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In this article, we will address 10 questions about anxiety that are relevant to doctors who encounter this in their practice. This often occurs in the primary care setting, where individuals with anxiety frequently present with somatic complaints. A focused medical history, including questions about the use and withdrawal of psychoactive substances, can assist in the diagnostic process. Psychoeducation may be sufficient, otherwise cognitive-behavioral therapy can be conducted. In cases of non-response, serotonergic antidepressants represent a treatment option. Half of the individuals with anxiety symptoms experience remission, while the other half have a recurrent or chronic course, which may be accompanied by comorbid depression.

Background: Sleep gets little attention in mental health care treatments. Epidemiological research with regards to the association between sleep problems and anxiety and mood disorders can contribute to good clinical decision making., Aim: Based on data from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), we examined the relation between sleep problems and first onset, recurrence and persistence of anxiety and mood disorders within a 3 year period., Method: Different groups of respondents were selected to examine the relation between sleep problems and different stages of anxiety and mood disorders within three years. DSM-IV diagnoses were determined using the Composite International Diagnostic Interview (CIDI 3.0) and sleep problems with the Women’s Health Initiative Insomnia Rating Scale (IRS; ≥ 9). Logistic regression was performed. Multivariable analysis took into account a large number of potentially confounding variables., Results: Almost a quarter of the respondents without an anxiety or mood disorder and almost half of the respondents with an anxiety or mood disorder experience sleep problems. In the multivariable analysis, sleep problems were associated with recurrence of an anxiety disorder (OR 2.10; 95% CI 1.31-3.38), but not with the first onset and persistence of an anxiety disorder. Furthermore, sleep problems appear to be associated with the first onset of a mood disorder (OR 2.18; 95% CI 1.27-3.74) and with the persistence of a mood disorder (OR 2.51; 95% CI 1.17-5.37), but not with recurrence of this disorder., Conclusion: The results underline the importance of identifying sleep problems of people with (an increased risk of) anxiety and mood disorders. The treatment of sleep problems may contribute to a reduced incidence of these mental disorders and a better and sustainable recovery.

Objective: Psychiatric conditions are insufficiently highlighted as cardiovascular risk factors in the CVRM guideline. Objectives of this review are 1) to determine if anxiety and mood symptoms/disorders are independent cardiovascular risk factors; 2) to compare this risk to a population without these psychiatric conditions and 3) to ascertain the influence of psychiatric disease severity., Design: Narrative systematic review METHOD: We searched for meta-analyses and systematic reviews in PubMed. Quality assessment by AMSTAR criteria., Results: 10 reviews were included from 172 hits. (Sub)clinical depression and mood disorders are associated with an increased independent risk to develop cardiovascular diseases, coronary artery disease, myocardial infarction and cerebrovascular disease. Bipolar disorders increase the cerebrovascular risk, but not myocardial infarction. Anxiety disorders/symptoms heighten the cardiovascular, myocardial and cerebrovascular risk., Conclusion: Anxiety and mood symptoms/disorders are independent cardiovascular risk factors. Severe anxiety and mood disorders should be included as separate risk factors in the CVRM guideline.

Individuals with a depressive or bipolar mood disorder have a higher prevalence of somatic comorbidities, including dental problems. This is partly due to impaired self-care, smoking, alcohol use, and an unhealthy diet, and partly due to the often long-term use of medication. Depression has a negative impact on concentration and motivation and increases anxiety and avoidant behavior. In addition, there are indications for an interaction between stress, psychopathology, neuro-inflammatory processes and somatic health. These (temporary) factors must be taken into consideration in dental care for persons suffering from depression. Also, one must be alert for interactions between psychiatric medications and medications used in dental care. Especially in chronic psychiatric disorders, a coordinated care between dentist, general practitioner, and psychiatrist is of importance.

Background: Most mental health hospitals in the Netherlands use disorder specific standards of care. In case of comorbidity, we lack evidence in choosing the treatment of preference when both depressive- and anxiety disorder(s) are present in the same patient.
AIM: To investigate the prevalence of depression and anxiety (including obsessive compulsive disorder and post-traumatic stress disorder) in an outpatient mental health hospital population treated for their anxiety disorder, and to investigate the difference in outcome of (anxiety) treatment between patients with and without a comorbid depressive disorder.
METHOD: A retrospective study using outcome data from 2012 to 2017. In this period, we identified 127 patients for whom outcome data and diagnostic criteria were available. Comorbidity in this group was determined by a clinical interview. During treatment symptoms were monitored using self-reporting scales, among others the Inventory of Depressive Symptomatology (IDS) and the Beck Anxiety Inventory (BAI).
RESULTS: In 46,5% of the patients a comorbid depressive disorder was diagnosed. No significant difference in treatment outcome was observed between the group of patients with and the group of patients without a comorbid depressive disorder. However, the amount of reduction of depressive symptoms measured by the ids was a good predictor of the reduction of anxiety: a faster reduction of depressive symptoms predicts a better outcome of the treatment of anxiety.
CONCLUSION: Comorbid depressive disorders were observed in almost half of the patients treated in specialized (outpatient) clinics for anxiety disorders. A slower reduction of depressive symptoms predicts worse outcome of the treatment of anxiety.

Background: Anxiety and depression in Parkinson's disease (PD) are often unrecognized, partially due to a complex relationship with sleep disorders and other PD-related symptoms.
AIM: To gain more insight in anxiety, depression and sleep disorders in PD, their reciprocal interaction and relationship with other (non)motor symptoms.
METHOD: With three epidemiological studies in this thesis article we describe: the symptom dimensions of anxiety, motor symptoms and autonomic failure; predictors of the course of anxiety; and the temporal relationship between anxiety, depression and insomnia in PD.
RESULTS: Anxiety in PD has one affective and various somatic symptom dimensions. There is a symptomatic overlap between anxiety and symptoms of motor and autonomic dysfunctions. Anxiety, depression and impulsive-compulsive behaviors in de novo PD show a parallel course. Cognitive dysfunctions and REM-sleep behaviour disorder are risk factors for anxiety in PD patients. The relationship between insomnia and anxiety and depression is bi-directional.
CONCLUSION: There is an overlap, co-morbidity and interaction between anxiety, depression, sleep disorders and (non)motor symptoms, which warrants a multi-disciplinary approach to PD. Sleep disorders and cognitive dysfunctions may provide starting points for treatment and preventions of anxiety in PD.

Background: Demoralisation is a multidimensional concept, with helplessness and hopelessness as its key elements. Many patients, both in somatic and in mental health care, suffer from demoralisation. In the process of recovery, remoralisation constitutes a first step.
AIM: To investigate demoralisation in alcohol-dependent inpatients with co-occurring psychiatric disorders.
METHOD: Included in this study were 159 alcohol-dependent inpatients admitted to clinics for dual diagnosis. Demoralisation was assessed at treatment entry and again one month later.
RESULTS: A strong level of demoralisation was found, particularly in the co-occurrence of depression, anxiety and personality disorders. At treatment entry, 92% of patients was clinically demoralised and, one month later, this was 89%. In patients with co-occurring depression, mood and personality disorders, a significant decrease of demoralisation was found after one month, whereas in patients with developmental and psychotic disorders this was not the case. In 11% of patients there was clinically relevant improvement and in 7.5% there was clinically relevant deterioration; the latter mainly in patients with co-occurring developmental and psychotic disorders.
CONCLUSION: At start of treatment, these alcohol-dependent patients were strongly demoralised, especially in the co-occurrence of psychiatric disorders. Although there was a significant improvement in demoralisation after one month of treatment, patients remained strongly demoralised. In one in ten patients there was clinically relevant remoralisation. As a first step in the process of recovery, clinicians should pay more attention to remoralisation. Targeted interventions, aimed at this specific population, are necessary.

Background: Attention-deficit/hyperactivity disorder (ADHD) is a frequently occurring problem in child and adolescent psychiatry. Most prevalent comorbid disorders are oppositional defiant behavior, tics, autism spectrum disorder, anxiety and depression. Stimulants are the first pharmacological choice. Recently, long-acting guanfacin became available in Belgium and the Netherlands.
AIM: To investigate the efficacy of guanfacin on comorbid symptoms in ADHD.
METHOD: A systematic search in Medline and Cochrane databases for randomized controlled trials in which the effect of guanfacin on comorbid symptoms is evaluated.
RESULTS: Guanfacin had an effect on autism symptoms, oppositional defiant symptoms and possibly on tics in children and adolescents with adhd. On anxiety symptoms, no effect was reported. The effect on depression needs to be further investigated. The side effects of guanfacin are similar in comorbid disorders and pure ADHD.
CONCLUSION: Guanfacin is a treatment option for ADHD in children and adolescents with comorbid autism or behavioural symptoms and possibly also tics, as it has a demonstrated effect on these comorbid features. Further research is necessary in order to decide on the preference for a particular medication in ADHD with these various comorbid disorders.

Background: The co-occurrence of bipolar disorder and anxiety disorder is associated with a worse prognosis. Clinical guidelines do not give clear therapeutic recommendations on this subject., AIM: To review the evidence on the effectiveness of both psychotherapy and pharmacotherapy for anxiety disorders in patients with a bipolar disorder., METHOD: A systematic search in PubMed, Embase, Cochrane en Psycinfo and subsequent screening of potential studies resulted in 11 included studies., RESULTS: Five studies examined the effect of pharmacotherapy on treatment of comorbid anxiety disorders. One of these studies showed that both olanzapine and lamotrigine provided positive results in treating the anxiety disorders, with olanzapine being the more effective of the two. Conflicting results were found for quetiapine and valproic acid. The conclusion of one study was that risperidone was not effective. No studies were found researching the effect of psychotherapy on treatment of comorbid anxiety disorders. However, two case studies and four studies that included patients with mixed diagnoses, including bipolar disorder, proposed evidence that behavioral and cognitive behavioral therapy (cbt) had a positive effect on treatment of the comorbid anxiety disorder., CONCLUSION: There is little evidence on the treatment of comorbid anxiety disorders in people with bipolar disorder. Psychotherapy is preferred due to the uncertainty of the effects of pharmacotherapy and the associated risk of causing side effects. Pharmacotherapy can be considered in cases where this is insufficiently effective.

Background: Childhood trauma and negative life events in childhood are risk factors for the development of anxiety and depressive disorders in adulthood.
AIM: To increase our understanding of the specific associations between trauma and negative life events in childhood and the development and course of anxiety and depressive disorders in adulthood.
METHOD: Our research findings are based on data from the Netherlands Study of Depression and Anxiety (NESDA). In our article we report on two cross-sectional and three prospective studies.
RESULTS: All domains of childhood trauma are risk factors for the development of anxiety and/or depressive disorders in adulthood. Emotional neglect is the main independent predictor of the occurrence and the course of anxiety and depressive disorders. Certain personality characteristics and more unfavorable clinical factors play an important role in mediating the relationship between childhood trauma and the course of anxiety and depressive disorders later in life.
CONCLUSION: Not only does childhood trauma increase an individual's vulnerability to the development of anxiety and depressive disorders, it is also associated with a more serious and more chronic course of these disorders. Our studies have provided new insights into the underlying mechanism that links childhood trauma and anxiety and later anxiety depressive disorders. Consequently, we feel justified in making some recommendations with regards to clinical practice and public health interventions.

Background: Although anxiety disorders are more prevalent during the perinatal period, little attention has been given so far to the influence that pregnancy and the post-partum period can have on anxiety disorders., Aim: To review the literature concerning the prevalence, presentation and treatment of anxiety disorders during pregnancy and the post-partum period and to identify the risk factors involved., Method: We reviewed the literature in order to find articles concerning the influence of the post-partum period on various types of anxiety disorders., Results: Having selected the most relevant articles, we discuss the findings in relation to specific types of anxiety disorder., Conclusion: Women are more vulnerable to anxiety disorders during the perinatal period. Because anxiety disorders can have a significant impact on the mother and her foetus/infant it is important that anxiety disorders are identified and treated at the earliest opportunity.

Background: Routine outcome monitoring (rom) is a method for the systematic monitoring of treatment-progression. Because rom data are collected regularly and systematically, we believe it should be possible to use these data in clinical epidemiological research., Aim: To describe, on the basis of publications of the Leiden Routine Outcome Monitoring Study, a number of potential research topics in which rom data can play a role., Method: We used rom data of patients referred, between 2004 and 2009, to secondary or tertiary care for treatment of a mood, anxiety or somatoform disorder., Results: We describe three cross-sectional studies and one prospective study in which we aimed to identify predictors of outcome., Conclusion: These studies demonstrate clearly that it is feasible to use rom data to supplement clinical epidemiological research done on patients. Together these findings can be a useful addition to data derived from randomised clinical trials.

Background: Although it is generally the severity of a patient's symptoms and impairments which determines the amount of care allocated to patients with somatoform disorders, comorbidity appears to be an additional relevant factor. A number of studies in different populations with somatoform disorders have shown that these disorders overlap with mood disorders, anxiety disorders, and personality disorders. So far, however, little is known about comorbidity in patients in tertiary care who are suffering from severe somatoform disorders., Aim: To determine comorbidity of mood, anxiety and personality disorders in patients in tertiary care suffering from severe somatoform disorders., Method: The study was based on a sample of 340 patients with dsm-iv-tr somatoform disorder who were awaiting treatment in a specialised care centre. The sample was examined by means of structured clinical assessment of dsm-iv-tr axis I and axis II disorders., Results: 49.4% of the 340 participants was diagnosed with a mood disorder, 62.1% with an anxiety disorder and 50.6% with a personality disorder., Conclusion: Patients in tertiary care suffering from (severe) somatic disorders show higher comorbidity of mood, anxiety and personality disorder than previously reported for somatoform disorder patients in primary and secondary care.

Objective: To examine the effects of the mass shooting in the city of Alphen aan den Rijn, the Netherlands, on 9 April 2011 on the health and healthcare utilisation of those affected, compared with a reference group of neighbouring residents., Design: Observational longitudinal study., Method: Those affected by the shooting incident and a reference group of neighbouring residents were identified using patient and health care data from various care providers (Dutch Victim Support (SHN), Dutch Association of Mental Health and Addiction Care, social work), in which the request for assistance was documented. The health and healthcare process of 161 affected persons and 115 local residents in the year before and the year after the mass shooting could be followed with data extracted from the electronic medical records of general practices. The effects of the mass shooting on health and healthcare utilisation were analysed with logistic and Poisson multilevel regression analyses for repeated measurements., Results: After the mass shooting, the prevalence of psychological and social problems presented to the GP increased for affected persons (OR: 2.99; 95% CI: 1.75-5.12) compared with the year before the shooting incident, and differed from the reference group (OR: 2.68; 95% CI: 0.93-7.72). In particular, there was a sharp increase in the prevalence of anxiety and stress reactions (OR: 4.07; 95% CI: 1.86-8.92) and the prescription of hypnotics and sedatives (OR: 2.32; 95% CI: 1.08-4.98) and benzodiazepines (OR: 187; 95% CI: 1.07-3.26). However, these problems declined significantly after the first quarter. A small group of people was treated by mental health care for a post-traumatic stress disorder while half of those affected had registered with SHN., Conclusion: For a limited period of time, the mass shooting had a negative impact on the psychological well-being and healthcare utilisation of those affected.

Background: Little is known about the prevalence and the consequences of attention-deficit hyperactivity disorder (ADHD) among adults in the general Dutch population., Aim: To ascertain the prevalence of ADHD in childhood and adulthood, to investigate characteristics associated with the prevalence and persistency of ADHD and to draw a number of comparisons: to compare the functioning of adults with ADHD with that of people with a different mental disorder and to compare the extent to which these groups make use of treatment facilities., Method: Data were derived from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), in which the occurrence of ADHD was determined in a representative sample of the Dutch population (n = 3,309; aged 18-44)., Results: 2.9% of the respondents had had ADHD in childhood, 70.0% of them still had the disorder in adulthood. An anxiety disorder before the age of 16 increased the risk of ADHD persistency, whereas an impulse-control disorder decreased this risk. ADHD in adulthood was associated with lower socio-economic status, mental disorders, poor functioning and increased use of treatment facilities. ADHD adults and adults with an anxiety or substance use disorder showed very similar functional limitations and used treatment facilities to approximately the same extent., Conclusion: More than two-thirds of the adults who had had childhood ADHD still had the disorder in adulthood. The consequences of this in terms of functioning and use of treatment facilities are substantial.

Anxiety is common in children and adolescents with autism spectrum disorders and can cause severe dysfunction and suffering. An 11-year-old boy with an autism spectrum disorder and suffering from anxiety and mood problems responded positively to treatment with fluoxetine. After four weeks he developed clinically observable paroxysmal events accompanied by absence and confusion.

Patients with an 'at risk mental state' (ARMS) run an increased risk of developing a psychosis within the near future. Patients with an arms can be divided into three groups: those with genetic predisposition to schizophrenia and displaying decreased social functioning, those with attenuated psychotic symptoms and those with brief limited and intermittent psychotic symptoms (BLIPS). Patients with an arms are often suffering from comorbid anxiety and depressive symptoms. Our study focuses on two patients with an ARMS.

Aim: To collect empirical evidence concerning the effectiveness of the treatment of anxiety disorders in the elderly., Method: Meta-analysis and randomised controlled trials., Results: Meta-analysis showed that cognitive behavioural therapy (CBT) was more successful than waiting-list control or active control as a treatment for older persons with anxiety disorders. In a direct comparison of the treatment of older persons with panic disorder (PD) both CBT an paroxetine were found to be more effective than waiting-list control. CBT was more successful in reducing avoidance behaviours in older persons with PD. Older persons with reported fewer and less severe agoraphobic cognitions than younger patients, but there was no difference between the severity of agoraphobic avoidance in older patients with PD and younger patients with PD., Conclusion: There is sufficient empirical evidence to support the effectiveness of CBT in the treatment of older persons with anxiety disorders. In assessing the severity of PD in the elderly, one should carefully consider the severity of avoidance behaviours. Because no difference was found between the effectiveness of CBT and paroxetine for the treatment of PD in the elderly and because was more effective in reducing avoidance behaviours in older patients with PD than in younger patients with pd, there seems to be a slight preference for CBT in the case of older patients with PD. Older age is not associated with a poorer outcome of treatment with CBT.

Background: Bipolar I disorder (bp i) is a very debilitating psychiatric disorder which is frequently associated with comorbid psychiatric and somatic disorders. Many studies in other countries show strongly elevated prevalences of anxiety disorders and alcohol-related disorders in the bp i population, but so far no data on this topic are available with regard to the Flemish population., Aim: To determine the prevalence of anxiety disorders and alcohol-related disorders in a Flemish population of bp i outpatients in remission and to find out whether comorbidity of these disorders is linked to the onset of the disorder at a younger age., Method: Sixty-nine bp i patients in remission were given structured interviews at home and the results were compared with the Belgian prevalence reported in the European Study of the Epidemiology of Mental Disorders (esemed) project. results Both the prevalence of the alcohol-related disorders (15 of 69 patients or 21.7%) and the prevalence of anxiety disorders (17 patients or 24.6%) were elevated compared to the general population (8.1 and 13.2% respectively). Among the anxiety disorders the prevalence was elevated for panic disorder, social phobia and post-traumatic stress disorder. No significant association was found between the comorbidity and the patient's age at the onset of the illness., Conclusion: The prevalence of anxiety disorders and alcohol-related disorders in an outpatient population of Flemish patients with bp i in remission is elevated.

Background: The relatively recent adoption of modern statistical analysis methods, such as latent growth modelling (lgm), makes it possible to study differences in the individual trajectories of development over time., Aim: To examine prospectively the developmental trajectories of anxiety disorder symptoms in a large sample of adolescents (N = 1,318) from the general population over a period of five years., Method: The adolescents were divided into two cohorts: early adolescents (average age 12 at the first measurement) and middle adolescents (average age 16 at the first measurement). Age and gender differences in the developmental trajectories of adolescent anxiety disorder symptoms over time were examined by means of lgm. results Over the course of five years there was a slight decrease in panic disorder, school anxiety and separation anxiety disorder symptoms for all adolescents, with the exception of social phobia symptoms, which remained fairly stable over time. Adolescent girls showed a slight increase in generalised anxiety disorder symptoms over time, whereas these symptoms decreased among adolescent boys., Conclusion: The use of individual trajectory-based analyses, enabled us to study advance our understanding of age and gender differences in the development of adolescent anxiety symptoms.

Many psychiatric disorders are a result of a disturbance in or exhaustion of the human stress response system. It is striking that many of these disorders such as depression, anxiety disorders and post-traumatic stress and somatoform and dissociative disorders are more prevalent in women. There are various explanations for this differing prevalence: it can be attributed to molecular, genetic, neurophysiological, relational and neurohormonal differences. Among the topics discussed are differences in exposure to chronic and traumatic stressors, the role of vasopressin and oxytocin in recovery and neurophysiological differences, the differentiating effect of hormones and neuropeptides such as oxytocin and vasopressin, the tend and befriend response and factors such as abuse and attachment disruption in early childhood.

Background: There is evidence that the post-treatment relapse rate for alcohol-dependent patients with a comorbid anxiety disorder is higher than for alcohol-dependent patients without this disorder. aim To discover whether the post-treatment relapse rate in alcohol-dependent patients who suffer from both alcohol-dependence and a comorbid anxiety disorder can be lowered by giving them additional treatment specifically for the comorbid anxiety disorder., Method: A 32-week randomised controlled trial among 96 abstinent patients with a primary diagnosis of alcohol dependence and a comorbid anxiety disorder involving agoraphobia or social phobia. The patients were randomly assigned either to an intensive psychosocial relapse-prevention programme only (n = 49) or to a combined programme in which the aforementioned programme was supplemented by an anxiety treatment programme comprising cognitive behavioural therapy and optional pharmacotherapy in the form of an SSRI (n = 47). The primary outcome measure was the percentage of patients who suffered an alcohol relapse during a 32-week period. The secondary outcome measures were: total abstinence, a reduction in the number of days of heavy drinking and a reduction in anxiety symptoms. results Although the anxiety symptoms in the group receiving cognitive behavioural therapy diminished more than in the group not receiving this therapy, the alcohol relapse rates in the former group were not significantly lower than in the latter group., Conclusion: Anxiety treatment for alcohol-dependent patients with a comorbid anxiety disorder can alleviate anxiety symptoms but has no significant effect on the outcome of alcohol treatment programmes.

Background: Despite growing interest in attention deficit and hyperactivity disorders (ADHD) in adults in Belgium, little is known about its prevalence in the Belgian general population., Aim: To estimate the prevalence of ADHD in adults (aged 18 to 44) in Belgium, to study its comorbidity with other mental disorders and its impact on daily living and to find out the extent to which professional help is sought., Method: A representative sample (n = 486) taken from the Belgian population was studied by means of an ADHD screening questionnaire which is included in the third version of the Composite International Diagnostic Interview., Results: The prevalence of ADHD in adults in the Belgian population was estimated to be 4.1%. The disorder started in early childhood (median age 7 years) and developed fastest between the ages of 7 and 9. ADHD was comorbid with anxiety disorders (adjusted odds ratio: 7.5; 95% ci: 1.2-45.2) and alcohol-related disorders (adjusted odds ratio: 7.6; 95% ci: 1.1-52.5), and results in a suboptimal daily functioning on about 7.7 days a month. Only one person in five had sought professional help in the 12 month period prior to the screening test., Conclusion: This is the first study to estimate the prevalence of ADHD in adults in Belgium. ADHD is a relatively frequent disorder that starts early in life, and has a considerable impact on the way in which an individual functions in daily life. In spite of this, few persons with this disorder seek professional help.

Background: Body dysmorphic disorder (BDD) is a somatoform disorder, characterized by a patient's preoccupation with the belief that some aspect of his/her physical appearance is abnormal. The prevalence of BDD in the general population is 0.7 - 1.7%. The prevalence of BDD in patients attending a Dutch general outpatient clinic has never been examined., Aim: Examine the prevalence of BDD in patients attending a Dutch general outpatient clinic., Method: All patients aged 18 to 65 who were referred between September 2003 and July 2007 to six general outpatients clinics for treatment of a depressive disorder, an anxiety disorder, or a somatoform disorder were assessed with the Mini International Neuropsychiatric Interview (mini). Patients with BDD were also assessed by means of the Body Dysmorphic Disorder - Yale- Brown Obsessive Compulsive Scale (BDD-YBOCS). results BDD was diagnosed in 45 out of 5848 patients (0.8% (0.6-1.0%)). The average age of these patients was 31.1. years and 69% were female. A comorbid depressive disorder was present in 35 patients (78%) and a comorbid anxiety disorder in 26 patients (58%). Of the anxiety disorders, social phobia was the most common, with a prevalence of 27%. The average score on the BDD-YBOCS was 22.5 points. The BDD-YBOCS score was significantly higher in patients with a comorbid obsessive-compulsive disorder (35.7 points; p = 0.01)., Conclusion: The prevalence of BDD in psychiatric outpatients who were referred for treatment of a depressive disorder, an anxiety disorder, or a somatoform disorder was 0.8%. There was a high comorbidity of BDD with depressive and anxiety disorders.

Fragile X syndrome is, after Down's syndrome, the most common form of mental retardation. Women are potential carriers and can have the defective gene on one of their two X chromosomes without developing the complete syndrome. In this paper we examine which psychiatric disturbances may appear or develop in women because they are carriers of the fragile X mutation. Carriers have been found to have a higher frequency of anxiety disorders, affective disorders and schizotypal features.

Objective: To quantify the prevalence of, and functional impairment associated with, somatoform disorders in general practice and their comorbidity with anxiety and depression., Design: Prevalence study., Method: In the first phase of a two-stage prevalence study from April 2000 up to December 2001, a questionnaire was completed by 1046 consecutive attendees at general practices, aged 25-79 years (n = 1778). This was followed in the second phase by a standardised diagnostic interview ('Schedules for clinical assessment in neuropsychiatry'; SCAN 2.1) in a stratified sample of 473 patients. In the analyses, the prevalence figures were estimated by weighting back to the original attending population., Results: The prevalence ofsomatoform disorders was 16% (95% CI: 12.8-19.4). Comorbidity of somatoform disorders and anxiety or depression disorders was 3.3 times more likely than would be expected by chance. Somatoform disorders as well as anxiety or depressive disorders were associated with substantial functional impairment. In patients with comorbid disorders, physical symptoms, depressive symptoms and functional limitations were proportionately increased., Conclusion: These findings underline the importance of a comprehensive diagnostic approach covering anxiety and depressive disorders as well as somatoform disorders in general practice.

Psychiatric disorders such as dementia and depression are highly prevalent in nursing homes. The prevalence of anxiety disorders is less clear. Prevalence, course and risk-indicators of anxiety disorders among nursing home residents were examined, based on a review of the literature. Medline and PsychINFO searches were conducted for 1966-2002. Twelve studies were considered relevant. These differed substantially with respect to study-population, diagnostic instruments and diagnostic criteria that were used and the specific anxiety disorders investigated. The prevalence of anxiety disorders ranged from 0-20%. Only in one study the course of anxiety disorders was investigated. About 60% of the nursing home residents recovered in one year. The most important risk-indicators for anxiety disorders identified were: female sex, depression, lack of social support, poor physical health and functional and cognitive impairments. Generalization of these results to the Dutch nursing home population is restricted by the substantial heterogeneity of the studies. Further studies are required to provide reliable estimates of prevalence, course and risk-indicators of anxiety disorders among nursing home residents using appropriate diagnostic instruments and adjusted diagnostic criteria. This will enhance detection and improve treatment of anxiety disorders among nursing home residents.

Objective: To determine the prevalence of psychiatric disorders in non-institutionalised Dutch adults., Design: Cross-sectional., Setting: Trimbos Institute, Utrecht, the Netherlands., Methods: A representative sample of 7076 adults (18-64 years) in the Netherlands' population were interviewed in 1996 to determine the prevalence of mental disorders ever, in the previous 12 months and in the previous month. Objectives and study design are described in the previous article (1997: 2448-52). The 'Composite international diagnostic interview' (CIDI) was used to assess the following mental disorders according to Diagnostic and statistical manual of mental disorders, 3rd revised edition (DSM-III-R): affective disorders, anxiety disorders, eating disorders, schizophrenia and other non-affective psychoses, substance dependence and substance abuse., Results: Mental disorders were common in the general population: the prevalence 'ever' of all disorders was 41.2%, the 12-month prevalence 23.5%, without sex differences. Depression, anxiety disorders and alcohol abuse and dependence showed high prevalence and comorbidity. The prevalence 'ever' of schizophrenia and other non-affective psychoses was low (0.4%).

In this study we estimated the prevalence of dementia, affective and anxiety disorders among residents of homes for the elderly in Amsterdam. Of a sample of 3.828 residents, 954 persons were interviewed with the Mini-Mental State Examination (MMSE) and the Center for Epidemiologic Studies Depression Scale; 324 were additionally interviewed with the Diagnostic Interview Scheme (DIS). The prevalence of dementia and of affective- and anxiety disorders is estimated to be 12.0% and 16.8%, respectively. These estimates, however, should be interpreted with caution. Analyses of the non-response group showed that about one-fourth of those who did not or could not participate in the study showed signs of dementia or other psychiatric problems. Although mental health care in homes for the elderly is underdeveloped, it should be an integral part of its health care delivery.

In the present study, 192 extremely anxious dental patients were asked for the factors which may have influenced their dental anxiety. The results showed that a traumatic dental experience, personality and professional behaviour of the dentist, persons in the direct environment, and psychological background all played an important role. Almost all extremely anxious dental patients had more than one negative experience with the dental treatment. Most patients acquired their anxiety at an early age.