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Offspring of depressed and anxious patients: Help-seeking after first onset of a mood and/or anxiety disorder. J Affect Disord 2018; 227:618-626. [PMID: 29172055 DOI: 10.1016/j.jad.2017.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 09/27/2017] [Accepted: 11/06/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Offspring of patients with depressive and/or anxiety disorders are at high risk of developing a similar disorder themselves. Early recognition and treatment may have substantial effects on prognosis. The main aim of this study was to examine the time to initial help-seeking and its determinants in offspring after the first onset of a mood and/or anxiety disorder. METHODS Data are presented of 215 offspring with a mood and/or anxiety disorder participating in a cohort study with 10 year follow-up. We determined age of disorder onset and age of initial help-seeking. Offspring characteristics (gender, IQ, age of onset, disorder type, suicidal ideation) and family characteristics (socioeconomic status, family functioning) were investigated as potential predictors of the time to initial help-seeking. RESULTS The estimated overall proportion of offspring of depressed/anxious patients who eventually seek help after onset of a mood and/or anxiety disorder was 91.9%. The time to initial help-seeking was more than two years in 39.6% of the offspring. Being female, having a mood disorder or comorbid mood and anxiety disorder (relative to anxiety) and a disorder onset in adolescence or adulthood (relative to childhood) predicted a shorter time to initial help-seeking. LIMITATIONS Baseline information relied on retrospective reports. Age of onsets and age of initial help-seeking may therefore be subject to recall bias. CONCLUSION Although most offspring eventually seek help after onset of a mood/anxiety disorder, delays in help-seeking were common, especially in specific subgroups of patients. This information may help to develop targeted strategies to reduce help-seeking delays.
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102
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Aktar E, Nikolić M, Bögels SM. Environmental transmission of generalized anxiety disorder from parents to children: worries, experiential avoidance, and intolerance of uncertainty. DIALOGUES IN CLINICAL NEUROSCIENCE 2018. [PMID: 28867938 PMCID: PMC5573558 DOI: 10.31887/dcns.2017.19.2/eaktar] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Generalized anxiety disorder (GAD) runs in families. Building on recent theoretical approaches, this review focuses on potential environmental pathways for parent-to-child transmission of GAD. First, we address child acquisition of a generalized pattern of fearful/anxious and avoidant responding to potential threat from parents via verbal information and via modeling. Next, we address how parenting behaviors may contribute to maintenance of fearful/anxious and avoidant reactions in children. Finally, we consider intergenerational transmission of worries as a way of coping with experiential avoidance of strong negative emotions and with intolerance of uncertainty. We conclude that parents with GAD may bias their children's processing of potential threats in the environment by conveying the message that the world is not safe, that uncertainty is intolerable, that strong emotions should be avoided, and that worry helps to cope with uncertainty, thereby transmitting cognitive styles that characterize GAD. Our review highlights the need for research on specific pathways for parent-to-child transmission of GAD.
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Affiliation(s)
- Evin Aktar
- Research Institute of Child Development and Education, University of Amsterdam, the Netherlands; Clinical Psychology Unit, Leiden University, the Netherlands
| | - Milica Nikolić
- Research Institute of Child Development and Education, University of Amsterdam, the Netherlands
| | - Susan M Bögels
- Research Institute of Child Development and Education, University of Amsterdam, the Netherlands
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103
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Ojserkis R, Boisseau CL, Reddy MK, Mancebo MC, Eisen JL, Rasmussen SA. The impact of lifetime PTSD on the seven-year course and clinical characteristics of OCD. Psychiatry Res 2017; 258:78-82. [PMID: 28988123 PMCID: PMC5681424 DOI: 10.1016/j.psychres.2017.09.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 09/12/2017] [Accepted: 09/17/2017] [Indexed: 02/06/2023]
Abstract
Research has suggested that the co-occurrence of PTSD in individuals with OCD is associated with more severe symptoms and less responsivity to empirically supported treatment as compared to individuals with OCD and no history of PTSD. However, much of this work has been limited by non-empirical case report design, cross-sectional and retrospective analyses, or small sample sizes. The current study extended this research by comparing the clinical characteristics of individuals with OCD with and without a lifetime PTSD diagnosis in a large, naturalistic, longitudinal sample over the course of seven years. At baseline, individuals with comorbid lifetime PTSD reported significantly more severe symptoms of OCD (including symptom levels and insight), lower quality of life, and higher rates of comorbid lifetime mood and substance use disorders than participants without lifetime PTSD. Further, individuals with comorbid OCD and lifetime PTSD reported significantly more severe OCD symptoms over the course of seven years than those without lifetime PTSD. These results are largely consistent with the existing literature and support the need to consider PTSD symptoms in the assessment and treatment of OCD.
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Affiliation(s)
- Rachel Ojserkis
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA.
| | - Christina L Boisseau
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA; Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906, USA
| | - Madhavi K Reddy
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA; McGovern Medical School, The University of Texas Health Science Center at Houston, Department of Psychiatry and Behavioral Sciences, 1941 East Road, Houston, TX 77054, USA
| | - Maria C Mancebo
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA; Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906, USA
| | - Jane L Eisen
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA; Mount Sinai St. Luke's/Mount Sinai West, Department of Psychiatry, 1090 Amsterdam Avenue, New York, NY 10025, USA
| | - Steven A Rasmussen
- Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Boulevard, Providence, RI 02906, USA
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104
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Individual differences in fear relapse. Behav Res Ther 2017; 100:37-43. [PMID: 29174218 DOI: 10.1016/j.brat.2017.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/06/2017] [Accepted: 11/16/2017] [Indexed: 01/03/2023]
Abstract
Vulnerability to anxiety disorders might be due to enhanced acquisition of aversive associations, impaired inhibition of those associations (extinction), and/or vulnerability to the return of fear (relapse). Animal research investigating the processes underpinning fear learning, extinction, and relapse will be critical to further advancing our understanding of anxiety disorders and their treatment. Here we examined whether individual differences in the rate of extinction might be related to vulnerability to relapse. Relapse of fear was examined by testing animals for conditioned freezing using renewal, reinstatement, and spontaneous recovery procedures. Across all three experiments we found that when tested under "milder" relapse conditions (in a novel context, after a mild reinstatement procedure, or 8 days after extinction training) Slow Extinguishers exhibited relapse of fear whereas Fast Extinguishers did not. However, when tested under "stronger" relapse conditions (in the training context, after a strong reinstatement procedure, or 29 days after extinction training) both Fast and Slow Extinguishers exhibited comparable relapse of fear. These results show that Slow Extinguishers are more vulnerable to relapse than Fast Extinguishers. These findings have clinical implications for identifying those most at risk of relapse following treatment and highlight the importance of developing further strategies to reduce relapse.
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105
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Pignon B, Tezenas du Montcel C, Carton L, Pelissolo A. The Place of Antipsychotics in the Therapy of Anxiety Disorders and Obsessive-Compulsive Disorders. Curr Psychiatry Rep 2017; 19:103. [PMID: 29110139 DOI: 10.1007/s11920-017-0847-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review was to assess and present the findings up to this date on the efficacy of antipsychotics in the treatment of generalized anxiety disorders (GAD), social anxiety disorders (SAD), panic disorders (PD), and obsessive-compulsive disorders (OCD), mostly based on published randomized controlled trials (RCTs) or on open-label studies when RCT were lacking. RECENT FINDINGS Quetiapine could be recommended in patients with GAD. The efficacy of aripiprazole in two open-label studies on patients with antidepressant-refractory GAD should be assessed in RCTs. Despite preliminary positive results in open studies, there are currently no strong evidence for the effectiveness of antipsychotics in refractory SAD and in refractory PD. Conversely, risperidone and aripiprazole can be used for the treatment of refractory OCD as augmentation agents to antidepressants. Contrary to SAD and PD, this review found evidence for the use of second-generation antipsychotics in GAD and OCD. Otherwise, first-generation antipsychotics cannot be recommended in anxiety disorders and OCD.
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Affiliation(s)
- Baptiste Pignon
- AP-HP, DHU PePSY, Hôpitaux Universitaires Henri-Mondor, Pôle de Psychiatrie, 94000, Créteil, France. .,INSERM, U955, team 15, 94000, Créteil, France. .,Fondation FondaMental, 94000, Créteil, France. .,Faculté de médecine, UPEC, Université Paris-Est, 94000, Créteil, France. .,Hôpital Albert Chenevier, Groupe Hospitalier Henri-Mondor, CHU de Créteil, Assistance Publique-Hôpitaux de Paris (AP-HP), 40 rue de Mesly, 94 000, Créteil, France.
| | - Chloé Tezenas du Montcel
- AP-HP, DHU PePSY, Hôpitaux Universitaires Henri-Mondor, Pôle de Psychiatrie, 94000, Créteil, France
| | - Louise Carton
- Département de Pharmacologie Médicale, Univ.Lille, Inserm U1171, CHU Lille, 59000, Lille, France.,Service d'addictologie, CHU Lille, 59000, Lille, France
| | - Antoine Pelissolo
- AP-HP, DHU PePSY, Hôpitaux Universitaires Henri-Mondor, Pôle de Psychiatrie, 94000, Créteil, France.,INSERM, U955, team 15, 94000, Créteil, France.,Fondation FondaMental, 94000, Créteil, France.,Faculté de médecine, UPEC, Université Paris-Est, 94000, Créteil, France
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106
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Yonkers KA, Gilstad-Hayden K, Forray A, Lipkind HS. Association of Panic Disorder, Generalized Anxiety Disorder, and Benzodiazepine Treatment During Pregnancy With Risk of Adverse Birth Outcomes. JAMA Psychiatry 2017; 74:1145-1152. [PMID: 28903165 PMCID: PMC5710298 DOI: 10.1001/jamapsychiatry.2017.2733] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Registry data show that maternal panic disorder, or anxiety disorders in general, increase the risk for adverse pregnancy outcomes. However, diagnoses from registries may be imprecise and may not consider potential confounding factors, such as treatment with medication and maternal substance use. OBJECTIVE To determine whether panic disorder or generalized anxiety disorder (GAD) in pregnancy, or medications used to treat these conditions, are associated with adverse maternal or neonatal pregnancy outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study conducted between July 1, 2005, and July 14, 2009, recruited women at 137 obstetric practices in Connecticut and Massachusetts before 17 weeks of pregnancy and reassessed them at 28 (±4) weeks of pregnancy and 8 (±4) weeks postpartum. Psychiatric diagnoses were determined by answers to the World Mental Health Composite International Diagnostic Interview. Assessments also gathered information on treatment with medications and confounding factors, such as substance use, previous adverse birth outcomes, and demographic factors. EXPOSURE Panic disorder, GAD, or use of benzodiazepines or serotonin reuptake inhibitors. MAIN OUTCOMES AND MEASURES Among mothers: preterm birth, cesarean delivery, and hypertensive diseases of pregnancy. Among neonates: low birth weight, use of minor respiratory interventions, and use of ventilatory support. RESULTS Of the 2654 women in the final analysis (mean [SD] age, 31.0 [5.7] years), most were non-Hispanic white (1957 [73.7%]), 98 had panic disorder, 252 had GAD, 67 were treated with a benzodiazepine, and 293 were treated with a serotonin reuptake inhibitor during pregnancy. In adjusted models, neither panic disorder nor GAD was associated with maternal or neonatal complications of interest. Most medication exposures occurred early in pregnancy. Maternal benzodiazepine use was associated with cesarean delivery (odds ratio [OR], 2.45; 95% CI, 1.36-4.40), low birth weight (OR, 3.41; 95% CI, 1.61-7.26), and use of ventilatory support for the newborn (OR, 2.85; 95% CI, 1.2-6.9). Maternal serotonin reuptake inhibitor use was associated with hypertensive diseases of pregnancy (OR, 2.82; 95% CI, 1.58-5.04), preterm birth (OR, 1.56; 95% CI, 1.02-2.38), and use of minor respiratory interventions (OR, 1.81; 95% CI, 1.39-2.37). With maternal benzodiazepine treatment, rates of ventilatory support increased by 61 of 1000 neonates and duration of gestation was shortened by 3.6 days; with maternal serotonin reuptake inhibitor use, gestation was shortened by 1.8 days, 152 of 1000 additional newborns required minor respiratory interventions, and 53 of 1000 additional women experienced hypertensive diseases of pregnancy. CONCLUSIONS AND RELEVANCE Panic disorder and GAD do not contribute to adverse pregnancy complications. Women may require treatment with medications during pregnancy, which can shorten the duration of gestation slightly. Maternal treatment with a serotonin reuptake inhibitor is also associated with hypertensive disease of pregnancy and cesarean delivery.
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Affiliation(s)
- Kimberly Ann Yonkers
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut,Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut,Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut
| | | | - Ariadna Forray
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Heather S. Lipkind
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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107
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Luyten L, Beckers T. A preregistered, direct replication attempt of the retrieval-extinction effect in cued fear conditioning in rats. Neurobiol Learn Mem 2017; 144:208-215. [PMID: 28765085 PMCID: PMC5931313 DOI: 10.1016/j.nlm.2017.07.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/11/2017] [Accepted: 07/28/2017] [Indexed: 11/19/2022]
Abstract
In 2009, Monfils and colleagues proposed a behavioral procedure that was said to result in a permanent attenuation of a previously established fear memory, thereby precluding a possible return of fear after extinction (Monfils, Cowansage, Klann, & LeDoux, 2009). By presenting a single retrieval trial one hour before standard extinction training, they found an enduring reduction of fear. The retrieval-extinction procedure holds great clinical potential, particularly for anxiety patients, but the findings are not undisputed, and several conceptual replications have failed to reproduce the effect. These failures have largely been attributed to small procedural differences. This preregistered study is the first endeavor to exactly replicate three key experiments of the original report by Monfils et al. (2009), thereby gauging the robustness of their seminal findings. Despite adhering to the original procedures as closely as possible, we did not find any evidence for reduced return of fear with the retrieval-extinction procedure relative to regular extinction training, as assessed through spontaneous recovery, reinstatement and renewal. Behavior of animals in the control condition (extinction only) was comparable to that in the original studies and provided an adequate baseline to reveal differences with the retrieval-extinction condition. Our null findings indicate that the effect sizes in the original paper may have been inflated and question the legitimacy of previously proposed moderators of the retrieval-extinction effect. We argue that direct experimental evaluation of purported moderators of the retrieval-extinction effect will be key to shed more light on its nature and prerequisites.
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Affiliation(s)
- Laura Luyten
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Belgium.
| | - Tom Beckers
- Centre for the Psychology of Learning and Experimental Psychopathology, KU Leuven, Belgium
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108
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Leibold NK, van den Hove DLA, Viechtbauer W, Kenis G, Goossens L, Lange I, Knuts I, Smeets HJ, Myin-Germeys I, Steinbusch HW, Schruers KR. Amiloride-sensitive cation channel 2 genotype affects the response to a carbon dioxide panic challenge. J Psychopharmacol 2017; 31:1294-1301. [PMID: 28121219 DOI: 10.1177/0269881116686880] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Until recently, genetic research into panic disorder (PD) has had only limited success. Inspired by rodent research, demonstrating that the acid-sensing ion channel 1a (ASIC1a) is critically involved in the behavioral fear response to carbon dioxide (CO2) exposure, variants in the human homologue gene amiloride-sensitive cation channel 2 (ACCN2) were shown to be associated with PD. However, the relationship between changes in brain pH and ACCN2, as done in rodents by CO2 exposure, has not been investigated yet in humans. Here, we examined this link between the ACCN2 gene and the response to CO2 exposure in two studies: in healthy volunteers as well as PD patients and using both behavioral and physiological outcome measures. More specifically, 107 healthy volunteers and 183 PD patients underwent a 35% CO2 inhalation. Negative affect was assessed using visual analogue scales and the panic symptom list (PSL), and, in healthy volunteers, cardiovascular measurements. The single nucleotide polymorphism rs10875995 was significantly associated with a higher emotional response in PD patients and with an increase in systolic as well as diastolic blood pressure in healthy subjects. In all measurements, subjects homozygous for the T-allele showed a heightened reactivity to CO2. Furthermore, a trend towards an rs685012 genotype effect on the emotional response was found in PD patients. We provide the first evidence that genetic variants in the ACCN2 are associated with differential sensitivity to CO2 in PD patients as well as healthy volunteers, further supporting ACCN2 as a promising candidate for future research to improve current treatment options.
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Affiliation(s)
- Nicole K Leibold
- 1 Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Daniel LA van den Hove
- 1 Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands.,2 Department of Psychiatry, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Wolfgang Viechtbauer
- 1 Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Gunter Kenis
- 1 Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Liesbet Goossens
- 1 Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Iris Lange
- 1 Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Inge Knuts
- 1 Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Hubert J Smeets
- 3 Genome Center Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Inez Myin-Germeys
- 3 Genome Center Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Harry Wm Steinbusch
- 1 Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
| | - Koen Rj Schruers
- 1 Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
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109
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Rådmark L, Magnusson Hanson LL, Bojner Horwitz E, Osika W. Prevalence of mind and body exercises (MBE) in relation to demographics, self-rated health, and purchases of prescribed psychotropic drugs and analgesics. PLoS One 2017; 12:e0184635. [PMID: 28915274 PMCID: PMC5600368 DOI: 10.1371/journal.pone.0184635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 08/28/2017] [Indexed: 11/20/2022] Open
Abstract
This study aims to identify any differences regarding gender, age, socioeconomic status (SES), self-rated health, perceived stress and the purchase of prescribed drugs among people who practice mind and body exercises (MBE) extensively compared to people who do not. METHODS The study includes 3,913 men and 4,803 women aged 20-72 who participated in the Swedish Longitudinal Occupational Survey of Health (SLOSH). The respondents were divided into three groups depending on frequency of MBE practice (never/seldom/often). Measures regarding MBE practice, health behaviors, self-rated health, and illnesses were drawn from the SLOSH questionnaire, while more objective measures of socioeconomic status and education were derived from registry data. In addition, data on purchases of prescription drugs for all respondents were included in the study. These data were obtained from the Swedish Prescribed Drug Register, which contains information about prescription drugs dispensed at Swedish pharmacies. Separate analyses were performed for mental MBE (mindfulness, meditation, relaxation techniques) and physical MBE (yoga, Tai Chi, Qi Gong), respectively. RESULTS A high intensity MBE practice is cross-sectionally related to poor self-assessed health (sleeping problems, pain, depressive symptoms, mental disorders), high levels of stress, and high levels of purchases of psychotropic drugs and analgesics. These cross-sectional relationships are generally stronger for mental MBE than for bodily-directed MBE. More women than men are practicing MBE on a regular basis, and physically active people participate to a greater extent in MBE compared with the physically inactive. CONCLUSION Overall, the study shows that frequent participation in mind and body exercises is associated with high levels of purchases of psychotropic drugs and analgesics as well as with poor self-assessed health and high levels of stress. However, since this is a cross-sectional study, it is impossible to establish cause and effect, and to further investigate the associations found; longitudinal studies that can account for temporality between covariates and MBE use are needed.
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Affiliation(s)
- Lina Rådmark
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | | | - Eva Bojner Horwitz
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health, Uppsala University, Uppsala, Sweden
| | - Walter Osika
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Social Sustainability, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Stress Clinic, Stockholm, Sweden
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110
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More than just noise: Inter-individual differences in fear acquisition, extinction and return of fear in humans - Biological, experiential, temperamental factors, and methodological pitfalls. Neurosci Biobehav Rev 2017; 80:703-728. [DOI: 10.1016/j.neubiorev.2017.07.007] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/12/2017] [Accepted: 07/20/2017] [Indexed: 01/07/2023]
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111
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Pathways towards the proliferation of avoidance in anxiety and implications for treatment. Behav Res Ther 2017; 96:3-13. [DOI: 10.1016/j.brat.2017.04.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 04/03/2017] [Accepted: 04/11/2017] [Indexed: 11/18/2022]
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112
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Salomonsson S, Santoft F, Lindsäter E, Ejeby K, Ljótsson B, Öst LG, Ingvar M, Lekander M, Hedman-Lagerlöf E. Cognitive–behavioural therapy and return-to-work intervention for patients on sick leave due to common mental disorders: a randomised controlled trial. Occup Environ Med 2017; 74:905-912. [DOI: 10.1136/oemed-2017-104342] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/21/2017] [Accepted: 06/22/2017] [Indexed: 12/13/2022]
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113
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Hennemann S, Farnsteiner S, Sander L. Internet- and mobile-based aftercare and follow-up for mental disorders: protocol of a systematic review and meta-analysis. BMJ Open 2017; 7:e016696. [PMID: 28652294 PMCID: PMC5726109 DOI: 10.1136/bmjopen-2017-016696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Mental disorders are characterised by a high likelihood of symptom recurrence or chronicity. Thus, in the vulnerable post-discharge phase, aftercare and follow-up aim at stabilising treatment effects, promoting functionality and preventing relapse or readmission. Internet- and mobile-based interventions may represent low threshold and effective extensions to aftercare in tertiary prevention of mental disorders. OBJECTIVES The planned systematic review and meta-analysis aims to synthesise and analyse existing evidence on the effectiveness of psychological internet- and mobile-based aftercare or follow-up in maintaining treatment effects and/or preventing recurrence in adults with mental disorders. METHODS AND ANALYSIS Electronic databases (PsycInfo, MEDLINE and Cochrane Central Register of Controlled trials) will be searched systematically, complemented by a hand-search of ongoing trials and reference lists of selected studies. Data extraction and evaluation will be conducted by two independent researchersand quality will be assessed with the Cochrane risk of bias tool. Eligibility criteria for selecting studies will be: randomised controlled trials of internet-based and mobile-based, psychological aftercare and follow-up for the tertiary prevention of mental disorders in an adult population. Primary outcome will be symptom severity. Secondary outcomes will be symptom or disorder recurrence rate, rehospitalisation rate, functionality, quality of life or adherence to primary treatment. Further data items to be extracted will be: study design, intervention and technical characteristics, type of mental disorder or clinical symptom to be treated, target population items, setting, treatment engagement and assessment of additional outcome variables. Meta-analytic pooling will be conducted when data of included studies are comparable in terms of study design, intervention type, endpoints, assessments and target mental disorder. Cumulative evidence will be evaluated according to the Grading of Recommendations Assessment, Development and Evaluation framework. ETHICS AND DISSEMINATION Ethics approval is not required. Results from this review will be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER PROSPERO CRD42017055289.
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Affiliation(s)
- Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Germany
| | - Sylvia Farnsteiner
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Germany
| | - Lasse Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany
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114
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De Venter M, Van Den Eede F, Pattyn T, Wouters K, Veltman DJ, Penninx BWJH, Sabbe BG. Impact of childhood trauma on course of panic disorder: contribution of clinical and personality characteristics. Acta Psychiatr Scand 2017; 135:554-563. [PMID: 28369890 DOI: 10.1111/acps.12726] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the impact of childhood trauma on the clinical course of panic disorder and possible contributing factors. METHOD Longitudinal data of 539 participants with a current panic disorder were collected from the Netherlands Study of Depression and Anxiety (NESDA). Childhood trauma was assessed with a structured interview and clinical course after 2 years with a DSM-IV-based diagnostic interview and the Life Chart Interview. RESULTS At baseline, 54.5% reported childhood trauma, but this was not predictive of persistence of panic disorder. Emotional neglect and psychological abuse were associated with higher occurrence of anxiety disorders other than panic disorder (social phobia) and with higher chronicity of general anxiety symptoms (anxiety attacks or episodes and avoidance). Baseline clinical features (duration and severity of anxiety and depressive symptoms) and personality traits (neuroticism and extraversion) accounted for roughly 30-60% of the total effect of childhood trauma on chronicity of anxiety symptoms and on occurrence of other anxiety disorders. CONCLUSION After two years, childhood trauma is associated with chronicity of anxiety symptoms and occurrence of social phobia, rather than persistence of panic disorder. These relationships are partially accounted for by duration and severity of anxiety and depressive symptoms, and neuroticism and extraversion.
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Affiliation(s)
- M De Venter
- University Department of Psychiatry, Campus University Hospital Antwerp (UZA), Antwerp, Belgium.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - F Van Den Eede
- University Department of Psychiatry, Campus University Hospital Antwerp (UZA), Antwerp, Belgium.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - T Pattyn
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - K Wouters
- Department of Scientific Coordination and Biostatistics, University Hospital Antwerp (UZA), Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - D J Veltman
- Department of Psychiatry, Amsterdam Neuroscience and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - B W J H Penninx
- Department of Psychiatry, Amsterdam Neuroscience and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - B G Sabbe
- University Department of Psychiatry, Campus University Hospital Antwerp (UZA), Antwerp, Belgium.,Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium.,University Department of Psychiatry, Campus Psychiatric Hospital Duffel, Duffel, Belgium
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115
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Gender differences in social anxiety disorder: A review. Clin Psychol Rev 2017; 56:1-12. [PMID: 28578248 DOI: 10.1016/j.cpr.2017.05.004] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 05/24/2017] [Accepted: 05/29/2017] [Indexed: 11/23/2022]
Abstract
Gender differences in social anxiety disorder (SAD) have not received much empirical attention despite the large body of research on the disorder, and in contrast to significant literature about gender differences in other disorders such as depression or posttraumatic stress disorder. To address this gap, we comprehensively reviewed the literature regarding gender differences in eight domains of SAD: prevalence, clinical presentation, functioning and impairment, comorbidity, course, treatment seeking, physiological arousal, and the oxytocin system. Findings from the present review indicate that women are more likely to have SAD and report greater clinical severity. Notwithstanding, men with the disorder may seek treatment to a greater extent. According to the present review, the course of SAD seems to be similar for men and women, and findings regarding gender differences in functional impairment and comorbidity are inconclusive. We highlight areas requiring future research and discuss the findings in the context of a number of theoretical perspectives. We believe that further research and integration of scientific findings with existing theories is essential in order to increase our understanding and awareness of gender differences in SAD, thus facilitating gender-sensitive and specifically-tailored interventions for both men and women with the disorder.
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116
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Weingarten K, Worthen M. Unreliable Bodies: A Follow-up Twenty Years Later by a Mother and Daughter about the Impact of Illness and Disability on their Lives. FAMILY PROCESS 2017; 56:262-277. [PMID: 26576686 DOI: 10.1111/famp.12197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We are a mother and daughter, both health care professionals, who offer a follow-up to an article we published twenty years ago about the impact of each other's ongoing, serious medical problems on our relationship. In this article, we contribute a long-term perspective on the differences between having an illness that is well or poorly understood by medical professionals and the lay community. We also discuss health in the context of identity formation and life stage, as during this interval the daughter left home, graduated college, married, and had two children. Also in this period, the mother survived a third breast cancer and other life-threatening illnesses. We discuss the impact of these experiences on each other and in other important relationships in our lives. Current discourses on daughters of breast cancer survivors do not fit our experience and we speculate about why our story differs. We find that although we continue to contend with serious medical issues that impact our own, each other's, and our families' lives, nonetheless, our lives are rich, rewarding, and "appropriate" for our life stage. That is the news.
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Affiliation(s)
| | - Miranda Worthen
- Health Science & Recreation, San Jose State University, San Jose, CA
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117
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Mwinyi J, Pisanu C, Castelao E, Stringhini S, Preisig M, Schiöth HB. Anxiety Disorders are Associated with Low Socioeconomic Status in Women but Not in Men. Womens Health Issues 2017; 27:302-307. [PMID: 28215982 DOI: 10.1016/j.whi.2017.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 12/23/2016] [Accepted: 01/09/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We investigated to what extent the lifetime prevalence of anxiety disorders relates to negative economic changes, taking important lifestyle factors and unexpected life events into consideration. METHODS We included 3,695 participants recruited in the city of Lausanne (Switzerland), from the population-based CoLaus/PsyCoLaus study. The association between anxiety disorders, lifestyle factors, and life events related to income was investigated using binary logistic regression analyses correcting for demographic and clinical confounders. RESULTS Compared with men, women with anxiety disorders showed a significantly lower socioeconomic status (Mann-Whitney U = 56,318; p < .001) and reported a higher negative impact of substantial reduction of income (Mann-Whitney U = 68,531; p = .024). When performing adjusted analyses, low socioeconomic status (odd ratio, 0.87; p = .001) and negative impact of reduction of income (odd ratio, 1.01; p = .004) were associated significantly with anxiety disorders in women but not in men. CONCLUSION Our results suggest that anxiety disorders aggravate already existing gender differences in economic conditions, and that women with anxiety need additional support to attain socioeconomic security similar to that of men.
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Affiliation(s)
- Jessica Mwinyi
- Department of Neuroscience, University of Uppsala, Uppsala, Sweden.
| | - Claudia Pisanu
- Department of Neuroscience, University of Uppsala, Uppsala, Sweden; Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
| | - Enrique Castelao
- Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Silvia Stringhini
- Institute of Social and Preventive Medicine, Lausanne University Hospital (CHUV), Prilly, Switzerland
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Helgi B Schiöth
- Department of Neuroscience, University of Uppsala, Uppsala, Sweden
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118
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Kelly KM, Mezuk B. Predictors of remission from generalized anxiety disorder and major depressive disorder. J Affect Disord 2017; 208:467-474. [PMID: 27863710 PMCID: PMC5515235 DOI: 10.1016/j.jad.2016.10.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/06/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The predictors of onset of major depressive disorder (MDD) and generalized anxiety disorder (GAD) are well-characterized. However the factors that predict remission from these conditions are less clear, and the study of this area is further complicated by differing definitions of remission. METHODS Data come from the National Comorbidity Survey - Replication, and analysis was limited to respondents with a lifetime history of GAD (n=621) or MDD (n=1299) assessed by the Composite International Diagnostic Interview. Predictors of remission included demographic factors, adverse childhood events, family history, and clinical characteristics. Multiple definitions of remission were explored to account for residual symptoms. RESULTS Half (54.4%) of respondents with MDD and 41.1% of respondents with GAD experienced full remission. Older age and higher socioeconomic status were positively related to remission in a dose-response manner for both disorders. Adverse childhood experiences and family history of anxious/depressive symptoms were negatively associated with remission from MDD. Comorbid GAD was inversely associated with remission from MDD (Odds ratio (OR): 0.62, 95% Confidence interval (CI): 0.44-0.88), but comorbid MDD did not impact remission from GAD (OR: 0.93, 95% CI: 0.64-1.35). With the exception of the influence of comorbidity, these associations were robust across definitions of remission. LIMITATIONS Cross-sectional analysis and retrospective recall of onset of MDD/GAD. CONCLUSIONS Many individuals with MDD or GAD will experience full remission. Some predictors appear to have a general association with remission from both disorders, while others are uniquely associated with remission from MDD.
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Affiliation(s)
- Kristen M. Kelly
- Corresponding author: One Capitol Plaza, Suite 824, PO Box 980212, Richmond, Virginia 23298. Tel.: +517 703 4718; fax: N/A.
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119
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Li SH, Graham BM. Why are women so vulnerable to anxiety, trauma-related and stress-related disorders? The potential role of sex hormones. Lancet Psychiatry 2017; 4:73-82. [PMID: 27856395 DOI: 10.1016/s2215-0366(16)30358-3] [Citation(s) in RCA: 310] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 02/08/2023]
Abstract
Increased prevalence, severity, and burden of anxiety, trauma-related and stress-related disorders in women compared with men has been well documented. Evidence from a variety of fields has emerged suggesting that sex hormones, particularly oestradiol and progesterone, play a significant part in generation of these sex differences. In this Series paper, we aim to integrate the literature reporting on the effects of sex hormones on biological, behavioural, and cognitive pathways, to propose two broad mechanisms by which oestradiol and progesterone influence sex differences in anxiety disorders: augmentation of vulnerability factors associated with anxiety disorder development; and facilitation of the maintenance of anxious symptoms post-development. The implications for future research, along with novel approaches to psychological and pharmacological treatment of anxiety disorders, are also considered.
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Affiliation(s)
- Sophie H Li
- School of Psychology, The University of New South Wales, Sydney, NSW, Australia
| | - Bronwyn M Graham
- School of Psychology, The University of New South Wales, Sydney, NSW, Australia.
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120
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Keefe JR, Mao JJ, Soeller I, Li QS, Amsterdam JD. Short-term open-label chamomile (Matricaria chamomilla L.) therapy of moderate to severe generalized anxiety disorder. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2016; 23:1699-1705. [PMID: 27912871 PMCID: PMC5589135 DOI: 10.1016/j.phymed.2016.10.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/28/2016] [Accepted: 10/23/2016] [Indexed: 05/06/2023]
Abstract
BACKGROUND Conventional drug treatments for Generalized Anxiety Disorder (GAD) are often accompanied by substantial side effects, dependence, and/or withdrawal syndrome. A prior controlled study of oral chamomile (Matricaria chamomilla L.) extract showed significant efficacy versus placebo, and suggested that chamomile may have anxiolytic activity for individuals with GAD. HYPOTHESIS We hypothesized that treatment with chamomile extract would result in a significant reduction in GAD severity ratings, and would be associated with a favorable adverse event and tolerability profile. STUDY DESIGN We report on the open-label phase of a two-phase randomized controlled trial of chamomile versus placebo for relapse-prevention of recurrent GAD. METHODS Subjects with moderate to severe GAD received open-label treatment with pharmaceutical-grade chamomile extract 1500mg/day for up to 8 weeks. Primary outcomes were the frequency of clinical response and change in GAD-7 symptom scores by week 8. Secondary outcomes included the change over time on the Hamilton Rating Scale for Anxiety, the Beck Anxiety Inventory, and the Psychological General Well Being Index. Frequency of treatment-emergent adverse events and premature treatment discontinuation were also examined. RESULTS Of 179 subjects, 58.1% (95% CI: 50.9% to 65.5%) met criteria for response, while 15.6% prematurely discontinued treatment. Significant improvement over time was also observed on the GAD-7 rating (β=-8.4 [95% CI=-9.1 to -7.7]). A similar proportion of subjects demonstrated statistically significant and clinically meaningful reductions in secondary outcome ratings of anxiety and well-being. Adverse events occurred in 11.7% of subjects, although no serious adverse events occurred. CONCLUSION Chamomile extract produced a clinically meaningful reduction in GAD symptoms over 8 weeks, with a response rate comparable to those observed during conventional anxiolytic drug therapy and a favorable adverse event profile. Future comparative effectiveness trials between chamomile and conventional drugs may help determine the optimal risk/benefit of these therapies for patients suffering from GAD.
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Affiliation(s)
- John R Keefe
- Department of Psychology, University of Pennsylvania, Philadelphia, PA United States
| | - Jun J Mao
- Bendheim Center for Integrative Medicine, Memorial Sloan-Kettering Cancer Center, 1429 First Avenue, New York, NY 10021 United States.
| | - Irene Soeller
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA United States
| | - Qing S Li
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA United States
| | - Jay D Amsterdam
- Depression Research Unit, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA United States
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121
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Mao JJ, Xie SX, Keefe JR, Soeller I, Li QS, Amsterdam JD. Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2016; 23:1735-1742. [PMID: 27912875 PMCID: PMC5646235 DOI: 10.1016/j.phymed.2016.10.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/28/2016] [Accepted: 10/23/2016] [Indexed: 05/22/2023]
Abstract
BACKGROUND Generalized Anxiety Disorder (GAD) is one of the most common anxiety disorders treated in primary care, yet current therapies have limited efficacy and substantial side effects. PURPOSE To evaluate long-term chamomile (Matricaria chamomilla L.) use for prevention of GAD symptom relapse. METHODS Outpatients from primary care practices and local communities with a primary diagnosis of moderate-to-severe GAD were enrolled for this two-phase study at a large US academic medical center. During Phase 1, eligible participants received 12 weeks of open-label therapy with chamomile pharmaceutical grade extract 1500mg (500mg capsule 3 times daily). During Phase 2, treatment responders were randomized to either 26 weeks of continuation chamomile therapy or placebo in a double-blinded, placebo-substitution design. The primary outcome was time to relapse during continuation therapy, analyzed using Cox proportional hazards. Secondary outcomes included the proportion who relapsed, treatment-emergent adverse events, and vital sign changes. This study is registered at ClinicalTrials.gov, identifier NCT01072344. RESULTS Between March 1, 2010, and June 30, 2015, we enrolled 179 participants. Of those, 93 (51.9%) were responders and agreed to continue in the double-blind randomized controlled trial. A numerically greater number of placebo-switched (n=12/47; 25.5%) versus chamomile-continuation (n = 7/46; 15.2%) participants relapsed during follow-up. Mean time to relapse was 11.4 ± 8.4 weeks for chamomile and 6.3 ± 3.9 weeks for placebo. Hazard of relapse was non-significantly lower for chamomile (hazard ratio, 0.52; 95% CI, 0.20-1.33; P = 0.16). During follow-up, chamomile participants maintained significantly lower GAD symptoms than placebo (P = 0.0032), with significant reductions in body weight (P = 0.046) and mean arterial blood pressure (P = 0.0063). Both treatments had similar low adverse event rates. CONCLUSIONS Long-term chamomile was safe and significantly reduced moderate-to-severe GAD symptoms, but did not significantly reduce rate of relapse. Our limited sample size and lower than expected rate of placebo group relapse likely contributed to the non-significant primary outcome finding. Possible chamomile superiority over placebo requires further examination in large-scale studies.
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Affiliation(s)
- Jun J Mao
- Bendheim Center for Integrative Medicine, Memorial Sloan Kettering Cancer Center, 1429 First Avenue, New York, NY 10021, United States.
| | - Sharon X Xie
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - John R Keefe
- Department of Psychology, School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, United States
| | - Irene Soeller
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Qing S Li
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Jay D Amsterdam
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Kuhn M, Mertens G, Lonsdorf TB. State anxiety modulates the return of fear. Int J Psychophysiol 2016; 110:194-199. [DOI: 10.1016/j.ijpsycho.2016.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/22/2016] [Accepted: 08/01/2016] [Indexed: 12/12/2022]
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123
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Chen MH, Tsai SJ. Treatment-resistant panic disorder: clinical significance, concept and management. Prog Neuropsychopharmacol Biol Psychiatry 2016; 70:219-26. [PMID: 26850787 DOI: 10.1016/j.pnpbp.2016.02.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 01/30/2016] [Accepted: 02/01/2016] [Indexed: 12/17/2022]
Abstract
Panic disorder is commonly prevalent in the population, but the treatment response for panic disorder in clinical practice is much less effective than that in our imagination. Increasing evidence suggested existence of a chronic or remitting-relapsing clinical course in panic disorder. In this systematic review, we re-examine the definition of treatment-resistant panic disorder, and present the potential risk factors related to the treatment resistance, including the characteristics of panic disorder, other psychiatric and physical comorbidities, and psychosocial stresses. Furthermore, we summarize the potential pathophysiologies, such as genetic susceptibility, altered brain functioning, brain-derived neurotrophic factor, and long-term inflammation, to explain the treatment resistance. Finally, we conclude the current therapeutic strategies for treating treatment-resistant panic disorder from pharmacological and non-pharmacological views.
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Affiliation(s)
- Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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124
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Adversity-induced relapse of fear: neural mechanisms and implications for relapse prevention from a study on experimentally induced return-of-fear following fear conditioning and extinction. Transl Psychiatry 2016; 6:e858. [PMID: 27434492 PMCID: PMC5545712 DOI: 10.1038/tp.2016.126] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/22/2016] [Accepted: 05/05/2016] [Indexed: 12/18/2022] Open
Abstract
The efficacy of current treatments for anxiety disorders is limited by high relapse rates. Relapse of anxiety disorders and addiction can be triggered by exposure to life adversity, but the underlying mechanisms remain unexplored. Seventy-six healthy adults were a priori selected for the presence or absence of adverse experiences during childhood (CA) and recent past (RA; that is, past 12 months). Participants underwent fear conditioning (day 1) and fear extinction and experimental return-of-fear (ROF) induction through reinstatement (a model for adversity-induced relapse; day 2). Ratings, autonomic (skin conductance response) and neuronal activation measures (functional magnetic resonance imaging (fMRI)) were acquired. Individuals exposed to RA showed a generalized (that is, not CS- specific) fear recall and ROF, whereas unexposed individuals showed differential (that is, CS+ specific) fear recall and ROF on an autonomic level despite no group differences during fear acquisition and extinction learning. These group differences in ROF were accompanied by corresponding activation differences in brain areas known to be involved in fear processing and differentiability/generalization of ROF (that is, hippocampus). In addition, dimensional measures of RA, CA and lifetime adversity were negatively correlated with differential skin conductance responses (SCRs) during ROF and hippocampal activation. As discriminating signals of danger and safety, as well as a tendency for overgeneralization, are core features in clinically anxious populations, these deficits may specifically contribute to relapse risk following exposure to adversity, in particular to recent adversity. Hence, our results may provide first and novel insights into the possible mechanisms mediating enhanced relapse risk following exposure to (recent) adversity, which may guide the development of effective pre- and intervention programs.
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125
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Machado Junior SB, Celestino MIO, Serra JPC, Caron J, Pondé MP. Risk and protective factors for symptoms of anxiety and depression in parents of children with autism spectrum disorder. Dev Neurorehabil 2016; 19:146-53. [PMID: 24950424 DOI: 10.3109/17518423.2014.925519] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The severity of symptoms of anxiety and depression was evaluated in 102 parents of children with autism spectrum disorders (ASD) and correlated with the severity of their child's behavioral symptoms. DESIGN An observational, cross-sectional study. METHODS The Portuguese versions of the Hospital Anxiety and Depression Scale and the Aberrant Behavior Checklist were used to assess symptoms in the parents and in their children. MAIN OUTCOMES AND RESULTS Depression was present in 26.7% of parents and anxiety in 33.7%. Severe behavioral symptoms in the child increased the likelihood of severe anxiety and depression symptoms in the parents by a factor of 35. If the child had severe behavioral symptoms and the father lived in the family home, the likelihood of severe symptoms of anxiety and depression in the parents was 95.2% lower. CONCLUSION The presence of the father living in the family home acted as a buffer against parents' symptoms.
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Affiliation(s)
- Samuel Bezerra Machado Junior
- a Interdisciplinary Research Laboratory on Autism (LABIRINTO), BAHIANA School of Medicine and Public Health , Salvador , Bahia , Brazil , and
| | - Meline Ivone Oliveira Celestino
- a Interdisciplinary Research Laboratory on Autism (LABIRINTO), BAHIANA School of Medicine and Public Health , Salvador , Bahia , Brazil , and
| | - Juliane Penalva Costa Serra
- a Interdisciplinary Research Laboratory on Autism (LABIRINTO), BAHIANA School of Medicine and Public Health , Salvador , Bahia , Brazil , and
| | - Jean Caron
- b Douglas Mental Health Institute, McGill University , Montreal , Quebec , Canada
| | - Milena Pereira Pondé
- a Interdisciplinary Research Laboratory on Autism (LABIRINTO), BAHIANA School of Medicine and Public Health , Salvador , Bahia , Brazil , and
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Khan A, Durgam S, Tang X, Ruth A, Mathews M, Gommoll CP. Post Hoc Analyses of Anxiety Measures in Adult Patients With Generalized Anxiety Disorder Treated With Vilazodone. Prim Care Companion CNS Disord 2016; 18:15m01904. [PMID: 27486544 PMCID: PMC4956429 DOI: 10.4088/pcc.15m01904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/04/2016] [Indexed: 11/04/2022] Open
Abstract
Objective To investigate vilazodone, currently approved for major depressive disorder in adults, for generalized anxiety disorder (GAD). Method Three randomized, double-blind, placebo-controlled studies showing positive results for vilazodone (2,040 mg/d) in adult patients with GAD (DSM-IV-TR) were pooled for analyses; data were collected from June 2012 to March 2014. Post hoc outcomes in the pooled intent-to-treat population (n = 1,462) included mean change from baseline to week 8 in Hamilton Anxiety Rating Scale (HARS) total score, psychic and somatic anxiety subscale scores, and individual item scores; HARS response (≥ 50% total score improvement) and remission (total score ≤ 7) at week 8; and category shifts, defined as HARS item score ≥ 2 at baseline (moderate to very severe symptoms) and score of 0 at week 8 (no symptoms). Results The least squares mean difference was statistically significant for vilazodone versus placebo in change from baseline to week 8 in HARS total score (−1.83, P < .0001) and in psychic anxiety (−1.21, P < .0001) and somatic anxiety (−0.63, P < .01) subscale scores; differences from placebo were significant on 11 of 14 HARS items (P < .05). Response rates were higher with vilazodone than placebo (48% vs 39%, P < .001), as were remission rates (27% vs 21%, P < .01). The percentage of patients who shifted to no symptoms was significant for vilazodone on several items: anxious mood, tension, intellectual, depressed mood, somatic-muscular, somatic-sensory, cardiovascular, respiratory, and autonomic symptoms (P < .05). Conclusions Treatment with vilazodone versus placebo was effective in adult GAD patients, with significant differences between treatment groups found on both psychic and somatic HARS items. Trial Registration ClinicalTrials.gov identifiers: NCT01629966, NCT01766401, NCT01844115.
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Affiliation(s)
- Arif Khan
- Northwest Clinical Research Center, Bellevue, Washington; Duke University School of Medicine, Department of Psychiatry, Durham, North Carolina
| | - Suresh Durgam
- Forest Research Institute, an Allergan affiliate, Jersey City, New Jersey
| | - Xiongwen Tang
- Forest Research Institute, an Allergan affiliate, Jersey City, New Jersey
| | - Adam Ruth
- Prescott Medical Communications Group, Chicago, Illinois
| | - Maju Mathews
- Forest Research Institute, an Allergan affiliate, Jersey City, New Jersey
| | - Carl P Gommoll
- Forest Research Institute, an Allergan affiliate, Jersey City, New Jersey
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127
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Johnson SB, Anderson PL. Don't ask, don't tell: a systematic review of the extent to which participant characteristics are reported in social anxiety treatment studies. ANXIETY STRESS AND COPING 2016; 29:589-605. [DOI: 10.1080/10615806.2016.1138289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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128
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Nikayin S, Rabiee A, Hashem MD, Huang M, Bienvenu OJ, Turnbull AE, Needham DM. Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis. Gen Hosp Psychiatry 2016; 43:23-29. [PMID: 27796253 PMCID: PMC5289740 DOI: 10.1016/j.genhosppsych.2016.08.005] [Citation(s) in RCA: 275] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/20/2016] [Accepted: 08/24/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the epidemiology of and postintensive care unit (ICU) interventions for anxiety symptoms after critical illness. METHODS We searched five databases (1970-2015) to identify studies assessing anxiety symptoms in adult ICU survivors. Data from studies using the most common assessment instrument were meta-analyzed. RESULTS We identified 27 studies (2880 patients) among 27,334 citations. The Hospital Anxiety and Depression Scale-Anxiety (HADS-A) subscale was the most common instrument (81% of studies). We pooled data at 2-3, 6 and 12-14month time-points, with anxiety symptom prevalences [HADS-A≥8, 95% confidence interval (CI)] of 32%(27-38%), 40%(33-46%) and 34%(25-42%), respectively. In a subset of studies with repeated assessments in the exact same patients, there was no significant change in anxiety score or prevalence over time. Age, gender, severity of illness, diagnosis and length of stay were not associated with anxiety symptoms. Psychiatric symptoms during admission and memories of in-ICU delusional experiences were potential risk factors. Physical rehabilitation and ICU diaries had potential benefit. CONCLUSIONS One third of ICU survivors experience anxiety symptoms that are persistent during their first year of recovery. Psychiatric symptoms during admission and memories of in-ICU delusional experiences were associated with post-ICU anxiety. Physical rehabilitation and ICU diaries merit further investigation as possible interventions.
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Affiliation(s)
- Sina Nikayin
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD,Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Anahita Rabiee
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD,Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Mohamed D. Hashem
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD,Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Minxuan Huang
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD,Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - O. Joseph Bienvenu
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD,Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Alison E. Turnbull
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD,Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Dale M. Needham
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, MD,Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD,Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore
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129
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Are Anxiety Disorders Associated with Accelerated Aging? A Focus on Neuroprogression. Neural Plast 2015; 2016:8457612. [PMID: 26881136 PMCID: PMC4736204 DOI: 10.1155/2016/8457612] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 12/16/2022] Open
Abstract
Anxiety disorders (AnxDs) are highly prevalent throughout the lifespan, with detrimental effects on daily-life functioning, somatic health, and quality of life. An emerging perspective suggested that AnxDs may be associated with accelerated aging. In this paper, we explored the association between AnxDs and hallmarks of accelerated aging, with a specific focus on neuroprogression. We reviewed animal and human findings that suggest an overlap between processes of impaired neurogenesis, neurodegeneration, structural, functional, molecular, and cellular modifications in AnxDs, and aging. Although this research is at an early stage, our review suggests a link between anxiety and accelerated aging across multiple processes involved in neuroprogression. Brain structural and functional changes that accompany normal aging were more pronounced in subjects with AnxDs than in coevals without AnxDs, including reduced grey matter density, white matter alterations, impaired functional connectivity of large-scale brain networks, and poorer cognitive performance. Similarly, molecular correlates of brain aging, including telomere shortening, Aβ accumulation, and immune-inflammatory and oxidative/nitrosative stress, were overrepresented in anxious subjects. No conclusions about causality or directionality between anxiety and accelerated aging can be drawn. Potential mechanisms of this association, limitations of the current research, and implications for treatments and future studies are discussed.
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130
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Kanuri N, Newman MG, Ruzek JI, Kuhn E, Manjula M, Jones M, Thomas N, Abbott JAM, Sharma S, Taylor CB. The Feasibility, Acceptability, and Efficacy of Delivering Internet-Based Self-Help and Guided Self-Help Interventions for Generalized Anxiety Disorder to Indian University Students: Design of a Randomized Controlled Trial. JMIR Res Protoc 2015; 4:e136. [PMID: 26679295 PMCID: PMC4704912 DOI: 10.2196/resprot.4783] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 08/29/2015] [Accepted: 10/09/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Generalized anxiety disorder (GAD) is one of the most common mental disorders among university students; however, many students go untreated due to treatment costs, stigma concerns, and limited access to trained mental health professionals. These barriers are heightened in universities in India, where there are scant mental health care services and severe stigma surrounding help seeking. OBJECTIVE To evaluate the feasibility, acceptability, and efficacy of Internet-based, or "online," cognitive behavioral therapy (CBT)-based unguided and guided self-help interventions (using the programs GAD Online and Lantern, respectively) to reduce GAD symptoms in students with clinical and subthreshold GAD and, ultimately, reduce the prevalence and incidence of GAD among the student population. METHODS Students will be recruited via 3 colleges in Hyderabad, India, and referred for a campus-wide online screening. Self-report data will be collected entirely online. A total of 300 qualifying students will be randomized in a 1:1:1 ratio to receive GAD Online, Lantern, or to be in a wait-list control condition, stratified by clinical and subthreshold GAD symptomatology. Students will complete a postintervention assessment after 3 months and a follow-up assessment 6 months later, at which point students in the wait-list control condition will receive one of the programs. The primary outcome is GAD symptom severity at 3 months postintervention. Secondary outcomes include GAD caseness at 9 months, other anxiety and depression symptoms, self-efficacy, and functional measures (eg, sleep, social functioning) at 3 and 9 months, respectively. Primary analyses will be differences between each of the intervention groups and the wait-list control group, analyzed on an intention-to-treat (ITT) basis using mixed-design ANOVA. RESULTS The study commenced in February 2015. The sample was recruited over a 3-week period at each college. The trial is expected to end in December 2015. CONCLUSIONS This trial will be the first to evaluate the use of Internet-based CBT programs compared with a wait-list control group for the treatment of GAD among students in Indian universities. If effective, these programs have the potential to reduce the mental health care treatment gap by providing readily accessible, private, and cost-effective evidence-based care to students with GAD who do not currently receive the treatment they need. TRIAL REGISTRATION ClinicalTrials.gov NCT02410265 http://clinicaltrials.gov/ct2/show/NCT02410265 (Archived by WebCite at http://www.webcitation.org/6ddqH6Rbt).
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Affiliation(s)
- Nitya Kanuri
- Behavioral Medicine Lab, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States.
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131
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Barrera TL, Smith AH, Norton PJ. Motivational Interviewing as an Adjunct to Cognitive Behavioral Therapy for Anxiety. J Clin Psychol 2015; 72:5-14. [DOI: 10.1002/jclp.22239] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Terri L. Barrera
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety; Michael E. DeBakey VA Medical Center
- Baylor College of Medicine
- VA South Central Mental Illness Research; Education and Clinical Center
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132
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Abstract
People with anxiety disorders demand psychological attention most often. Therefore, it seems important to identify both the characteristics of the patients who demand help and the clinical variables related to that demand and its treatment. A cohort of 292 patients who requested help at a university clinical facility was studied. The typical profile of the patient was: being female, young, unmarried, with some college education, and having previously received treatment, especially pharmacological one. The three most frequent diagnoses of anxiety, which include 50% of the cases, were: Anxiety Disorder not otherwise specified, Social Phobia, and Panic Disorder with Agoraphobia. Regarding the characteristics of the intervention, the average duration of the assessment was 3.5 sessions (SD = 1.2), and the duration of the treatment was 14 sessions (SD = 11.2). The percentage of discharges was 70.2%. The average cost of treatment was around €840. The results are discussed, underlining the value of empirically supported treatments for anxiety disorders.
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133
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Mihalopoulos C, Vos T, Rapee RM, Pirkis J, Chatterton ML, Lee YC, Carter R. The population cost-effectiveness of a parenting intervention designed to prevent anxiety disorders in children. J Child Psychol Psychiatry 2015; 56:1026-33. [PMID: 26111550 DOI: 10.1111/jcpp.12438] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prevention and early intervention for anxiety disorders has lagged behind many other forms of mental disorder. Recent research has demonstrated the efficacy of a parent-focussed psycho-educational programme. The programme is directed at parents of inhibited preschool children and has been shown to reduce anxiety disorders at 1 and 3 years following intervention. The current study assesses the cost-effectiveness of this intervention to determine whether it could provide value-for-money across a population. METHOD A cost-utility economic framework, using Disability-Adjusted-Life-Years (DALYs) as the outcome, was adopted. Economic modelling techniques were used to assess the incremental cost-effectiveness ratio (ICER) of the intervention within the Australian population context, which was modelled as add-on to current practice. The perspective was the health sector. Uncertainty was measured using multivariate probabilistic testing and key assumptions were tested using univariate sensitivity analysis. RESULTS The median ICER for the intervention was AUD$8,000 per DALY averted with 99.8% of the uncertainty iterations falling below the threshold value-for-money criterion of AUD$50,000 per DALY averted. The results were robust to sensitivity testing. CONCLUSIONS Screening young children in a preschool setting for an inhibited temperament and providing a brief intervention to the parents of children with high levels of inhibition appears to provide very good value-for-money and worth considering in any package of preventive care. Further evaluation of this intervention under routine health service conditions will strengthen conclusions. Acceptability issues associated with this intervention, particularly to preschool staff and parents, need to be considered before wide-scale adoption is undertaken.
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Affiliation(s)
| | - Theo Vos
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Jane Pirkis
- Centre for Health Policy Programs and Economics, University of Melbourne, Melbourne, Vic., Australia
| | | | - Yu-Chen Lee
- Deakin Health Economics, Deakin University, Melbourne, Vic., Australia
| | - Rob Carter
- Deakin Health Economics, Deakin University, Melbourne, Vic., Australia
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134
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Kanuri N, Taylor CB, Cohen JM, Newman MG. Classification models for subthreshold generalized anxiety disorder in a college population: Implications for prevention. J Anxiety Disord 2015; 34:43-52. [PMID: 26119139 PMCID: PMC6707508 DOI: 10.1016/j.janxdis.2015.05.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 04/29/2015] [Accepted: 05/19/2015] [Indexed: 12/11/2022]
Abstract
Generalized anxiety disorder (GAD) is one of the most common psychiatric disorders on college campuses and often goes unidentified and untreated. We propose a combined prevention and treatment model composed of evidence-based self-help (SH) and guided self-help (GSH) interventions to address this issue. To inform the development of this stepped-care model of intervention delivery, we evaluated results from a population-based anxiety screening of college students. A primary model was developed to illustrate how increasing levels of symptomatology could be linked to prevention/treatment interventions. We used screening data to propose four models of classification for populations at risk for GAD. We then explored the cost considerations of implementing this prevention/treatment stepped-care model. Among 2489 college students (mean age 19.1 years; 67% female), 8.0% (198/2489) met DSM-5 clinical criteria for GAD, in line with expected clinical rates for this population. At-risk Model 1 (subthreshold, but considerable symptoms of anxiety) identified 13.7% of students as potentially at risk for developing GAD. Model 2 (subthreshold, but high GAD symptom severity) identified 13.7%. Model 3 (subthreshold, but symptoms were distressing) identified 12.3%. Model 4 (subthreshold, but considerable worry) identified 17.4%. There was little overlap among these models, with a combined at-risk population of 39.4%. The efficiency of these models in identifying those truly at risk and the cost and efficacy of preventive interventions will determine if prevention is viable. Using Model 1 data and conservative cost estimates, we found that a preventive intervention effect size of even 0.2 could make a prevention/treatment model more cost-effective than existing models of "wait-and-treat."
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Affiliation(s)
- Nitya Kanuri
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States.
| | - C. Barr Taylor
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States,Palo Alto University, United States
| | | | - Michelle G. Newman
- The Pennsylvania State University, Department of Psychology, United States
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135
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Abstract
BACKGROUND Comorbid anxiety disorders are common in late-life depression and negatively impact treatment outcome. This study aimed to examine personality characteristics as well as early and recent life-events as possible determinants of comorbid anxiety disorders in late-life depression, taking previously examined determinants into account. METHODS Using the Composite International Diagnostic Interview (CIDI 2.0), we established comorbid anxiety disorders (social phobia (SP), panic disorder (PD), generalized anxiety disorder (GAD), and agoraphobia (AGO)) in 350 patients (aged ≥60 years) suffering from a major depressive disorder according to DSM-IV-TR criteria within the past six months. Adjusted for age, sex, and level of education, we first examined previously identified determinants of anxious depression: depression severity, suicidality, partner status, loneliness, chronic diseases, and gait speed in multiple logistic regression models. Subsequently, associations were explored with the big five personality characteristics as well as early and recent life-events. First, multiple logistic regression analyses were conducted with the presence of any anxiety disorder (yes/no) as dependent variable, where after analyses were repeated for each anxiety disorder, separately. RESULTS In our sample, the prevalence rate of comorbid anxiety disorders in late-life depression was 38.6%. Determinants of comorbid anxiety disorders were a lower age, female sex, less education, higher depression severity, early traumatization, neuroticism, extraversion, and conscientiousness. Nonetheless, determinants differed across the specific anxiety disorders and lumping all anxiety disorder together masked some determinants (education, personality). CONCLUSIONS Our findings stress the need to examine determinants of comorbid anxiety disorder for specific anxiety disorders separately, enabling the development of targeted interventions within subgroups of depressed patients.
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136
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Matsuda S, Matsuzawa D, Ishii D, Tomizawa H, Sutoh C, Shimizu E. Sex differences in fear extinction and involvements of extracellular signal-regulated kinase (ERK). Neurobiol Learn Mem 2015; 123:117-24. [PMID: 26079214 DOI: 10.1016/j.nlm.2015.05.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 05/02/2015] [Accepted: 05/26/2015] [Indexed: 12/13/2022]
Abstract
Stress-related disorders, such as post-traumatic stress disorder (PTSD) and panic disorders, are disproportionately prevalent in females. However, the biological mechanism underlying these sex differences in the prevalence rate remains unclear. In the present study, we examined sex differences in fear memory, fear extinction, and spontaneous recovery of fear. We investigated the presence of sex differences in recent and remote fear memory in mice using contextual fear conditioning, as well as sex differences in spontaneous recovery of fear memory using a consecutive fear extinction paradigm. We examined the number of fear extinction days required to prevent spontaneous recovery of fear in either sex. We investigated whether ovariectomy affected fear extinction and spontaneous recovery. We also measured the activation of extracellular signal-regulated kinase (ERK) 1 and 2 in the dorsal hippocampus and the medial prefrontal cortex following fear extinction sessions. In our results, we found no sex difference in recent or remote fear memory. However, females required more fear extinction sessions compared to males to prevent spontaneous recovery. Within-extinction freezing also differed between males and females. Moreover, females required more extinction sessions than males to increase ERK2 phosphorylation in the dorsal hippocampus. Our data suggest that contextual fear extinction was unstable in females compared to males and that such sex differences may be related to the ERK2 phosphorylation in the hippocampus.
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Affiliation(s)
- Shingo Matsuda
- Department of Ultrastructural Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo 187-8502, Japan.
| | - Daisuke Matsuzawa
- Department of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba 260-8670, Japan; Research Center for Child Mental Development, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba 260-8670, Japan
| | - Daisuke Ishii
- Department of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba 260-8670, Japan
| | - Haruna Tomizawa
- Department of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba 260-8670, Japan
| | - Chihiro Sutoh
- Department of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba 260-8670, Japan
| | - Eiji Shimizu
- Department of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba 260-8670, Japan; Research Center for Child Mental Development, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba 260-8670, Japan
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137
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Liu Y, Sareen J, Bolton J, Wang J. Development and validation of a risk-prediction algorithm for the recurrence of panic disorder. Depress Anxiety 2015; 32:341-8. [PMID: 25774487 DOI: 10.1002/da.22359] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 01/22/2015] [Accepted: 01/24/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND To develop and validate a risk prediction algorithm for the recurrence of panic disorder. METHODS Three-year longitudinal data were taken from the National Epidemiologic Survey on Alcohol and Related Conditions (2001/2002-2004/2005). One thousand six hundred and eighty one participants with a lifetime panic disorder and who had not had panic attacks for at least 2 months at baseline were included. The development cohort included 949 participants; 732 from different census regions were in the validation cohort. Recurrence of panic disorder over the follow-up period was assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule, based on the DSM-IV criteria. Logistic regression was used for deriving the algorithm. Discrimination and calibration were assessed in the development and the validation cohorts. RESULTS The developed algorithm consisted of 11 predictors: age, sex, panic disorder in the past 12 months, nicotine dependence, rapid heartbeat/tachycardia, taking medication for panic attacks, feelings of choking and persistent worry about having another panic attack, two personality traits, and childhood trauma. The algorithm had good discriminative power (C statistic = 0.7863, 95% CI: 0.7487, 0.8240). The C statistic was 0.7283 (95% CI: 0.6889, 0.7764) in the external validation data set. CONCLUSIONS The developed risk algorithm for predicting the recurrence of panic disorder has good discrimination and excellent calibration. Data related to the predictors can be easily attainable in routine clinical practice. It can be used by clinicians to calculate the probability of recurrence of panic disorder in the next 3 years for individual patients, communicate with patients regarding personal risks, and thus improve personalized treatment approaches.
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Affiliation(s)
- Yan Liu
- Faculty of Medicine, Department of Psychiatry, University of Calgary, Calgary, Canada; Faculty of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Canada
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138
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Allan NP, Norr AM, Macatee RJ, Gajewska A, Schmidt NB. Interactive Effects of Anxiety Sensitivity and Emotion Regulation on Anxiety Symptoms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2015. [DOI: 10.1007/s10862-015-9484-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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139
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Ranøyen I, Stenseng F, Klöckner CA, Wallander J, Jozefiak T. Familial aggregation of anxiety and depression in the community: the role of adolescents' self-esteem and physical activity level (the HUNT Study). BMC Public Health 2015; 15:78. [PMID: 25649024 PMCID: PMC4324879 DOI: 10.1186/s12889-015-1431-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 01/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Symptoms of anxiety and depression are significantly associated in parents and children, but few studies have examined associations between recurrent parental problems and offspring symptoms, and fathers have rarely been included in these studies. Additionally, few have investigated factors that may protect against familial aggregation of anxiety and depression. The aims of the present study are to examine the associations between recurrent parental anxiety/depression over a ten-year time span and offspring anxiety/depression in adolescence and to test whether two factors proposed to be inversely related to anxiety and depression, namely, adolescent self-esteem and physical activity, may moderate and mediate the transmission of anxiety/depression. METHODS This study used data from two waves of a Norwegian community study (the HUNT study) consisting of 5,732 adolescents, ages 13-18, (mean age = 15.8, 50.3% girls) who had one (N = 1,761 mothers; N = 742 fathers) or both parents (N = 3,229) participating in the second wave. In the first wave, 78% of the parents also participated. The adolescents completed self-reported questionnaires on self-esteem, physical activity, and symptoms of anxiety/depression, whereas parents reported on their own anxiety/depressive symptoms. The data were analysed with structural equation modeling. RESULTS The presence of parental anxiety/depression when offspring were of a preschool age predicted offspring anxiety/depression when they reached adolescence, but these associations were entirely mediated by current parental symptoms. Self-esteem partly mediated the associations between anxiety/depression in parents and offspring. No sex differences were found. Physical activity moderated the direct associations between anxiety/depression in mothers and offspring, whereas no moderating effect was evident with regard to paternal anxiety/depression. CONCLUSIONS These findings suggest that children of parents with anxiety/depression problems are at a sustained risk for mental health problems due to the apparent 10-year stability of both maternal and paternal anxiety/depression. Thus, preventing familial aggregation of these problems as early as possible seems vital. The associations between parental and offspring anxiety/depression were partially mediated by offspring self-esteem and were moderated by physical activity. Hence, prevention and treatment efforts could be aimed at increasing self-esteem and encouraging physical activity in vulnerable children of parents with anxiety/depression.
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Affiliation(s)
- Ingunn Ranøyen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine, Norwegian University of Science and Technology, Pb. 8905, Medisinsk teknisk forskningssenter (MTFS), NO-7491, Trondheim, Norway.
| | - Frode Stenseng
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine, Norwegian University of Science and Technology, Pb. 8905, Medisinsk teknisk forskningssenter (MTFS), NO-7491, Trondheim, Norway.
- NTNU Social Research, Trondheim, Norway.
| | - Christian A Klöckner
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Jan Wallander
- Psychological Sciences, School of Social Sciences, Humanities and Arts, and Health Sciences Research Institute, University of California, Merced, CA, US.
| | - Thomas Jozefiak
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Faculty of Medicine, Norwegian University of Science and Technology, Pb. 8905, Medisinsk teknisk forskningssenter (MTFS), NO-7491, Trondheim, Norway.
- Department of Child and Adolescent Psychiatry, St. Olav's Hospital, Trondheim, Norway.
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140
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Abstract
Anxiety disorders belong to the most frequent mental disorders and are often characterized by an early onset and a progressive, persistent/chronic, or recurrent course. Several individual, familial, and environmental risk factors for adverse course characteristics of anxiety disorders (including higher persistence, lower probability of remission, and increased risk of recurrence) have been identified, and previous research suggests that clinical features of anxiety (e.g., higher severity, duration, and avoidance) as well as comorbid other mental disorders are particularly useful for predicting an unfavorable course of anxiety disorders. However, additional studies are needed to identify risk factors for individual course trajectories of anxiety disorders in general as well as specific diagnoses. Doing so is essential in order to more precisely identify individuals with anxiety disorders who are at increased risk for adverse long-term outcomes and might thus particularly profit from targeted early interventions.
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141
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Martin MHT, Nielsen MBD, Pedersen J, Rugulies R. Stability of return to work after a coordinated and tailored intervention for sickness absence compensation beneficiaries with mental health problems: results of a two-year follow-up study. Disabil Rehabil 2015; 37:2107-13. [PMID: 25579668 DOI: 10.3109/09638288.2014.1001524] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Mental health problems (MHPs) are increasingly common as reasons for long-term sickness absence. However, the knowledge of how to promote a stable return to work (RTW) after sickness absence due to MHPs is limited. The purpose of this study was to assess the effects of a multidisciplinary, coordinated and tailored RTW-intervention in terms of stability of RTW, cumulative sickness absence and labour market status after 2 years among sickness absence compensation beneficiaries with MHPs. METHODS In a quasi-randomised, controlled trial, we followed recipients of the intervention (n = 88) and of conventional case management (n = 80) for 2 years to compare their risk of recurrent sickness absence and unemployment after RTW, their cumulative sickness absence and their labour market status after 2 years. RESULTS We found no statistically significant intervention effect in terms of the risk of recurrent sickness absence or unemployment. Intervention recipients had more cumulated sickness absence in year one (mean difference = 58 days; p < 0.01) and year two (mean difference = 36 days; p = 0.03), and fewer were self-supported at the end of follow-up (52% versus 69%; p = 0.02). CONCLUSION The intervention showed no benefits in terms of improved stability of RTW, reduced sickness absence or improved labour market status after 2 years when compared to conventional case management. IMPLICATIONS FOR REHABILITATION Evidence for effective return-to-work (RTW) interventions for people with mental health problems is limited, as most research to date has been done in the context of musculoskeletal disorders. A complex, multidisciplinary intervention, detached from the workplace, does not appear to improve the stability of RTW and may actually lead to more sickness absence days and less self-support when compared to conventional case management of sickness absence beneficiaries in Denmark. A stronger focus on cooperation with social insurance officers and employers may produce better results.
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Affiliation(s)
- Marie H T Martin
- a National Research Centre for the Working Environment , Copenhagen , Denmark .,b Department of Psychology , University of Copenhagen , Denmark , and
| | - Maj Britt D Nielsen
- a National Research Centre for the Working Environment , Copenhagen , Denmark
| | - Jacob Pedersen
- a National Research Centre for the Working Environment , Copenhagen , Denmark
| | - Reiner Rugulies
- a National Research Centre for the Working Environment , Copenhagen , Denmark .,b Department of Psychology , University of Copenhagen , Denmark , and.,c Department of Public Health , University of Copenhagen , Copenhagen , Denmark
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142
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Bullis JR, Fortune MR, Farchione TJ, Barlow DH. A preliminary investigation of the long-term outcome of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Compr Psychiatry 2014; 55:1920-7. [PMID: 25113056 PMCID: PMC4252968 DOI: 10.1016/j.comppsych.2014.07.016] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 07/15/2014] [Accepted: 07/17/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study is to conduct a preliminary examination of long-term outcomes on a broad range of affective disorder symptoms treated with a newly developed intervention: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP). METHOD Maintenance of treatment gains at long-term follow-up (LTFU) were explored in patients (N=15, mean age=32.27; 60% female) who completed a clinical trial of the UP. RESULTS Treatment gains observed at 6-month follow-up (6MFU) on measures of clinical severity, general symptoms of depression and anxiety, and a measure of symptom interference in daily functioning were largely maintained 12months later (at an average of 18months posttreatment), and any significant changes from 6MFU to LTFU reflected small increases in symptoms that remained, on average, in the subclinical range. CONCLUSIONS These findings provide the first initial support for the durability of broad treatment gains following transdiagnostic treatment.
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Affiliation(s)
| | - Meghan R Fortune
- Boston University, 648 Beacon Street, 6th floor, Boston, MA 02215, USA.
| | - Todd J Farchione
- Boston University, 648 Beacon Street, 6th floor, Boston, MA 02215, USA.
| | - David H Barlow
- Boston University, 648 Beacon Street, 6th floor, Boston, MA 02215, USA.
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143
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Rozeske RR, Valerio S, Chaudun F, Herry C. Prefrontal neuronal circuits of contextual fear conditioning. GENES BRAIN AND BEHAVIOR 2014; 14:22-36. [PMID: 25287656 DOI: 10.1111/gbb.12181] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/17/2014] [Accepted: 10/05/2014] [Indexed: 12/12/2022]
Abstract
Over the past years, numerous studies have provided a clear understanding of the neuronal circuits and mechanisms involved in the formation, expression and extinction phases of conditioned cued fear memories. Yet, despite a strong clinical interest, a detailed understanding of these memory phases for contextual fear memories is still missing. Besides the well-known role of the hippocampus in encoding contextual fear behavior, growing evidence indicates that specific regions of the medial prefrontal cortex differentially regulate contextual fear acquisition and storage in both animals and humans that ultimately leads to expression of contextual fear memories. In this review, we provide a detailed description of the recent literature on the role of distinct prefrontal subregions in contextual fear behavior and provide a working model of the neuronal circuits involved in the acquisition, expression and generalization of contextual fear memories.
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Affiliation(s)
- R R Rozeske
- INSERM U862, Neurocenter Magendie, Bordeaux, France
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Jin X, Cao X, Zhong M, Chen L, Zhu X, Yao S, Yi J. The psychometric properties of the Cognitive-Somatic Anxiety Questionnaire in Chinese undergraduate students and clinical patients. Compr Psychiatry 2014; 55:1751-6. [PMID: 25088516 DOI: 10.1016/j.comppsych.2014.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The present study was conducted to develop a Chinese version of the 14-item Cognitive-Somatic Anxiety Questionnaire (CSAQ) and examine its psychometric properties. METHODS The original English version of the CSAQ was first translated into Chinese and then backtranslated and modified until cross-language equivalence was established. This version was then completed by 2168 undergraduate students and 289 clinical patients with mental disorder in China. The Mood and Anxiety Symptoms Questionnaire (MASQ) was also administered to students. Confirmatory factor analysis was performed to examine the two-factor construct, and the CSAQ's internal consistency, test-retest reliability, and concurrent and discriminant validity were also evaluated. RESULTS The two-factor model (cognitive and somatic) of the CSAQ was confirmed, and the scale showed an adequate model fit in the student and clinical samples. The CSAQ showed adequate internal consistency (student sample: Cronbach's α=0.82, mean inter-item correlation coefficient=0.25; clinical sample: Cronbach's α=0.81, mean inter-item correlation coefficient=0.23) and good stability (2-week test-retest reliability in student sample, 0.84). The coefficient of correlation between CSAQ and overall anxious symptoms MASQ scores among students was 0.64. CONCLUSIONS The Chinese version of the CSAQ is a promising instrument for reliable and valid measurement of anxiety in Chinese populations.
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Affiliation(s)
- Xinhu Jin
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, 410011, PR China
| | - Xiyu Cao
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, 410011, PR China
| | - Mingtian Zhong
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, PR China
| | - Lingyu Chen
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, PR China
| | - Xiongzhao Zhu
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, 410011, PR China; Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, 410011, PR China
| | - Shuqiao Yao
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, 410011, PR China; Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, 410011, PR China
| | - Jinyao Yi
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, 410011, PR China; Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, 410011, PR China.
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Skodol AE, Geier T, Grant BF, Hasin DS. Personality disorders and the persistence of anxiety disorders in a nationally representative sample. Depress Anxiety 2014; 31:721-8. [PMID: 24995387 DOI: 10.1002/da.22287] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 05/20/2014] [Accepted: 05/27/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Among individuals with anxiety disorders, comorbid personality disorders (PDs) increase cross-sectional symptom severity and decrease functioning. Little is known, however, about how PDs influence the course of anxiety disorders over time. The purpose of this study was to examine the effect of PDs on the persistence of four anxiety disorders in a nationally representative sample in the United States. METHODS Two waves of data were collected on 34,653 participants, 3 years apart. At both waves, participants were evaluated for generalized anxiety disorder (GAD), social and specific phobias, and panic disorder. Predictors of persistence included all DSM-IV PDs. Control variables included demographics, comorbid PDs, age at onset of the anxiety disorder, number of prior episodes, duration of the current episode, treatment history, and cardinal symptoms of exclusionary diagnoses for each anxiety disorder. RESULTS Any PD, two or more PDs, borderline PD, schizotypal PD, mean number of PD criteria met, and mean number of PDs diagnosed predicted the persistence of all four anxiety disorders. Narcissistic PD predicted persistence of GAD and panic disorder. Schizoid and avoidant PDs also predicted persistence of GAD. Finally, avoidant PD predicted persistence of social phobia. Particular patterns of cross-cluster PD comorbidity were strong predictors of the persistence of individual anxiety disorders as well. CONCLUSIONS In this national sample, a variety of PDs robustly predicted the persistence of anxiety disorders over 3 years, consistent with the results of recent prospective clinical studies. Personality psychopathology should be assessed and addressed in treatment for all patients with anxiety disorders.
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Affiliation(s)
- Andrew E Skodol
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York; New York State Psychiatric Institute, New York, New York; Department of Psychiatry, University of Arizona College of Medicine, Tucson, Arizona
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147
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Blanco C, Rubio J, Wall M, Wang S, Jiu CJ, Kendler KS. Risk factors for anxiety disorders: common and specific effects in a national sample. Depress Anxiety 2014; 31:756-64. [PMID: 24577934 PMCID: PMC4147018 DOI: 10.1002/da.22247] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 11/12/2013] [Accepted: 01/18/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Anxiety disorders and major depressive disorder (MDD) often co-occur and share a broad range of risk factors. The goal of this study was to examine whether the co-occurrence of anxiety disorders and MDD could be explained by an underlying latent factor and whether the risk factors exert their effect exclusively through this factor, directly on each disorder, or through a combination of effects at both levels. METHODS Data were drawn from a large, nationally representative sample. Confirmatory factor analysis was used to identify the latent structure of anxiety disorders. A multiple indicators multiple causes (MIMIC) approach was used to assess the common and specific effects of risk factors for anxiety disorders. RESULTS A one-factor model provided a good fit to the co-occurrence of anxiety disorders. Low self-esteem, family history of depression, female sex, childhood sexual abuse, White race, years of education, number of traumatic experiences, and disturbed family environment increased the risk of anxiety disorders and MDD through their effect on the latent factor. There were also several direct effects of the covariates on the disorders, indicating that the effect of the covariates differed across disorders. CONCLUSIONS Risk for anxiety disorders and MDD appears to be mediated partially by a latent variable underlying anxiety disorders and MDD, and partially by disorder-specific effects. These findings may contribute to account for the high rates of comorbidity among disorders, identify commonalities in the etiologies of these disorders, and provide clues for the development of unified preventive interventions.
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Affiliation(s)
- Carlos Blanco
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York
| | - José Rubio
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York
| | - Melanie Wall
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Shuai Wang
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York
| | - Chelsea J. Jiu
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York
| | - Kenneth S. Kendler
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
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Abstract
BACKGROUND Despite their high prevalence, the global burden of anxiety disorders has never been calculated comprehensively. The new Global Burden of Disease (GBD) study has estimated burden due to morbidity and mortality caused by any anxiety disorder. METHOD Prevalence was estimated using Bayesian meta-regression informed by data identified in a systematic review. Years of life lived with disability (YLDs) were calculated by multiplying prevalent cases by an average disability weight based on severity proportions (mild, moderate and severe). Disability-adjusted life years (DALYs) were then calculated and age standardized using global standard population figures. Estimates were also made for additional suicide mortality attributable to anxiety disorders. Findings are presented for YLDs, DALYs and attributable burden due to suicide for 21 world regions in 1990 and 2010. RESULTS Anxiety disorders were the sixth leading cause of disability, in terms of YLDs, in both high-income (HI) and low- and middle-income (LMI) countries. Globally, anxiety disorders accounted for 390 DALYs per 100,000 persons [95% uncertainty interval (UI) 191-371 DALYs per 100,000] in 2010, with no discernible change observed over time. Females accounted for about 65% of the DALYs caused by anxiety disorders, with the highest burden in both males and females experienced by those aged between 15 and 34 years. Although there was regional variation in prevalence, the overlap between uncertainty estimates means that substantive differences in burden between populations could not be identified. CONCLUSIONS Anxiety disorders are chronic, disabling conditions that are distributed across the globe. Future estimates of burden could be further improved by obtaining more representative data on severity state proportions.
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Affiliation(s)
- A J Baxter
- School of Population Health,University of Queensland,Herston,Australia
| | - T Vos
- University of Washington,Institute for Health Metrics and Evaluation, Seattle, WA,USA
| | - K M Scott
- Department of Psychological Medicine,University of Otago,Dunedin,New Zealand
| | - A J Ferrari
- School of Population Health,University of Queensland,Herston,Australia
| | - H A Whiteford
- School of Population Health,University of Queensland,Herston,Australia
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Hedman E, El Alaoui S, Lindefors N, Andersson E, Rück C, Ghaderi A, Kaldo V, Lekander M, Andersson G, Ljótsson B. Clinical effectiveness and cost-effectiveness of Internet- vs. group-based cognitive behavior therapy for social anxiety disorder: 4-Year follow-up of a randomized trial. Behav Res Ther 2014; 59:20-9. [DOI: 10.1016/j.brat.2014.05.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/23/2014] [Accepted: 05/27/2014] [Indexed: 11/27/2022]
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Muntingh A, van der Feltz-Cornelis C, van Marwijk H, Spinhoven P, Assendelft W, de Waal M, Adèr H, van Balkom A. Effectiveness of collaborative stepped care for anxiety disorders in primary care: a pragmatic cluster randomised controlled trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 83:37-44. [PMID: 24281396 DOI: 10.1159/000353682] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 06/11/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Collaborative stepped care (CSC) may be an appropriate model to provide evidence-based treatment for anxiety disorders in primary care. METHODS In a cluster randomised controlled trial, the effectiveness of CSC compared to care as usual (CAU) for adults with panic disorder (PD) or generalised anxiety disorder (GAD) in primary care was evaluated. Thirty-one psychiatric nurses who provided their services to 43 primary care practices in the Netherlands were randomised to deliver CSC (16 psychiatric nurses, 23 practices) or CAU (15 psychiatric nurses, 20 practices). CSC was provided by the psychiatric nurses (care managers) in collaboration with the general practitioner and a consultant psychiatrist. The intervention consisted of 3 steps, namely guided self-help, cognitive behavioural therapy and antidepressants. Anxiety symptoms were measured with the Beck Anxiety Inventory (BAI) at baseline and after 3, 6, 9 and 12 months. RESULTS We recruited 180 patients with a DSM-IV diagnosis of PD or GAD, of whom 114 received CSC and 66 received usual primary care. On the BAI, CSC was superior to CAU [difference in gain scores from baseline to 3 months: -5.11, 95% confidence interval (CI) -8.28 to -1.94; 6 months: -4.65, 95% CI -7.93 to -1.38; 9 months: -5.67, 95% CI -8.97 to -2.36; 12 months: -6.84, 95% CI -10.13 to -3.55]. CONCLUSIONS CSC, with guided self-help as a first step, was more effective than CAU for primary care patients with PD or GAD.
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Affiliation(s)
- Anna Muntingh
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands
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