Background: Anxious-depressive attack (ADA) is a proposed novel symptom complex associated with anxiety and mood disorders. Its main features are (1) sudden intense distressing emotions with no direct psychological cause, (2) intrusive memories of various negative events, (3) worry and agitation about the details of the rumination and (4) various coping behaviors, including acting out. The author has reported five previous cases of ADA. The present study investigates the clinical significance of ADA.

Method: First, to compare clinical characteristics between subjects with and without ADA, 331 consecutive new outpatients were examined (Study I). Second, because of the similarities between ADA and panic attack, the characteristics of ADA were examined in 65 panic disorder (PD) patients (Study II).

Results: The overall incidence of ADA was 43.2%. In PD and social anxiety disorder patients, those exhibiting ADA were significantly younger and had significantly more severe depression and social anxiety than those without ADA (Study I). In PD patients with ADA, ADA preceded panic attacks, and ADA frequency was correlated with the severity of depression and social anxiety but not with panic symptoms (Study II). ADA was often managed with acting out behavior (Study II).

Conclusion: ADA appears to be relatively common among people with anxiety and mood disorders. We found that ADA was correlated with the severity of social anxiety, but not PD. PD patients exhibited a “seesaw” phenomenon between ADA and panic attacks. ADA may be a core symptom complex of a severe form of anxious depression.

A Japanese version of the self-rating format of the Panic and Agoraphobia Scale (PAS) was developed and its reliability and validity were investigated. Outpatients diagnosed with panic disorder or agoraphobia according to the DSM-IV-TR were assessed using both the clinician-administered version of the PAS and the self-rating format of the PAS on the first clinic visit, after 3 days, and after 4 weeks. We found that the self-rating PAS showed sufficient reliability, especially when untreated patients were educated about their disease before the treatment. However, the Pearson's coefficient of correlation between the self-rating PAS and the Global Impression-Improvement score was not highly significant as the correlation between the clinician-administered PAS and the Global Impression-Improvement score. Our results indicate that the clinician-administered PAS should be used as a primary test while the self-rating PAS should be used as a secondary test in clinical research.

The purpose of this study was to validate a model where cognitive fusion which refers to the tendency for verbal knowledge to dominate over other sources of stimulus control mediates negative appraisal for trauma and post-traumatic stress symptoms, and adversely affects post-traumatic stress symptoms. We distributed questionnaires measuring trauma experience, cognitive fusion (CFQ), cognitive appraisal for trauma (CARS) and post-traumatic stress symptoms (NAP), post-traumatic stress symptoms (IES-R) to 557 college students. As a result of conducting covariance structure analysis for 281 participants that had experienced trauma, adequate values of fitness for the assumed model were obtained. In other words, cognitive fusion has a positive effect on negative appraisal of trauma and post-traumatic stress symptoms, and this negative appraisal has been shown to have a positive effect on post-traumatic stress symptoms. In the future, verification of the effectiveness of intervention techniques using cognitive fusion and verification of the improvement process are expected.

Few studies have evaluated prefrontal cortex (PFC) activity using near-infrared spectroscopy (NIRS) during the performance of multiple neuropsychological tasks in patients with obsessive-compulsive disorder (OCD). The aims of the current study were 1) to examine the patterns of hemodynamic changes in PFC regions, as measured by NIRS, during various neuropsychological tasks in OCD patients and normal controls, and 2) to clarify the relationship between PFC activity and other comorbid symptoms. Fourteen patients with OCD diagnosed using DSM-5, and 16 age- and gender-matched healthy volunteers were enrolled in this study. Brain activity was measured using NIRS during the administration of several neuropsychological test batteries. We compared hemodynamic changes and psychometric and executive functioning test results between the groups. We also examined the relationships between the variables using structural equation modeling (SEM). The OCD group showed significantly lower activity in the dorso-lateral PFC (DLPFC) during the verbal fluency (VFT) and Tower of London (ToL) tasks. Hemodynamic changes in the left DLPFC during the VFT were negatively correlated with OCD severity. The findings analyzed using SEM indicated that brain activity observed in the specific regions had robust direct or indirect relationships with comorbid symptoms, such as depressive or anxiety status, in the OCD group. The current study supports the view that a variety of psychopathological features observed in OCD patients might be explained by abnormal brain activity in the PFC, particularly in the left DLPFC.

Many treatment strategies including neuromodulation have been proposed for obsessive–compulsive disorder (OCD) patients who do not respond to conventional pharmacotherapy and behavioral therapy. Neuromodulation that could be effective for OCD includes deep brain stimulation (DBS), electroconvulsive therapy (ECT), transcranial direct current stimulation (tDCS), and repetitive transcranial magnetic stimulation (rTMS). Invasiveness, target brain regions, efficacy and adverse events of each treatment were reviewed in this article. DBS could be effective for half of patients with severe and refractory OCD, while it is invasive therapy. ECT will bring some sort of good effect for 60% of patients with OCD, while there is no randomized controlled study so far. tDCS is non-invasive neuromodulation, but the number of clinical trials is low. Finally, rTMS have been well investigated and some meta-analyses showed its efficacy, but the optimal setting is still unknown. As there are advantages and disadvantages for each treatment, further research is needed.

This article reviewed current research trends of cognitive behavior therapy (CBT) for pediatric anxiety disorders and described practical studies of the CBT program for Japanese children and adolescents. In Japan, pediatric anxiety disorders tend to be underestimated and unidentified. As a result of the review of treatment studies in Western countries, CBT is designated as a first-line psychosocial treatment for anxiety in children and adolescents. In line with evidence, the Japanese CBT program has been developed based on the previous studies. Furthermore, two clinical trials adopted the program supported efficacy of CBT for Japanese children and adolescents with anxiety disorders. Finally, future directions of CBT for pediatric anxiety disorders in Japan were discussed.