R. Lieb, Agnes Nocon, T. Brückl, K. Beesdo, P. Zimmermann, H.-U. Wittchen, M. Pfister, M. Höfler
Differential familial liability of panic disorder and agoraphobia
Depression and Anxiety, vol. 25, no. 5, pp. 422-434
To examine the familial liability of panic disorder (PD) and agoraphobia (AG) in a community sample, namely the effect of parental PD and AG on the offspring's risk to develop either or both conditions in adolescence or adulthood. A representative community sample of N=3,021 adolescents and young adults aged 14-24 years at baseline was followed up over a period of 10 years in up to four waves. Family information was assessed by either direct interviews with at least one parent or by using subjects' family history information at either wave (N=3,014). Diagnoses and selected symptoms were assessed in both, parents and subjects, by using a standardized diagnostic interview (DSM-IV M-CIDI) with its respective family history module. (1) Parental panic attacks (PA), PD, and AG were all shown to be associated with an increased risk of offspring to also develop PA, PD, and AG. (2) Associations of parental PD were present irrespective of parental AG, whereas parental AG without PD was not associated with an increased offspring risk. (3) Outcome risk was particularly elevated in offspring of parents with PD+AG. (4) Parental PD or AG was not associated with an earlier age of onset of any syndrome in the offspring. We confirmed and expanded previous results from clinical samples that comorbid PD and AG aggregate in families. AG without PD is not familial, but it might enhance the familial transmission of PD.
R. Lieb, Agnes Nocon, T. Brückl, P. Zimmermann, H.-U. Wittchen
Specific vulnerability and risk factors for the onset of panic disorder, agoraphobia and other phobias
[Congress Abstract; 25th Symposium of the AGNP; Munich; October, 3-6, 2007]
Pharmacopsychiatry, vol. 40, no. 5
Background: On the background of the ongoing debate whether agoraphobia is a conditioned reaction to biologically elicited panic attacks as proposed by Donald Klein, or whether agoraphobia is accompanied by panic attacks just like other phobias as suggested by Isaac Marks, we aim to study the common and the specific nature of vulnerability/risk factors of panic disorder [PD], agoraphobia [AG], social [SOC] and specific phobia [SPE]. Method: Analyses are based on 3021 participants from a 10-year prospective-longitudinal community survey (14-24 years old at baseline). Lifetime DSM-IV diagnoses and syndromes were assessed via standardized M-CIDI interview. Vulnerabilities in three domains (socio-demographic, family and behavioral-emotional) were assessed. Results: (1) Subjects with PD, SOC and SP were at higher risk for AG, and subjects with AG and SP were at higher risk for panic attacks/disorder. 2) All syndromes were associated with behavioral inhibition (fear). 3) Only phobias, but not PD, were associated with temperament (harm avoidance), behavioral inhibition (social), gender, parental mood disorder, and separation from parents. 4) Parenting style (rejection) was associated to SOC and SP, but not to AG or PD. Discussion: There is some evidence that phobias (particularly AG and SP) are similar with respect to anxiety comorbidity patterns and associations with socio-demographic, family and behavioral-emotional factors, and that these associations are not accounted for by anxiety comorbidity. Risk factors for PD might be rather unspecific and accounted for by comorbid phobias.
R. Lieb, Agnes Nocon, P. Zimmermann, H.-U. Wittchen, H. Pfister
Dependence symptoms in young cannabis users? A prospective epidemiological study
Journal of Psychiatric Research, vol. 40, no. 5, pp. 394-403
To examine prospectively over a period of 4 years the profile of cannabis dependence and the risk of specific dependence criteria in a community sample of adolescents.
A representative community sample of 2446 young adults aged 14-24 years at baseline was followed up over a period of 4 years. Frequency of use measures and of criteria for DSM-IV dependence were assessed by standardized diagnostic interview measures (CIDI). To explore the nature of this association, frequency of use and concomitant use of other psychoactive substances was considered.
30% of the sample were cannabis users. Among all users 35% met at least one dependence criterion. Most frequently reported dependence criteria among all users were withdrawal (17%), tolerance (15%), loss of control (14%) and continued use despite a health problem (13%). Even without concomitant use of other illicit drugs, 22% of low frequency users and 81% of high frequency users met at least one dependence criterion. Symptom patterns were similar in high and low frequency users. The occurrence of a dependence syndrome or of specific dependence criteria could not be attributed to the use of other illicit drugs or to comorbid nicotine and alcohol dependence.
Regular cannabis use in adolescence is associated with the development of a dependence syndrome. This association cannot be explained by the concomitant use of other illicit substances or by comorbid nicotine and alcohol dependence.
M. Torrens, Agnes Nocon, F. Fonseca, D. Bergé, G. Mateu
Edad de inicio en el consumo de sustancias y gravedad clínica de la drogodependencia [Age of onset of substance use and clinical severity]
Revista de Psiquiatría de la Facultad de Medicina de Barcelona, vol. 32, no. 4, pp. 166-172
The aim of this study is to confirm the hypothesis of more
psychiatric and somatic (HIV, HCV) comorbidity, more
psycho-social severity and worst global functioning in
patients with early-onset of illicit substance use (before
18 years old), in an inpatient detoxification unit. All ca-
ses admitted to a detoxification unit during a 20 years
study period (n=2883) were studied prospectively,
comparing those patients with an onset of substance use
before 18 years old (early-onset) with the rest of the
patients, considering socio-demographic and substance
use characteristics, psychiatric comorbidity, somatic
complications (HCV, HIV), psycho-social severity and glo-
bal functioning and outcome characteristics. Early-onset
substance users (EOSU) had more number of substance
use disorders, more frequently presented opioids,
cannabis and sedatives related disorders and presented
more Axis II comorbidity, concretely antisocial and
borderline PD diagnostics. EOSU had also more HIV and
HCV infection, more previous overdoses, more arrests
and imprisonments, a lower score in GAF Scale, and
were more frequently unemployed in comparison to late-
onset substance users.
F. Waszak, R. Lieb, Agnes Nocon, P. Zimmermann, H.-U. Wittchen, M. Höfler
Pathways into ecstasy use: Impact of cannabis on availability and first use of ecstasy
Drug and Alcohol Dependence, vol. 79, no. 3, pp. 331-341
To explore the role of cannabis use for the availability of ecstasy as a potential pathway to subsequent first ecstasy use.
Baseline and 4-year follow-up data from a prospective-longitudinal community study of originally 3021 adolescents and young adults aged 14-24 years at baseline were assessed using the standardized M-CIDI and DSM-IV criteria.
Baseline cannabis users reported at follow-up more frequent access to ecstasy than cannabis non-users. Higher cannabis use frequencies were associated with increased ecstasy availability reports. Logistic regression analyses revealed that cannabis use and availability of ecstasy at baseline are predictors for incident ecstasy use during the follow-up period. Testing simultaneously the impact of prior cannabis use and ecstasy availability including potential confounders, the association with cannabis use and later ecstasy use was confirmed (OR=6.3; 95%CI=3.6-10.9). However, the association with ecstasy availability was no longer significant (OR=1.2; 95%CI=0.3-3.9).
Results suggest that cannabis use is a powerful risk factor for subsequent first onset of ecstasy use and this relation cannot be sufficiently explained by availability of ecstasy in the observation period.
Beitrag (Sammelband oder Tagungsband)
Agnes Nocon, H.-U. Wittchen
Kann man von Cannabis eigentlich abhängig werden?
22. Symposium Klinische Psychologie und Psychotherapie, Fachgruppe Klinische Psychologie und Psychotherapie der DGPs (20.-22. Mai 2004; Halle/Saale), Lengerich; Berlin; Bremen; Miami; Riga; Viernheim; Wien; Zagreb
R. Lieb, Agnes Nocon, P. Zimmermann, G. Bühringer, H.-U. Wittchen, A. Perkonigg, B. Spiegel, A. Settele
Grundlagen und Forschungsstrategien regionaler Bedarfs- und Allokationsprozesse am Beispiel des ASAT-F1-Projektes
Suchtmedizin, vol. 6, no. 1, pp. 14-21