Buspirone and lorazepam in the treatment of generalized anxiety disorder in outpatients

In this double-blind, placebo-controlled 10-week trial, the anxiolytic properties of the nonbenzodiazepine buspirone were compared with the benzodiazepine lorazepam and placebo in 125 outpatients with generalized anxiety disorder according to DSM-III. After a 3- to 7-day wash-out period, patients were allocated at random to receive orally 3 x 5 mg buspirone (n=58), 3 x 1 mg lorazepam (n=57), or placebo (n=10) over a 4-week period. The study also comprised a 2-week taper period and a 4-week placebo-control period to assess the stability of clinical improvement. The patient's clinical state was estimated on entry and at weekly intervals by general practitioners using the Hamilton Rating Scale for Anxiety (HAM-A) and Clinical Global Impression (CGI) assessment and by a self-rating scale (State Trait Anxiety Inventory X2=STAI-X2). Lorazepam treatment resulted in descriptively, but not significantly, greater improvement on the Hamilton Rating Scale for Anxiety during the whole treatment (week 0-4) and taper period (week 5, 6) than did buspirone. After treatment with active drugs had been discontinued, the 4-week placebo control period showed buspirone-treated patients to display a stability of clinical improvement, while the symptoms of lorazepam-treated patients worsened at week 7-10. Both buspirone and lorazepam were more efficacious in reducing anxiety symptoms than placebo during the treatment and taper period; however, in contrast to the active drugs (buspirone, lorazepam), patients of the placebo group showed further clinical improvement during the control period, especially in the HAM-A score, so differences between placebo and active drugs became smaller at the end of the study.

An evaluation of the iatrosedative process for treating dental fear

The iatrosedative process is an interpersonal-cognitive technique by which fearful patients are calmed by the behavior, attitude, and communicative stance of the dentist. The process consists of an iatrosedative interview and a clinical encounter. In our study, 58 fearful dental patients were assigned to 1 of 3 treatment groups. The Corah Dental Anxiety Scale was administered at admission to the clinic, immediately after the iatrosedative interview or standard interview, and again after the first and second clinical encounters. Participants who received the iatrosedative interview had a significantly greater reduction in dental anxiety after the interview than those who received the standard interview. After the two clinical encounters, however, the difference in anxiety reduction between the two groups was not significant. In addition, there was no significant difference in anxiety reduction between iatrosedative participants who had the same dentist for both the interview and the clinical encounter and participants who had different dentists for each part of the study. It is concluded that an iatrosedative interview is more effective than a standard dental interview in decreasing anxiety.

Self-reported fears in Hispanic youth with mental retardation: a preliminary study

There is a paucity of research on the frequency, intensity, and content of fears experienced by Hispanic (or Latino) American youth with mental retardation. We assessed fears experienced by 48 Hispanic youth with mental retardation (ages 10 to 21 years) using the Fear Survey for Children With and Without Mental Retardation. Although differences were found in the content of fears across age and gender groups, the number and intensity of fears did not differ. Promising evidence of the validity of this survey instrument was attained by its significant correlations with the Revised Children's Manifest Anxiety Scale. Implications for future research were discussed.

[Psychiatric studies of chemotherapy and chemotherapy-induced nausea and vomiting of patients with lung or thymic cancer]

Psychiatric studies were made on 26 inoperable patients with lung cancer or thymic cancer to exam the possible correlation of chemotherapy and chemotherapy-induced nausea and vomiting. All patients were informed of their disease and how to undergo the therapy. Psychiatric tests of CMI (Cornell Medical, Index), MAS (Manifest Anxiety Scale), SDS (Self-Rating Depression Scale) and QOL questionnaire were performed just before the chemotherapy. SDS and QOL questionnaire were also done after chemotherapy. The patients were given chemotherapy including CDDP (80 mg/m2) and anti-emetic agents of 30 mg of azasetron, 750 mg of methylprednisolone and 1,800 mg of domperidone. The patients showing neurosis, anxiety or depression had significantly high nausea scores, so we concluded that psychiatric support was needed to improve these patients' QOL in chemotherapy.

[Construction of a scale for college life anxiety and its reliability and validity]

The purpose of this study are to construct the College Life Anxiety Scale for measuring the level of college students' anxiety and to examine its reliability and validity. After collecting items about the anxiety in college life, factor analysis was performed on the data obtained from 2,782 college students. The result, firstly, showed that the College Life Anxiety Scale consisting of 30 items had three factors, which were daily life anxiety, test anxiety and college maladjustment. Secondly, it was indicated that the Scale had both high test-retest reliability and internal consistency (.82 and .84, respectively). It was also suggested that the Scale had high content, clinical, and criterion-related validities. In conclusion, the College Life Anxiety Scale is well able to measure the level of college students' anxiety in their usual life.

[State of bullying in a geriatric hospital]

Recently, reports of bullying and beatings among school children has brought these problems to the public attention. Unfortunately similar problems exist among the aged and institutionalized patients in geriatric hospitals, e.g., covert teasing and bullying of the weak. Therefore, the present status of bullying or being bullied in our geriatric hospital was analyzed and their backgrounds studied to develop clinical countermeasures against bullying. Results of this study were as follows; 1. Nineteen percent of patients were victims of bullying, and patients who had performed the bullying were 3.0%. 2. Of those who were bullied 20.0% wanted to change hospitals, while 60.0% felt they could tolerate the situation or suppress their anger, and 13.3% of the patients who had exhausted their patience took revenge on the bully. 3. Patients who had been bullied tended to be more tenacious and had a high level of depression by Self-rating Depression Scale (SDS). The apparent error rate in these results was 22.5%.

Dental fear among university students: implications for pharmacological research

University students are often subjects in randomized clinical trials involving anxiolytic and analgesic medications used during clinical dental and medical procedures. The purpose of this study was to describe a typical university student population available for research by using data from a mail survey. Subjects were 350 students chosen randomly from all enrolled, full-time, traditional students on the main campus at the University of Washington in Seattle, WA. The aim was to determine the extent and nature of dental anxiety in this population. In addition, the relationships between subject willingness to receive dental injections and general and mental health and medical avoidance and medical fears were examined. The Dental Anxiety Scale (DAS) was used to measure dental anxiety. Dental anxiety was prevalent in this population; 19% of students reported high rates of dental fear. Thirteen percent of students had never had a dental injection. Students with no experience with dental injections were more reluctant than those with experience to receive an injection if one were needed. DAS scores were correlated with injection reluctance. Students who were reluctant to go ahead with a dental injection also reported poorer general and mental health than those who were less reluctant. These students also reported higher medical avoidance and medical anxiety scores. University students provide a rich source of potential subjects for clinical research. The student population, like the community at large, contains people with high levels of dental and medical fear.

Comparative studies on the effects of the combination drug lorazepam plus diphenhydramine (Somnium) versus lorazepam on the noopsyche, thymopsyche and psychophysiology in nonorganic insomnia related to generalized anxiety disorder

In a double-blind, parallel-group design study on hypnotic and anxiolytic effects of the combination drug Somnium (lorazepam 1 mg + diphenhydramine 25 mg) (SOM) as compared with 1 mg lorazepam (LOR) alone, daytime behavioral effects were studied in 44 patients with nonorganic insomnia related to a mild generalized anxiety disorder. After a placebo run-in phase of 1 week, they received active treatment for 4 weeks. Psychometric evaluations included 6 thymopsychic variables (somatic complaints, state anxiety, trait anxiety, self-rating anxiety and depression scale and adjective mood scale), 6 noopsychic variables (general, associative, numerical and total verbal memory; correct reproductions and errors-Benton visual memory test), 4 pupillary measures (pupillary diameter, latency, relative change in % and half recovery time in pupillary response) and 6 skin conductance measures (baseline, latency, ascending time, time to peak, skin conductance response and skin conductance response maximum). Multivariate statistical analysis of the thymopsyche demonstrated significant improvement after both compounds, with the combination drug significantly superior to its single component lorazepam. Also regarding noopsychic measures, Somnium was significantly superior to the single component lorazepam, as specifically verbal memory was improved after Somnium, while opposite changes occurred after lorazepam alone. Pupillary measures revealed no significant overall inter-drug differences, whereas skin conductance findings demonstrated that the combination drug Somnium was superior to the single component lorazepam also in regard to the anxiolytic effect at the autonomic nervous system level.

The relation between anxiety sensitivity and depression in children and adolescents referred for anxiety

Research conducted with adult samples suggests that anxiety sensitivity is positively related to depression (Otto et al., 1995, Journal of Anxiety Disorders, 10, 117-123). The Childhood Anxiety Sensitivity Index (CASI, Silverman et al., 1991, Journal of Clinical Child Psychology, 20 162-168) was used in this study to provide an examination of the relation between anxiety, anxiety sensitivity, and depression in a sample of children and adolescents (N = 234) referred for anxiety disorders. A significant correlation between depression and anxiety sensitivity was found. This relation remained statistically significant when controlling for other aspects of anxiety (i.e. worry, physiological anxiety, and concentration). The similarities between these findings and findings obtained with adults are discussed, as well as suggestions for future research.

Comparison of sublingually and orally administered triazolam for premedication before oral surgery

OBJECTIVES

This study evaluated sublingual administration of triazolam for preoperative sedation in dental outpatients.

STUDY DESIGN

A double-blind, placebo-controlled study compared 0.25 mg sublingual triazolam, 0.25 mg oral triazolam, and placebo administered 1 hour before oral surgery.

RESULTS

Sublingual triazolam resulted in significantly less anxiety and pain at 15 minutes intraoperatively than both oral triazolam and placebo (p < 0.05). Patients' global evaluation of the efficacy of sedation ranked sublingual triazolam as significantly more efficacious than placebo (p < 0.05) with oral triazolam intermediate between the two. No difference was demonstrated in the rate of recovery or incidence of side effects between the two drug groups. Plasma triazolam levels were higher after sublingual administration during and after the surgical procedure.

CONCLUSIONS

These results indicate that sublingual triazolam results in greater anxiolytic activity and less pain perception than oral administration as a result of greater plasma drug levels and may be useful as an alternative for nonparenteral outpatient sedation.

Psychological predictors of pain during dental hygiene treatment

This study examined the role of catastrophizing (i.e. a tendency to exaggerate the threat value of potentially painful situations) in predicting pain experience during dental hygiene treatment. Participants in the research were 100 patients undergoing scaling and/or root planing procedures at Dalhousie University's Dental Clinic. Following treatment, participants completed the Pain Catastrophizing Scale, a measure of emotional distress, a pain scale, and the Dental Anxiety Scale-Revised. Participants who scored above the median on the Pain Catastrophizing Scale were classified as catastrophizers, participants who scored below the median were classified as noncatastrophizers. Results showed that catastrophizers reported significantly more dental anxiety, emotional distress and pain than noncatastrophizers; and that distress reactions were more pronounced in men that in women. Discussion focuses on the importance of addressing psychological factors in dental hygiene practice, particularly as they relate to reactions to dental hygiene procedures, and avoidance of dental care.

Changes in self-reported dental anxiety in New Zealand adolescents from ages 15 to 18 years

Little is understood of the natural history of dental anxiety. The aim of this study was to examine three-year changes in self-reported dental anxiety among adolescent participants in the Dunedin Multidisciplinary Health and Development Study. Dental anxiety was estimated at ages 15 and 18 by means of the Corah Dental Anxiety Scale (DAS). A DAS score of 13+ defined high dental anxiety. Participants were assigned to one of four dental-anxiety study groups (Chronic, Incident, Remitted, or Never) on the basis of changes in reported level of anxiety from ages 15 to 18. Results are reported for the 691 participants who completed the DAS at both ages. The sample's overall dental anxiety score decreased significantly from age 15 (mean, 8.79) to 18 (8.52) (paired t test, t = 2.37; P < 0.05). The Chronic and Never groups had small negative DAS increments, the Incident group showed a substantial positive increment, and the Remitted group recorded an even larger negative increment. Multivariate analysis showed that the DAS score at age 15 was the sole predictor of the change in DAS score for the Chronic and Remitted groups, and was a co-predictor for the Incident and Never groups. An episodic dental visiting pattern was a strong predictor of a positive change in DAS score for the Incident group; and for the Never group, a higher DMFS score at age 15 predicted a positive change in DAS score at 18, but being female was predictive of a decrement. This study indicates lower stability of dental anxiety in late adolescence than has been reported from other age groups.

Four dimensions of fear of dental injections

In 1995, students and staff at the University of Washington were surveyed regarding avoidance of dental care and fear of dental injections. More than 25 percent of adults surveyed expressed at least one clinically significant fear of injections. Almost one in 20 respondents indicated avoiding, cancelling or not appearing for dental appointments because of fear of dental injections. Fear of dental injections consists of four dimensions. General fear of dental injections including pain of injection and of bodily injury from injection are the two most common dimensions of dental injection fear. Many people also express fears of acquired disease. Fear related to local anesthetic (such as side effects, inadequate anesthesia) is less frequent. Some respondents have fears that must be categorized using more than one of these dimensions. Understanding the nature of a patient's fear of injection may suggest strategies to address his or her concerns.

Assessing dental anxiety, dental care use and oral status in older adults

This study examined associations between dental anxiety and dental care use and oral health status in dentate older adults. Analysis of data from the Piedmont 65+ Dental Study revealed that aspects of dental care use and oral health status were independently associated with high dental anxiety. These results suggest that measures to control dental anxiety may help to improve dental care use and oral health status in older adults.

The influence of a patient-management course to dental hygiene students on the dental anxiety of their patients

This study investigated the effect of teaching dental hygiene students a course in caregiver-patient relationships on their patients' dental anxiety, and patients' feelings toward known anxiety-provoking stimuli. The study group (twenty-five men and twenty-five women) was treated by a class of dental hygiene students following a behavioral course given after the first visit. The control group (twenty-four men, twenty-six women) was treated by another class without the intervention. Corah's Dental Anxiety Scale (DAS) and a twelve-item questionnaire identifying specific anxiety-provoking situations were completed by the patients before initial visit and after the third visit. A significant reduction in DAS within the study group was observed after the intervention. In both groups, women demonstrated higher anxiety. No significant difference was found in the twelve-item questionnaire after intervention in both groups. These findings suggest that a four-hour behavioral course to a class of dental hygiene students was an influencing factor in reducing their patients' levels of dental anxiety.

Validation of the Dental Fear Scale and the Dental Belief Survey in a Norwegian sample

The aim of this study was to validate the Kleinknecht's Dental Fear Scale and the Getz's Dental Belief Survey in a Norwegian sample by 1) testing their ability to discriminate between fearful (n = 151) and regular (n = 160) patients, and 2) correlating them. Both instruments were highly reliable (Cronbach's alpha > 0.90). Between 81% and 95% of the fearful and regular patients were correctly assigned to their appropriate groups with both instruments. It may thus be concluded that both instruments are valid. Also, the correlation between the instruments was 0.68, indicating that they to a large extent seem to measure the same concept. The most important predictor items for both instruments were related to avoidance of dental treatment.

[Subjective happiness and psychological condition in SLE]

We reported the relationship between subjective happiness and psychological condition to investigate which factor effects the quality of life (QOL) in 18 patients with systemic lupus erythematosus (SLE) and compared them with age, sex and dose of steroid matched 18 patients with chronic glomerular nephritis (CGN). The patients were evaluated in morale scale-revised (Japanese version) which is a standard method of evaluating subjective happiness in relation to QOL. State-trait anxiety inventory (STAI) of Spielberger was used for evaluation of anxiety condition with self rating depression scale (SDS) of Zung in evaluation of depressive state. We examined the relationship between morale scale and SDS and morale scale and STAI. The relationship between morale scale and age; period of the disease, dose of steroid and activity were also investigated. There were no significant differences between the groups on morale scale, SDS and STAI and there were no significant correlations between morale scale and age; period of the disease and the dose of steroid in the both groups. There were correlations between morale scale and state and trait anxiety in the group with SLE and morale scale and trait anxiety in the group with CGN. We concluded that anxiety decreased the QOL in patients with SLE and CGN.

Hypnosis compared with group therapy and individual desensitization for dental anxiety

Effects of hypnotherapy (HT) and self-hypnosis training on extreme dental anxiety in adults aged 19-65 years were compared with group therapy (GT) and individual desensitization (SD) using scales of dental anxiety, dental beliefs, and fear of a next dentist (after specialist treatment). All experimental groups were demographically comparable and showed reduced anxiety and improved dental beliefs compared with 51 control patients. The 25 HT patients did not differ significantly in numbers of dropouts during training compared with the 30 GT patients or 68 SD patients. For patients completing treatment, HT (n = 22) reduced dental anxiety to the same degree as GT (n = 24) and SD (n = 60). HT and SD patients required more therapist hours per patient than did GT, but total dropouts at 1 yr after specialist treatment were significantly greater in HT (13/ 25) than for SD rehearsals (5/34) or SD video (8/32), but not GT (15/30). Hypnotizability was found to vary from patient to patient, with a direct relationship to time saved. But hypnotizability had an inverse relationship to STAI general anxiety level for those who went on to dentists after 1 year. Transference effects were noted for most HT dropout patients as an aversive response to continued dental treatment with other dentists than the specialist.

Who is dentally anxious? Concordance between measures of dental anxiety

Studies of the prevalence of dental anxiety in general population samples have produced estimates which range from a low of 2.6% to a high of 20.4%. It is not clear whether these reflect real differences among populations or whether they are the result of the use of different measures and different cut-off points. We undertook a large scale mail survey of dental anxiety in a random sample of the adult population living in Metropolitan Toronto designed to assess the performance of and agreement between three measures. These were Corah's DAS, the single item used by Milgrom and colleagues in Seattle and the ten-point fear scale used by Gatchel. These measures and their published cut-off points produced prevalence estimates of 10.9%, 23.4% and 8.2% respectively. While there was a significant association between scores on pairs of measures the agreement between them was far from perfect. Kappa values ranged from 0.37 to 0.56, indicating only fair to moderate agreement beyond chance. There was evidence to indicate that the dentally anxious subjects identified by each measure differed according to certain behavioural and other characteristics. The results of the study suggest the need to revisit the issue of measurement in studies of dental anxiety.

Investigation of the effects and aftereffects of naturally occurring upper respiratory tract illnesses on mood and performance

This study examined the effects and aftereffects of naturally occurring upper respiratory tract illnesses on mood and performance. Twenty-six subjects (12 males, 14 females, mean age 23 years 10 months, age range 18-39 years) were tested once a week for a period of a month. Fifteen subjects were suffering from a common cold on the first week and the other 11 subjects were matched healthy controls. Subjects attended for an initial 3-h testing period that consisted of a set of practice trials and two test sessions involving mood rating and performance of a battery of tests measuring psychomotor functions, attention, and memory. Sessions 3, 4, and 5 took place 1, 2, and 3 weeks later, respectively. In addition to measuring mood and mental performance, symptom severity was rated on a subjective checklist. The results showed that subjects with a cold reported an increase in negative mood and that this was only significant in the first week. Impairments of psychomotor function (simple reaction time and tracking) were also observed at this time. Performance of sustained and selective attention tasks was also impaired in subjects with colds but this effect was only significant in the second week. Other functions such as working and semantic memory were unimpaired in subjects with colds at any point in the experiment. Overall, the present results confirm many of the earlier results obtained in studies of experimentally induced upper respiratory tract illnesses. Indeed, these results are both of great practical importance and theoretical interest and further studies must now elucidate the mechanisms underlying these effects.

Application of the multidimensional fatigue inventory (MFI-20) in cancer patients receiving radiotherapy

In this paper the psychometric properties of the multidimensional fatigue inventory (MFI-20) are established further in cancer patients. The MFI is a 20-item self-report instrument designed to measure fatigue. It covers the following dimensions: general fatigue, physical fatigue, reduced activity, reduced motivation and mental fatigue. The instrument was used in a Dutch and Scottish sample of cancer patients receiving radiotherapy. The dimensional structure was assessed using confirmatory factor analyses (Lisrel's unweighted least-squares method). The hypothesised five-factor model appeared to fit the data in both samples (adjusted goodness of fit; AGFI: 0.97 and 0.98). Internal consistency of the separate scales was good in both the Dutch and Scottish samples with Cronbach's alpha coefficients ranging from 0.79 to 0.93. Construct validity was assessed by correlating the MFI-20 to activities of daily living, anxiety and depression. Significant relations were assumed. Convergent validity was investigated by correlating the MFI scales with a visual analogue scale measuring fatigue and with a fatigue-scale derived from the Rotterdam Symptom Checklist. Results support the validity of the MFI-20. The highly similar results in the Dutch and Scottish sample suggest that the portrayal of fatigue using the MFI-20 is quite robust.

Dental anxiety and the absorption of orally administered erythromycin stearate

Erythromycin stearate is an acid labile antibiotic, therefore fear and apprehension, which are known to affect gastric motility, may produce erratic absorption resulting in lower serum levels. The mean (SD) serum erythromycin concentration 75 minutes after a 1.5 gm oral dose of erythromycin stearate to 45 patients was 8.7 (4.8) mg/L and ranged widely from 0.4 to 20.5 mg/L. The serum concentration of erythromycin was below therapeutic levels (1.0 mg/L) in two patients. No significant association was found between anxiety and serum levels of erythromycin when age, gender, and gastric distress were taken into account. It is concluded that dental anxiety may indirectly influence the uptake of oral erythromycin stearate; but this relationship is complex, and there is no evidence from this study that increased dental anxiety decreases the uptake of the drug.

Dentist's ratings of child dental-patients' anxiety

This study investigates the extent to which dentists giving treatment are able to evaluate the (changes in) child patients' levels of fear, based on a comparison between direct behavior observations of a group of highly anxious children during sequential dental visits and video observations of the same group made by two independent evaluators using the measuring instrument described by Venham et al. (9). A significant difference was found between the fear scores given by the two dentists giving treatment and also between their fear scores and those by the independent observers. Both the fear and behavior scores of the two dentists giving treatment, however, clearly correlated with the fear scores of the observers. It is concluded that in this study the two dentists giving treatment were unable to award an unbiased fear score for each treatment given to a child but it was not possible to show that the bias was caused by experiences from previous sessions with the same child. After video training dentists giving treatment are capable of giving a picture of changes in children's fear levels during sequential dental visits.

Equivalence of the original and revised dental anxiety scales

PURPOSE

The Corah Dental Anxiety Scale (DAS) was introduced in 1969 as a brief, valid, and reliable instrument to measure anxiety about dental visits. Since then, changes in language usage and dental practice have rendered the scale outdated. In 1994, Ronis introduced the Dental Anxiety Scale-Revised (DAS-R), a version of the DAS revised to acknowledge the roles of dental hygienists and female dentists in the dental office. The current study was conducted to determine whether the original and revised scales are equivalent.

METHODS

The study tested the equivalence of the two scales by including both in a questionnaire filled out by 141 male and female college students. Psychometric equivalence was examined by comparing the means, and reliabilities (alphas) of the two scales and by correlating the two scales with each other.

RESULTS

Mean scores, variances, and reliabilities of the two versions of the scale did not differ. The Pearson correlation between the two scales was .98.

CONCLUSIONS

It appears that the DAS-R is psychometrically equivalent to the DAS and can be used in its place whenever more up-to-date wording is desired.