[The effects of hormone replacement therapy in menopause on symptoms of anxiety and depression]

OBJECTIVE

Replacement of deficient hormones (hormone replacement therapy, HRT) is the main treatment modality in menopause. There is no concensus among researchers as to how HRT influences psychiatric symptoms that might develop during menopausal period. In this study we aimed to explore the effects of HRT on symptoms of anxiety and depression comparatively by using either estrogen or tibolone.

METHOD

Women with natural menopause who applied to the outpatient Clinic of Obstetrics and Gynecology Department were included in the study. Subjects (n=70) were randomized into two groups with one group to receive 17beta-estradiol and other group tibolon. All subjects were evaluated at baseline and after 3-months of HRT with Hamilton Anxiety Rating Scale (HARS) and Hamilton Depression Rating Scale (HDRS).

RESULTS

Forty six of 70 patients completed the study. The 17beta-estradiol (n=23) and the tibolone (n=23) groups were similar with respect to age, education and occupational status. The time from onset of menopause was longer in the tibolon group. HARS and HDRS scores were significantly decreased after 3 months of HRT in both the 17beta-estradiol and the tibolone groups. The two drug regimens were not significantly different in this respect.

CONCLUSION

HRT with 17beta-estradiol and tibolone improves symptoms of anxiety and depression in menopausal women.

Psychosocial outcomes of a pilot multidisciplinary program for weight management

OBJECTIVE

To investigate psychosocial effects of a 6-month pilot multidisciplinary weight-management program for young females.

METHODS

Participants (n=57), ages 8-15, completed the Revised Children's Manifest Anxiety Scale (RCMAS) and Self-Perception Profile for Children (SPPC) at baseline, 6 months, and 12 months.

RESULTS

Positive changes were noted in the scores of both surveys. Significant decreases occurred in the RCMAS mean Total Anxiety and Worry/Oversensitivity scores; significant increases were found in the SPPC mean Social Acceptance and Athletic Competence scores.

CONCLUSIONS

Enrollment in multifaceted weight-management programs that include stress management and social support may reduce anxiety level and enhance self-perception.

[Epidemiologic study of dental fear in school children 8-15 years of age]

Authors investigated the dental fear scores (DAS, DFS) of 139 primary school children in Budapest, Hungary (72 females, 67 males, ages between 8-15 years). Sex and age had no effect on the scales. Mean dental fear scores were high (DAS: 10.7 +/- 3.7, DFS: 40.4 +/- 15.3). A strong correlation between DAS and DFS, and somewhat lower correlation between these scales and the general anxiety scales were demonstrated. Children's evaluation of the dental fear of the family and relations strongly correlated with dental fear and moderately with general anxiety. The results indicate that, dental fear is influenced by dental fear of family and relations, and general anxiety, but much less influenced by other demographic variables (i.e. age, sex) in primary-school children.

The memorial anxiety scale for prostate cancer: validation of a new scale to measure anxiety in men with with prostate cancer

BACKGROUND

The psychological difficulties facing men with prostate cancer are acknowledged widely, yet identifying men who may benefit from mental health treatment has proven to be a challenging task. The authors developed the Memorial Anxiety Scale for Prostate Cancer (MAX-PC) to facilitate the identification and assessment of men with prostate cancer-related anxiety. This scale consists of three subscales that measure general prostate cancer anxiety, anxiety related to prostate specific antigen (PSA) levels in particular, and fear of recurrence.

METHODS

Ambulatory men with prostate cancer (n = 385 patients) were recruited from clinics throughout the United States. Prior to routine PSA tests, participants completed a baseline assessment packet that included the Hospital Anxiety and Depression Scale; the Distress Thermometer; the Functional Assessment of Cancer Therapy Scale, Prostate Module; and measures of role functioning, sleep, and urinary functioning. PSA values from the last three tests also were collected. Follow-up evaluation was completed within 2 weeks after patients learned of their PSA test result using a subset of these scales.

RESULTS

Analysis of the MAX-PC revealed a high degree of internal consistency and test-retest reliability for the total score and for the three subscales, although reliability was somewhat weaker for the PSA Anxiety Scale. Concurrent validity was demonstrated by correlations between the MAX-PC and measures of anxiety. Overall changes in PSA levels were correlated only modestly with changes in MAX-PC scores (correlation coefficient, 0.13; P = 0.02).

CONCLUSIONS

The MAX-PC appears to be a valid and reliable measure of anxiety in men with prostate cancer receiving ambulatory care.

Temperament and character personality dimensions in patients with dental anxiety

The aim of the present study was to investigate character and temperament dimensions of personality in six men and 31 women (aged 20-57 yr) with severe dental anxiety, and to evaluate whether these dimensions were associated with the level of dental anxiety. The Dental Anxiety Scale (DAS) and the Temperament and Character Inventory (TCI) were used. High ratings in novelty seeking and female gender predicted high DAS scores. Compared with controls, the patients scored significantly higher on the temperament dimension, novelty seeking. For character dimensions, the patients scored lower on cooperativeness and higher on self-transcendence than controls. Our results indicated that patients with dental anxiety are neurotic extravert (i.e. novelty seekers who experience brief dissociative periods and magical thinking). Furthermore, the combination of the inherited temperament dimension novelty seeking and the social learned character dimension cooperativeness and self-transcendence seem to form a vulnerable personality to develop dental anxiety.

[Clinical analysis of endoscopy negative gastroesophageal reflux disease in the elderly]

The purpose of this study was to describe the clinical analysis of endoscopy negative gastroesophageal reflux disease (EN-GERD) in the elderly. 35 elderly patients of both sexes, 60 years or older with EN-GERD, 33 elderly patients with reflux esophagitis and 41 elderly patients as control group were included in this study. All patients witnessed verbal informed consent to participate in the study. EN-GERD was defined as the patients with normal endoscopy despite of heartburn as their chief complaint and who were completely relieved with heartburn after one-week omeprazole treatment. Helicobacter pylori infection between EN-GERD, reflux esophagitis and control were 37.1%, 24.2% and 56.1%, respectively. The gastric mucosal atrophy under endoscopic findings and the serum pepsinogen I, II ratio in EN-GERD had no significant differences with control. A hiatus hernia with EN-GERD was diagnosed 37.1%, which was lower significantly than 87.9% with reflux esophagitis. The motility of the stomach using the acetaminophen method was the same in patients with EN-GERD, reflux esophagitis and control. The anxiety score of the Hospital Anxiety and Depression Scale was significantly higher in the patients with EN-GERD than in those with reflux esophagitis and control. On the other hand, the severity of reflux symptoms in the patients with EN-GERD was similar as those with reflux esophagitis. We concluded that general anxiety plays an important role in the severity of the reflux symptoms in the patients with EN-GERD. As such symptoms in EN-GERD significantly impair the quality of life, further studies of patients with EN-GERD are greatly needed.

[The effect of giving information forms about side effects of intravenous iodinated contrast material on the anxiety level of patients]

PURPOSE

We aimed to determine the effect of informing patients about side effects of the contrast material on the level of patients' anxiety.

MATERIALS AND METHODS

Two hundred-ninety seven patients undergoing computed tomography examination were enrolled in the study. Patients were grouped in three categories: (1) patients informed about adverse effects of contrast material and waiting for i.v. contrast material injection, (2) uninformed patients waiting for i.v. contrast material injection, (3) uninformed patients undergoing unenhanced CT examination. All patients were requested to complete a questionnaire including a standard anxiety test. The results were compared statistically.

RESULTS

The mean anxiety scores calculated by variant analysis were 39.2 +/- 11.7, 42 +/- 10.4, and 38.6 +/- 9.5 in groups 1, 2, and 3, respectively. No statistically significant difference was found between the anxiety scores of the 3 groups.

CONCLUSION

Informing patients about the adverse effects of the contrast material does not affect their anxiety level.

An investigation into the efficacy of Scutellaria lateriflora in healthy volunteers

Scutellaria lateriflora is an herbal medicine with long-standing traditional use as a relaxing nervine. There has been controversy in the literature with regards to its efficacy, and this study was designed to clarify its effectiveness in reducing anxiety, one of the phytotherapeutic indications. A double blind, placebo-controlled study of healthy subjects demonstrated noteworthy anxiolytic effects. The use of phytomedicines for the treatment of anxiety is reviewed, as is the published literature on S. lateriflora and its putative toxicity.

The Fear of Dental Pain questionnaire: construction and validity

Anxiety, fear and pain play an important role in the context of dental treatment and patients' well-being. The Fear of Pain Questionnaire (FPQ)-III is a recently developed self-report questionnaire measuring pain-related fear of a variety of painful stimuli. The present study was undertaken in order to develop a dental equivalent of the FPQ-III, called the Fear of Dental Pain questionnaire (FDP), to determine standard psychometric characteristics and to assess the instruments' validity. Four experienced dentists generated the initial pool of items and two methodologists constructed the initial questionnaire. Two studies were performed. In the study one, a sample of psychology freshmen (n = 309) was taken in order to analyse response patterns. In study two, a sample (n = 176) of patients, dental students and the general population was examined. Results from both studies were used to determine reliability and validity. High internal consistency (0.93) with satisfactory test-retest reliability (0.75) was obtained. Factor analysis revealed a strong one-dimensional factor underlying almost all items. Finally, the proposed FDP version was related to a measure of dental fear and a general measure of fear of pain. All a priori hypotheses were confirmed, thereby providing evidence for the validity of the FDP. The FPD may prove to be a clinically useful tool in the dental setting, and a potentially important covariate in dental pain perception research.

Trauma-related phenomena in anxious dental patients

OBJECTIVES

The main purpose of this descriptive study was to investigate whether dental anxiety is associated with the occurrence of trauma-related symptoms (i.e. recurrent memories and a tendency to avoid these memories) associated with earlier traumatic dental experiences.

METHODS

A sample of 37 consecutive anxious patients attending a dental fear clinic was assessed prior to dental treatment. The results were compared with those of a sample of 32 consecutive patients of a general dental practice, who served as a reference group.

RESULTS

The proportion of patients who indicated they had had a horrific dental experience at least once in their life did not significantly differ between the anxious group and the reference group. Conversely, significantly more patients (76%) in the anxious group reported suffering from memories of these events. They also showed a higher level of trauma-related symptomatology as indexed by the Impact of Event Scale (IES). About half of the anxious patients suffered from symptoms typically reported by patients with posttraumatic stress disorder (PTSD). Severity of dental anxiety showed a high correlation with both frequency of intrusions (r = 0.64, P < 0.001) and avoidance of the memories (r = 0.62, P < 0.001).

CONCLUSIONS

The results suggest that in anticipation of treatment dentally anxious individuals suffer from a high level of intrusive recollections of earlier dental experiences.

Anxiety sensitivity and panic attack symptomatology among low-income African-American adolescents

This study examined the concurrent and prospective relation between anxiety sensitivity (AS) and panic attack symptomatology among a community sample of African-American adolescents (N = 107; mean age 15.6 years) from predominantly low-income, single-parent households. On two occasions, 6 months apart, youth completed self-report measures of AS, measured by the Childhood Anxiety Sensitivity Index (CAS I), and panic symptomatology, measured by the Panic Attack Questionnaire (PAQ) and/or the Panic subscale of the Screen for Child Anxiety-Related Emotional Disorders (SCARED-P). Results indicated that adolescents with high levels of AS reported higher concurrent levels of panic symptomatology, compared to their less anxious peers. Earlier levels of AS were correlated with panic symptoms 6 months later but did not predict later panic symptoms once initial levels of panic were controlled. Panickers, compared to non-panickers, also reported significantly higher levels of AS at Time 2. Overall, these findings are consistent with research on AS and panic in adult and Caucasian populations and support the hypothesis that elevated levels of AS may be one of several risk factors implicated in the development of panic attack symptomatology.

[Medical history in relation to dental anxiety in adults]

Fear in adults has a clearly endogenous component. Specific fear anamnesis questionnaires are available to gauge the fear of dental treatment. On the basis of a literature review the different questionnaires and their usefulness are being discussed.

Treating depression comorbid with anxiety--results of an open, practice-oriented study with St John's wort WS 5572 and valerian extract in high doses

Depressive disorders in comorbidity with anxiety disorders represent an frequently diagnostic and therapeutic problem. The studies quoted here prove that the symptoms associated with anxiety that severely afflict patients can be clearly improved more quickly with a combination therapy of St John's wort extract and valerian extract than with St John's wort monotherapy. The combination therapy was well tolerated, no significant side-effects occurred. Further studies are necessary to compare the combination treatment with other forms of therapy (serotonin- and noradrenalin re-uptake inhibitors).

Validación de las versiones en español de la Clinical Anxiety Scale y del Physician Questionnaire para la evaluación de los trastornos de ansiedad

BACKGROUND AND OBJECTIVE

To validate the Spanish versions of both the Clinical Anxiety Scale (CAS) and the Physician Questionnaire (PQ) to assess the severity of symptoms in patients with Anxiety Disorders (AD) treated in ambulatory psychiatric care facilities.

PATIENTS AND METHOD

Observational, prospective and multi-centre study (15 psychiatric facilities included) with a follow-up of 1 to 6 weeks in clinically stable or unstable AD patients. We assessed their convergent validity (with the Hamilton Anxiety Rating Scale as reference), discriminant validity (as compared with the Clinical Global Impression), reliability (internal consistency, test-retest and inter-raters) and sensitivity to change.

RESULTS

One hundred and sixty one AD patients were included (48 stable and 133 unstable patients). Both the CAS and the PQ showed appropriate convergent (r >= 0.70) and discriminant validity (p 0.001), internal consistency (Cronbach's a > 0.75), test-retest reliability (intraclass correlation coefficient [ICC] > 0,90), inter-raters reliability (ICC > 0.90) and sensitivity to change (p < 0.0001; effect size >= 1.5).

CONCLUSIONS

The Spanish versions of both rating scales show appropriate validity and reliability and thus can be used to assess the severity of anxiety symptoms and their change in AD patients treated in ambulatory care.

[Medical history in relation to dental anxiety in children]

Fear in children is of clearly exogenous origin. Negative experiences will cause fear by direct conditioning. The influence of an important other person can be the root of fear by indirect conditioning. Antecedent factors and intermediary variables associated with fear are described. Usefulness and indications of the different questionnaires for children are specified.

Kava-Kava extract LI 150 is as effective as Opipramol and Buspirone in Generalised Anxiety Disorder--an 8-week randomized, double-blind multi-centre clinical trial in 129 out-patients

OBJECTIVE

An 8-week randomized, reference-controlled, double-blind, multi-centre clinical trial investigated Kava-Kava LI 150 in Generalized Anxiety Disorder (GAD; ICD-10: F41.1).

METHOD

129 out-patients received either 400 mg Kava LI 150, 10 mg Buspirone or 100 mg Opipramol daily for 8 weeks. At week 9, subjects were seen to check for symptoms of withdrawal or relapse. Primary outcome measures comprised the HAMA scale and the proportion of responders at week 8. Secondary measures were the Boerner Anxiety Scale (BOEAS), SAS, CGI, a self-rating scale for well-being (Bf-S), a sleep questionnaire (SF-B), a quality-of-life questionnaire (AL) and global judgements by investigator and patients.

RESULTS

In 127 patients (ITT) no significant differences could be observed regarding all efficacy and safety measures. About 75% of patients were classified as responders (50% reduction of HAMA score) in each treatment group, about 60% achieved full remission.

CONCLUSION

Kava-Kava LI150 is well tolerated and as effective as Buspirone and Opipramol in the acute treatment of out-patients suffering from GAD.

Intercessory prayer in psychological well-being: using a multiple-baseline, across-subjects design

Undergraduates from an upper-level psychology course were volunteer participants in the study. The 8 participants were to be prayed for in a Multiple Baseline Across Subjects research design, which included a 1-week minimum baseline period for all subjects followed by the sequential presentation of the independent variable so that every two weeks, two additional subjects were being prayed for until all but 2 participants, who maintained baseline, were exposed to being prayed for at 7 weeks. All participants were prayed for by one of the experimenters using a nondirective method of prayer where no specific requests were made. All subjects completed the Taylor Manifest Anxiety Scale on a daily basis for 5 weeks and the Minnesota Multiphasic Personality Inventory-2 on a weekly basis for 7 weeks. Analysis of data identified significant reductions in anxiety scores on both the tests for subjects who were prayed for but not for those who were not prayed for. Subjects' lower mean anxiety scores somewhat matched the sequential timing of being prayed for.

Cooperation during dental treatment: the Children's Fear Survey Schedule in Japanese children

OBJECTIVE

The aim of this study was to evaluate dental fear and cooperation during dental treatment using the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS).

METHODS

From the behaviour assessment of regular patients of the Pediatric Dental Clinic in Niigata University Dental Hospital (aged 5-12 years old), the patients were classified into two groups: uncooperative and cooperative. CFSS-DS questionnaires were sent to a total of 295 patients, 186 of which were returned, 61 from the uncooperative group and 125 from the cooperative group.

RESULTS

In the uncooperative and the cooperative groups, the CFSS-DS mean total scores were 31.79 and 24.02 (P < 0.05), respectively, and the ratios of the patients whose scores were equal to or more than 35 were 36.1 and 11.2%, respectively. Fear of 'injections' and 'the dentist drilling' had high scores in both groups.

CONCLUSIONS

The results indicated that there are many uncooperative patients with low dental fear and cooperative patients with high dental fear.

[Comparison of zopiclone and midazolam premedication for preoperative anxiolysis]

To compare the anxiolysis property of zopiclone (ZPC) and midazolam (MDZ), 117 patients were given zopiclone 7.5 mg p.o. or midazolam 0.05 mg.kg-1 i.m. as premedication. In the study 1, patients were randomly allocated to 4 groups: ZZ group (n = 16) received ZPC in the night before operation and 2 h before operation, ZM group (n = 18) received ZPC in the night before operation and MDZ 1 h before operation, Z group (n = 18) received ZPC 2 h before operation, and M group (n = 24) received MDZ 1 h before operation. The degree of anxiety was evaluated using the state-trait anxiety inventory (STAI) on the day before operation and after receiving premedication. ZPC showed a significant reduction in the STAI score in the ZZ and Z group, but premedication with MDZ showed no changes in the STAI score. In the study 2, patients were randomly allocated to 2 groups: ZPC group (n = 22) received ZPC 2 h before operation, and M group (n = 19) received MDZ 1 h before operation. The degree of anxiety was evaluated using the visual analog scale (VAS) on the day before operation and after receiving premedication. ZPC showed a significant reduction in the VAS score, but MDZ showed no changes in the VAS. It is concluded that ZPC (7.5 mg p.o.) is suitable to reduce the preoperative anxiety in patients who are to undergo surgery as compared to MDZ (0.05 mg.kg-1 i.m.).

Reliability and validity of a short form of the dental subscale of the child fear survey schedule used in a Nigerian children population

This study sought to establish the reliability and validity of a short form of the Dental Subscale of the Child Fear Survey Schedule (DFSS-SF). The schedule was administered twice to 23 children who had not attended a dental clinic for dental treatment before. The second administration was done two weeks after the first. They had no preknowledge of the second administration of the schedule. The children's behaviour during treatment was also assessed using the Frankl's scale. An additional assessment was also made using the dichotomy "anxious" or "not anxious". Analysis of the reliability was done using the Cronbach's coefficient alphas as well as the Pearson product-moment coefficient. The overall coefficient alphas for the DFSS-SF was 0.82 (p < 0.0001). A test retest correlation of 0.73 (p < 0.0001) was obtained. On comparison of the DFSS-SF with the Frankl's scale, a significant difference was found in the psychometric scores of the children grouped as anxious and no anxious. Also, on comparison of the DFSS-SF with the dichotomy scale, a highly significant difference between the two was observed (p = 0.005). A good negative correlation was found between the second administration of the DFSS-SF and Frankl's scale (r = -0.54; p = < 0.01). The DFSS-SF is a reliable and valid instrument for measuring dental anxiety in Nigerian children. However the study needs to be replicated on a larger number of children.

Five-year incidence of dental anxiety in an adult population

OBJECTIVES

The purpose of the study was to assess the incidence of dental anxiety and factors associated with onset in adults aged 18 years and over.

DESIGN

A longitudinal mail survey of a random sample of the general population consisting of a baseline phase and a follow-up after five years.

SUBJECTS

1,422 individuals completed baseline and follow-up questionnaires concerning dental anxiety; 1,226 subjects who were not anxious at baseline were included in the analysis. A sub-sample of 747 of these subjects had also completed a psychological questionnaire at baseline.

MEASURES

Dental anxiety was assessed using the Dental Anxiety Scale (DAS). Other measures included the Dental Belief Survey, The Iowa Dental Control Index, a scale to measure attitudes towards pain, and measures of trait anxiety and general fearfulness. Questions were also asked about dental visiting patterns and dental treatment experiences prior to baseline and between baseline and follow-up.

RESULTS

The five-year incidence of dental anxiety in this population was 5.8%. This varied from 12.2% in those aged 18 to 24 years at baseline to 1.7% among those aged 65 years and over at baseline. Those reporting an episodic visiting pattern between baseline and follow-up and those who avoided dental care altogether were also more likely to become anxious about dental treatment. Seven variables entered a logistic regression model predicting onset: age at baseline, DAS score at baseline, fear of pain, dental visiting pattern and three variables indicating aversive dental experiences between baseline and follow-up. These were: experiencing pain during dental treatment; being treated by a dentist in a cold or uncaring manner and being frightened or worried about things the dentist did. Data from the 747 subjects completing the baseline psychological questionnaire indicated that scores on a trait anxiety index were also predictive of onset.

CONCLUSION

Dental anxiety may arise during adulthood, younger adults being particularly vulnerable to onset. Both aversive conditioning experiences and pre-existing psychological states appear to be associated with the development of anxiety about dental treatment in this adult population.

[Association between headache and anxiety disorders indicators in a school sample from Ribeirão Preto, Brazil]

A sample of 374 public elementary and junior high school students aged 8 to 13 years were evaluated to assess the prevalence of frequent headache complaints, associated with indications of anxiety disorder. Parents answered a questionnaire to investigate the presence and frequency of headache and of behaviors/symptoms that might indicate the presence of anxiety disorders. Children were evaluated using the Revised Children's Manifest Anxiety Scale adapted to this population. Among them, 45.4% had never had a headache complaint; 41.2% had occasional headache complaints; and 13.5% had frequent headache complaints. Among children with frequent headache complaints there were more girls than boys, higher anxiety scores, higher occurrence of bruxism, and higher frequency of agitation. The high prevalence of headache and its association with bruxism in this sample is compatible with North American and Brazilian epidemiological data. Results show an association between frequent headache complaints and high anxiety scores.

A 3-year comparison of dental anxiety treatment outcomes: hypnosis, group therapy and individual desensitization vs. no specialist treatment

Outcomes of hypnotherapy (HT), group therapy (GT) and individual systematic desensitization (SD) on extreme dental anxiety in adults aged 19-65 yr were compared by regular attendance behaviors, changes in dental anxiety and changes in beliefs about dentists and treatment after 3 yr. Treatment groups were comparable with a static reference control group of 65 anxious patients (Dental Anxiety Scale > or = 15) who were followed for a mean of nearly 6 yr. After 3 yr, 54.5% of HT patients, 69.6% of GT patients and 65.5% of SD patients were maintaining regular dental care habits. This was better than the 46.1% of the reference group, who reported going regularly to the dentist again within the cohort follow-up period, and 38.9% of a control subgroup with observation for 3 yr. Women were better regular attenders than men at 3 yr. Specialist-treated regular attenders were significantly less anxious and had more positive beliefs than regular attenders from reference groups. There were few differences between HT, GT and SD after 3 yr. It was concluded that many patients can, on their own, successfully start and maintain regular dental treatment habits with dentists despite years of avoidance associated with phobic or extreme anxiety. However, it also appears that these patients had less success in reducing dental anxiety and improving beliefs about dentists long-term than did patients who were treated at the specialist clinic with psychological strategies.

Parental anxiety as a possible predisposing factor to child dental anxiety in patients seen in a suburban dental hospital in Nigeria

INTRODUCTION

The aim of this study was to determine the relationship between parents' anxiety level and that of the child patient.

METHODS

The Short Form of the Dental Anxiety Survey Schedule was administered to 81 children who were attending the dental clinic for the first time. The Dental Anxiety Scale was also used to collect relevant information from the parents.

RESULTS

There was no statistically significant correlation between the anxiety level of the mother (r = -0.02, P = 0.82) or the father (r = -0.59, P = 0.62) and that of their child. However, bivariate analysis showed a closer association between the anxiety levels of the mother and the child (P = 0.055) compared to that between the father and the child (P = 0.475) although this was again found not to be statistically significant.

CONCLUSION

Assessment and management of the anxiety level of the mother may be needed in some cases, both to manage the child effectively and to break the cycle of dental care anxiety in families.