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Brain and Behavior Jan 2024The existing literature on the association between brain-derived neurotrophic factor (BDNF) protein levels and panic disorder presents inconsistent findings. This... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The existing literature on the association between brain-derived neurotrophic factor (BDNF) protein levels and panic disorder presents inconsistent findings. This systematic review and meta-analysis aim to synthesize the available evidence and determine the overall effect of BDNF protein levels in individuals diagnosed with panic disorder.
METHODS
A comprehensive literature search was conducted using electronic databases (PubMed, Embase, Scopus, PsycINFO, and Web of Science) from inception to April 21, 2023. The search strategy included relevant keywords and medical subject headings terms related to BDNF, panic disorder, and protein levels. A random-effects model was used for the meta-analysis, and subgroup analyses were performed to explore heterogeneity. Publication bias was assessed using funnel plots and statistical tests.
RESULTS
A total of 12 studies met the inclusion criteria. The meta-analysis demonstrated a significant decrease in BDNF protein levels in individuals with panic disorder (SMD = -.53, 95% CI: -1.02 to -.04, p < .001; I : 92%). The results of subgroup and meta-regression analyses were not statistically significant. No significant publication bias was observed based on the results of Egger's regression test (p-value = .3550).
CONCLUSION
This systematic review and meta-analysis provide evidence of lower BDNF protein levels in individuals diagnosed with panic disorder compared to healthy controls. The findings suggest a potential role for BDNF dysregulation in the pathophysiology of panic disorder. Further research is warranted to elucidate the underlying mechanisms and potential therapeutic implications.
Topics: Humans; Panic Disorder; Brain-Derived Neurotrophic Factor; Regression Analysis
PubMed: 38376041
DOI: 10.1002/brb3.3349 -
BMC Family Practice Jun 2016Studies evaluating collaborative care for anxiety disorders are recently emerging. A systematic review and meta-analysis to estimate the effect of collaborative care for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Studies evaluating collaborative care for anxiety disorders are recently emerging. A systematic review and meta-analysis to estimate the effect of collaborative care for adult patients with anxiety disorders in primary care is therefore warranted.
METHODS
A literature search was performed.
DATA SOURCES
PubMed, Psycinfo, Embase, Cinahl, and the Cochrane library.
STUDY ELIGIBILITY CRITERIA
Randomized controlled trials examining the effects of collaborative care for adult primary care patients with an anxiety disorder, compared to care as usual or another intervention. Synthesis methods: Standardized mean differences (SMD) on an anxiety scale closest to twelve months follow-up were calculated and pooled in a random effects meta-analysis.
RESULTS
Of the 3073 studies found, seven studies were included with a total of 2105 participants. Included studies were of moderate to high quality. Collaborative care was superior to care as usual, with a small effect size (SMD = 0.35 95 % CI 0.14-0.56) for all anxiety disorders combined and a moderate effect size (SMD = 0.59, 95 % CI 0.41-0.78) in a subgroup analysis (five studies) on patients with panic disorder.
CONCLUSIONS
Collaborative care seems to be a promising strategy for improving primary care for anxiety disorders, in particular panic disorder. However, the number of studies is still small and further research is needed to evaluate the effectiveness in other anxiety disorders.
Topics: Anxiety Disorders; Humans; Patient Care Management; Patient Care Team; Primary Health Care
PubMed: 27250527
DOI: 10.1186/s12875-016-0466-3 -
Journal of Affective Disorders Mar 2024Anxiety-related disorders feature elevated negative affect (NA), and in some cases, diminished positive affect (PA). It remains unclear how well extant psychotherapies... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Anxiety-related disorders feature elevated negative affect (NA), and in some cases, diminished positive affect (PA). It remains unclear how well extant psychotherapies for anxiety-related disorders improve PA versus NA.
METHODS
We systematically searched the Cochrane Central Register of Controlled Trials, PubMed, PsychInfo, and Web of Science databases. Records included studies involving (1) patients with a principal or co-principal diagnosis of at least one anxiety-related disorder (i.e., generalized anxiety, social anxiety, panic, agoraphobia, health anxiety, specific phobia, obsessive-compulsive disorder, or posttraumatic stress disorder), and (2) pre- and post-treatment PA and NA scores or a change index between pre- and post-treatment PA and NA scores. Effect sizes were calculated for meta-analyses.
RESULTS
Fourteen studies with 1001 adults with an anxiety-related disorder were included. Psychotherapeutic interventions included cognitive behavioral, present-centered, and imagery-based approaches. Treatments reduced NA (g = -0.90; 95%CI [-1.19, -0.61]) to a greater extent than they improved PA (g = 0.27; 95%CI [0.05, 0.59]), Z = -5.26, p < .001. The limited number of studies available precluded analyses of the relationship between changes in affect and symptoms.
LIMITATIONS
Results should be considered with caution given the small number and heterogeneity of included studies.
CONCLUSIONS
Current psychotherapeutic interventions for anxiety-related disorders may not improve PA and NA to comparable levels.
Topics: Adult; Humans; Anxiety Disorders; Phobic Disorders; Psychotherapy; Agoraphobia; Anxiety; Psychotropic Drugs
PubMed: 38211753
DOI: 10.1016/j.jad.2024.01.086 -
Neuropsychopharmacology Reports Sep 2023Previous behavioral pharmacology studies involving rodents suggested riluzole had potential to be an ideal psychotropic drug for psychiatric disorders with anxiety or... (Review)
Review
AIM
Previous behavioral pharmacology studies involving rodents suggested riluzole had potential to be an ideal psychotropic drug for psychiatric disorders with anxiety or fear as primary symptoms. Several clinical studies have recently been conducted. The purpose of this study was to gather information about the efficacy and tolerability of riluzole for patients with those symptoms.
METHODS
We searched PubMed, PsycINFO, CINAHL, EMBASE, and the Cochrane database from inception until April 2021, and performed manual searches for additional relevant articles. This review included: (1) studies involving participants that were patients with generalized anxiety disorder (GAD), social anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), acute stress disorder, or phobias; and (2) randomized controlled trials (RCTs) or intervention studies (e.g., single arm trials) examining the effects and safety of riluzole.
RESULTS
Of the 795 identified articles, four RCTs, one RCT subgroup-analysis, and three open-label trials without control groups met the inclusion criteria. Most trials evaluated the efficacy of riluzole as an augmentation therapy with selective serotonin reuptake inhibitors and other antidepressants for PTSD, OCD, or GAD. However, there was insufficient evidence to confirm the effects of riluzole for patients with these psychiatric disorders. Most trials demonstrated adequate study quality.
CONCLUSIONS
This review found insufficient evidence to confirm the effects of riluzole for psychiatric disorders with anxiety or fear as primary symptoms. It would be worthwhile to conduct studies that incorporate novel perspectives, such as examining the efficacy of riluzole as a concomitant medication for psychotherapy.
Topics: Humans; Riluzole; Anxiety Disorders; Anxiety; Obsessive-Compulsive Disorder; Fear
PubMed: 37463744
DOI: 10.1002/npr2.12364 -
International Journal of Preventive... 2021Over the last 20 years, internet-delivered cognitive behavior therapy (ICBT) has been tested in a large number of randomized controlled trials, often with positive... (Review)
Review
BACKGROUND
Over the last 20 years, internet-delivered cognitive behavior therapy (ICBT) has been tested in a large number of randomized controlled trials, often with positive results. However, it is not widely known about the efficacy of ICBT as compared to face-to-face cognitive behavior therapy (CBT).
METHODS
In the present systematic review and meta-analysis, ICBT for treatment of anxiety disorders was directly compared to face- to-face CBT within the same trial. This study aimed to reinvestigate the effect of ICBT compared to face-to-face CBT for anxiety disorders. A total of 8 studies out of the 236 articles screened met all the inclusion criteria. The included studies targeting five different anxiety disorders, social anxiety disorder, adolescent anxiety, panic disorder, spider phobia, and fear of public speaking, had been carried out in Australia, Spain, and Sweden. The total number of participants was 348 in ICBT and 316 in face-to-face conditions.
RESULTS
The results of our meta-analysis are interesting both from theoretical and practical standpoints, which showed a pooled effect size posttreatment with Hedges' = 0.01 (95% CI: -0.16 to 0.18).
CONCLUSIONS
ICBT and face-to-face CBT created equivalent overall effects. in treatment of anxiety disorders. Since there have been similar systematic reviews about anxiety disorders so far, and in majority of them, ICBT has not been compared against face-to-face treatment. More research is needed to establish the general equivalence of the two treatment formats. Also, understanding what makes ICBT work is a challenge for future research.
PubMed: 35070186
DOI: 10.4103/ijpvm.ijpvm_208_21 -
Journal of the American Medical... Jan 2016Mobile technologies may be suitable for delivering Ecological Momentary Interventions (EMI) to treat anxiety in real-time. This review aims to synthesize evidence on the... (Review)
Review
OBJECTIVES
Mobile technologies may be suitable for delivering Ecological Momentary Interventions (EMI) to treat anxiety in real-time. This review aims to synthesize evidence on the effectiveness of EMI for treating anxiety conditions.
MATERIALS AND METHODS
Four databases and the reference lists of previous studies were searched. A total of 1949 abstracts were double screened for inclusion. Sufficient studies were available to undertake a quantitative meta-analysis on EMIs on generalized anxiety symptoms.
RESULTS
The 15 randomized trials and randomized controlled trials examined anxiety (n = 7), stress (n = 3), anxiety and stress (n = 2), panic disorder (n = 2), and social phobia (n = 1). Eight EMIs comprised self-monitoring integrated with therapy modules, seven comprised multimedia content, and three comprised self-monitoring only. The quality of studies presented high risk of biases. Meta-analysis (n = 7) demonstrated that EMIs reduced generalized anxiety compared to control and/or comparison groups (Effect Size (ES) = 0.32, 95% CI, 0.12-0.53). Most EMIs targeting stress were reported effective relative to control as were the two EMIs targeting panic disorders. The EMI targeting social phobia was not effective.
DISCUSSION
EMIs have potential in treating both anxiety and stress. However, few high-quality trials have been conducted for specific anxiety disorders. Further trials are needed to assess the value of EMI technologies for anxiety in enhancing existing treatments.
CONCLUSION
This study found a small significant effect of EMI studies on reducing generalized anxiety. Studies on stress demonstrated EMI was effective compared to control, with the small number of studies on panic and social phobia demonstrating mixed results.
Topics: Adolescent; Adult; Anxiety; Anxiety Disorders; Humans; Mobile Applications; Panic Disorder; Psychotherapy, Brief; Stress, Psychological; Telemedicine
PubMed: 25997643
DOI: 10.1093/jamia/ocv043 -
Neuroradiology Sep 2021Vagus nerve stimulation (VNS) is an effective adjunctive treatment for drug-resistant epilepsy (DRE) and difficult-to-treat depression (DTD). More than 125.000 patients... (Review)
Review
PURPOSE
Vagus nerve stimulation (VNS) is an effective adjunctive treatment for drug-resistant epilepsy (DRE) and difficult-to-treat depression (DTD). More than 125.000 patients have been implanted with VNS Therapy® System (LivaNova PLC) since initial approval. Patients with DRE often require magnetic resonance imaging (MRI) of the brain during the course of their disease. VNS Therapy System devices are labeled to allow MRI under certain conditions; however, there are no published comprehensive articles about the real-world experience using MRI in patients with implanted VNS devices.
METHODS
A systematic review in accordance with PRISMA statement was performed using PubMed database. Full-length articles reporting MRI (1.5 T or 3 T scanner) of patients with implanted VNS for DRE or DTD and published since 2000 were included. The primary endpoint was a positive outcome that was defined as a technically uneventful MRI scan performed in accordance with the VNS Therapy System manufacturer guidelines and completed according to the researchers' planned scanning protocol without harm to the patient.
RESULTS
Twenty-six articles were eligible with 25 articles referring to the VNS Therapy System, and 216 patients were included in the analysis. No serious adverse events or serious device-related adverse events were reported. MRI scan was prematurely terminated in one patient due to a panic attack.
CONCLUSION
This systematic review indicates that cranial MRI of patients with an implanted VNS Therapy System can be completed satisfactorily and is tolerable and safe using 1.5 T and 3 T MRI scanners when performed in adherence to the VNS manufacturer's guidelines.
Topics: Drug Resistant Epilepsy; Humans; Magnetic Resonance Imaging; Prostheses and Implants; Treatment Outcome; Vagus Nerve Stimulation
PubMed: 33846830
DOI: 10.1007/s00234-021-02705-y -
Cureus Aug 2022Anxiety is one of the most common mental disorders in the adolescent age group due to both physiological and psychological changes along with substance use in this age... (Review)
Review
Anxiety is one of the most common mental disorders in the adolescent age group due to both physiological and psychological changes along with substance use in this age group. Generalized anxiety disorder, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), and social phobia (or social anxiety disorder) constitute anxiety disorders as per the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria. In India, the National Mental Health Survey was conducted to estimate the burden of different mental health disorders, but the adolescent age group was not included in that survey. A comprehensive search strategy was used to find out articles from PubMed and ProQuest, along with a risk of bias assessment using two components of the Quality in Prognosis Studies (QUIPS) tool. The 13 articles included in the meta-analysis were divided into two groups depending on sampling strategy and outcome measurement. Due to more than 99% heterogeneity, the random effect model is used to find the pooled estimate. The pooled prevalence of anxiety disorder among adolescents in India is found to be 0.41 (CI: 0.14-0.96) for studies with more than low risk and 0.29 (CI: 0.11-0.46) for studies with low risk. The Begg and Mazumdar rank correlation test revealed no publication bias in the included studies. One study was found to be an outlier using the Baujat test, but pooled estimate and heterogeneity did not change significantly after its removal from analysis. The weight of individual studies calculated using the random effect model did not show any gross difference. A significant burden of anxiety was found in adolescents in India. Effective intervention should be planned to reduce this burden.
PubMed: 36127986
DOI: 10.7759/cureus.28084 -
The Cochrane Database of Systematic... Sep 2014Panic disorder (PD) is a common type of anxiety disorder, characterized by unexpected and repeated panic attacks or fear of future panic attacks, or both. Individuals... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Panic disorder (PD) is a common type of anxiety disorder, characterized by unexpected and repeated panic attacks or fear of future panic attacks, or both. Individuals with PD are often resistant to pharmacological or psychological treatments and this can lead to the disorder becoming a chronic and disabling illness. Repetitive transcranial magnetic stimulation (rTMS) can deliver sustained and spatially selective current to suppress or induce cortical excitability, and its therapeutic effect on pathological neuronal activity in people with PD has already been examined in case studies and clinical trials. However, a systematic review is necessary to assess the efficacy and safety of rTMS for PD.
OBJECTIVES
To assess the effects of repetitive transcranial magnetic stimulation (rTMS) for panic disorder (PD) in adults aged 18 to 65 years, either as a monotherapy or as an augmentation strategy.
SEARCH METHODS
An electronic search of the Cochrane Depression, Anxiety and Neurosis Review Group Controlled Trials Register (CCDANCTR) was conducted to 19 February 2014. The CCDANCTR includes reports of relevant randomised controlled trials (RCTs) from MEDLINE (1950 to date), EMBASE (1974 to date), PsycINFO (1967 to date) and the Cochrane Central Register of Controlled Trials (CENTRAL) (all years). Additional searches were conducted in Psyndex and the main Chinese medical databases.
SELECTION CRITERIA
RCTs or quasi-randomised trials evaluating rTMS for PD in people aged between 18 and 65 years, either as a monotherapy or as an augmentation strategy.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies and extracted data and verified the data by cross-checking. Disagreements were resolved by discussion. For binary data, we calculated fixed-effect model risk ratio (RR) and its 95% confidence interval (CI). For continuous data, we calculated fixed-effect model standardized mean difference (SMD) and its 95% CI.
MAIN RESULTS
Two RCTs (n = 40) were included in this review. The included trials compared rTMS with sham rTMS; no trials comparing rTMS with active treatments (electroconvulsive therapy (ECT), pharmacotherapy, psychotherapy) met our inclusion criteria. Both included studies used 1 Hz rTMS over the right dorso-lateral prefrontal cortex (DLPFC) for two or four weeks as an augmentation treatment for PD. However, in both studies the data for the primary outcome, panic symptoms as measured by the Panic Disorder Severity Scale (PDSS), were skewed and could not be pooled for a quantitative analysis. For this primary outcome one trial with 25 participants reported a superior effect of rTMS in reducing panic symptoms compared with sham rTMS (t = 3.04, df = 16.57, P = 0.007), but this trial had a 16% dropout rate and so was deemed as having a high risk of attrition bias. The other trial found that all 15 participants exhibited a reduction in panic symptoms but there was no significant difference between rTMS and sham rTMS (Mann Whitney U test, P > 0.05). Regarding the acceptability of rTMS, no significant difference was found between rTMS and sham rTMS in dropout rates or in reports of side effects. The quality of evidence contributing to this review was assessed as very low. Assessments of the risk of bias for the two studies were hampered by the lack of information provided in the reports, especially on methods of sequence generation and whether allocation concealment had been applied. Of the remaining sources of bias, we considered one of the studies to have been at risk of attrition bias.
AUTHORS' CONCLUSIONS
Only two RCTs of rTMS were available and their sample sizes were small. The available data were insufficient for us to draw any conclusions about the efficacy of rTMS for PD. Further trials with large sample sizes and adequate methodology are needed to confirm the effectiveness of rTMS for PD.
Topics: Adult; Humans; Panic Disorder; Patient Dropouts; Prefrontal Cortex; Randomized Controlled Trials as Topic; Transcranial Magnetic Stimulation
PubMed: 25230088
DOI: 10.1002/14651858.CD009083.pub2 -
Brain Sciences Jun 2019Interoception is the sense of the physiological condition of the entire body. Impaired interoception has been associated with aberrant activity of the insula in major... (Review)
Review
Interoception is the sense of the physiological condition of the entire body. Impaired interoception has been associated with aberrant activity of the insula in major depressive disorder (MDD) during heartbeat perception tasks. Despite clinical relevance, studies investigating interoceptive impairments in MDD have never been reviewed systematically according to the guidelines of the PRISMA protocol, and therefore we collated studies that assessed accuracy in detecting heartbeat sensations (interoceptive accuracy, IAc) in MDD (databases: PubMed/Medline, PsycINFO, and PsycARTICLES). Out of 389 records, six studies met the inclusion criteria. The main findings suggest that (i) moderately depressed samples exhibit the largest interoceptive deficits as compared with healthy adults. (ii) difficulties in decision making and low affect intensity are correlated with low IAc, and (iii) IAc seems to normalize in severely depressed subjects. These associations may be confounded by sex, anxiety or panic disorder, and intake of selective serotonin reuptake inhibitors. Our findings have implications for the development of interoceptive treatments that might relieve MDD-related symptoms or prevent relapse in recurrent depression by targeting the interoceptive nervous system.
PubMed: 31174264
DOI: 10.3390/brainsci9060131