those with major depressive disorder alone, those with no depression who had disabling chronic pain, those with depression who had chronic pain that was not disabling, and those who had neither pain nor depression. Costs for the group with major depressive disorder alone were compared to costs for the three groups without depression.A questionnaire assessing major depressive disorder, chronic pain, and pain-related disability was mailed to a random sample of Kaiser Permanente patients who visited a primary care clinic. A total of 5,808 patients responded (54% participation rate). Costs for a two-year period were obtained from Kaiser Permanente's Cost Management Information System. Analyses were adjusted for presence of any of four major chronic medical illnesses.Total costs for patients in the reference group were significantly higher than costs for the other five subgroups. Regression analyses indicated that continuous measures of severity of pain and severity of depression were associated with increased costs, but no statistically significant interaction of depression and pain on total cost was observed.Patients with major depressive disorder and comorbid disabling chronic pain had higher medical service costs than other groups of patients with and without depression. However, findings suggest that the increases in cost from having both pain and depression are additive and not multiplicative.
View details for Web of Science ID 000263723600010
View details for PubMedID 19252047
A critical review of the empirical literature on the relation between anxiety and puberty
CLINICAL PSYCHOLOGY REVIEW
2009; 29 (1): 1-23
The current paper critically reviews the empirical literature focused on the association between puberty and anxiety. A detailed review of more than 45 empirical articles is provided. There is some evidence that among girls, but not boys, a more advanced pubertal status (controlling for age) is associated with higher reported anxiety symptoms. Also among girls, earlier pubertal timing is linked to higher anxiety scores. It is unclear whether early puberty may lead to increased anxiety or if high anxiety influences pubertal timing. With respect to hormones, there were relatively few significant associations for girls, although this literature is very small. Among boys, several studies reported positive associations between both gonadal and adrenal hormones and anxiety. The direction of effect for these finding is also unstudied. The primary limitation of the hormone-anxiety literature pertains to the absence of pubertal measures in samples of youth in which hormones are measured. The paper concludes with a comprehensive examination of the methodological strengths and weaknesses of the literature and recommendations for future work.
View details for DOI 10.1016/j.cpr.2008.09.005
View details for Web of Science ID 000262821300001
View details for PubMedID 19019513
View details for PubMedCentralID PMC2652567
- The Interactive Effects of Puberty and Social Victimization on Weight Concerns and Depression Symptoms Among Early Adolescent Girls The Journal of early Adolescence 2009; 29 (3): 357-375
- A Critical Review of the Empirical Literature on the Relationship between Anxiety and Puberty. Clinical Psychology Review 2009; 29: 1-23
- Relationships Among Depression, Chronic Pain, Disability and Medical Costs Psychiatric Services 2009; 60 (3): 344-350
Gender, victimization, and psychiatric outcomes
2008; 38 (10): 1377-1391
Although gender differences in rates of internalizing disorders, particularly depression, are well documented, the causes of these differences are not well understood. One influential hypothesis [Cutler & Nolen-Hoeksema, Sex Roles (1991), 24, 425-438] proposes that higher rates of depression in females compared to males may be partially attributable to gender differences in the effects of childhood sexual abuse. The present study has evaluated this possibility by reviewing evidence for gender moderating the effects of childhood victimization on psychiatric outcomes.Literature search using PsycINFO and Medline, applying the following inclusion criteria: publication from 1996 to 2006, community-based sampling, adequate male-to-female sample ratio, use of clearly defined psychiatric outcomes, and a statistical test of gender differences in the effects of childhood victimization on psychiatric outcomes.Thirty studies met inclusion criteria. Overall, the results were mixed. Nearly half of all studies find no gender differences. In studies that do observe gender differences, victimization tends to be associated with higher psychiatric risk in females in studies with adult samples, whereas in samples of youth, victimization tends to be associated with higher psychiatric risk in males. With respect to outcome, when gender differences were observed, outcomes were distributed across both internalizing and externalizing categories for both genders.The gender differences in prevalence rates of internalizing disorders, such as depression, do not appear to be attributable to differential effects of childhood victimization.
View details for DOI 10.1017/S0033291708003000
View details for Web of Science ID 000259654300001
View details for PubMedID 18387212
Extended cognitive behavior therapy for cigarette smoking cessation
2008; 103 (8): 1381-1390
PRIMARY AIM: Examine the effectiveness of extended cognitive behavior therapy (CBT) in promoting longer-term smoking abstinence.Open-label treatment phase followed by extended treatment phase. Randomization conducted prior to entry into open-label treatment phase; analysis based on intention-to-treat to avoid threat of selection bias.Community smoking cessation clinic.A total of 304 adult smokers (> or = 18 years of age; > or = 10 cigarettes/day).Open-label (8 weeks): all participants received bupropion SR, nicotine patch, CBT. Extended treatment (12 weeks): participants received either CBT + voicemail monitoring and telephone counseling or telephone-based general support.Seven-day point prevalence abstinence, expired-air carbon monoxide.At week 20 follow-up, CBT produced a higher 7-day point prevalence abstinence rate: 45% versus 29%, P = 0.006; at 52 weeks the difference in abstinence rates (31% versus 27%) was not significant. History of depression was a moderator of treatment. Those with a positive history had a better treatment response at 20 weeks when assigned to the less intensive telephone support therapy (P < 0.05).The superiority of CBT to 20 weeks suggests that continued emphasis on the development of cognitive and behavioral strategies for maintaining non-smoking during an extended treatment phase may help smokers to maintain abstinence in the longer term. At present, the minimum duration of therapy is unknown.
View details for DOI 10.1111/j.1360-0443.2008.02273.x
View details for Web of Science ID 000257692800021
View details for PubMedID 18855829
- Extended Cognitive Behavior Therapy for Cigarette Smoking Cessation Addiction 2008; 103: 1381-1390
The developmental psychopathology of social anxiety in adolescents
DEPRESSION AND ANXIETY
2008; 25 (3): 200-206
To evaluate a developmental psychopathology approach for understanding adolescent social anxiety, parent-reported predictors of social anxiety were examined in a nonclinical sample of adolescents. Structured diagnostic interviews were obtained from biological parents of 770 participants. Potential risk factors assessed included child characteristics: negative affect, shyness, separation anxiety disorder, and childhood chronic illness, as well as parent characteristics: major depression, panic disorder, and agoraphobia. Adolescent social anxiety was measured multiple times during high school. Findings indicate stability in social anxiety symptoms across time. Parent-reported, childhood negative affect, shyness, and chronic illness as well as parental panic disorder or agoraphobia were associated with adolescent social anxiety. Interactions were observed between parent-reported childhood shyness and gender and between parent-reported childhood shyness and parent-reported childhood chronic illness in the prediction of social anxiety. Parent-reported childhood shyness was a stronger predictor of adolescent social anxiety in females compared to males. The combined effect of subjects being positive for both parent-reported childhood shyness and parent-reported childhood chronic illness was greater than would be expected based on additive effects. This study provides support for a multifactorial and developmentally informed understanding of adolescent social anxiety.
View details for DOI 10.1002/da.20289
View details for Web of Science ID 000254588400004
View details for PubMedID 17348001
- Gender, victimization, and psychiatric outcomes Psychological Medicine 2008: 1-15
The reliability of self reported menarcheal timing
JOURNAL OF EARLY ADOLESCENCE
2007; 27 (3): 386-398
View details for Web of Science ID 000248051100006
Puberty and gender interact to predict social anxiety symptoms in early adolescence
JOURNAL OF ADOLESCENT HEALTH
2007; 41 (1): 102-104
This study examines direct and interactive effects of puberty and gender on social anxiety symptoms in early adolescence. One hundred-six participants were assessed at ages 9.5 and 11 years. Results suggest that gender and puberty interact to predict social anxiety symptoms. Advanced puberty was associated with increased symptoms for girls only.
View details for DOI 10.1016/j.jadohealth.2007.02.013
View details for Web of Science ID 000247616200015
View details for PubMedID 17577541
View details for PubMedCentralID PMC2710300
Anxiety sensitivity - A missing piece to the agoraphobia-without-panic puzzle
2007; 31 (2): 162-173
This article reviews the controversy surrounding the diagnosis of agoraphobia without panic attacks and proposes a key role for anxiety sensitivity in explaining agoraphobic avoidance among those who have never experienced panic. Although rare in clinical samples, agoraphobia without panic is commonly observed in population-based surveys, including more recent studies in which misclassification bias is addressed. Differential treatment seeking may partially explain these discrepant findings; however, it remains unclear why agoraphobic avoidance develops in the absence of panic. Because anxiety sensitivity is a dispositional analogue of panic, it is proposed that high anxiety sensitivity is a risk factor for agoraphobic avoidance in the absence of frank panic attacks. Preliminary evidence to support this contention is reviewed.
View details for DOI 10.1177/0145445506297015
View details for Web of Science ID 000244179200003
View details for PubMedID 17307933
- Anxiety Sensitivity: The Missing Piece to the Agoraphobia-Without-Panic Puzzle. Behavior Modification 2007; 31 (2): 162-173
- Puberty and Gender Interact to Predict Social Anxiety in Early Adolescence. Journal of Adolescent Health 2007; 41 (1): 102-104
- The Reliability of Self-reported Menarcheal Timing. Journal of Early Adolescence 2007; 27: 386-398
Lifetime prevalence and pseudocomorbidity in psychiatric research
ARCHIVES OF GENERAL PSYCHIATRY
2006; 63 (6): 604-608
Comorbidity is the rule rather than the exception with psychiatric disorders and is consequently of great interest to both researchers and clinicians. However, many studies of psychiatric comorbidity have been based on lifetime prevalence with mixed-age samples, a practice that (1) biases the assessment of epidemiologic comorbidity and (2) creates the appearance of comorbidity even when disorders are randomly associated. This bias is what we refer to as pseudocomorbidity.To clarify the source of the problem and to discuss strategies that might be adopted to deal hereafter with lifetime prevalence data.A simulated example is presented to show that even when there is only random association between disorders, there will appear to be nonrandom comorbidity when lifetime prevalence is used with mixed-age samples. An actual example relating psychosis to phobia is presented to show the bias that can result and to illustrate one way of dealing with lifetime prevalence data.Use of lifetime prevalence with mixed-age samples, used almost exclusively in psychiatric research, generates problematic results, especially when used for assessment of comorbidity, and should be viewed with some skepticism. Hereafter, we recommend that any future use of lifetime prevalence should require determination of the age of onset, even if only by retrospective report. Comorbidity then should be reported by age.
View details for Web of Science ID 000238050200002
View details for PubMedID 16754833
Extended treatment with bupropion SR for cigarette smoking cessation
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
2006; 74 (2): 286-294
The authors present results of a randomized clinical trial of the efficacy of extended treatment with bupropion SR in producing longer term cigarette smoking cessation. Adult smokers (N = 362) received open-label treatment (11 weeks) that combined relapse prevention training, bupropion SR, and nicotine patch followed by extended treatment (14 weeks) with bupropion SR or matching placebo. Abstinence percentages were relatively high (week 11: 52%; week 25: bupropion, 42%; placebo, 38%; week 52: bupropion, 33%; placebo, 34%), but bupropion SR did not surpass placebo. Gender and baseline craving level were identified as significant, independent moderators of treatment response. Men were more likely to abstain than women (week 11: 59% vs. 43%, p = .001; week 25: 48% vs. 31%, p = .001; week 52: 39% vs. 27%, p = .01). Because most smokers suffer relapse with any current cessation treatment, the comparatively high abstinence percentages achieved in this trial are of interest.
View details for DOI 10.1037/0022-006X.74.2.286
View details for Web of Science ID 000237667500009
View details for PubMedID 16649873
Comorbid depression, chronic pain, and disability in primary care
2006; 68 (2): 262-268
The objectives of this study were to provide estimates of the prevalence and strength of association between major depression and chronic pain in a primary care population and to examine the clinical burden associated with the two conditions, singly and together.A random sample of Kaiser Permanente patients who visited a primary care clinic was mailed a questionnaire assessing major depressive disorder (MDD), chronic pain, pain-related disability, somatic symptom severity, panic disorder, other anxiety, probable alcohol abuse, and health-related quality of life (HRQL). Instruments included the Patient Health Questionnaire, SF-8, and Graded Chronic Pain Questionnaire. A total of 5808 patients responded (54% of those eligible to participate).Among those with MDD, a significantly higher proportion reported chronic (i.e., nondisabling or disabling) pain than those without MDD (66% versus 43%, respectively). Disabling chronic pain was present in 41% of those with MDD versus 10% of those without MDD. Respondents with comorbid depression and disabling chronic pain had significantly poorer HRQL, greater somatic symptom severity, and higher prevalence of panic disorder than other respondents. The prevalence of probable alcohol abuse/dependence was significantly higher among persons with MDD compared with individuals without MDD regardless of pain or disability level. Compared with participants without MDD, the prevalence of other anxiety among those with MDD was more than sixfold greater regardless of pain or disability level.Chronic pain is common among those with MDD. Comorbid MDD and disabling chronic pain are associated with greater clinical burden than MDD alone.
View details for DOI 10.1097/01.psy.0000204851.15499.fc
View details for Web of Science ID 000236591400013
View details for PubMedID 16554392
- Lifetime Prevalence and Pseudocomorbidity in Psychiatric Research. Archives of General Psychiatry 2006: 604-608
- Unique Contributions of Anxiety Sensitivity to Avoidance: A Prospective Study in Adolescents Behaviour Research and Therapy 2006; 44 (4): 601-609
- Comorbid Depression, Chronic Pain and Disability in Primary Care. Psychometric Medicine 2006: 262-268
- A Prospective Evaluation of Agoraphobia andDepression Symptoms Following Panic Attacks in a Community Sample ofAdolescents. Journal of Anxiety Disorders 2005; 19 (1): 87-103
Parent-reported predictors of adolescent panic attacks
JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY
2004; 43 (5): 613-620
To identify parent-reported risk factors for adolescent panic attacks.Structured diagnostic interviews were obtained from 770 parents of participants in a school-based risk factor study for adolescent panic. Parent-reported risk factors assessed included characteristics of the child (negative affect, separation anxiety disorder [SAD], childhood chronic illness, and childhood loss) as well as characteristics of the parent (parental panic disorder or agoraphobia [PDA], parental major depression, and parental chronic illness).Bivariate predictors of adolescent panic attacks included parent history of PDA, parent history of chronic illness, child negative affect, and child SAD. Using signal detection methods, three subgroups of participants at risk for panic attacks were identified. Fifty-eight percent of adolescents with panic attacks belonged to one of these high-risk groups. Adolescents with a positive parental history of PDA were at highest risk: 24% of this group experienced panic attacks. Among those without a positive parental history of PDA, those with high childhood negative affect or history of SAD were at increased risk for panic attacks (14% and 20%, respectively).The use of parent-reported data provides cross-validation for previously identified risk factors of adolescent panic attacks. Signal detection results suggest there are multiple paths (equifinality) to the development of adolescent panic attacks.
View details for Web of Science ID 000221014800015
View details for PubMedID 15100568
Gender-stereotyped imagined dates and weight concerns in sixth-grade girls
2004; 50 (7-8): 515-523
View details for Web of Science ID 000220712100007
- Parent-Reported Risk Factors for Panic Attacks Journal of the American Academy of Child and Adolescent Psychiatry 2004; 43 (5): 613-620
Coming to terms with risk factors for eating disorders: Application of risk terminology and suggestions for a general taxonomy
2004; 130 (1): 19-65
The aims of the present review are to apply a recent risk factor approach (H. C. Kraemer et al., 1997) to putative risk factors for eating disorders, to order these along a timeline, and to deduce general taxonomic questions. Putative risk factors were classified according to risk factor type, outcome (anorexia nervosa, bulimia nervosa, binge-eating disorder, full vs. partial syndromes), and additional factor characteristics (specificity, potency, need for replication). Few of the putative risk factors were reported to precede the onset of the disorder. Many factors were general risk factors; only few differentiated between the 3 eating disorder syndromes. Common risk factors from longitudinal and cross-sectional studies were gender, ethnicity, early childhood eating and gastrointestinal problems, elevated weight and shape concerns, negative self-evaluation, sexual abuse and other adverse experiences, and general psychiatric morbidity. Suggestions are made for the conceptualization of future risk factor studies.
View details for DOI 10.1037/0033-2909.130.1.19
View details for Web of Science ID 000187852600002
View details for PubMedID 14717649
The relationship between agoraphobia symptoms and panic disorder in a non-clinical sample of adolescents
2003; 33 (4): 733-738
The purpose of this study was to evaluate the clinical correlates of agoraphobic fear and avoidance and panic disorder in a non-clinical sample of adolescents.In a sample of 2365 high school students, combined data from a questionnaire and a structured clinical interview were used to classify subjects with agoraphobic fear and avoidance. Panic symptoms, major depression, childhood separation anxiety disorder, anxiety sensitivity and negative affectivity were also assessed.Fifteen subjects met study criteria for agoraphobic fear and avoidance in the past year. Only three (20%) of those with agoraphobia symptoms reported histories of panic attacks and there was no overlap between those with agoraphobic fear and avoidance and the 12 subjects who met DSM-III-R criteria for panic disorder. However, subjects with agoraphobia symptoms and those with panic disorder reported similar levels of anxiety sensitivity and negative affectivity. Childhood separation anxiety disorder was more common among those with agoraphobic fear and avoidance compared to those without.Agoraphobic avoidance is rare in non-clinical samples of adolescents and usually not associated with panic attacks. However, adolescents with agoraphobia symptoms and those with panic disorder have similar clinical correlates consistent with a panic/agoraphobia spectrum model.
View details for DOI 10.1017/S0033291702006955
View details for Web of Science ID 000183495600017
View details for PubMedID 12785475
A longitudinal investigation of anxiety sensitivity in adolescence
JOURNAL OF ABNORMAL PSYCHOLOGY
2002; 111 (3): 471-477
This investigation sought to expand existing knowledge of anxiety sensitivity in a sample of high school students (N = 2,365) assessed over 4 years. The stability of anxiety sensitivity levels across assessment periods was examined, and cluster analyses were used to identify different developmental pathways in levels of anxiety sensitivity. Groups of adolescents with stable low, stable high, and escalating anxiety sensitivity levels were identified. Adolescents with stable high or escalating anxiety sensitivity were significantly more likely to report experiencing a panic attack than individuals with stable low anxiety sensitivity. Results also indicated that Asian and Hispanic adolescents tended to report higher anxiety sensitivity but that their anxiety sensitivity was less strongly associated with panic than that of Caucasian adolescents.
View details for DOI 10.1037//0021-843X.111.3.471
View details for Web of Science ID 000176960100007
View details for PubMedID 12150423
- Psychological versus biological clinical interpretation: A patient with prion disease AMERICAN JOURNAL OF PSYCHIATRY 2002; 159 (4): 528-537
- Puberty and the emergence of gender differences in psychopathology JOURNAL OF ADOLESCENT HEALTH 2002; 30 (4): 49-58
- Puberty and the Emergence of Gender Differences in Psychopathology Journal of Adolescent Health 2002; 30S: 49-58
Cognitive-behavioral group therapy for social phobia in female adolescents: Results of a pilot study
JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY
2000; 39 (6): 721-726
To examine the efficacy of cognitive-behavioral group therapy for adolescents (CBGT-A) in females with social phobia and the effect of this treatment on the risk for major depression.Female adolescents with social phobia (N = 35) were randomly assigned to treatment (n = 12) or no treatment (n = 23) groups. Assessments were conducted at baseline, after treatment, and at a 1-year follow-up.Eleven subjects completed treatment. Sixteen weeks of treatment produced a significant improvement in interference and reduction in symptoms of social anxiety. There was a significant reduction in the number of subjects meeting DSM-IV criteria for social phobia in the CBGT-A versus the untreated group; however, at the 1-year follow-up there were no significant differences by treatment condition. There was also suggestive evidence that treatment of social phobia lowers the risk for relapse of major depression among those with a history of major depression. Combining social phobia and major depression as the outcome produced more robust treatment effects in the 1-year follow-up.This pilot study provides evidence for a moderate short-term effect of CBGT-A for treating female adolescents suffering from social phobia and indicates that treatment of social phobia may result in a reduction of major depression.
View details for Web of Science ID 000087331200010
View details for PubMedID 10846306
Predictors of panic attacks in adolescents
JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY
2000; 39 (2): 207-214
To identify risk factors for onset of panic attacks in adolescents, a prospective cohort design was used to evaluate the following risk factors: negative affectivity, female sex, anxiety sensitivity, and childhood separation anxiety disorder. These risk factors were also evaluated for predicting onset of major depression to test their specificity.The sample consisted of 2,365 high school students assessed over a 4-year period. Assessments included self-report questionnaires and structured clinical interviews. Cox proportional hazards models were used to evaluate risk.Consistent with previous studies, prior major depression predicted onset of panic attacks and a history of panic attacks predicted onset of major depression. After adjusting for the effects of prior major depression, negative affectivity and anxiety sensitivity, but not female sex or childhood separation anxiety disorder, predicted onset of 4-symptom panic attacks. However, female sex and negative affectivity but not anxiety sensitivity or childhood separation anxiety disorder predicted onset of major depression after adjustment for the effects of prior panic attacks.Negative affectivity appears to be a nonspecific risk factor for panic attacks and major depression, whereas anxiety sensitivity appears to be a specific factor that increases the risk for 4-symptom panic attacks in adolescents.
View details for Web of Science ID 000085031900021
View details for PubMedID 10673832
- Cognitive-Behavioral Group Therapy for Social Phobia in Female Adolescents: Results of a Pilot Study Journal of the American Academy of Child and Adolescent Psychiatry 2000; 39: 721-726
- Predictors of Panic Attacks in Adolescence Journal of the American Academy of Child and Adolescent Psychiatry 2000; 39: 207-214
Naturalistic weight-reduction efforts prospectively predict growth in relative weight and onset of obesity among female adolescents
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
1999; 67 (6): 967-974
This study examined the prospective relations of naturalistic weight-reduction efforts to growth in relative weight and onset of obesity with data from a community study of female adolescents (N = 692). Initial self-labeled dieting, appetite suppressant/laxative use, incidental exercise, vomiting for weight-control purposes, and binge eating predicted elevated growth in relative weight over the 4-year period. Dietary restraint, self-labeled dieting, exercise for weight-control purposes, and appetite suppressant/laxative use predicted an increased risk for obesity onset. Data imply that the weight-reduction efforts reported by adolescents are more likely to result in weight gain than in weight loss and suggest the need to educate youth on more effective weight-control strategies.
View details for Web of Science ID 000083979000015
View details for PubMedID 10596518
Gender differences in correlates of depressive symptoms in adolescents
JOURNAL OF ADOLESCENT HEALTH
1999; 25 (2): 98-108
To determine: (a) what demographic and psychosocial factors are associated with elevated levels of depressive symptoms in adolescence; (b) whether girls and boys show different profiles of correlates and probable risk factors for depressive symptoms; and (c) what the implications are of these results for future research directions and policy decisions.Using a nationally representative sample of adolescent school students in Grades 5-12, the Commonwealth Fund Adolescent Health Survey assessed depressive symptoms as well as a number of variables posited to be risk factors and correlates of depression.Depressive symptoms were found to differ by gender, age, socioeconomic status, and ethnicity. In addition, life stress, social support, and coping were associated with depressive symptoms. Importantly, stress and social support appear to be particularly salient aspects of depression among girls. Both physical and sexual abuse were strongly linked with depression for both boys and girls, with sexual abuse having a stronger impact among boys. Finally, high levels of depressive symptoms were associated with increased use of both mental and physical health care resources among boys and girls.The correlates of depression in this adolescent sample closely resemble those seen in adult samples, including demographic and psychosocial variables. Some psychosocial variables, such as stress and social support, may have a greater impact on depressive symptoms for girls than for boys. Results of this study also have important implications for the health care system, given that higher levels of depressive symptoms were found to be associated with greater utilization of physical health care resources.
View details for Web of Science ID 000081723700004
View details for PubMedID 10447037
Ethnic differences in the association between pubertal status and symptoms of depression in adolescent girls
JOURNAL OF ADOLESCENT HEALTH
1999; 25 (2): 143-149
To examine the importance of chronologic age versus pubertal status in predicting adolescent girls' depressive symptoms in different ethnic groups.A national probability sample was used to obtain a representative cohort of 3216 adolescents, 5th through 8th grades. Subjects completed a questionnaire, which included a modified version of the Children's Depression Inventory (CDI) and an assessment of timing of menarche.Among Caucasians, post-menarcheal adolescent girls had higher depression scores than did same-aged pre-menarcheal girls. Boys and pre-menarcheal girls had similar depression scores in most age groups. Among African-Americans and Hispanics, there were no menarche-associated differences in depressive symptoms.In early adolescence pubertal status is a better predictor of depressive symptoms than chronological age in Caucasian, but not African-American or Hispanic girls.
View details for Web of Science ID 000081723700008
View details for PubMedID 10447041
Salivary cortisol levels in socially phobic adolescent girls
DEPRESSION AND ANXIETY
1999; 10 (1): 25-27
Anxiety disorders such as social phobia (SP) often have their onset during adolescence and frequently precede the onset of major depression. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is well-documented in major depression. Consequently, there is considerable interest in HPA function in anxiety disorders. We examined salivary cortisol levels in 27 SP adolescent girls and 21 matched controls during normal daily activities, and immediately before and after a modified Trier Social Stress Test (TSST). Both SP subjects and controls showed significant elevations in cortisol levels prior to the TSST, and prior to attending school. These results suggest that salivary cortisol is a sensitive measure of anticipatory anxiety, but we failed to find significant differences between SP subjects and controls.
View details for Web of Science ID 000085271400004
View details for PubMedID 10499186
Acculturation and eating disorder symptoms in adolescent girls
JOURNAL OF RESEARCH ON ADOLESCENCE
1999; 9 (1): 67-83
View details for Web of Science ID 000078462000004
- Ethnic Differences in the Association Between Pubertal Status and Symptoms of Depression in Adolescent Girls Journal of Adolescent Health 1999; 25: 143-149
Linking self-reported childhood behavioral inhibition to adolescent social phobia
JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY
1998; 37 (12): 1308-1316
Behavioral inhibition in children has been hypothesized to be a risk factor for the later development of social phobia. However, this hypothesis has yet to be demonstrated in a prospective study. The purpose of the study presented here is to test whether behavioral inhibition in childhood constitutes a risk factor for social phobia during adolescence.The sample consisted of 2,242 high school students assessed over a 4-year period. Assessments included self-report questionnaires, structured clinical interviews, and measurements of heart rate. Cox proportional hazards models were used to evaluate risk.Social avoidance, a component of behavioral inhibition, predicted onset of social phobia during high school. However, social avoidance was not related to depression in adolescence. Another component of behavioral inhibition, fearfulness, increased the risk for both social phobia and depression. Among subjects who were both socially avoidant and fearful, 22.3% developed social phobia--a risk more than four times greater than that for subjects with neither feature of behavioral inhibition.This prospective study demonstrates that behavioral inhibition in childhood increases the risk of social phobia in adolescence.
View details for Web of Science ID 000077278300015
View details for PubMedID 9847504
Age of onset for binge eating and purging during late adolescence: A 4-year survival analysis
JOURNAL OF ABNORMAL PSYCHOLOGY
1998; 107 (4): 671-675
This prospective study examined age of onset for binge eating and purging among girls during late adolescence and tested whether dieting and negative affectivity predicted these outcomes. Of initially asymptomatic adolescents, 5% reported onset of objective binge eating, 4% reported onset of subjective binge eating, and 4% reported onset of purging. Peak risk for onset of binge eating occurred at age 16, whereas peak risk for onset of purging occurred at age 18. Adolescents more often reported onset of a single symptom rather than multiple symptoms, and symptoms were episodic. Dieting and negative affectivity predicted onset of binge eating and purging. Findings suggest that late adolescence is a high-risk period for onset of bulimic behaviors and identify modifiable risk factors for these outcomes.
View details for Web of Science ID 000076987000013
View details for PubMedID 9830254
Support for the continuity hypothesis of bulimic pathology
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
1998; 66 (5): 784-790
There has been debate as to whether bulimia represents the endpoint of an eating disorder continuum (the continuity hypothesis) or is categorically different from subthreshold bulimia or an absence of eating disorders (the discontinuity hypothesis). The present study tested whether differences among bulimic, subthreshold bulimic, and control women on weight-concern and psychopathology variables better accord with the continuity or discontinuity hypothesis. These 3 groups were compared on body mass, thin-ideal internalization, body dissatisfaction, dietary restraint, depressive symptoms, anxiety symptoms, and temperamental emotionality. Discriminant function analysis and follow-up pairwise contrasts indicated that the continuity hypothesis was supported for measures of both weight concern and psychopathology. Research and treatment implications of the continuity perspective are discussed.
View details for Web of Science ID 000076550300008
View details for PubMedID 9803697
Psychiatric risk associated with early puberty in adolescent girls
JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY
1997; 36 (2): 255-262
This study prospectively evaluated the relationship between early puberty and the onset of internalizing symptoms and disorders in adolescent girls.The sample was drawn from 1,463 sixth-, seventh-, and eighth-grade girls who participated in a longitudinal school-based study of growth and development. Pubertal stage was determined by self-assessment of Tanner stage. Psychiatric assessments included self-report instruments and structured diagnostic interviews. Survival methods were utilized for data analysis.Girls with onset of internalizing symptoms were on average 5 months earlier in pubertal development than those who were asymptomatic (p < .001). In addition, girls with earlier maturation (earliest quartile) were more likely to develop internalizing symptoms than were nonearly matures (hazard ratio = 1.8, confidence interval = 1.2, 2.7). In a subsample of girls followed into high school, early-maturing girls were at marginally higher risk (p < .10) for developing internalizing disorders by the study's end. The highest risk for internalizing disorders was for those girls with both early puberty and prior internalizing symptoms (odds ratio = 3.3).Early puberty increases the risk of internalizing symptoms and perhaps internalizing disorders in adolescent girls.
View details for PubMedID 9031579
Assessment and phenomenology of nonclinical panic attacks in adolescent girls
JOURNAL OF ANXIETY DISORDERS
1997; 11 (1): 17-32
Recent reviews of studies concerning panic attacks in adolescents have emphasized research limitations, noting problems of validity, reliability, and lack of normative data. To address some of these limitations we evaluated two methods of panic ascertainment (questionnaire versus interview), reliability of interview-determined panic, and clinical correlates of panic symptoms in a large sample (N = 1013) of early adolescent girls. The 5.4% of the sample who, when interviewed, reported ever experiencing a panic attack scored significantly higher on measures of depression, anxiety sensitivity, and alcohol use, but were not more avoidant than others. Using the interview as the standard, the questionnaire had a specificity of 81% and a sensitivity of 72%. Adolescents do experience panic attacks-whether identified by questionnaire or interview-although for many the attacks may not be salient. Longitudinal studies are required to determine those qualities of nonclinical panic (severity, context, interpretation/attribution), which render some episodes as clinically meaningful.
View details for Web of Science ID A1997WU76400002
View details for PubMedID 9131879
- Journal of Anxiety Disorders School Refusal in Girls with Nonclinical Panic Attacks. Journal of Anxiety Disorders 1995; 4 (9): 329-338
PSYCHIATRIC-ILLNESS AND CARDIOVASCULAR-DISEASE RISK
1995; 17 (1): 129-138
Studies evaluating the risk of cardiovascular disease in the psychiatrically ill yield mixed results. Phobic anxiety in men is associated with an increased risk for cardiovascular disease, particularly sudden coronary death. This finding is in need of replication in women, and hypotheses regarding the potential mechanisms for this association warrant pilot testing. Other than this finding, there is only weak evidence supporting an association between psychiatric illness and risk for cardiovascular disease. This is surprising in light of the strong evidence that psychiatric illness in general is associated with elevated rates of cigarette smoking. In addition, there may also be higher rates of hypertension, hypercholesterolemia, and physical inactivity in some psychiatric disorders. Why the high rates of cigarette smoking and possibly other cardiovascular disease risk factors have not translated into consistently detectable elevated cardiovascular disease risk in individuals with psychiatric diagnoses is not apparent. Weaknesses in study designs and variations in assessment methods may partially explain the inconsistent results. Future studies of cardiovascular disease in the psychiatrically ill should be prospective, use nonclinical samples of men and women, have clear diagnostic criteria, determine order of onset of the two disorders if they coexist, and control for variability in known cardiovascular disease risk factors.
View details for Web of Science ID A1995RU55500017
View details for PubMedID 8521931
TIMING AND RATE OF SEXUAL-MATURATION AND THE ONSET OF CIGARETTE AND ALCOHOL-USE AMONG TEENAGE GIRLS
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE
1994; 148 (8): 789-795
To test the hypothesis that the patterns of pubertal progression, early vs late puberty and fast vs slow, are associated with the age at which girls start to drink alcohol and smoke cigarettes.The study included 1463 female students, 10.7 to 18.2 years of age, who were assessed five times during the 2.7-year study. Data regarding pubertal stage, alcohol use, and cigarette use were obtained at each assessment. These data were used to calculate two indexes of pubertal development, the age at which the midpoint of puberty was achieved and the rate of progression through puberty, and the ages when each subject first drank, first drank moderate amounts of alcohol, and first smoked.Girls with earlier puberty (midpoint < 12.2 years) first reported drinking any alcohol at a median age of 12.5 years, 0.7 years younger than girls whose puberty was later. Similarly, girls with earlier puberty reported drinking moderate amounts of alcohol at a median age of 13.7 years, 0.9 years younger than girls with later puberty. Girls with earlier puberty further reported first smoking cigarettes at a median age of 12.8 years, 0.6 years younger than girls with later puberty. The rate of pubertal progression was significantly associated only with the age when girls first drank moderate amounts of alcohol.Earlier puberty is associated with a younger age of onset for both drinking and smoking among adolescent girls.
View details for Web of Science ID A1994PB26400003
View details for PubMedID 8044254
AN ATTEMPT TO MODIFY UNHEALTHFUL EATING ATTITUDES AND WEIGHT REGULATION PRACTICES OF YOUNG ADOLESCENT GIRLS
INTERNATIONAL JOURNAL OF EATING DISORDERS
1993; 13 (4): 369-384
This is the first long-term, controlled study evaluating the effectiveness of a prevention curriculum designed to modify the eating attitudes and unhealthful weight regulation practices of young adolescent girls. Nine hundred sixty-seven sixth and seventh-grade girls were randomized to experimental healthy weight regulation curriculum or no-treatment control classes. A prevention intervention was developed around three principal components: (1) Instruction on the harmful effects of unhealthful weight regulation; (2) promotion of healthful weight regulation through the practice of sound nutrition and dietary principles and regular aerobic physical activity; (3) development of coping skills for resisting the diverse sociocultural influences that appear linked to the current popular obsessions with thinness and dieting. The intervention failed to achieve the hoped-for impact. We did observe a significant increase in knowledge among girls receiving the intervention and among high-risk students only, there was a small albeit statistically significant effect on body mass index. These findings question the wisdom of providing a curriculum directed at all young adolescents, most of whom are not at risk to develop an eating disorder. Rather than targeting the entire population, a healthy weight curriculum designed to modify the eating attitudes and unhealthful weight regulation practices of young adolescent girls might better focus on "at risk" students.
View details for Web of Science ID A1993KZ50300004
View details for PubMedID 8490639
DOES TELEVISION VIEWING INCREASE OBESITY AND REDUCE PHYSICAL-ACTIVITY - CROSS-SECTIONAL AND LONGITUDINAL ANALYSES AMONG ADOLESCENT GIRLS
1993; 91 (2): 273-280
To examine the relationships between hours of television viewing and adiposity and physical activity among female adolescents, a cohort study with follow-up assessments 7, 14, and 24 months after baseline was conducted. All sixth- and seventh-grade girls (N = 971) attending four northern California middle schools were eligible to participate. Six hundred seventy-one students had sufficient data for baseline cross-sectional analyses, and 279 students in a no-intervention cohort had sufficient data for longitudinal analyses. The baseline sample had a mean age of 12.4 years and was 43% white, 22% Asian, 21% Latino, 6% Pacific Islander, 4% black, 2% American Indian, and 2% other. Hours of after-school television viewing, level of physical activity, and stage of sexual maturation were assessed with self-report instruments. Height, weight, and triceps skinfold thickness were measured and body mass index (ratio of weight [in kilograms] to height [in meters] squared) and triceps skinfold thickness were adjusted by level of sexual maturity for the analyses. Baseline hours of after-school television viewing was not significantly associated with either baseline or longitudinal change in body mass index or triceps skinfold thickness. Baseline hours of after-school television viewing was weakly negatively associated with level of physical activity in cross-sectional analyses but not significantly associated with change in level of physical activity over time. All results were essentially unchanged when adjusted for age, race, parent education, and parent fatness. Among adolescent girls, television viewing time appears to have only weak, if any, meaningful associations with adiposity, physical activity, or change in either over time.
View details for PubMedID 8424000
PUBERTAL STAGE AND PANIC ATTACK HISTORY IN 6TH-GRADE AND 7TH-GRADE GIRLS
INTERNATIONAL CONGRESS ON SCHIZOPHRENIA RESEARCH
AMER PSYCHIATRIC ASSOCIATION. 1992: 1239–43
Although the incidence of first panic attacks appears to peak during adolescence, little is known about which features of adolescence contribute to the risk of a first panic episode. The purpose of this study was to compare the relative importance of age and pubertal stage in explaining the occurrence of panic attacks in adolescents.From a school-based sample of sixth- and seventh-grade girls, 754 subjects completed both a structured clinical interview determining history of one or more panic episodes and a self-assessment of Tanner stages of pubertal development. A multiple logistic regression analysis was performed with panic attack history as the dependent variable and pubertal stage, age, and their interaction as the independent variables.A history of one or more four-symptom panic attacks was found in 5.3% of the girls (N = 40). After age was controlled for, pubertal stage was significantly related to panic attack history. At each age, higher rates of panic attacks were found in the more physically mature girls.Pubertal stage, after adjustment for the effects of age, appears to predict panic attack occurrence in young adolescent girls. Understanding the link between puberty and panic may offer clues regarding the onset and etiology of panic attacks.
View details for PubMedID 1503139
SCHIZOPHRENIA AND RHEUMATOID-ARTHRITIS - A REVIEW
1992; 6 (3): 181-192
Fourteen epidemiologic studies of the relationship of rheumatoid arthritis to schizophrenia have been conducted between 1934 and 1985. Twelve of the studies report a lower-than-expected rate of rheumatoid arthritis in populations of schizophrenics. Methodologic weaknesses in the studies are assessed. Nutritional, hormonal, psychosocial, genetic, and immunologic data and theories are briefly reviewed which might explain the epidemiologic results. There is sufficient evidence for the negative association between the two disorders to justify further research.
View details for Web of Science ID A1992HK32600001
View details for PubMedID 1571312
INSULIN-LIKE GROWTH FACTOR-I AS A REFLECTION OF BODY-COMPOSITION, NUTRITION, AND PUBERTY IN 6TH AND 7TH GRADE GIRLS
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
1991; 73 (4): 907-912
Large variations in nutritional intake have profound effects on the GH-insulin-like growth factor-I (IGF-I) axis in children and adults, but the effect of normal variations in nutrition on IGF-I concentrations is largely unstudied, particularly during puberty. We measured serum IGF-I concentrations in 325 sixth and seventh grade girls (12.4 +/- 0.7 yr) at the beginning of a multisite school-based health curriculum. The mean serum IGF-I level among the 243 girls with complete data was 573 +/- 244 micrograms/L. Pubertal stage was significantly associated with IGF-I (P less than 0.0001, by analysis of variance). Mean concentrations rose from 427 +/- 198 micrograms/L among those at the earliest pubertal stages to 639 +/- 219 micrograms/L among the mature girls. After adjusting for the association with the stage of pubertal development, serum IGF-I was not significantly associated with measures of body composition (body mass index, triceps skin fold thickness, waist/hip ratio, height, and weight). Additionally, IGF-I concentrations were not associated with nutritional intake (total calories, total protein, total fat, and total carbohydrate) or such measures of nutrition as serum iron, hemoglobin, red cell mean corpuscular volume, white cell count, and cholesterol. IGF-I concentrations, however, were significantly correlated with transferrin concentrations, another possible index of nutritional status (r = 0.29; P less than 0.0001). IGF-I is not a clinically useful index of nutritional status among normal pubertal girls.
View details for PubMedID 1890162
CARDIOVASCULAR AND SYMPTOMATIC REDUCTION EFFECTS OF ALPRAZOLAM AND IMIPRAMINE IN PATIENTS WITH PANIC DISORDER - RESULTS OF A DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL
JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY
1990; 10 (2): 112-118
Seventy-nine patients with panic disorder were randomized to an 8-week double-blind treatment with alprazolam, imipramine, or placebo. Patients kept daily records of panic attacks, activity, anxiety, sleep, and medication use. Weekly measures of anxiety, depression, somatic symptoms, fears, avoidance, disability, and improvement were obtained. All patients underwent a symptom-limited exercise treadmill and other cardiovascular measures. By physician and patient global assessment, patients receiving alprazolam or imipramine were significantly better than patients on placebo. The alprazolam effects were apparent by week 1; the imipramine effects by week 4. All groups showed significant reductions in anxiety, depression, somatic measures, and panic attack frequency. At 8 weeks, patients in the alprazolam group reported significantly less fear than patients in the other two groups. Subjects in the imipramine group showed a significant increase in heart rate and blood pressure.
View details for Web of Science ID A1990CX84900006
View details for PubMedID 2187912
MOTOR-ACTIVITY AND TONIC HEART-RATE IN PANIC DISORDER
1990; 32 (1): 45-53
Motor activity and tonic heart rate were monitored in 62 drug-free panic disorder patients and 40 normal control subjects. Mean daily activity, mean waking heart rate controlled for activity, and mean sleeping heart rate were determined. Panic disorder patients without phobic avoidance showed higher activity than control subjects or patients with limited or extensive avoidance. Similarly, an "inverted U", relationship between trait anxiety and activity was observed. On the other hand, neither mean waking nor sleeping heart rate showed significant differences between patients and controls, suggesting that the differences previously reported in laboratory studies result from anticipatory anxiety.
View details for Web of Science ID A1990DC99700006
View details for PubMedID 2349312
CARDIOVASCULAR CONSIDERATIONS IN SELECTION OF ANTI-PANIC PHARMACOTHERAPY
MEETING ON BENZODIAZEPINES : THERAPEUTIC, BIOLOGIC, AND PSYCHOSOCIAL ISSUES
PERGAMON-ELSEVIER SCIENCE LTD. 1990: 43–49
Patients with panic disorder may be at increased risk for cardiovascular morbidity and mortality. There is also preliminary evidence that some cardiovascular risk factors may be increased in patients with panic disorder. Since anti-panic medications can alter cardiovascular function, the cardiovascular effect of these medications should be considered, particularly when used in patients with cardiovascular disease. This article will review the cardiovascular side effects of anti-panic medications.
View details for Web of Science ID A1990EJ50000005
View details for PubMedID 1980698
PANIC ATTACKS IN YOUNG ADOLESCENTS
AMERICAN JOURNAL OF PSYCHIATRY
1989; 146 (8): 1061-1062
The lifetime prevalence of interview-determined four-symptom panic attacks in 95 ninth graders was 11.6%. Those with panic attacks were significantly more depressed, were significantly more likely to have separated or divorced parents, and tended to be more likely to have tried cigarette smoking.
View details for Web of Science ID A1989AH11900022
View details for PubMedID 2787606
PLASMA-LIPID LEVELS IN PATIENTS WITH PANIC DISORDER OR AGORAPHOBIA
AMERICAN JOURNAL OF PSYCHIATRY
1989; 146 (7): 917-919
Plasma lipids were measured in 102 subjects with panic disorder or agoraphobia. In women, but not men, a significantly higher than expected number of subjects had cholesterol values that exceeded the 75th percentile of national reference values for their sex and age.
View details for Web of Science ID A1989AD14300020
View details for PubMedID 2742017
CONSULTATION IN CLINICAL PSYCHOPHARMACOLOGY - A CASE OF SUDDEN-DEATH IN A PATIENT ON NORTRIPTYLINE
1987; 22 (2): 172-175
View details for Web of Science ID A1987G154600006