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Expert Review of Neurotherapeutics 2023Recommendations for treating panic disorder (PD) in older patients are scarce. The authors have systematically reviewed whether several recommended medications are... (Review)
Review
INTRODUCTION
Recommendations for treating panic disorder (PD) in older patients are scarce. The authors have systematically reviewed whether several recommended medications are superior to others and their optimal doses in this age group.
METHODS
A database search of studies involving patients with PD with/without agoraphobia aged ≥ 60 years was carried out using PubMed, PsycINFO, Embase, and Clinical Trials.gov, from their inception dates to 1 March 2023. Only four (published from 2002 to 2010) of the 1292 records screened were included. A risk of bias assessment was provided. This systematic review was performed using The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).
RESULTS
Two studies were randomized clinical trials, whereas two were open-label, including paroxetine, citalopram, escitalopram, and sertraline; three studies reported short-term evaluations, whereas one study included a 26-week follow-up. Medications provided benefits, with good tolerability. Preliminary results suggested greater benefits of paroxetine in reducing panic attacks vs. cognitive - behavioral therapy, and an earlier decrease in PAs with escitalopram vs. citalopram. Risk of bias was considerable.
CONCLUSIONS
The pharmacological management of PD in older patients has received no attention. Findings are scant, dated, and affected by methodological flaws; thus, they do not provide significant advances.
Topics: Humans; Aged; Panic Disorder; Paroxetine; Citalopram; Selective Serotonin Reuptake Inhibitors; Escitalopram; Randomized Controlled Trials as Topic
PubMed: 37676054
DOI: 10.1080/14737175.2023.2254938 -
The British Journal of Psychiatry : the... Sep 2022Psychotherapies are the treatment of choice for panic disorder, but which should be considered as first-line treatment is yet to be substantiated by evidence. (Meta-Analysis)
Meta-Analysis Review
Comparative efficacy and acceptability of psychotherapies for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials.
BACKGROUND
Psychotherapies are the treatment of choice for panic disorder, but which should be considered as first-line treatment is yet to be substantiated by evidence.
AIMS
To examine the most effective and accepted psychotherapy for the acute phase of panic disorder with or without agoraphobia via a network meta-analysis.
METHOD
We conducted a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the most effective and accepted psychotherapy for the acute phase of panic disorder. We searched MEDLINE, Embase, PsycInfo and CENTRAL, from inception to 1 Jan 2021 for RCTs. Cochrane and PRISMA guidelines were used. Pairwise and network meta-analyses were conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol was published in a peer-reviewed journal and in PROSPERO (CRD42020206258).
RESULTS
We included 136 RCTs in the systematic review. Taking into consideration efficacy (7352 participants), acceptability (6862 participants) and the CINeMA confidence in evidence appraisal, the best interventions in comparison with treatment as usual (TAU) were cognitive-behavioural therapy (CBT) (for efficacy: standardised mean differences s.m.d. = -0.67, 95% CI -0.95 to -0.39; CINeMA: moderate; for acceptability: relative risk RR = 1.21, 95% CI -0.94 to 1.56; CINeMA: moderate) and short-term psychodynamic therapy (for efficacy: s.m.d. = -0.61, 95% CI -1.15 to -0.07; CINeMA: low; for acceptability: RR = 0.92, 95% CI 0.54-1.54; CINeMA: moderate). After removing RCTs at high risk of bias only CBT remained more efficacious than TAU.
CONCLUSIONS
CBT and short-term psychodynamic therapy are reasonable first-line choices. Studies with high risk of bias tend to inflate the overall efficacy of treatments. Results from this systematic review and network meta-analysis should inform clinicians and guidelines.
Topics: Agoraphobia; Cognitive Behavioral Therapy; Humans; Network Meta-Analysis; Panic Disorder; Psychotherapy; Psychotherapy, Psychodynamic; Randomized Controlled Trials as Topic
PubMed: 35049483
DOI: 10.1192/bjp.2021.148 -
Journal of Behavior Therapy and... Dec 2023Anxiety disorders are the most prevalent mental disorders worldwide. Virtual reality (VR) treatment approaches have increasingly been studied. Before clinical... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVES
Anxiety disorders are the most prevalent mental disorders worldwide. Virtual reality (VR) treatment approaches have increasingly been studied. Before clinical implementation, it is necessary to evaluate the treatment effect of VR applications. The objective is to evaluate the treatment effect of virtual reality applications in the treatment of anxiety disorders compared to conventional therapy.
METHODS
A systematic literature review with meta-analysis was conducted. Four databases were used to identify randomized controlled trials published between April 2011 and April 2021 which compare VR applications with non-VR interventions or waiting lists. Study characteristics, pre- and post-treatment data were extracted. Hedges g was calculated as effect size. Primary outcome was anxiety symptoms.
RESULTS
Data from 17 studies from 827 participants was extracted. The studies examined specific phobia (n = 9), social anxiety disorder (n = 4), agoraphobia (n = 2) and panic disorder (n = 2). 16 out of 17 studies used head-mounted displays as VR application. A non-significant effect size with significant heterogeneity was observed in favor of the use of VR applications in anxiety symptoms (g, 0.33; 95%-CI, -0.20-0.87). Compared to passive control groups, VR applications are associated significant with lower anxiety symptoms (g, 1.29; 95%-CI, 0.68-1.90).
LIMITATIONS
The study and patient characteristics varied between the individual studies which is reflected in a high statistical heterogeneity of the effect sizes.
CONCLUSIONS
The added value of VR applications over waiting-list or psychoeducation only control groups is obvious. VR applications can be used as part of the treatment of anxiety disorders, especially when conventional therapy is unavailable.
Topics: Humans; Anxiety Disorders; Phobic Disorders; Phobia, Social; Anxiety; Virtual Reality; Virtual Reality Exposure Therapy; Randomized Controlled Trials as Topic
PubMed: 37453405
DOI: 10.1016/j.jbtep.2023.101893 -
Journal of the American Academy of... Apr 2024To examine the risk of anxiety disorders in offspring of parents with mood disorders. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To examine the risk of anxiety disorders in offspring of parents with mood disorders.
METHOD
We conducted a systematic review and meta-analysis. We searched 4 electronic databases (Medline, Embase, PsycINFO, and Web of Science [core collection]) to identify cross-sectional and cohort studies that examined the association between parental mood disorders (including bipolar disorder and unipolar depression) and risk of anxiety disorders in offspring. Pooled risk ratios (RRs) of overall and specific anxiety disorders were synthesized using a random effects model. Subgroup analyses and meta-regression were performed to identify moderation factors.
RESULTS
A total of 35 studies were included in the final analysis. Our results showed higher risks of all types of anxiety disorders in the offspring of parents with mood disorders (any anxiety disorder, RR = 1.82, 95% CI = 1.47-2.26), except for agoraphobia (RR = 1.08, 95% CI = 0.56-2.08), and with an especially elevated risk of panic disorder (RR = 3.07, 95% CI = 2.19-4.32). Subgroup analysis demonstrated no significant difference between the risks of anxiety disorders across the offspring of parents with bipolar disorder as opposed to unipolar depression. The absence of anxiety disorders in control parents, younger offspring age, and specific parent/offspring sex were associated with higher RRs for some anxiety disorders in offspring of parents with mood disorders.
CONCLUSION
Our findings suggest a robust relationship between parental mood disorders and offspring anxiety disorders, and highlight the potential value of prevention and early intervention for anxiety disorders in this context.
DIVERSITY & INCLUSION STATEMENT
We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.
STUDY PREREGISTRATION INFORMATION
Anxiety Disorders in Offspring of Parents with Mood Disorders: A Systematic Review; https://www.crd.york.ac.uk/prospero/; CRD42021215058.
Topics: Humans; Mood Disorders; Cross-Sectional Studies; Anxiety Disorders; Parents; Depressive Disorder; Child of Impaired Parents
PubMed: 37453607
DOI: 10.1016/j.jaac.2023.06.022 -
Clinical Psychology Review Nov 2020Anxiety disorders and related traits have become increasingly relevant to the study of physical health and health behaviors over the years. One important health behavior...
Anxiety disorders and related traits have become increasingly relevant to the study of physical health and health behaviors over the years. One important health behavior is healthcare utilization, and both over- and under-use have important implications within both personal and public health domains. Anxiety disorders are associated with reassurance-seeking, avoidance behaviors, and other characteristics and traits that may impact patterns of healthcare utilization. The current paper reviews the literature on the known associations between anxiety disorders and healthcare utilization, including studies (N = 70) that examined the association of healthcare utilization with generalized anxiety disorder, social anxiety disorder, panic disorder and agoraphobia, dental and blood-injection-injury phobias, and illness anxiety disorder/health anxiety. Overall, the majority of the studies reviewed indicate that anxiety disorders and health anxiety are associated with increased healthcare utilization across multiple care settings. In addition, there is preliminary but limited evidence that, in some cases, anxiety can be associated with delayed, irregular, or inconsistent use of healthcare services. More work is needed to fine-tune our understanding of the impact of anxiety disorders in healthcare settings.
Topics: Adult; Aged; Anxiety Disorders; Female; Humans; Male; Middle Aged; Panic Disorder; Patient Acceptance of Health Care; Phobia, Social; Phobic Disorders
PubMed: 32818687
DOI: 10.1016/j.cpr.2020.101894 -
Cognitive Behaviour Therapy Jul 2020The current systematic review and meta-analysis examined the efficacy and effectiveness of internet-delivered cognitive behavioral therapy (iCBT) on panic disorder and... (Meta-Analysis)
Meta-Analysis
The current systematic review and meta-analysis examined the efficacy and effectiveness of internet-delivered cognitive behavioral therapy (iCBT) on panic disorder and agoraphobia symptom severity. Twenty-seven studies were identified. Results from nine randomised controlled trials (RCTs) showed that iCBT outperformed waiting list and information controls for panic ( = 1.22) and agoraphobia ( = .91) symptoms, but the quality of RCTs varied and heterogeneity was high. Results from three RCTs suggested iCBT may have similar outcomes to face-to-face CBT in reducing panic and agoraphobia symptoms. Within-group effect sizes between baseline and post-treatment were large for panic ( = 29, = 1.16) and medium for agoraphobia symptom severity ( = 18, = .73). Subgroup analyses of within-group pre/post treatment effect sizes showed larger within-group effect sizes for efficacy studies ( = 15) compared to effectiveness studies ( = 14) for panic severity ( = 1.38 vs. = .98) but not agoraphobia severity. There was no impact of program length, inclusion or arousal reduction techniques, or degree of clinician support. Within-group effects of iCBT suggest the reduction in panic and agoraphobia symptom severity is maintained at 3-6 month follow-up ( = 12).
Topics: Agoraphobia; Cognitive Behavioral Therapy; Humans; Internet; Panic Disorder; Therapy, Computer-Assisted; Treatment Outcome
PubMed: 31303121
DOI: 10.1080/16506073.2019.1628808 -
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 -
Frontiers in Psychology 2019Convincing evidence on Virtual Reality (VR) exposure for phobic anxiety disorders has been reported, however, the benchmark and golden standard for phobia treatment is...
Inferiority or Even Superiority of Virtual Reality Exposure Therapy in Phobias?-A Systematic Review and Quantitative Meta-Analysis on Randomized Controlled Trials Specifically Comparing the Efficacy of Virtual Reality Exposure to Gold Standard Exposure in Agoraphobia, Specific Phobia, and Social...
Convincing evidence on Virtual Reality (VR) exposure for phobic anxiety disorders has been reported, however, the benchmark and golden standard for phobia treatment is exposure. For direct treatment comparisons, the control of confounding variables is essential. Therefore, the comparison of VR and exposure in studies applying an equivalent amount of exposure in both treatments is necessary. We conducted a systematic search of reports published until June 2019. Inclusion criteria covered the diagnosis of Specific Phobia, Social Phobia, or Agoraphobia, and a randomized-controlled design with an equivalent amount of exposure in VR and . We qualitatively reviewed participants' characteristics, materials, and the treatment procedures of all included studies. For quantitative synthesis, we calculated Hedges' effect sizes for the treatment effects of VR exposure, exposure, and the comparison of VR to exposure in all studies and separately for studies on each diagnosis. Nine studies ( = 371) were included, four on Specific Phobia, three on Social Phobia, and two on Agoraphobia. VR and exposure both showed large, significant effect sizes. The comparison of VR to exposure revealed a small, but non-significant effect size favoring ( = -0.20). Specifically, effect sizes for Specific Phobia ( = -0.15) and Agoraphobia ( = -0.01) were non-significant, only for Social Phobia we found a significant effect size favoring ( -). Except for Agoraphobia, effect sizes varied across studies from favoring VR to favoring exposure. We found no evidence that VR exposure is significantly less efficacious than exposure in Specific Phobia and Agoraphobia. The wide range of study specific effect sizes, especially in Social Phobia, indicates a high potential of VR, but also points to the need for a deeper investigation and empirical examination of relevant working mechanisms. In Social Phobia, a combination of VR exposure with cognitive interventions and the realization of virtual social interactions targeting central fears might be advantageous. Considering the advantages of VR exposure, its dissemination should be emphasized. Improvements in technology and procedures might even yield superior effects in the future.
PubMed: 31551840
DOI: 10.3389/fpsyg.2019.01758 -
Journal of Anxiety Disorders Mar 2022Panic disorder is a common and disabling psychiatric condition marked by sudden onset of physiological sensations that are appraised as dangerous. A number of studies...
BACKGROUND
Panic disorder is a common and disabling psychiatric condition marked by sudden onset of physiological sensations that are appraised as dangerous. A number of studies and reviews have examined the efficacy of psychosocial treatments for PD; however, there is a lack of overarching reports that discuss the strength of evidence for the different psychosocial treatments for PD. This umbrella review provides an overview of systematic reviews and meta-analyses on psychosocial treatments for PD.
METHODS
A systematic search and review of the literature was conducted according to PRISMA guidelines.
RESULTS
A total of 38 reviews (31 meta-analyses and 7 systematic reviews) were included in the umbrella review. Most of the 38 reviews were focused on the use of CBT, both in-person and internet-based, to treat PD among adults, generally finding it to be an efficacious treatment compared to control conditions. A limited number of the 38 reviews included other age ranges or examined other forms of psychosocial treatments. The methodological quality of most included reviews was rated as critically low according to the AMSTAR-2 rating system.
CONCLUSIONS
Future reviews should focus on improving their methodological quality. Although the included reviews supported CBT as an efficacious treatment for reducing panic symptoms among adults, future research could focus on how CBT compares to other psychosocial treatments and the efficacy of CBT for PD among other populations (e.g., children and adolescents) and among diverse cultural groups.
Topics: Adolescent; Adult; Child; Humans; Meta-Analysis as Topic; Panic Disorder
PubMed: 35063924
DOI: 10.1016/j.janxdis.2022.102528 -
Behaviour Research and Therapy Sep 2019Both dysfunctional and self-efficacy-related cognitions are theorized as etiological and maintaining factors in agoraphobia. Exposure therapy is an effective treatment... (Meta-Analysis)
Meta-Analysis
Both dysfunctional and self-efficacy-related cognitions are theorized as etiological and maintaining factors in agoraphobia. Exposure therapy is an effective treatment and central component of CBT for agoraphobia, but the role of changes in these cognitions as a mechanism of action has not been established. The present review aims to evaluate (a) whether exposure without cognitive interventions elicits changes in cognitive variables and (b) whether cognitive changes mediate outcomes in exposure-based treatments. We searched PsycInfo and PubMed for studies on agoraphobia (with or without panic disorder) and exposure as a treatment component. Fifteen articles with 29 relevant study arms (N = 921) were identified for a meta-analysis of cognitive changes after exposure. Seventeen articles (N = 1881) were included in a systematic narrative review of cognitive mediation. A random effects model revealed a large effect of cognitive improvement after pure exposure treatments, d = 1.02 (95% CI 0.81-1.23). The systematic review mostly supported changes in cognition as mediators of symptom change. Improved study designs and statistical methods in future mediation studies are needed to strengthen causal interpretation. Cognitive change is a probable mechanism of action in exposure therapy, especially change in self-efficacy. The present review suggests novel ways in which cognitive interventions can augment exposure therapy.
Topics: Agoraphobia; Cognition; Humans; Implosive Therapy; Prognosis; Self Efficacy
PubMed: 31374484
DOI: 10.1016/j.brat.2019.103443