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Journal of Medical Internet Research Mar 2021Previous studies provide evidence for the effectiveness of web-based interventions for panic disorder with and without agoraphobia. Smartphone-based technologies hold... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Previous studies provide evidence for the effectiveness of web-based interventions for panic disorder with and without agoraphobia. Smartphone-based technologies hold significant potential for further enhancing the accessibility and efficacy of such interventions.
OBJECTIVE
This randomized controlled trial aims to evaluate the efficacy of a guided, hybrid web-based training program based on cognitive behavioral therapy for adults with symptoms of panic disorder.
METHODS
Participants (N=92) with total scores in the Panic and Agoraphobia Scale ranging from 9 to 28 were recruited from the general population and allocated either to a hybrid intervention (GET.ON Panic) or to a wait-list control group. The primary outcome was the reduction in panic symptoms, as self-assessed using a web-based version of the Panic and Agoraphobia Scale.
RESULTS
Analysis of covariance-based intention-to-treat analyses revealed a significantly stronger decrease in panic symptoms posttreatment (F=9.77; P=.002; Cohen d=0.66; 95% CI 0.24-1.08) in the intervention group than in the wait-list control group. Comparisons between groups of the follow-up measures at 3 and 6 months yielded even stronger effects (3-month follow-up: F=17.40, P<.001, Cohen d=0.89, 95% CI 0.46-1.31; 6-month follow-up: F=14.63, P<.001, Cohen d=0.81, 95% CI 0.38-1.24).
CONCLUSIONS
Hybrid web-based training programs may help reduce the symptoms of panic disorder and hence play an important role in improving health care for patients with this debilitating disorder.
TRIAL REGISTRATION
German Clinical Trial Register DRKS00005223; https://tinyurl.com/f4zt5ran.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
RR2-10.1186/1745-6215-15-427.
Topics: Adult; Agoraphobia; Cognitive Behavioral Therapy; Humans; Internet; Internet-Based Intervention; Panic Disorder; Treatment Outcome; Waiting Lists
PubMed: 33661121
DOI: 10.2196/20829 -
Brain Sciences Jun 2021Individuals with agoraphobia exhibit impaired exploratory activity when navigating unfamiliar environments. However, no studies have investigated the contribution of...
Individuals with agoraphobia exhibit impaired exploratory activity when navigating unfamiliar environments. However, no studies have investigated the contribution of visuospatial working memory (VSWM) in these individuals' ability to acquire and process spatial information while considering the use of egocentric and allocentric coordinates or environments with or without people. A total of 106 individuals (53 with agoraphobia and 53 controls) navigated in a virtual square to acquire spatial information that included the recognition of landmarks and the relationship between landmarks and themselves (egocentric coordinates) and independent of themselves (allocentric coordinates). Half of the participants in both groups navigated in a square without people, and half navigated in a crowded square. They completed a VSWM test in addition to tasks measuring landmark recognition and egocentric and allocentric judgements concerning the explored square. The results showed that individuals with agoraphobia had reduced working memory only when active processing of spatial elements was required, suggesting that they exhibit spatial difficulties particularly in complex spatial tasks requiring them to process information simultaneously. Specifically, VSWM deficits mediated the relationship between agoraphobia and performance in the allocentric judgements. The results are discussed considering the theoretical background of agoraphobia in order to provide useful elements for the early diagnosis of this disorder.
PubMed: 34208661
DOI: 10.3390/brainsci11060796 -
The South African Journal of Psychiatry... 2018Anxiety disorders are the most prevalent class of lifetime mental disorders according to South African research. However, little is known about the prevalence of factors...
BACKGROUND
Anxiety disorders are the most prevalent class of lifetime mental disorders according to South African research. However, little is known about the prevalence of factors that might complicate treatment among adults in a psychiatric outpatient setting.
AIM
To explore the psychiatric comorbidities and psychosocial stressors among a population of adults treated for anxiety disorders at the outpatient unit of a tertiary psychiatric facility in Bloemfontein.
METHODS
In this retrospective cross-sectional study, clinical files of all mental healthcare users receiving treatment were reviewed to identify those with a current or previous diagnosis of one or more of the following anxiety disorders: generalised anxiety disorder (GAD), panic disorder, social anxiety disorder (SAD) and agoraphobia.
RESULTS
Of the 650 available records, 103 (15.8%) included at least one anxiety disorder. Of those, 65.1% had GAD, 34.0% had panic disorder and 29.1% had SAD. Agoraphobia was diagnosed in 14.6% of patients almost exclusively as comorbid with panic disorder. Additional psychiatric disorders were present for 98.1% of patients and 36.9% had multiple anxiety disorders. The patients had a history of relational problems (64.1%), educational and occupational stressors (55.3%), abuse and neglect (28.2%), other problems related to the social environment (24.3%) and self-harm (23.3%).
CONCLUSION
Clinical practice should take the high rates of comorbidity into account and the importance of integrated substance-related interventions in mental healthcare settings is clear. Diagnostic practices regarding agoraphobia without panic, and the comorbidity of anxiety and personality disorders should receive further attention. Clinicians should be aware of the potential impact of the frequently reported psychosocial stressors.
PubMed: 30263217
DOI: 10.4102/sajpsychiatry.v24i0.1138 -
Psychiatry and Clinical Neurosciences Dec 2015In the 3 decades since Liebowitz's review of 'a neglected anxiety disorder,' controversy and challenges have remained in the study of social anxiety disorder (SAD). This... (Review)
Review
In the 3 decades since Liebowitz's review of 'a neglected anxiety disorder,' controversy and challenges have remained in the study of social anxiety disorder (SAD). This review examines evidence around the classification and subtyping of SAD, focusing on generalized SAD. Substantial discrepancies and variation in definition, epidemiology, assessment, and treatment of generalized SAD exist as the international literature on it has grown. In East Asian cultures in particular, study of taijin kyofusho has been important to a broadened conceptualization of SAD into generalized SAD. Despite important progress with biological and other studies, many challenges in the understanding of generalized SAD will remain in the years to come.
Topics: Agoraphobia; Anxiety Disorders; Australia; Autism Spectrum Disorder; Canada; Comorbidity; Depressive Disorder; Europe; Asia, Eastern; Humans; Middle East; Nigeria; Panic Disorder; Personality Disorders; Phobic Disorders; Schizophrenia; South Africa; Substance-Related Disorders; United States
PubMed: 26121185
DOI: 10.1111/pcn.12327 -
Psychological Reports Apr 2019Whistleblowers play a very important and indispensable role in society and health care sector, but their act may elicit retaliation and other negative effects, which may... (Comparative Study)
Comparative Study
Whistleblowers play a very important and indispensable role in society and health care sector, but their act may elicit retaliation and other negative effects, which may impact their mental health. The main aim of the present comparative study is to assess to what extent whistleblowers ( N = 27) more often suffer from severe mental health problems than other population-based groups in the Netherlands, i.e., matched controls ( N = 135), cancer patients ( N = 130), persons with (partial) work disabilities ( N = 194), physically "healthy" persons ( N = 200), and general population ( N = 1026), using the 36-Item Short-Form Health Survey scales (for general mental health) and the Symptom Checklist-90-Revised scales (for specific mental health problems: depression, anxiety, agoraphobia, interpersonal sensitivity and distrust, and sleeping problems). Logistic regression analyses showed that the prevalence of general mental health problems was much higher than among matched controls and people with work disabilities but similar to cancer patient when controlling for demographics. About 85% suffered from severe to very severe anxiety, depression, interpersonal sensitivity and distrust, agoraphobia symptoms, and/or sleeping problems, and 48% reached clinical levels of these specific mental health problems. These specific mental health problems were much more prevalent than among the general population.
Topics: Adult; Aged; Anxiety Disorders; Depressive Disorder; Disabled Persons; Female; Humans; Interpersonal Relations; Male; Middle Aged; Neoplasms; Sleep Wake Disorders; Whistleblowing
PubMed: 29451073
DOI: 10.1177/0033294118757681 -
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 -
Psychiatric Services (Washington, D.C.) Apr 2008This study investigated the combination of item response theory and computerized adaptive testing (CAT) for psychiatric measurement as a means of reducing the burden of...
OBJECTIVE
This study investigated the combination of item response theory and computerized adaptive testing (CAT) for psychiatric measurement as a means of reducing the burden of research and clinical assessments.
METHODS
Data were from 800 participants in outpatient treatment for a mood or anxiety disorder; they completed 616 items of the 626-item Mood and Anxiety Spectrum Scales (MASS) at two times. The first administration was used to design and evaluate a CAT version of the MASS by using post hoc simulation. The second confirmed the functioning of CAT in live testing.
RESULTS
Tests of competing models based on item response theory supported the scale's bifactor structure, consisting of a primary dimension and four group factors (mood, panic-agoraphobia, obsessive-compulsive, and social phobia). Both simulated and live CAT showed a 95% average reduction (585 items) in items administered (24 and 30 items, respectively) compared with administration of the full MASS. The correlation between scores on the full MASS and the CAT version was .93. For the mood disorder subscale, differences in scores between two groups of depressed patients--one with bipolar disorder and one without--on the full scale and on the CAT showed effect sizes of .63 (p<.003) and 1.19 (p<.001) standard deviation units, respectively, indicating better discriminant validity for CAT.
CONCLUSIONS
Instead of using small fixed-length tests, clinicians can create item banks with a large item pool, and a small set of the items most relevant for a given individual can be administered with no loss of information, yielding a dramatic reduction in administration time and patient and clinician burden.
Topics: Adolescent; Adult; Aged; Agoraphobia; Anxiety Disorders; Bipolar Disorder; Diagnosis, Computer-Assisted; Female; Humans; Male; Mental Disorders; Middle Aged; Mood Disorders; Obsessive-Compulsive Disorder; Panic Disorder; Phobic Disorders; Reproducibility of Results; Surveys and Questionnaires; Time Factors
PubMed: 18378832
DOI: 10.1176/ps.2008.59.4.361 -
Neuropsychiatric Disease and Treatment 2020This study compared predictors of passive suicidal ideation (SI), active SI, and suicide attempt (SA) among elderly Thai patients in tertiary care settings.
PURPOSE
This study compared predictors of passive suicidal ideation (SI), active SI, and suicide attempt (SA) among elderly Thai patients in tertiary care settings.
PATIENTS AND METHODS
Psychiatric diagnoses and suicidality of 803 older people were assessed using the Mini-International Neuropsychiatric Interview and the Structured Clinical Interview for DSM-IV-TR. All participants completed the Montreal Cognitive Assessment, multidimensional scale of perceived social support (MSPSS), 15-item Thai geriatric depression scale (TGDS-15), 10-item perceived social scale and the Core Symptoms Index. The chi-square test, -test and ANOVA were used for bivariate analysis of predictors of specific suicidality types. Multiple logistic regression was used to determine the predictors for each type of suicidality.
RESULTS
The patients' mean age was 69.24 ± 6.90 years, and the majority were female (69.74%). Passive SI, active SI and SA were found among 20.42%, 3.74% and 2.37%, respectively, of the patients. Major depressive disorder (MDD) was a predictor of both passive and active SI (OR = 2.06 and 3.74, respectively). Other predictors of passive SI included hypomania (OR = 8.27) and positive score on the TGDS-15 (OR = 1.29). Predictors of active SI included agoraphobia (OR = 6.84) and hypomania (OR = 7.10). Predictors of SA included a family history of alcohol dependence (OR = 14.16), a history of depression (OR = 4.78) and agoraphobia (OR = 19.89). Surprisingly, hypertension and self-reported anxiety symptoms were protective factors for passive SI (OR = 0.51 and 0.85, respectively). Likewise, MSPSS was a protective factor for SA (OR = 0.90).
CONCLUSION
Predictors of each type of suicidality differed. MDD was the main predictor for SI; however, agoraphobia and poor perceived social support were more pronounced among individuals with SA. Further investigation, especially in longitudinal fashion, should be warranted.
PubMed: 33364770
DOI: 10.2147/NDT.S283022