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Advances in Therapy Sep 2021Recent network meta-analyses support the use of pharmacotherapy in patients with generalised anxiety disorder (GAD). Compared with placebo, drug treatment can improve... (Review)
Review
Recent network meta-analyses support the use of pharmacotherapy in patients with generalised anxiety disorder (GAD). Compared with placebo, drug treatment can improve symptoms and quality of life, and is more effective in preventing relapse. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are generally considered the first-line agents of choice in GAD, but in some patients, an alternative evidence-based treatment with a different mechanism of action may also be considered (e.g. those with severe GAD, inadequate response, adverse effects and/or contraindications). One example is agomelatine, a melatonin receptor agonist and serotonin 2C (5-HT) receptor antagonist, which has been shown to have efficacy that is greater than placebo in patients with GAD, and to have a tolerability profile that compares favourably with that of escitalopram. Both agomelatine and escitalopram are efficacious in treating patients with GAD, including those with severe symptoms. Video Abstract.
Topics: Acetamides; Anxiety Disorders; Humans; Quality of Life; Selective Serotonin Reuptake Inhibitors
PubMed: 34417992
DOI: 10.1007/s12325-021-01860-1 -
Journal of Affective Disorders Dec 2021Although anxiety and depression are highly comorbid disorders, it remains unclear whether and how a concurrent depression affects the outcome of anxiety treatment.
BACKGROUND
Although anxiety and depression are highly comorbid disorders, it remains unclear whether and how a concurrent depression affects the outcome of anxiety treatment.
METHOD
Using anonymized routine outcome monitoring (ROM) data of 740 patients having received specialized treatment for an anxiety disorder, OCD, or PTSD, this study investigates whether a comorbid diagnosis of depression and/or self-reported depression severity levels relate to the patients' improvement following anxiety treatment.
RESULTS
The results show that both the patients with and those without comorbid depression had profited similarly from the anxiety, OCD, or PTSD treatment, regardless of whether depression was merely diagnosed prior to treatment or based on self-reported severity (and assuming a smallest effect size of interest of d = 0.35/r = .2). Importantly, the post-treatment reductions in self-reported depressive symptoms were strongly and positively related to the reductions in self-reported anxiety symptoms and disorder-related disability.
LIMITATIONS
Causal inferences cannot be made due to the retrospective cross-sectional design.
CONCLUSIONS
The outcomes obtained in a naturalistic patient sample support current treatment guidelines recommending evidence-based treatment for anxiety disorders, OCD, and PTSD in patients with and without a comorbid depression. Future treatment studies are recommended for investigate the (bi)directionality of anxiety and depressive symptoms throughout treatment.
Topics: Anxiety Disorders; Comorbidity; Cross-Sectional Studies; Depression; Humans; Obsessive-Compulsive Disorder; Retrospective Studies; Stress Disorders, Post-Traumatic
PubMed: 34706408
DOI: 10.1016/j.jad.2021.08.146 -
The Clinical Neuropsychologist Jul 2022To examine overlap and divergence of symptomatology in Autism Spectrum Disorder (ASD) with and without co-occurring Attention/Deficit Hyperactivity Disorder (ADHD)...
OBJECTIVE
To examine overlap and divergence of symptomatology in Autism Spectrum Disorder (ASD) with and without co-occurring Attention/Deficit Hyperactivity Disorder (ADHD) and/or Anxiety Disorder by age and sex.
METHOD
Participants included 25,078 individuals registered in the SPARK cohort, age 6-18 years. SPARK participation includes online consent and registration, as well as parent-reported ASD, ADHD, and Anxiety Disorder diagnoses, developmental, medical, and intervention history, and standardized rating scales. Individuals with ASD, ASD + ADHD, ASD + Anxiety, or ASD + ADHD + Anxiety were compared on measures assessing social communication, restricted and repetitive behaviors (RRBs), and motor functioning, and differences between male and female profiles were examined.
RESULTS
Significant differences in symptom presentation between females/males, school-age/adolescent individuals, and by co-occurring conditions (ASD/ADHD/Anxiety) are apparent, and the impact of co-occurring conditions differed by age and sex. Most notably, school-age femaleswith ASD without co-occurring conditions present with significantly fewer concerns about social communication skills and have better motor skills, but have more prominent RRBs as compared to same-aged males with ASD alone; co-occurring conditions were associated with increased social communication problems and motor concerns, most consistently for school-age females.
CONCLUSIONS
School-age females with ASD are at highest risk for underestimation of autism-related symptoms, including underestimation of symptoms beyond core ASD features (motor skills). Further, across ages, particular consideration should be given when probing for social communication symptoms, RRBs, and motor skills in females with ASD alone, as well as with co-occurring ADHD and/or Anxiety. For females with co-occurring symptoms and conditions, use of symptom-specific measures in lieu of omnibus measures should be considered.
Topics: Adolescent; Anxiety Disorders; Attention Deficit Disorder with Hyperactivity; Autism Spectrum Disorder; Autistic Disorder; Female; Humans; Male; Neuropsychological Tests
PubMed: 34315336
DOI: 10.1080/13854046.2021.1942554 -
Journal of Affective Disorders Mar 2021Associations between physical activity (PA) and subclinical anxiety disorder symptoms and status, and potential mediating effect of social physique anxiety (SPA), remain...
BACKGROUND
Associations between physical activity (PA) and subclinical anxiety disorder symptoms and status, and potential mediating effect of social physique anxiety (SPA), remain understudied. We examined associations between PA and analogue Generalized Anxiety Disorder (AGAD), analogue Social Anxiety Disorder (ASAD), and analogue Panic Disorder (APD) symptoms and status, the mediating effect of SPA, and sex-related differences.
METHODS
Participants (n = 470, 23.2 ± 4.8 years, 298 female) completed the Psychiatric Diagnostic Screening Questionnaire, seven-day PA recall, and Social Physique Anxiety Scale. ANCOVA examined differences in SPA and anxiety disorder symptoms between PA levels. Logistic regression examined associations between PA and analogue anxiety disorder status. Mediation analyses estimated the effect of change in PA on analogue anxiety disorder odds when SPA was at its mean.
RESULTS
AGAD, ASAD, and APD prevalence was 38.1%, 60.0%, and 15.1%, respectively. AGAD and ASAD symptoms, but not APD symptoms, were significantly lower among higher PA levels. PA was associated with lower odds of AGAD, ASAD, and APD; findings were not significant after adjustment. The pure indirect effect of SPA significantly accounted for 58.2% and 47.9% of the total effect of PA on AGAD and ASAD, respectively; findings were not significant after adjusting for depression. Females showed greater odds of AGAD, ASAD, and APD; mediation findings did not differ based on gender.
LIMITATIONS
Cross-sectional design, self-reported exposure and outcomes, and sample size are potential limitations.
CONCLUSION
Symptoms and odds of AGAD and ASAD status were lower among young adults with greater PA; SPA partially mediated associations and warrants experimental investigation.
Topics: Anxiety; Anxiety Disorders; Cross-Sectional Studies; Exercise; Female; Humans; Panic Disorder; Young Adult
PubMed: 33433380
DOI: 10.1016/j.jad.2020.12.163 -
BMC Psychiatry Oct 2023In the recent years, a growing body of literature stressed the importance of a dimensional perspective on mental disorders. In particular, since its conceptualization,...
BACKGROUND
In the recent years, a growing body of literature stressed the importance of a dimensional perspective on mental disorders. In particular, since its conceptualization, one of the main concerns in the field of Social Anxiety Disorder (SAD) has been the definition of a diagnostic threshold, leading to the suggestion that SAD may be more properly classified as a spectrum of severity rather than a discrete disorder based on subjectively determined threshold. The purpose of the current research is to evaluate the psychometric qualities of the Social Anxiety Spectrum - Short Version (SHY-SV), a novel questionnaire designed to measure the complete range of social anxiety symptoms, from overt manifestations to subthreshold ones.
METHODS
42 subjects with a clinical diagnosis of social anxiety disorder (SAD) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 43 subjects with a clinical diagnosis of Obsessive-Compulsive Disorder (OCD) and 60 individuals without current or lifetime mental disorders (HC) were recruited from the Psychiatric Clinic of the University of Pisa. Subjects were assessed with the SCID-5, Liebowitz Social Anxiety Scale (LSAS) and the SHY-SV.
RESULTS
SHY-SV showed strong internal consistency, and both the total and domain scores had great test-retest reliability. The Pearson's coefficients for the SHY-SV domain scores ranged from 0.391 to 0.933, and they were positively and significantly correlated with one another (p 0.001). All the SHY-SV domain scores were highly correlated with the SHY-SV total score. Results from of the correlation coefficients between SHY-SV and alternative measures of SAD were all significant and positive. Significant differences among diagnostic groups on both SAD-SV domains and total scores were found. SAD-SV total score increased significantly and progressively from HCs, to the OCD up to the SAD group which showed the highest values.
CONCLUSION
The SHY-SV demonstrated significant convergent validity with other dimensional SAD measures, great internal consistency, and test-retest reliability. With an increasing score gradient from healthy controls to patients with OCD to those with SAD, the questionnaire performed differently in each of the three diagnostic categories.
Topics: Humans; Reproducibility of Results; Anxiety Disorders; Anxiety; Obsessive-Compulsive Disorder; Surveys and Questionnaires
PubMed: 37784074
DOI: 10.1186/s12888-023-05137-5 -
BMC Psychiatry Dec 2021Deficits in cognitive performance are reported in patients with anxiety disorders, but research is limited and inconsistent. We aimed to investigate cross-sectional...
BACKGROUND
Deficits in cognitive performance are reported in patients with anxiety disorders, but research is limited and inconsistent. We aimed to investigate cross-sectional associations between cognitive function, with focus on executive function, and anxiety severity in primary care patients diagnosed with anxiety disorders.
METHODS
189 Swedish patients aged 18-65 years (31% men) with anxiety disorders diagnosed according to Mini International Neuropsychiatric Interview were included. Severity of anxiety was assessed using Beck Anxiety Inventory self-assessment scale. Digit span, block design and matrix reasoning tests from the Wechsler Adult Intelligence Scale IV, and the design fluency test from the Delis-Kaplan Executive Function System were used. Multivariable linear regression models were applied to investigate the relationship of anxiety severity and cognitive functioning. Comparisons were also performed to a normed non-clinical population, using the Wilcoxon signed rank test.
RESULTS
More severe anxiety was associated with lower digit span test scores (R = 0.109, B = -0.040, p = 0.018), but not with block design, matrix reasoning or design fluency tests scores, after adjustment for comorbid major depression in a multivariable model. When compared to a normed population, patients with anxiety performed significantly lower on the block design, digit span forward, digit span sequencing and matrix reasoning tests.
CONCLUSIONS
Severity of anxiety among patients with anxiety disorder was associated with executive functions related to working memory, independently of comorbid major depression, but not with lower fluid intelligence. A further understanding of the executive behavioral control in patients with anxiety could allow for more tailored treatment strategies including medication, therapy and interventions targeted to improve specific cognitive domains.
Topics: Adult; Anxiety; Anxiety Disorders; Cognition; Cross-Sectional Studies; Depressive Disorder, Major; Executive Function; Female; Humans; Male; Neuropsychological Tests; Primary Health Care
PubMed: 34886841
DOI: 10.1186/s12888-021-03618-z -
Nursing Open May 2022Anxiety can have a profound influence on the health-related quality of life of people with epilepsy and caregivers. The study aimed to assess the prevalence and...
AIM
Anxiety can have a profound influence on the health-related quality of life of people with epilepsy and caregivers. The study aimed to assess the prevalence and associated factors of anxiety disorder among people with epilepsy.
DESIGN
An institutional-based cross-sectional study was conducted.
METHOD
From 18 April 2019-30 May 2019, systematically selected 300 peoples with epilepsy were recruited. Anxiety was assessed by using the generalized anxiety disorder-7 (GAD-7). The data were entered by using Epi Info and analysed by SPSS version 25.
RESULT
The prevalence of anxiety was 38.3%. Secondary educational status, medication-related side effect, substance use history, seizure-related physical trauma, stress symptoms and a mental illness belief were significantly associated factors. The prevalence of anxiety disorder symptom was high, and it reinforced the need for recognition and treatment of mental disorders in people with epilepsy.
Topics: Anxiety Disorders; Cross-Sectional Studies; Epilepsy; Ethiopia; Humans; Mental Disorders; Prevalence; Quality of Life
PubMed: 35170244
DOI: 10.1002/nop2.1198 -
Psychological Medicine Mar 2022In research and clinical practice, familial risk for depression and anxiety is often constructed as a simple Yes/No dichotomous family history (FH) indicator. However,...
BACKGROUND
In research and clinical practice, familial risk for depression and anxiety is often constructed as a simple Yes/No dichotomous family history (FH) indicator. However, this measure may not fully capture the liability to these conditions. This study investigated whether a continuous familial loading score (FLS), incorporating family- and disorder-specific characteristics (e.g. family size, prevalence of depression/anxiety), (i) is associated with a polygenic risk score (PRS) for major depression and with clinical/psychosocial vulnerabilities and (ii) still captures variation in clinical/psychosocial vulnerabilities after information on FH has been taken into account.
METHODS
Data came from 1425 participants with lifetime depression and/or anxiety from the Netherlands Study of Depression and Anxiety. The Family Tree Inventory was used to determine FLS/FH indicators for depression and/or anxiety.
RESULTS
Persons with higher FLS had higher PRS for major depression, more severe depression and anxiety symptoms, higher disease burden, younger age of onset, and more neuroticism, rumination, and childhood trauma. Among these variables, FH was not associated with PRS, severity of symptoms, and neuroticism. After regression out the effect of FH from the FLS, the resulting residualized measure of FLS was still associated with severity of symptoms of depression and anxiety, rumination, and childhood trauma.
CONCLUSIONS
Familial risk for depression and anxiety deserves clinical attention due to its associated genetic vulnerability and more unfavorable disease profile, and seems to be better captured by a continuous score that incorporates family- and disorder-specific characteristics than by a dichotomous FH measure.
Topics: Anxiety; Anxiety Disorders; Depressive Disorder, Major; Genetic Predisposition to Disease; Humans; Neuroticism
PubMed: 32624018
DOI: 10.1017/S0033291720002299 -
Ugeskrift For Laeger Jun 2022There is a bidirectional association between epilepsy and depression and anxiety which are more prevalent in temporal lobe epilepsy and medically intractable epilepsy... (Review)
Review
There is a bidirectional association between epilepsy and depression and anxiety which are more prevalent in temporal lobe epilepsy and medically intractable epilepsy and are underdiagnosed. Many factors determine the occurrence of psychiatric symptoms. It is recommended that The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Generalised Anxiety Disorder Assessment (GAD-7) are employed for screening. This review finds that systematic screening should be routinely performed and treatment should be carried out in a formalized collaboration between neurologist, psychiatrist and psychologist.
Topics: Adult; Anxiety; Anxiety Disorders; Depression; Drug Resistant Epilepsy; Epilepsy; Humans
PubMed: 35786228
DOI: No ID Found -
Neuropsychopharmacology Reports Sep 2023The development of clinical practice guidelines for social anxiety disorder began in March 2018 when the Joint Clinical Practice Guideline Development Committee for...
The development of clinical practice guidelines for social anxiety disorder began in March 2018 when the Joint Clinical Practice Guideline Development Committee for Anxiety and Obsessive-Compulsive Disorders was formed by the Japanese Society of Anxiety and Related Disorders and Japanese Society of Neuropsychopharmacology to jointly develop guidelines for anxiety and obsessive-compulsive disorders. Based on the universal concept of evidence-based medicine, three clinical questions (CQs) about pharmacotherapy and psychotherapy were developed for clinical guidelines for social anxiety disorder, panic disorders, and obsessive-compulsive disorder in accordance with the Minds "Manual for Guidelines Development 2017 by the Japan Council for Quality Health Care: CQ1-"What is the recommended pharmacotherapy for social anxiety disorder in adults?"; CQ2-"What is the recommended psychotherapy (psychological intervention) for social anxiety disorder in adults?"; and CQ3-"What are the recommendations regarding monotherapy and combination therapy for social anxiety disorder in adults in terms of pharmacotherapy and psychotherapy (psychological interventions)?" Summarized recommendations for social anxiety disorder in adults are selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitor for CQ1, cognitive behavioral therapy for CQ2, and there are no recommendations regarding monotherapy and combination therapy for CQ3. These were answered by considering the balance between benefits and harms based on systematic reviews of each. The aim of this brief guideline for the standard-of-care (i.e., medical treatment) for social anxiety disorder in adults (18 years and older) was to help "shared decision making," in which medical professionals, including physicians, and patients share scientific evidence to decide on a course of treatment.
Topics: Adult; Humans; Anxiety; Anxiety Disorders; Cognitive Behavioral Therapy; East Asian People; Phobia, Social; Japan; Anti-Anxiety Agents; Combined Modality Therapy
PubMed: 37624975
DOI: 10.1002/npr2.12365