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Psychiatry Research Aug 2023Evidence supports the antidepressant effects of resistance exercise training (RET); however, findings among young adults at-risk for elevated depressive symptoms are... (Randomized Controlled Trial)
Randomized Controlled Trial
Evidence supports the antidepressant effects of resistance exercise training (RET); however, findings among young adults at-risk for elevated depressive symptoms are limited. This randomized controlled trial examined the effects of eight weeks of ecologically-valid, guidelines-based RET, compared to a wait-list control, on depressive symptoms among 55 young adults (26±5y; 36 female) with and without subclinical, or analogue, Generalized Anxiety Disorder (AGAD; Psychiatric Diagnostic Screening Questionnaire GAD subscale ≥6 and Penn State Worry Questionnaire ≥45) and Major Depressive Disorder (AMDD). Following a three-week familiarization period, participants completed one-on-one, twice-weekly RET sessions. The 16-item, self-reported Quick Inventory of Depressive Symptomatology (QIDS) assessed depressive symptoms. RM-ANCOVAs examined between-group differences, and significant interactions were decomposed with simple effects analysis. Hedges' d effect sizes (95%CI) quantified the magnitude of differences in change between groups across time. Stratified analyses were conducted among subsamples with AMDD and AGAD. There were no baseline depressive symptom differences between groups. Attendance was 83%, and compliance was 80%. RET induced statistically significant, clinically-meaningful, large-magnitude reductions in depressive symptoms from baseline to week eight in the total (d = 1.01; [95%CI: 0.44-1.57]), AMDD (d = 1.71; [95%CI: 0.96-2.46]), and AGAD (d = 1.39; [95%CI: 0.55-2.24]) samples. These findings support guidelines-based RET as a promising treatment for mild depression.
Topics: Humans; Female; Young Adult; Depression; Resistance Training; Depressive Disorder, Major; Exercise; Anxiety Disorders
PubMed: 37429171
DOI: 10.1016/j.psychres.2023.115322 -
JAMA Psychiatry Mar 2024Generalized anxiety disorder (GAD) is one of the most common mental disorders in adults. Psychotherapies are among the most recommended treatments for GAD, but which... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Generalized anxiety disorder (GAD) is one of the most common mental disorders in adults. Psychotherapies are among the most recommended treatments for GAD, but which should be considered as first-line treatment needs to be clarified.
OBJECTIVE
To use a network meta-analysis to examine the short- and long-term associations of different psychotherapies with outcomes of effectiveness and acceptability in adults with GAD.
DATA SOURCES
MEDLINE, Embase, PsycINFO, and the Cochrane Register of Controlled Trials were searched from database inception to January 1, 2023, to identify randomized clinical trials (RCTs) of psychotherapies for adults with GAD.
STUDY SELECTION
RCTs comparing any type of psychotherapy against another or with a control condition for the treatment of adults (≥18 years, both sexes) with a primary diagnosis of GAD were eligible for inclusion.
DATA EXTRACTION AND SYNTHESIS
This study followed Cochrane standards for extracting data and assessing data quality and used the PRISMA guideline for reporting. Risk of bias of individual studies was assessed using the second version of the Cochrane risk of bias tool, and the Confidence in Network Meta-Analysis was used to rate the certainty of evidence for meta-analytical results.
MAIN OUTCOMES AND MEASURES
Eight psychotherapies were compared against one another and with 2 control conditions. Primary outcomes were severity of GAD symptoms and acceptability of the psychotherapies. Random-effects model pairwise and network meta-analyses were conducted. For effectiveness, standardized mean differences (SMDs) were pooled, and for acceptability, relative risks with 95% CIs were calculated.
RESULTS
Data from 65 RCTs were included. Effect size estimates on data from 5048 participants (mean [SD], 70.9% [11.9%] women; mean [SD] age, 42.2 [12.5] years) suggested that third-wave cognitive behavior therapies (CBTs) (SMD, -0.76 [95% CI, -1.15 to -0.36]; certainty, moderate), CBT (SMD, -0.74 [95% CI, -1.09 to -0.38]; certainty, moderate), and relaxation therapy (SMD, -0.59 [95% CI, -1.07 to -0.11]; certainty, low) were associated with reduced GAD symptoms vs treatment as usual. Relative risks for all-cause discontinuation (indication of acceptability) signaled no differences compared with treatment as usual for all psychotherapies (eg, relative risk, 1.04 [95% CI, 0.64-1.67] for CBT vs treatment as usual). When excluding studies at high risk of bias, relaxation therapy lost its superiority over treatment as usual (SMD, -0.47; 95% CI, -1.18 to 0.23). When considering anxiety severity at 3 to 12 months after completion of the intervention, only CBT remained significantly associated with greater effectiveness than treatment as usual (SMD, -0.60; 95% CI, -0.99 to -0.21).
CONCLUSIONS AND RELEVANCE
Given the evidence in this systematic review and network meta-analysis for its associations with both acute and long-term effectiveness, CBT may represent the first-line therapy of GAD. Third-wave CBTs and relaxation therapy were associated with short-term effectiveness and may also be offered.
Topics: Humans; Anxiety Disorders; Cognitive Behavioral Therapy; Network Meta-Analysis; Psychotherapy; Randomized Controlled Trials as Topic
PubMed: 37851421
DOI: 10.1001/jamapsychiatry.2023.3971 -
Annals of Clinical Psychiatry :... Nov 2023Trichotillomania is a common psychiatric disorder classified as an obsessive-compulsive and related condition in DSM-5. Despite being first described in the 1800s,...
BACKGROUND
Trichotillomania is a common psychiatric disorder classified as an obsessive-compulsive and related condition in DSM-5. Despite being first described in the 1800s, little is known about its phenomenology and clinical presentation. Most information about trichotillomania is based on small samples.
METHODS
Clinical and demographic data were collected from 858 individuals with trichotillomania who participated in research studies that used in-person assessments with validated instruments.
RESULTS
A total of 858 adolescents and adults (mean age 29.3; range 11 to 65; 89.9% female) were recruited. The peak age of symptom onset was 11 to 15, and most affected individuals (93.5%) had symptom onset before age 20. Individuals reported pulling from several body sites, and the most frequent triggers were stress and the feel of their hair. Comorbidities included major depressive disorder, generalized anxiety disorder, and skin picking disorder. Most individuals with trichotillomania (61.7%) previously had received treatment. Among those who had received treatment, more individuals had received medication (43.4%) than psychotherapy (33.0%).
CONCLUSIONS
This study sheds new light on the clinical presentation and phenomenology of trichotillomania. Results highlight the need for further research into its clinical presentation, longitudinal course, and optimal treatment approaches.
Topics: Adult; Adolescent; Humans; Female; Young Adult; Male; Trichotillomania; Depressive Disorder, Major; Anxiety Disorders; Comorbidity; Emotions
PubMed: 37850990
DOI: 10.12788/acp.0120 -
Therapeutische Umschau. Revue... Aug 2023Any acute state of dyspnoea will lead to feelings of insecurity and anxiety. In this context the paper elucidates the conceptual horizon of anxiety, stretching from its...
Any acute state of dyspnoea will lead to feelings of insecurity and anxiety. In this context the paper elucidates the conceptual horizon of anxiety, stretching from its status as «normal», essential element of conditio humana, to representing a symptom of another (somatic or mental) illness and to constituting a psychiatric disorder of its own. In any case of acute dyspnoea it is important to «normalize» the patient's anxiety, i.e. to contextualize it as a comprehensible reaction to the stressing experience and not as proof of personal weakness. If dyspnoea and anxiety occur in a patient with a preexisting psychiatric disorder, defining the appropriate therapeutic steps will be more complex and demanding, especially with regard to a targeted interdisciplinary cooperation (consultation liaison psychiatry). The paper highlights the principles of psychopharmacological and psychotherapeutical interventions, a stable therapeutical relationship always defining the center of any treatment procedure.
Topics: Humans; Anxiety; Anxiety Disorders; Emotions; Dyspnea; Psychiatry; Referral and Consultation
PubMed: 37855533
DOI: No ID Found -
Child and Adolescent Psychiatric... Jul 2023This review summarizes the developmental epidemiology of childhood and adolescent anxiety disorders. It discusses the coronavirus disease of 2019 (COVID-19) pandemic,... (Review)
Review
This review summarizes the developmental epidemiology of childhood and adolescent anxiety disorders. It discusses the coronavirus disease of 2019 (COVID-19) pandemic, sex differences, longitudinal course, and stability of anxiety disorders in addition to recurrence and remission. The trajectory of anxiety disorders-whether homotypic (ie, the same anxiety disorder persists over time) or heterotypic (ie, an anxiety disorder shifts to a different diagnosis over time) is discussed with regard to social, generalized, and separation anxiety disorders as well as specific phobia, and panic disorder. Finally, strategies for early recognition, prevention, and treatment of disorders are discussed.
Topics: Adolescent; Humans; Female; Male; Child; COVID-19; Anxiety Disorders; Phobic Disorders; Panic Disorder; Anxiety, Separation
PubMed: 37201964
DOI: 10.1016/j.chc.2023.02.001 -
Zeitschrift Fur Psychosomatische... Feb 2024Primaryemotions and attachment in mental disorder Objectives: There is increasing evidence for associations between primary emotions and attachment with mental illness....
UNLABELLED
Primaryemotions and attachment in mental disorder Objectives: There is increasing evidence for associations between primary emotions and attachment with mental illness. This study illuminates the mediation relationship of these psychodynamic constructs in relation to psychiatric disorders.
METHODS
921 subjects (69.9 % female) were examined, who completed the questionnaires Brief Affective Neuroscience Personality Scales including a LUST Scale, Experiences in Close Relationships - Revised 8, and ICD-10 Symptom Rating online. A path analysis was conducted to evaluate the mediation effects of attachment anxiety.
RESULTS
A disease-specific pattern of direct associations between primary emotions, attachment anxiety, and psychological impairment emerged (all p < .01). Attachment exerted mediating effects primarily for SADNESS (p < .01), and to a lesser extent for LUST and CARE (p > .01).The model provided variance resolution ranging from7%(eating disorders) to 47%(depression).
CONCLUSION
The results demonstrate the relevance of affective explanations regarding the development of psychological symptoms, as well as therapeutic implications.
Topics: Humans; Female; Male; Emotions; Mental Disorders; Anxiety Disorders; Anxiety; Surveys and Questionnaires
PubMed: 38229550
DOI: 10.13109/zptm.2024.70.oa1 -
Laterality 2023Handedness is a core phenotype in clinical laterality research and several different disorders such as schizophrenia and autism spectrum disorders have been linked to a... (Review)
Review
Handedness is a core phenotype in clinical laterality research and several different disorders such as schizophrenia and autism spectrum disorders have been linked to a higher prevalence of non-right-handedness. Moreover, subclinical personality traits like schizotypy have been linked to a higher prevalence of non-right-handedness. The association with handedness is poorly understood for generalized anxiety disorder and specific phobias, as well as for state and trait anxiety and fear of specific stimuli in nonclinical samples. Therefore, we performed a narrative review of studies investigating handedness in anxiety disorders patients and studies that compared anxiety scores between different handedness groups. Unlike schizophrenia and autism spectrum disorders, there seems to be no strong association between anxiety disorders and handedness in adult patients, except for specific phobias. Studies often had small sample sizes and therefore a high risk to report spurious findings. Similar findings were reported in most non-clinical studies. Importantly, familial handedness affects phobia risk and antenatal maternal anxiety increased the probability of mixed-handedness. This suggests that a transgenerational, developmental perspective is essential to better understand the complex interrelations between handedness and anxiety. Familial and especially maternal handedness and anxiety disorders should be integrated into future studies on handedness and anxiety whenever possible.
Topics: Adult; Humans; Female; Pregnancy; Functional Laterality; Schizotypal Personality Disorder; Surveys and Questionnaires; Anxiety Disorders; Anxiety
PubMed: 37605527
DOI: 10.1080/1357650X.2023.2250074 -
Child and Adolescent Psychiatric... Jul 2023The evidence base for psychopharmacologic interventions in children and adolescents with anxiety disorders has significantly increased, and our understanding of the... (Review)
Review
The evidence base for psychopharmacologic interventions in children and adolescents with anxiety disorders has significantly increased, and our understanding of the relative efficacy and tolerability of interventions has expanded contemporaneously. Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacologic treatment for pediatric anxiety due to their robust efficacy although other agents may have efficacy. This review summarizes the data concerning the use of SSRIs, serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, atypical anxiolytics (eg, 5HT agonists, alpha agonists), and benzodiazepines in pediatric anxiety disorder cases (ie, generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, and panic disorder). The extant data suggest that SSRIs and SNRIs are effective and well tolerated. SSRIs as monotherapy and SSRIs + cognitive behavioral therapy reduce symptoms in youth with anxiety disorders. However, randomized controlled trials do not suggest efficacy for benzodiazepines or the 5HT agonist, buspirone, in pediatric anxiety disorder cases.
Topics: Adolescent; Humans; Child; Selective Serotonin Reuptake Inhibitors; Serotonin and Noradrenaline Reuptake Inhibitors; Anxiety Disorders; Anxiety; Benzodiazepines
PubMed: 37201968
DOI: 10.1016/j.chc.2023.02.006 -
ESC Heart Failure Apr 2024Cardiovascular disease is the leading cause of death worldwide. Anxiety disorders are common psychiatric conditions associated with cardiovascular outcomes. This...
AIMS
Cardiovascular disease is the leading cause of death worldwide. Anxiety disorders are common psychiatric conditions associated with cardiovascular outcomes. This two-sample Mendelian randomization (MR) study investigated the causal relationship between anxiety disorders and coronary heart disease (CHD), myocardial infarction (MI), heart failure (HF), and atrial fibrillation (AF).
METHODS
Single nucleotide polymorphisms (SNPs) associated with anxiety disorders (16 730 cases; 101 021 controls) were obtained from the UK Biobank genome-wide association study (GWAS). Cardiovascular outcome data were derived from the FinnGen study (CHD: 21 012 cases and 197 780 controls; MI: 12 801 cases and 187 840 controls; HF: 23 397 cases and 194 811 controls; and AF: 22 068 cases and 116 926 controls). Inverse variance weighted (IVW), MR-Egger, weighted median, simple mode, and weighted mode analyses examined causality.
RESULTS
IVW analysis demonstrated significant causal relationships between anxiety disorders and increased risk of CHD [odds ratio (OR): 4.496; 95% confidence interval (CI): 1.777-11.378; P = 0.002], MI (OR: 5.042; 95% CI: 1.451-17.518; P = 0.011), and HF (OR: 3.255; 95% CI: 1.461-7.252; P = 0.004). No relationship was observed with AF (OR: 1.775; 95% CI: 0.612-5.146; P = 0.29). Other methods showed non-significant associations. Two-way analysis indicated no reverse causality.
CONCLUSIONS
Anxiety disorders were causally associated with greater risk of CHD, MI, and HF but not AF among individuals of European descent. Further research on mediating mechanisms and in diverse populations is warranted.
Topics: Humans; Cardiovascular Diseases; Genome-Wide Association Study; Mendelian Randomization Analysis; Heart Failure; Myocardial Infarction; Anxiety Disorders; Atrial Fibrillation
PubMed: 38279876
DOI: 10.1002/ehf2.14676 -
Journal of the American Geriatrics... Nov 2023Prescribing benzodiazepines to older patients is controversial. Anxiety disorders and benzodiazepines have been associated with dementia, but literature is inconsistent....
BACKGROUND
Prescribing benzodiazepines to older patients is controversial. Anxiety disorders and benzodiazepines have been associated with dementia, but literature is inconsistent. It is unknown if anxiety treated with a benzodiazepine, compared to anxiety disorder alone is associated with dementia risk.
METHODS
A retrospective cohort study (n = 72,496) was conducted using electronic health data from 2014 to 2021. Entropy balancing controlled for bias by indication and other confounding factors.
PARTICIPANTS
Eligible patients were ≥65 years old, had clinic encounters before and after index date and were free of dementia for 2 years prior to index date. Of the 72,496 eligible patients, 85.6% were White and 59.9% were female. Mean age was 74.1 (SD ± 7.1) years.
EXPOSURE
Anxiety disorder was a composite of generalized anxiety disorder, anxiety not otherwise specified, panic disorder, and social phobia. Sustained benzodiazepine use was defined as at least two separate prescription orders in any 6-month period.
MAIN OUTCOME AND MEASURES
ICD-9 or ICD-10 dementia diagnoses.
RESULTS
Six percent of eligible patients had an anxiety diagnosis and 3.6% received sustained benzodiazepine prescriptions. There were 6640 (9.2%) incident dementia events. After controlling for confounders, both sustained benzodiazepine use (HR 1.28, 95% CI: 1.11-1.47) and a diagnosis of anxiety (HR 1.19, 95% CI: 1.06-1.33) were associated with incident dementia in patients aged 65-75. Anxiety disorder with sustained benzodiazepine, compared to anxiety disorder alone, was not associated with incident dementia (HR 1.18, 95% CI: 0.92-1.51) after controlling for confounding. Results were not significant when limiting the sample to those ≥75 years of age.
CONCLUSIONS
Benzodiazepines and anxiety disorders are associated with increased risk for dementia. In patients with anxiety disorders, benzodiazepines were not associated with additional dementia risk. Further research is warranted to determine if benzodiazepines are associated with a reduced or increased risk for dementia compared to other anxiolytic medications in patients with anxiety disorders.
Topics: Humans; Female; Aged; Male; Benzodiazepines; Retrospective Studies; Anxiety Disorders; Anxiety; Prescriptions; Dementia
PubMed: 37503956
DOI: 10.1111/jgs.18515