Background and Objectives: Psychological studies in posttraumatic stress disorder (PTSD) have implicated negative appraisal in its development and maintenance. However, whether or not the same results apply in the Japanese population is unclear. We examined here the predictive value of negative appraisal after a traumatic event for subsequent severity of PTSD symptoms in Japan. Methods: We examined whether negative appraisal in the early posttraumatic phase predicts the development of PTSD in a cohort of motor vehicle accident (MVA) survivors (n=88). Negative appraisal at 1 month post-MVA was assessed using the Posttraumatic Cognitions Inventory, and PTSD diagnosis was evaluated at 6 months post-MVA using the Clinician Administered PTSD Scale. PTSD symptoms at 6 months post-MVA was used as the dependent variable in logistic regression analysis. Results: After controlling for confounding variables, multiple logistic regression analysis showed that negative appraisal at 1 month post-MVA was a predictor of PTSD symptoms at 6 months post-MVA (odds ratio, 1.48; 95% confidence interval, 1.09–1.99; p=.011). Conclusion: This finding suggests that negative appraisal in the early posttraumatic phase is a risk factor for PTSD following MVA. As negative appraisal following a traumatic experience is reversible, modifying negative appraisal early may prevent chronic and persistent PTSD.

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The purpose of the present study was to compare posttraumatic stress reactions, physical symptoms, and depressive symptoms of victims of lethal trauma to those of non-lethal trauma. Participants were 598 college students. Physical Symptoms Scale, Anxiety Sensitivity Index (ASI), Beck Depression Inventory-II (BDI-II), Event Check List (ECL), and the Impact of Event Scale Revised (IES-R) were administered. No significant difference in posttraumatic stress reaction was found between lethal trauma group and non-lethal trauma group. However, all of posttraumatic stress reaction, physical symptoms, and depressive symptoms had effects on anxiety sensitivity. In conclusion, in order to reduce posttraumatic stress reactions, it seems critical to evaluate a wide range of posttraumatic stress reactions, including physical symptoms, depressive symptoms, and anxiety sensitivity, in addition to the lethality of trauma.

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An overview of anxiety disorders in the recent literature was conducted. Anxiety disorders tend to be comorbid with other anxiety disorders and also with mood disorders. Environmental factors have more effect than genetic ones do, regarding the pathogenesis of anxiety disorders. It is argued that the hyperactivity of the amygdala and hypofrontality, especially in the ventromedial prefrontal cortex, were important mechanism in the occurrence of anxiety disorders. Meta-analyses of the effects of pharmacotherapy and cognitive behavior therapy were shown. Regarding psychopharmacology for anxiety disorders, neurotransmitter inputs and outputs of the amygdala were sketched. A dopamine hypothesis for anxiety disorder was proposed. In connection with the hypothesis, the merits of using serotonin/dopamine antagonists for anxiety disorders were emphasized. A lot of the literature showed that anxiety disorders have a chronic and recurrent nature, and comorbidity with depression makes them intractable.

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Association of pathophysiology of panic disorder has been suggested with functional and structural abnormalities in various brain regions, especially amygdala. These regions also include limbic structures (i.e., cingulate gyrus, hippocampus, insula), frontal regions (i.e., medial frontal region, orbitofrontal cortex), thalamus, hypothalamus, and brain stem. Structural magnetic resonance imaging studies have shown gray matter volume changes in these brain regions, reductions in the fronto-limbic regions and increases in the brain stem, in the patients with panic disorder compared to healthy control subjects. These volume changes were also reported to be associated with clinical measurements, such as severities of panic symptoms and anxiety, in the patient group. However, these studies have uncovered significant volume changes in other gray matter regions including superior temporal gyrus and cerebellum in the patients with panic disorder. In addition, symptomatic and epidemiological gender differences have been observed in panic disorder. Recent structural neuroimaging studies have also provided pathological evidences for these gender differences in the panic disorder. We have, here, reviewed recent studies that found structural changes in the brain of the panic disorder.

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