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Both Barrels:
The Devastating Comorbidity of Anxiety Disorders and Substance Abuse

(Released May 2012)

  by J. Erick Sinkhorn  


Key Citations




Resources eLibrary Resources
eLibrary Resources

  1. Six-year-old Daniel McKenna plays like a normal child but will not speak when away from home. The anxiety disorder is known as selective mutism. He is shown at home in Sharon Hill, Pennsylvania, on August 5, 2002.

  2. Iraq war veteran Pam O'Donnell (L), who served in the Marines in Anbar province during the height of combat in 2004, is accompanied by Sgt. Owen Powell of the 152nd Military Police platoon in Fort Hamilton in Brooklyn during Seaside Therapeutic Riding July 29, 2008 in the Brooklyn borough of New York City. The program brings US veterans suffering from Post-Traumatic Stress Disorder out to ride and care for horses as a means of treatment for their PTSD.
    Chris Hondros/Getty Images

  3. Chart shows the growth in post-traumatic stress disorder claims filed at the Veterans Administration, 1999-2006, compared to all anxiety disorder claims and all veterans receiving disability.
    Yingling/Knight-Ridder/Tribune News Service
Resources taken from Proquest's eLibrary

Charts and Tables
  1. Table 3. Parental psychopathology and risk for oinspring anxiety disorders and substance abuse/dependence ( n= 775 )

    Psychopathology in the adolescent and young adult offspring of a community sample of mothers and fathers with major depression
    KLEIN, DANIEL N; LEWINSOHN, PETER M; ROHDE, PAUL; SEELEY, JOHN R; OLINO, THOMAS M. Psychological Medicine [Psychol. Med.]. Vol. 35, no. 3, pp. 353-365. Apr 2005.
  2. PACAP blood levels predict PTSD symptoms in females. a, PTSD symptoms (scale range 0a51), relative to plasma PACAP38 blood levels (pM); (N 5 34 females; r 5 0.497, P # 0.005). b, Total PTSD symptoms plotted relative to sex and levels of plasma PACAP38 (N 5 64, low: ,20 pM, high: .20 pM); females with high PACAP blood levels have increased symptoms (**P , 0.0005). c, PACAP levels (low versus high) are also differentially associated with PTSD intrusive, avoidance and hyperarousal symptoms in females (N 5 64,**P , 0.005). d, PACAP levels (low versus high) were examined in a replication sample of highly traumatized women, with differential association in hyperarousal symptoms (left, N 5 74,**P 5 0.002) and in the percentage of subjects with significant symptoms (right, x2 5 4.9, P , 0.05). e, Acoustic startle reflex (EMG) relative to the fear conditioning trial in subjects without PTSD (blue) versus with PTSD (red). Habituation is seen in non-PTSD subjects during late acquisition (bar). f, Startle magnitude during the late acquisition period versus trial type (noise alone, CS1 and CS2), showing that females with high PACAP levels show enhanced startle responses to both fear cues (CS1, P 5 0.02) and safety cues (CS2, P 5 0.005) (N 5 27; 16 male, 11 female). Dashed lines, low PACAP; solid lines, high PACAP; blue, male; red, female. Bars represent mean 6 s.e.m., N values for each group at bottom of bar graphs.

    Post-traumatic stress disorder is associated with PACAP and the PAC1 receptor
    Ressler, Kerry J; Mercer, Kristina B; Bradley, Bekh; Jovanovic, Tanja; Mahan, Amy; et al. Nature 470. 7335 (Feb 24, 2011): 492-497.
  3. Comorbidity With MDD in the National Comorbidity Study-Replication

    Anxiety and Depression: Two Peas in a Pod?
    Stein, Murray B. Psychiatric Times 21. 11 (Oct 2004): I1-I8.
Tables taken from ProQuest's Illustrata
  1. Murray B. Stein
    Professor, Department of Psychiatry, University of California, San Diego
    Research Focus:

    - Dr. Stein's research focus is on the epidemiology, neurobiology, genetics and treatment of anxiety disorders. Treatment modalities of interest include pharmacotherapy and brief psychoeducational and cognitive-behavioral techniques. Population-based and clinical (including primary care) research are equally emphasized. Numerous collaborative projects (e.g., with experts in functional imaging and genetic epidemiology) enable Dr. Stein's laboratory to have an eclectic approach to the understanding of anxiety and anxiety disorders.

    Clinical Focus:

    - Dr. Stein's interests and expertise are in the treatment of persons with anxiety disorders. He is also interested in public health approaches to preventing anxiety and trauma-related disorders and their adverse consequences. Treatment of anxiety in children and adolescents is a growing clinical focus.

    Dr. Stein is a clinical psychiatric researcher with expertise in the anxiety disorders. Within the anxiety disorders, main areas of expertise are social phobia, panic disorder, and posttraumatic stress disorder; secondary areas of interest are generalized anxiety disorder and obsessive compulsive disorder and other phobic disorders. He has expertise in the conduct and interpretation of community surveys pertaining to anxiety disorders and risk factors therefore. He conducts clinical trials with new pharmacologic agents in the anxiety disorders. And he has expertise in the use of a variety of techniques (functional neuroimaging, neuroendocrine challenges, family and genetic studies) that are used to better understand the pathophysiology of anxiety disorders.

  2. Kathleen Merikangas
    Investigator, Division of Intramural Research Programs, National Institutes of Health (NIH)
    The major areas of Dr. Merikangas' research are:

    1. studies of the patterns and components of familial aggregation of mental disorders and familial mechanisms for comorbidity of mental and medical disorders;
    2. identification of early signs and risk factors for psychiatric disorders among high and low risk youth using prospective longitudinal high risk studies;
    3. large scale population based studies of mental disorders including high risk designs and prospective longitudinal research.

    The major project underway in her research group is a community-based family study of affective spectrum disorders and their overlap with other mental disorders, especially anxiety disorders and medical disorders such as migraine and cardiovascular disease. The goal of this research is to identify the endophenotypes that are closer to the biologic expression of genes underlying these disorders and environmental moderators of genetic expression. Findings from this research are likely to have important implications for targets of prevention and treatment of affective illness.

    My major theme of our work is the genetic epidemiology of psychiatric and neurological disorders in adults and children. Our current research focuses on the links between anxiety disorders, affective disorders, and substance abuse using family and longitudinal high risk studies to identify sources of comorbidity. Our study subjects are selected from both the community and clinical settings. A multidisciplinary approach is employed including input from the following disciplines: clinical psychiatry and psychology, epidemiology, genetics, biostatistics, psychophysiology, neurology, sociology and anthropology. The major goal of our work is to identify genetic and environmental vulnerability factors to inform the pathogenesis of these conditions as well as to serve as targets of prevention.

  3. William G. Iacono
    Professor, Graduate Program in Neuroscience, University of Minnesota Twin Cities
    Clinical, psychophysiology, behavior genetics, biological makers of schizophrenia, drug abuse, alcoholism, the course and development of psychopathology, lie detection.

    Psychophysiology of mental disorders.

    Statement of Interests

    In most of my research, family and twin study designs are used to investigate the etiology of different types of psychopathology.

    I am investigating how genetic and environmental factors combine to influence the development of substance use and related disorders in families that contain twin and adoptive children.

Scholars taken from ProQuest's Community of Scholars