Separation anxiety disorder, perceived overprotection and quality of life in epilepsy patients.

OBJECTIVE: People with epilepsy suffer from the stress of living with a chronic, unpredictable disease that can lead to discrimination, misunderstanding, social stigma, and loss of autonomy in activities of daily life, elevating anxiety. Within the scope of this research, we aimed to elucidate the frequency of separation anxiety disorder in adult people with epilepsy and to examine the relationship between separation anxiety symptoms, perceived overprotection, and quality of life in comparison to the control group. MATERIAL AND METHODS: This prospective study was conducted with 105 people with epilepsy and 115 healthy volunteers. All participants were evaluated by a psychiatrist in this study using a DSM-5-based clinical interview. Sociodemographic Data Questionnaire, Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), Separation Anxiety Symptom Inventory (SASI), Adult Separation Anxiety Questionnaire (ASA-27), Beck Depression Inventory (BDI) were administered to both groups, and Overprotection Scale, Quality of Life in Epilepsy Inventory (QOLIE-31) to only epilepsy group. Hierarchical regression analysis was used to explain the quality of life in epilepsy. Multivariate linear regression analysis was used to explain separation anxiety symptom scores. RESULTS: The rates of education, employment, and living alone were lower in the epilepsy group (p < 0.001, p < 0.001 and p < 0.001). Separation anxiety disorder of adulthood and other psychiatric comorbidities were significantly higher in the epilepsy group (p = 0.029 and p = 0.003). There was a significant negative correlation between the quality of life in epilepsy and separation anxiety symptom level, overprotection, and depression scores (p < 0.001, p = 0.01 and p < 0.01). In the logistic regression analysis, adult separation anxiety symptom level and depression scores were found to be independent factors for quality of life in epilepsy (p = 0.029 and p < 0.01). In patients with epilepsy, depression and quality of life scores were predictors for adult separation anxiety symptoms severity (p = 0.02 and p = 0.01). CONCLUSION: The frequency of diagnosis of separation anxiety disorder in adulthood was significantly higher in people with epilepsy. Overprotective attitudes of families and low quality of life were associated with high levels of separation anxiety.

Family Accommodation and Separation Anxiety: The Moderating Role of Child Attachment.

Family accommodation, or changes in parental behavior aimed at avoiding or alleviating child anxiety-related distress, contributes to the severity of anxiety symptoms, and is most strongly associated with separation anxiety. This study examined whether child attachment security, characterized as the degree to which children perceive their parents to be reliable, available, and communicative, moderates the association between family accommodation and separation anxiety symptoms, and whether this moderation is specific to separation anxiety among other anxiety symptoms. In a sample of clinically anxious children (N = 243, 6-12 years), family accommodation was significantly positively associated with separation anxiety symptoms across levels of attachment security. Family accommodation was more strongly associated with parent-reported separation anxiety symptoms in children with lower attachment security compared with those with higher attachment security. No significant moderation effect emerged for other anxiety symptoms. Findings enhance understanding of the role of attachment within family accommodation of child anxiety.

Separation-related Problems and Their Interaction with Physical Disease.

The condition of separation-related problems (SRPs) is common in companion dogs and clinicians should be comfortable diagnosing it. There are numerous diagnoses related to physical disease that have clinical signs similar to SRP, that exacerbate SRP, or may cause regression in treatment of SRP. Common examples include conditions affecting the following systems: musculoskeletal, neurologic, gastrointestinal, and dermatologic. Therefore, it is important for clinicians to rule out causes of physical disease and address them accordingly. The signalment of the patient, medications they are receiving, and other behavioral comorbidities should also be considered.

How is the loss of a parent in youth related to attachment and adult separation anxiety among women?

This study aimed to examine attachment and adult separation anxiety (ASA) among women who lost a parent in their youth. We hypothesized that insecure attachment and increased ASA from a romantic partner would be found among women who have lost a parent in youth, compared to women whose parents were both alive. Sixty women who lost one or both parents in their youth and 60 who had living parents participated in the study (mean age: 32.3, range: 18-62 years). Participants filled out the ASA and Short Attachment questionnaires. Women who lost a parent reported higher levels of anxious attachment and ASA from partner; the two groups did not differ, however, in terms of avoidant attachment. Additionally, similar effects on ASA and attachment were found among adult women who lost a father or a mother in their youth. In conclusion, the loss of a parent early in life may be associated with an insecure attachment style and increased ASA.

Family Accommodation and Separation Anxiety: The Moderating Role of Child Attachment.

Family accommodation, or changes in parental behavior aimed at avoiding or alleviating child anxiety-related distress, contributes to the severity of anxiety symptoms, and is most strongly associated with separation anxiety symptoms. This study examined whether child attachment security, characterized as the degree to which children perceive their parents to be reliable, available, and communicative, moderates the association between family accommodation and separation anxiety symptoms, and whether this moderator is specific to separation anxiety among other anxiety symptoms. In a sample of clinically anxious youth (N = 243, 6-12 yrs), family accommodation was significantly positively associated with separation anxiety symptoms across levels of attachment security. Family accommodation was more strongly associated with separation anxiety symptoms in children with lower attachment security compared with those with higher attachment security. No significant moderation effect emerged for other anxiety symptoms. Findings enhance understanding of the role of attachment within family accommodation of child anxiety.

Adult Separation Anxiety and Childhood Traumas: The Mediating Role of Cognitive Distortions.

While there are many studies on the relationship between anxiety disorders and childhood traumas in the literature, there are limited studies on the relationship between separation anxiety disorders and traumatic experiences in early life. It is widely known that trauma and negative cognitive processes are important factors in the etiology and prognosis of psychiatric disorders. In this study, it was aimed to determine the relationship between adult separation anxiety levels and childhood traumas and cognitive distortions, and to examine the mediating role of cognitive distortions in the relationship between childhood traumas and separation anxiety. A total of 366 students attending a private university were included in the study. The scales, which were converted into online questionnaires by the researchers, were sent to the students via e-mail, and were administered online. The participants were evaluated using "Adult Separation Anxiety Questionnaire", "Childhood Trauma Questionnaire", and "Cognitive Distortions Scale". The results of the study indicated that there was a positive and significant relationship between adult separation anxiety levels and childhood sexual abuse while there was no statistically significant correlation between adult separation anxiety levels and physical and emotional abuse, or physical and emotional neglect. A positive and significant relationship was found between separation anxiety levels and the sub-dimensions of cognitive distortions' self-image, self-blame, helplessness, hopelessness, and preoccupation with danger. In addition, it was determined that the helplessness and preoccupation with danger sub-dimensions of cognitive distortions had a full mediator effect on the relationship between sexual abuse and separation anxiety. Our results show that there is a positive relationship between separation anxiety disorder and childhood sexual abuse, and cognitive distortions play a mediating role between both variables.

Measures of Anxiety Disorder Symptoms in Adolescents.

This study examines select psychometric properties (i.e., internal reliability, and factorial, convergent, discriminant, and criterion validity) of three commonly-used measures of anxiety disorder symptoms in adolescents in the context of multi-trait, multi-method matrix analyses. A sample of 331 adolescents (age M = 17.1; 75.3% white; 71.0% female) completed three self-report scales that assess symptoms of separation anxiety, social anxiety, panic, and generalized anxiety, as well as measures of depression, experiential avoidance, and intolerance of uncertainty. Measures of panic disorder symptoms showed poor factorial, convergent, and discriminant validity. A multi-trait, multi-method matrix model to understand the relationships among the measures of separation anxiety, social anxiety, and generalized anxiety symptoms provided a reasonable fit to the data. Measures of separation anxiety showed poor discriminant and criterion validity, suggesting limited relevance of separation anxiety in this adolescent sample. Measures of social anxiety generally showed evidence of adequate-to-good factorial, convergent, and discriminant validity. Measures of generalized anxiety showed adequate -to-good factorial and convergent validity, and poor-to-adequate discriminant validity. The associations of measures of social and generalized anxiety with measures of depression, experiential avoidance, and intolerance of uncertainty were at least partially independent of method variance. The findings of this study add to the growing literature that evaluates the strengths and limitations of these scales for clinical practice and research.

Age regression in the treatment of needle phobia: a case report.

Trypanophobia (needle phobia) frequently occurs because of negative encounters with medical procedures and/or needles. Trypanophobia ranges in severity from causing mild anxiety, including apprehension about medical procedures, to severe anxiety and complete avoidance of medical care. In this case report, we describe a 29-year-old who underwent hypnosis-facilitated age regression therapy to improve his trypanophobia. Through the guidance of his subconscious, he realized his reaction to needles may not have been directly related to a difficult medical procedure he had undergone at the age of two. The patient's subconscious turned his attention to the anxiety he felt from being separated from his mother at the time of the procedure.

Oxytocin Levels in Children with Separation Anxiety and Their Mothers before and after Treatment.

Objective: The purpose of this study was to compare the plasma oxytocin levels of children with separation anxiety disorder (SAD) and their mothers with those of healthy controls and to examine the relationship between oxytocin levels and changes in anxiety three months after treatment. Methods: Thirty children aged 6-12 years with SAD, 30 healthy children, and mothers of both groups were included in the study. All cases were evaluated with semi-structured interview and Clinical Global Impression Scale. All cases and mothers of both groups filled out scales to determine various psychological variables (anxiety, depression, and attachment). The patient group children were re-evaluated with their mothers after three months, following treatment. Plasma oxytocin levels were evaluated from both groups and their mothers before and after treatment. Results: The plasma oxytocin levels of mothers of children with SAD were significantly lower than those of the controls and increased significantly three months after their children were treated. No difference was found between the plasma oxytocin levels of children with SAD and the control group, and these children's levels decreased significantly after treatment. A positive correlation was found between changes in the plasma oxytocin levels of children with SAD and the change in anxiety scores. Conclusion: Our results show that the change in plasma oxytocin levels in both children and mothers after treatment suggests that oxytocin may be important in the etiology of SAD.

Maternal Labor Force Participation During the Child's First Year and Later Separation Anxiety Symptoms.

Separation anxiety symptoms are frequent among preschool-aged children, but it is also a possible gateway for diagnosis of separation anxiety disorder. Early maternal employment after childbirth can increase the risk for the development of separation anxiety symptoms. From an economic perspective, however, securing employment is one effective strategy to ensure child well-being. This study investigated how mothers' participation in the labor force (vs. maternal leave) and the financial state of families when the child was 5 months old was prospectively associated with separation anxiety symptoms. This study is based on 1,295 Canadian families with children assessed longitudinally from 17 months to age 6 on their levels of separation anxiety. Separation anxiety was measured during face-to-face interviews with the mothers. Maternal labor force participation, financial status, and risk factors were measured at 5 months. Results adjusted for propensity scores and for sample weight revealed that children of working mothers, despite having sufficient income (n = 245, 18.9%), were at higher risk of separation anxiety during early childhood. In contrast, maternity leave was most beneficial for children's separation anxiety, whether they were in a family with sufficient income (n = 950, 73.4%) or temporary low income (n = 100, 7.7%). Children of mothers in maternity leave were at risk of heightened separation anxiety only if they experienced chronic economic hardship. Therefore, maternity leave uptake could help prevent the development of separation anxiety. Providing families with opportunity to care for the baby as their main occupation during this sensitive developmental period could help improve children's mental health.

Differential effects of generalized anxiety and separation anxiety on brain structural development during adolescence.

Excessive anxiety is highly prevalent during childhood and adolescence, with detrimental effects on somatic and mental health, and quality of life. Although structural abnormalities in the brain have been found in people with anxiety disorders, whether anxiety affects the brain development of children and adolescents remains unknown. Here, we applied a multivariate approach to two single-site MRI datasets consisting of 733 and 775 participants aged 5-18 years. Using linear support vector regression and cross-validation, brain age is estimated by predicting the chronological age from the features that combine cortical thickness and surface area of 68 brain regions. We found that gray matter can predict the chronological age of children and adolescents with a low mean absolute error. Compared to specific brain network, the whole structural brain measures predicted brain age better. Importantly, adolescents with higher generalized anxiety and those with lower separation anxiety showed lower brain age, indicating a slow development of brain structures. The relationship between anxiety and brain age of youths could also be found in parent-reported separation anxiety. The findings highlight differential effects of different anxiety types on brain structural development and suggest that different types of anxiety during childhood and adolescence should be treated differently.

Hematohidrosis induced by separation anxiety disorder during COVID-19 quarantine: a case report and brief literature review.

Here, we report a case involving a 10-year-old Vietnamese girl who developed hematohidrosis during the coronavirus disease quarantine. She was hospitalized with a 3-week recurrent bleeding on the abdominal skin. Physical examination revealed no signs of injuries on the skin. Hematological and biochemical test results and coagulation profiles were all within normal ranges. No abnormal findings were observed on abdominal ultrasonography and computed tomography. Numerous erythrocytes were observed during the microscopic examination of fluid samples from the abdominal skin. It was speculated that hematohidrosis was precipitated by separation anxiety disorder, because the onset and remission of symptoms correlated with the beginning and end of the local quarantine, respectively. Our case report and brief literature review highlight the transient and benign nature of hematohidrosis. Although specific guidelines are not well established, hematohidrosis is a transient phenomenon that is treatable with pharmaceutical and non-pharmaceutical interventions, and its overall prognosis is favorable.

Comparison of intranasal dexmedetomidine-midazolam, dexmedetomidine-ketamine, and midazolam-ketamine for premedication in paediatric patients: a double-blinded randomized trial.

BACKGROUND: Paediatric patients are a population with a high level of anxiety. The prevention of perioperative stress in a frightened child is important to render the child calm and cooperative for smoother induction. Intranasal premedication is easy and safe, and the drug is rapidly absorbed into the systemic circulation, ensuring early onset of sedation in children and good effectiveness. METHODS: 150 patients in the age group 2-4 years, ASA class I, undergoing elective surgical procedures were enrolled. The patients were randomly divided into 3 groups: a DM group (receiving intranasal dexmedetomidine 1 µg kg -1 and midazolam 0.12 mg kg -1 ), a DK group (receiving intranasal dexmedetomidine 1 µg kg -1 and keta-mine 2 mg kg -1 ), and an MK group (receiving intranasal midazolam 0.12 mg kg -1 and ketamine 2 mg kg -1 ). After 30 minutes of administration of the drugs, the patients were assessed for parent separation anxiety, sedation, ease of IV cannulation, and mask acceptance. RESULTS: The comparison among the 3 groups showed a statistically significant difference for ease of IV cannulation and mask acceptance at 30 minutes, with a P -value of 0.010 with CI of 0.0-0.02, and P -value 0.007 with CI 0.0-0.02, respectively. The parent separation anxiety and sedation score at 30 minutes was statistically insignificant with a P -value of 0.82 with CI of 0.03-0.14 and P -value 0.631 with CI of 0.38-0.58, respectively. CONCLUSIONS: The combination of midazolam and ketamine had a better clinical profile for premedication as compared to other combination drugs used in our study in terms of IV cannulation and acceptance of masks with a comparable decrease in separation anxiety from parents and adequate sedation.

Separation Anxiety among Kindergarten Children and its Association with Parental Socialization.

The present study aimed at investigating the association between separation anxiety and parental socialization styles among a sample of kindergarten children in Amman city, Jordan. The study adopted the descriptive cross-sectional design. A sample of 300 kindergarten children were enrolled in this study. The researcher used a modified version of the separation anxiety scale in addition to the parental socialization styles scale. Data were analyzed using the Statistical Package of Social Sciences (SPSS) (v. 27, IBM Corp.). The results of the study showed that 8% (n=24) of the enrolled participants had a high level of separation anxiety, normality parenting style was adopted by 38.7% (n=116). The results showed that there was significant statistical association between separation anxiety and cruelty parenting style (r=0.465, p=0.003), overprotection parenting style (r=0.301, p=0.000), negligence parenting style (p=0.641, p=0.04), and normality (r=0.09, p=0.000). The results showed that separation anxiety is significantly associated with parental socialization styles in general (r=0.326, p=0.007).

A Comparison of the Anti-Anxiety Effects of Oral Ketamine and Fluvoxamine in Children with Separation Anxiety Disorder Manifesting as School Refusal.

Background: Children suffer from a high prevalence of anxiety problems that require prompt treatment. It has been demonstrated that ketamine offers rapid anti-anxiety effects. This study aimed to evaluate ketamine's anti-anxiety impact in the treatment of children with school-refusal separation anxiety disorder. Materials and Methods: In this open-labeled randomized clinical trial, 71 children (6-10 years) diagnosed with school refusal separation anxiety disorder were randomly assigned to two groups; a case group, who received ketamine at a weekly rising dose of 0.1 to 1 mg/kg; the control group treated with Fluvoxamine (25 mg/day), which could increase to 200 mg/day if necessary. The SCARED and CATS questionnaires were used to assess anxiety before treatment, at the 8th and 16th weeks of intervention. The data were analyzed using repeated-measures analysis of covariance. Results: The mean anxiety scores in the eighth week (19.7 ± 16.1) were significantly lower in the ketamine group than before (31.5 ± 10.8). Until the sixteenth week (19.4 ± 14.6), there was no further decrease in scores in the ketamine group, in the fluvoxamine group, pre-treatment scores (36.3 ± 16.5) and eighth week (36.9 ± 16.6) were not significantly different, but scores decreased significantly in a sixteenth week (26.2 ± 12.5). Conclusion: In first eight weeks of treatment, ketamine was more successful than fluvoxamine at reducing anxiety disorder, considering the emergence of this disorder and the lack of major adverse effects of ketamine, it seems to be beneficial in early phases of treatment. Due to the quick onset of ketamine in future trials, their combination therapy is recommended during the initial weeks of treatment.

Estrogens, age, and, neonatal stress: panic disorders and novel views on the contribution of non-medullary structures to respiratory control and CO2 responses.

CO2 is a fundamental component of living matter. This chemical signal requires close monitoring to ensure proper match between metabolic production and elimination by lung ventilation. Besides ventilatory adjustments, CO2 can also trigger innate behavioral and physiological responses associated with fear and escape but the changes in brain CO2/pH required to induce ventilatory adjustments are generally lower than those evoking fear and escape. However, for patients suffering from panic disorder (PD), the thresholds for CO2-evoked hyperventilation, fear and escape are reduced and the magnitude of those reactions are excessive. To explain these clinical observations, Klein proposed the false suffocation alarm hypothesis which states that many spontaneous panics occur when the brain's suffocation monitor erroneously signals a lack of useful air, thereby maladaptively triggering an evolved suffocation alarm system. After 30 years of basic and clinical research, it is now well established that anomalies in respiratory control (including the CO2 sensing system) are key to PD. Here, we explore how a stress-related affective disorder such as PD can disrupt respiratory control. We discuss rodent models of PD as the concepts emerging from this research has influenced our comprehension of the CO2 chemosensitivity network, especially structure that are not located in the medulla, and how factors such as stress and biological sex modulate its functionality. Thus, elucidating why hormonal fluctuations can lead to excessive responsiveness to CO2 offers a unique opportunity to gain insights into the neuroendocrine mechanisms regulating this key aspect of respiratory control and the pathophysiology of respiratory manifestations of PD.

To Leave is to Die a Little: Assessing the Symptom Structure of Separation Anxiety Disorder in Left-Behind Emerging Adults.

The literature on separation anxiety disorder (SAD) presented two contentious issues relating to its assessment. First, studies are scarce in assessing the symptom structure of DSM-5 SAD among the adult population. Second, the accuracy in assessing the severity of SAD through measuring the intensity of disturbance and the frequency of occurrence of symptoms is yet to be studied. To address these limitations, the present study aimed to: (1) examine the latent factor structure of the newly developed separation anxiety disorder symptom severity inventory (SADSSI); (2) evaluate the necessity of using frequency or intensity formats through comparison of differences in the latent level; and (3) investigate SAD latent class analysis. Utilizing 425 left-behind emerging adults (LBA), the findings showed that a general factor with two dimensions (i.e., response formats) measuring frequency and intensity symptom severity separately has excellent fit and good reliability. Finally, the latent class analysis yielded a three-class solution best fitting to the data. Overall, the data provided evidence for the psychometric soundness of SADSSI as an assessment tool for separation anxiety symptoms among LBA.

The relationship of separation anxiety with the age of onset of panic disorder.

AIM: This study aimed to investigate whether separation anxiety (SA) constitutes a dimension related to age at onset of panic disorder (PD), in homogeneous subgroups of outpatients with PD, based on their age of onset and symptom severity. METHODS: A sample of 232 outpatients with PD was assessed with the Panic Disorder Severity Scale (PDSS) and the Sheehan Disability Scale (SDS) for functional impairments. Separation anxiety was evaluated using structured interviews and questionnaires. We applied a K-Means Cluster Analysis based on the standardized "PD age of onset" and "the PDSS total score" to identify distinct but homogeneous groups. RESULTS: We identified three groups of patients: group 1 ("PD early onset/severe", N = 97, 42%, onset 23.2 ± 6.7 years), group 2 ("PD early onset/not severe", N = 76, 33%, onset 23.4 ± 6.0 years) and group 3 ("PD adult onset/not severe", N = 59, 25%, onset 42.8 ± 7.0 years). Patients with early onset/severe PD had significantly higher scores on all SA measures than PD late-onset/not severe. Regression analyses showed that SA scores, but not PDSS scores, were predictive of impairment in SDS work/school, social life, and family functioning domains. CONCLUSIONS: Our data indicate a significant relationship between SA and PD with an earlier age of onset and an impact on individual functioning. This may have important implications for implementing preventive interventions targeting early risk factors for the subsequent onset of PD.

Changes in Dog Behaviour Associated with the COVID-19 Lockdown, Pre-Existing Separation-Related Problems and Alterations in Owner Behaviour.

During the COVID-19 pandemic, lockdowns provided an opportunity to assess what factors, including changes in an owner's routine and time spent at home, were associated with changes in dog behaviour. We undertook a longitudinal survey over a period of 8 months during which we asked about people's work patterns, dog management, and their dogs' behaviour. Generalized linear models revealed that the pre-existence of signs of potential separation-related problems, and especially vocalisation, self-injury, and chewing to escape confinement, was associated with an increase in a range of separation issues. Dogs showing separation-related signs prior to COVID were also more likely to develop more problems during lockdown. Management changes tended to result in increased physical and social stress, with a range of potential compensatory actions taken by the dog, however these signs of stress did not generally appear to be connected to separation-related issues. Survival analysis was used to investigate the emergence of specific issues over time. This indicated that a change to working from home was related initially to a decreased risk of aggression towards the owner, but over time, those who continued to work from the home were at an increased risk of this problem. No other significant time-related relationships were found.

Impact of Childhood Trauma and Adult Separation Anxiety Disorder on Quality of Life in Individuals with Schizophrenia.

Background: Childhood trauma and anxiety disorders are common in individuals with schizophrenia. This study aimed to investigate the effects of childhood trauma and adult separation anxiety disorder on the quality of life of individuals with schizophrenia. Methods: This cross-sectional study included 111 individuals with schizophrenia and 85 control subjects. The separation anxiety symptom inventory (SASI), adult separation anxiety questionnaire (ASAQ), Positive and Negative Syndrome Scale (PANSS), childhood trauma questionnaire (CTQ), and World Health Organization quality of life questionnaire (WHOQoL-BREF) were administered to the participants. Results: More individuals with schizophrenia than control subjects were unemployed and single (p<0.05). Individuals with schizophrenia scored significantly higher on the SASI, ASAQ, and CTQ (p<0.05), whereas the control subjects scored significantly higher on the WHOQoL-BREF (p<0.05). ASAQ scores had mild positive correlations with total PANSS and PANSS subscale scores, and moderate positive correlations with total CTQ, CTQ emotional subscale scores, and CTQ physical abuse subscale scores. A negative moderate correlation was found between ASAQ and total WHOQoL-BREF scores. Mediation analysis revealed that CTQ scores significantly affected total WHOQoL-BREF and ASAQ scores. The model pathway for ASAQ scores showed a significant direct and indirect effect of CTQ on the total WHOQoL-BREF scores. Conclusion: Childhood trauma predicts adult separation anxiety disorder, which partially mediates the impact of childhood trauma on quality of life in individuals with schizophrenia. Therapeutic interventions for adult separation anxiety disorder in individuals with schizophrenia and a history of childhood trauma may help increase their quality of life.